During endodontic treatment treatment on the interior of the tooth, such as root canals , the infected pulp within the root canal is removed and the cavity is cleaned.
Standard root canal treatment can be explained in four main steps, completed during two visits to your dentist or endodontist.
These steps include:. During the time between the first and second visit, patients are directed to use caution when applying pressure to the repaired tooth. This led to one of the two course of treatment either treat the root canal in one visit or seek an intracanal medicament that does not injure the periradicular tissues.
Those who believe that successful root canal treatment can be completed in one visit have rationale in literature. Studies concerning postoperative pain 3 - 6 as well as healing rates 7 - 9 shows the treatment outcome to be similar whether completed in one or multiple visits. In addition to this, treatment in one visit offers many advantages.
This decreases the number of operative procedure including additional anesthesia, gingival trauma from rubber dam application as well as eliminating the risk of inter appointment leakage through temporary restoration.
It is less time consuming resulting in less cost to the patients. Proponents of multiple visit procedures contend that antimicrobial property of inter appointment calcium hydroxide placement is required to ensure successful perradicular healing, 10 - 12 although predictable levels of bacterial reduction via refined cleaning and shaping techniques is one appointment may negate this need.
Furthermore, when flare-ups occur during multiple-visit procedures, they can be addressed prior to obturation. When flare-ups occur, non-surgical re-treatment or surgical intervention is usually necessary. The purpose of the study was to determine clinical success rate of single visit verses multiple visit root canal treatment in cariously exposed vital primary molars. One of the main objectives when endodontics is performed in multiple visits is the difficulty of effectively sealing off the root canal system from the oral cavity between visits.
Teeth with subgingival breakdown; coronal walls missing; and with full coverage that have decay below the margins of their finished restorations would all fall into this category.
Cases falling into this category would be maxillary anterior teeth involved in trauma that has resulted in a horizontal fracture of the crown at the gum line.
These cases are probably the most frequently treated teeth in one-visit. Therefore, isolation and sealing problems are solved and an esthetic temporary crown can be placed rapidly and retained by securing the crown to a temporary post placed into the space left in the root canal of the treated tooth. Cases that fall into this category require endodontic treatment for restorative reasons and not because they have pathologic pulp tissue that must be removed or because of pulp exposures.
Examples would include: teeth to be used as overdenture abutments; mandibular anterior teeth to be cut down for full jacket crowns; teeth with severe coronal breakdown that cannot possibly retain a restoration because of the loss of tooth structure; and teeth that require preparation that would result in pulp exposure in order to get them into a certain desired alignment for the construction of a specifically designed restoration.
Teeth containing vital pulps that fit into this category are those with pulp exposures caused by trauma, caries, or mechanical reasons and teeth that exhibit clinical symptoms to heat or cold stimuli but not percussion. A sample of 40 children in age group of 4 to 7 years visiting to Department of Pedodontic for dental treatment at Govt. Dental College, Rohtak, were included in this study after receiving permission from their parents.
Endodontic therapy in each case was carried out under local anesthesia and rubber dam isolation. The pulp was extirpated and diagnostic radiographs were made to determine working length. Biomechanical preparations were done using 2. In single visit group, after biomechanical preparation, root canals were dried using absorbent paper points and root canals were filled with thick mix of zinc oxide eugenol using engine driven lentulo spirals.
In multiple visit group, access was gained and after biomechanical preparation, root canals were dried and filled with calcium hydroxide powder mixed with normal saline and access cavities were sealed with zinc oxide eugenol cement. After 7 days, calcium hydroxides dressing were removed with reamers and normal saline as irrigant calcium hydroxide dissolved in this solution. The root canals were dried using absorbent paper points and obturated with zinc oxide eugenol cement using engine driven lentulo-spirals.
Recall visits were carried out after one week, one month and three months and six months. Success and failure of treatment was evaluated according to criteria laid down by Gutmann 15 Table 1. Two patients came with swelling and pain after two days of obturation. Antibiotics and analgesics were prescribed to him. Symptoms disappeared after seven days.
One of the two patient reported with postoperative complication , reported with intraoral sinus. Filling material was removed from primary molar and patient was treated according to multiple visit group regimen. To compare the number of success with failure in two groups we apply Fisher Exact test. In the first week 18 out of 20 patients gives successful result in group I where in group II all 20 patients gives successful result.
This gives the non significant difference in the results of two groups with test value 0. After one month group I, 18 out of 20 patients show successful result, whereas in group II all 20 patients give successful result. This failure of two patients in group I is not significantly different from group II, having test value 0. Since there is single patient which report negative result in group I against all 20 successful patients in group II after three month.
This also shows nonsignificant difference in both the treatments having test value 0. After six months one patient from each group was not reported. So excluded from the analysis and from remaining 19 patients only single gives negative response in group I against all 19 positive responses in group II. This also shows nonsignificant differences with t-value 0.
In all we can say that there is no significant difference in treatments results. In present study, patients in the age group of years were selected because root formation of primary molars has been completed up to 4 years of age and root resorption of primary molars has not been started up to 7 years of age. Further patients were followed-up for six months so that any postoperative complications like pain, swelling, sinus formation can be evaluated. Primary molars which were cariously exposed, were selected for study.
Because in an infected vital pulp due to carious exposure, the infection is normally found only at the wound surface, where it has resulted in a localized inflammatory response. This means that in most apical portion of pulp tissue, micro organisms are usually not present. Root canal treatment in such cases is carried out on presumption that the pulpal condition is irreversible and may lead to tissue break down and subsequent root canal infection. Cases presenting with minimal difficulty, such as uncomplicated crown fractures, may be addressed in a single-visit session, given that there are no other complications.
However, challenging cases, such as those involving avulsion, alveolar fracture, or luxation, may be best addressed through a multiple-appointment approach that allows for a thorough follow-up of symptoms, tooth prognosis, and response to therapy. Restorative concerns, such as anterior esthetics, issues related to isolation and sealing, and pre-prosthetic factors, can also impact the selection of either single- or multiple-visit therapy.
Complicated crown fractures of anterior and bicuspid teeth and horizontal crown fractures at the gum line of anterior teeth commonly involve esthetic considerations. In cases with such concerns, barring other complicating factors, consideration must be given to single-visit RCT to facilitate the rapid placement of a temporary crown in order to restore form, function, and esthetics. Achieving effective isolation and then subsequently sealing the canal system to prevent reinfection are essential components of successful RCT.
In most cases, both can be achieved. However, for teeth with subgingival breakdown, missing coronal walls, or full coverage restorations with decay below the margins, adequate isolation and sealing can be particularly challenging.
When teeth present with these findings, consideration should be given to single-visit therapy in order to reduce the chances of interappointment contamination and flare-up. The purview of pre-prosthetic concerns includes teeth that require RCT for restorative purposes, rather than for the debridement of pathologic pulp tissue or pulp exposures.
Several cases fall within this category, including teeth needed for overdenture abutments, teeth that cannot retain a restoration due to severe coronal breakdown, mandibular anterior teeth that are reduced for full jacket crowns, and teeth that require preparation that would result in pulp exposure for a specifically designed restoration. In such cases, a single-visit approach is encouraged to accelerate the process of restoring form, function, and esthetics of the involved teeth.
Time and time again, the endodontic literature demonstrates that the outcomes for single-visit treatment and multiple-visit treatment are equivalent. Given these findings, decisions to pursue either approach to treatment must be informed by factors that go beyond prognosis alone.
By considering preoperative pain, infection status, pulpal and periapical diagnoses, case complexity, and restorative concerns, clinicians can select the treatment modality that is most appropriate to treat their patients' endodontic needs.
Healing rate and post-obturation pain of single- versus multiple-visit endodontic treatment for infected root canals: a systematic review. J Endod.
Our team at Best Dental strongly recommend a dental crown after your root canal is completed. We have had so many patients with previous root canals that have broken their tooth.
Some of these cases end up leading to a dental extraction because the fracture has made the tooth non-restorable. Antibiotics are highly recommended, either after your first root canal visit, or after the root canal is completed. These medications help eliminate any nidus of bacteria that is left over from the procedure. Although there have been conflicting studies performed on this topic, our team almost always prescribes these medications after a root canal has been completed.
Not taking a course of antibiotics may end up leading to a re-infected tooth. We hope this article broke down the reasons why some teeth require two appointments in order for the root canal to be completed. See your dental healthcare professional to see if he or she requires this for your particular situation.
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