Outcome of One-visit and Two-visit Endodontic Treatment of Necrotic Teeth with Apical Periodontitis: A Randomized Controlled Trial with One-year Evaluation

By Penesis VA, Fitzgerald PI, Fayad MI, Wenckus CS, BeGole EA, Johnson BR.

Date: 01/2009
Journal: JOE


•Purpose:  to compare radiographic evidence of periapical healing after root canal therapy completed in one visit versus two visits with an interim calcium hydroxide/chlorhexidine paste dressing.

•n: 97 patients. Sixty-three patients were examined at the 12- month follow-up, 33 in group 1 and 30 group 2


  • Primary inclusion criteria were RG evidence of apical periodontitis (min, ≥2.0 mm) and pulpal necrosis. Excluded: younger than 18, pregnant, positive Hx of AB use within past month, needed AB premedication,  diabetic, or if the tooth previously accessed.
  • Patient was randomly assigned to either the one-or two-visit group.
  • Canals were irrigated with 2.0 mL 5.25% NaOCl, instrumentation was with 0.06- taper K3 rotary files.
  • After completion of C&S, all canals were irrigated with 5.0 mL 17% EDRA for 1 minute
  • Teeth in group 1 were obturated by using a warm vertical condensation technique with GP and Kerr EWT sealer. For group 2, canals filled with a paste of mixing calcium hydroxide powder and 2% CHX liquid for at least 2 weeks. At the second visit, paste was removed by filing & copious irrigation NaOCl, EDTA. Obturation as for group 1.
  • A custom polyvinylsiloxane bite registration index was created for each tooth.
  • Apical bone density at 12 months was the primary outcome measure by using (PAI) scale. Secondary outcome measures were the presence of clinical symptoms or abnormal findings.

Most highlighted Results:

  1.Both groups exhibited a statistically significant decrease in PAI score between the immediate postoperative and 12-month evaluation with no statistically significant difference between groups.

2.Proportion of teeth healed, improved, unchanged, or worse in each group at 12-month evaluation. Table

Clinical significance:   

there was no significant difference in radiographic evidence of periapical healing between one- visit and two-visit therapy after 1 year follow up in teeth with necrotic teeth with apical periodontitis