Healing Rate and Post-obturation Pain of Single- versus Multiple-visit Endodontic Treatment for Infected Root Canals: A Systematic Review

Purpose:

  • Compare the healing rate and post-obturation pain of single- versus multiple-visit root canal treatment for teeth with infected root canals.

Materials/Methods:

  • N= 10 articles met inclusion criteria (6 compared healing rate and 5 compared post-op pain)
  • Inclusion criteria: Mature permanent teeth, radiographic evidence of apical periodontitis, at least 1 year follow up.
  • Literature search combined with specified inclusion criteria was performed to identify randomized or quasi-randomized controlled trials (RCTs or quasi-RCTs), comparing root canal treatment in single and multiple appointments (2 or more visits) in patients with infected root canals

Results:

  • No significant difference was observed in the healing rate between single- versus multiple-visit root canal treatment
  • Prevalence of post-obturation pain was significantly lower in single-visit than in multiple-visit group.

Clinical Significance:

The healing rate of single- and multiple-visit root canal treatment is similar for infected teeth. Patients experience less frequency of short-term post-obturation pain after single-visit than those having multiple-visit root canal treatment.

Single Versus Multiple Visits for Endodontic Treatment of Permanent Teeth: A Cochrane Systematic Review

Purpose:

  • Investigate the effectiveness and frequency of short-term and long-term complications when endodontic treatment is completed in one or multiple visits.

Materials/Methods:

  • N= 12 articles met inclusion criteria
  • Randomized and quasi-randomized controlled trials were identified by searching biomedical databases and handsearching relevant journals. Outcomes considered were: tooth extraction as a result of endodontic problems and radiologic failure after 1 year, postoperative discomfort, swelling, analgesic use, or sinus track.

Results:

  • No detectable difference was found in the effectiveness between single and multiple visits.
  • Patients undergoing a single visit might experience a slightly higher frequency of swelling and require more analgesic use.

Clinical Significance:

No difference between 1 or 2-visit RCT in effectiveness of healing. Single visit may result in slightly more post-op symptoms.

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

Purpose:

  • Compare radiographic evidence of periapical healing after root canal therapy completed in one visit or two visits with an interim calcium hydroxide/chlorhexidine paste dressing.

Materials/Methods:

  • N= 97 patients w/radiographic evidence of apical periodontitis.
  • Patients were randomly assigned to either the one-visit or two-visit group, and root canal therapy was performed with a standardized protocol. Patients in the two-visit group received an intracanal dressing of calcium hydroxide/chlorhexidine paste.   Teeth were recalled at 1 yr and were evaluated with a PAI score.

Results:

  • 63 patients were recalled  at 1 yr.
  • 33 in the one-visit and  30 in the two-visit group.
  • Both groups exhibited equally favorable periapical healing at 12 months, with no statistically significant differences between groups.

Clinical Significance:

No difference was noted in healing between teeth treated in 1 visit or 2 visits in necrotic teeth at 12 months.

Clinical and Radiographic Evaluation of One- and Two-visit Endodontic Treatment of Asymptomatic Necrotic Teeth with Apical Periodontitis: A Randomized Clinical Trial

Purpose:

  • Record the 2-year clinical and radiographic outcome of one- and two visit endodontic treatment and study the significance of the bacteriologic sampling results on the outcome.

Materials/Methods:

  • N= 53 teeth were in one-visit group and 48 in two-visit group.
  • Patients were randomly assigned to one of 2 groups: 1 or 2 visit RCT. Microbial samples taken throughout appointments. Treatment performed by 4 endodontists. Healing results were clinically and radiographically evaluated 2 years postoperatively.

Results:

  • 32 teeth (65%) in the one-visit group and 30 teeth (75%) in the two-visit group were classified as healed.
  • The statistical analysis of the healing results did not show any significant difference between the groups
  • Forty-nine (80%) of the 61 teeth that were obturated after a negative micobiologic sample were classified as healed.
  • Teeth obturated after positive samples healed in 44%.

Clinical Significance:

Similar results were seen in both 1 and 2 visit treatments in necrotic teeth.

Incidence of periapical lesions and clinical symptoms after pulpectomy—A clinical and radiographic evaluation of 1- versus 2-session treatment

Purpose:

  • Evaluate outcome of pulpectomy in 2 treatment sessions with calcium hydroxide as an intracanal dressing was compared to a procedure comprising instrumentation and root-filling in 1 session.

Materials/Methods:

  • N= 256 patients from 2 practices in Italy. Included only vital pulps.
  • Patients were randomly assigned to one of 2 groups: 1 or 2 visit RCT. Patients were followed up at 1 week for painful symptoms and at 1-3 yrs for signs of apical periodontitis and radiographic healing.

Results:

  • 244 patients recalled
  • 17 teeth had PARL at recall
  • Evenly distributed between the 2 groups
  • Post-op pain at 1 week associated with overfill
  • No association with presence of overfilling and radiographic lesion at end point of recall.

Clinical Significance:

2 visit RCT does not increase success in vital teeth, but overfill is strongly associated with post-op pain.