Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious ...processes, coronal crack or fracture, or dental trauma. Successful RoCT is characterised by an absence of symptoms (i.e. pain) and clinical signs (i.e. swelling and sinus tract) in teeth without radiographic evidence of periodontal involvement (i.e. normal periodontal ligament). The success of RoCT depends on a number of variables related to the preoperative condition of the tooth, as well as the endodontic procedures. RoCT can be carried out with a single-visit approach, which involves root canal system obturation (filling and sealing) directly after instrumentation and irrigation, or with a multiple-visits approach, in which the treatment is completed in two or more sessions and obturation is performed in the last session. This review updates the previous versions published in 2007 and 2016.
To evaluate the benefits and harms of completion of root canal treatment (RoCT) in a single visit compared to RoCT over two or more visits, with or without medication, in people aged over 10 years.
We used standard, extensive Cochrane search methods. The latest search date was 25 April 2022.
We included randomised controlled trials and quasi-randomised controlled trials in people needing RoCT comparing completion of RoCT in a single visit compared to RoCT over two or more visits. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were 1. tooth extraction and 2. radiological failure after at least one year (i.e. periapical radiolucency). Our secondary outcomes were 3. postoperative and postobturation pain; 4. swelling or flare-up; 5. analgesic use and 6. presence of sinus track or fistula after at least one month. We used GRADE to assess certainty of evidence for each outcome. We excluded five studies that were included in the previous version of the review because they did not meet the current standard of care (i.e. rubber dam isolation and irrigation with sodium hypochlorite).
We included 47 studies with 5805 participants and 5693 teeth analysed. We judged 10 studies at low risk of bias, 17 at high risk of bias and 20 at unclear risk of bias. Only two studies reported data on tooth extraction. We found no evidence of a difference between treatment in one visit or treatment over multiple visits, but we had very low certainty about the findings (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.09 to 2.50; I
= 0%; 2 studies, 402 teeth). We found no evidence of a difference between single-visit and multiple-visit treatment in terms of radiological failure (RR 0.93, 95% CI 0.81 to 1.07; I
= 0%; 13 studies, 1505 teeth; moderate-certainty evidence). We found evidence of a higher proportion of participants reporting pain within one week in single-visit groups compared to multiple visit groups (RR 1.55, 95% CI 1.14 to 2.09; I
= 18%; 5 studies, 638 teeth; moderate-certainty evidence). We found no evidence of a difference in the proportion of participants reporting pain until 72 hours postobturation (RR 0.97, 95% CI 0.81 to 1.16; I
= 70%; 12 studies, 1329 teeth; low-certainty evidence), pain intensity until 72 hours postobturation (mean difference (MD) 0.26, 95% CI -4.76 to 5.29; I
= 98%; 12 studies, 1258 teeth; low-certainty evidence) or pain at one week postobturation (RR 1.05, 95% CI 0.67 to 1.67; I
= 61%; 9 studies, 1139 teeth; very low-certainty evidence). We found no evidence of a difference in swelling or flare-up incidence (RR 0.56 95% CI 0.16 to 1.92; I
= 0%; 6 studies; 605 teeth; very low-certainty evidence), analgesic use (RR 1.25 95% CI 0.75 to 2.09; I
= 36%; 6 studies, 540 teeth; very low-certainty evidence) or sinus tract or fistula presence (RR 1.00, 95% CI 0.24 to 4.28; I
= 0%; 5 studies, 650 teeth; very low-certainty evidence). Subgroup analysis found no differences between single-visit and multiple-visit RoCT for considered outcomes other than proportion of participants reporting post-treatment pain within one week, which was higher in the single-visit groups for vital teeth (RR 2.16, 95% CI 1.39 to 3.36; I
= 0%; 2 studies, 316 teeth), and when instrumentation was mechanical (RR 1.80, 95% CI 1.10 to 2.92; I
= 56%; 2 studies, 278 teeth).
As in the previous two versions of the review, there is currently no evidence to suggest that one treatment regimen (single-visit or multiple-visit RoCT) is more effective than the other. Neither regimen can prevent pain and other complications in the 12-month postoperative period. There was moderate-certainty evidence of higher proportion of participants reporting pain within one week in single-visit groups compared to multiple-visit groups. In contrast to the results of the last version of the review, there was no difference in analgesic use.
Abstract Introduction The objective of the present study was to clinically compare the incidence of postoperative pain and the intake of analgesic medication (frequency and quantity) after endodontic ...treatment of posterior teeth using 2 reciprocating systems and a continuous rotary system. Methods In a prospective randomized clinical study, 210 patients with vital teeth indicated for conventional endodontic treatment were treated by 5 specialists according to a pre-established protocol. The teeth were randomly assigned to 1 of 3 groups ( n = 70) according to the instrumentation system used: ProTaper Next (Dentsply Tulsa Dental Specialties, Johnson City, TN), WaveOne (Dentsply Tulsa Dental Specialties), or Reciproc (VDW, Munich, Germany). Treatments were performed in a single visit. After the visit, the patients were given a prescription for ibuprofen 400 mg to be taken every 6 hours if they experienced pain. Participants were asked to rate the intensity of the postoperative pain on a visual analog scale according to 4 classes (no pain, mild pain, moderate pain, and severe pain) after 24 hours, 48 hours, 72 hours, and 7 days. Patients were also asked to record the number of prescribed analgesic medication tablets taken at these time points. Results No statistically significant difference was found among the 3 groups in relation to postoperative pain or analgesic medication intake at the 4 time points assessed ( P > .05, Kruskal-Wallis test). Conclusions The reciprocating systems and the continuous rotary system were found to be equivalent in regard to the incidence of postoperative pain and intake of analgesic medication at the time points assessed.
Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious ...processes, tooth cracks or chips, or dental trauma. Successful RoCT is characterised by an absence of symptoms (i.e. pain) and clinical signs (i.e. swelling and sinus tract) in teeth without radiographic evidence of periodontal involvement (i.e. normal periodontal ligament). The success of RoCT depends on a number of variables related to the preoperative condition of the tooth, as well as the endodontic procedures. This review updates the previous version published in 2007.
To determine whether completion of root canal treatment (RoCT) in a single visit or over two or more visits, with or without medication, makes any difference in term of effectiveness or complications.
We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 14 June 2016), Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 5), MEDLINE Ovid (1946 to 14 June 2016), and Embase Ovid (1980 to 14 June 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 14 June 2016. We did not place any restrictions on the language or date of publication when searching the electronic databases.
We included randomised controlled trials (RCTs) and quasi-RCTs of people needing RoCT. We excluded surgical endodontic treatment. The outcomes of interest were tooth extraction for endodontic problems; radiological failure after at least one year, i.e. periapical radiolucency; postoperative pain; swelling or flare-up; painkiller use; sinus track or fistula formation; and complications (composite outcome including any adverse event).
We collected data using a specially designed extraction form. We contacted trial authors for further details where these were unclear. We assessed the risk of bias in the studies using the Cochrane tool and we assessed the quality of the body of evidence using GRADE criteria. When valid and relevant data were collected, we undertook a meta-analysis of the data using the random-effects model. For dichotomous outcomes, we calculated risk ratios (RRs) and 95% confidence intervals (CIs). For continuous data, we calculated mean differences (MDs) and 95% CIs. We examined potential sources of heterogeneity. We conducted subgroup analyses for necrotic and vital teeth.
We included 25 RCTs in the review, with a total of 3780 participants, of whom we analysed 3751. We judged three studies to be at low risk of bias, 14 at high risk, and eight as unclear.Only one study reported data on tooth extraction due to endodontic problems. This study found no difference between treatment in one visit or treatment over multiple visits (1/117 single-visit participants lost a tooth versus 2/103 multiple-visit participants; odds ratio (OR) 0.44, 95% confidence interval (CI) 0.04 to 4.78; very low-quality evidence).We found no evidence of a difference between single-visit and multiple-visit treatment in terms of radiological failure (risk ratio (RR) 0.91, 95% CI 0.68 to 1.21; 1493 participants, 11 studies, I
= 18%; low-quality evidence); immediate postoperative pain (dichotomous outcome) (RR 0.99, 95% CI 0.84 to 1.17; 1560 participants, 9 studies, I
= 33%; moderate-quality evidence); swelling or flare-up incidence (RR 1.36, 95% CI 0.66 to 2.81; 281 participants, 4 studies, I
= 0%; low-quality evidence); sinus tract or fistula formation (RR 0.98, 95% CI 0.15 to 6.48; 345 participants, 2 studies, I
= 0%; low-quality evidence); or complications (RR 0.92, 95% CI 0.77 to 1.11; 1686 participants, 10 studies, I
= 18%; moderate-quality evidence).The studies suggested people undergoing RoCT in a single visit may be more likely to experience pain in the first week than those whose RoCT was over multiple visits (RR 1.50, 95% CI 0.99 to 2.28; 1383 participants, 8 studies, I
= 54%), though the quality of the evidence for this finding is low.Moderate-quality evidence showed people undergoing RoCT in a single visit were more likely to use painkillers than those receiving treatment over multiple visits (RR 2.35, 95% CI 1.60 to 3.45; 648 participants, 4 studies, I
= 0%).
There is no evidence to suggest that one treatment regimen (single-visit or multiple-visit root canal treatment) is better than the other. Neither can prevent all short- and long-term complications. On the basis of the available evidence, it seems likely that the benefit of a single-visit treatment, in terms of time and convenience, for both patient and dentist, has the cost of a higher frequency of late postoperative pain (and as a consequence, painkiller use).
Aims
To compare radiographic periapical healing and tooth survival outcomes of root canal (re)treatment performed within two care pathways (Routine Dental Care and Referred Treatment Pathway), in the ...United Kingdom Armed Forces (UKAF), and determine the effects of endodontic complexity on outcomes.
Methodology
This retrospective cohort study included 1466 teeth in 1252 personnel who received root canal (re)treatment between 2015 and 2020. General Dental Practitioners treated 661 teeth (573 patients) (Routine cohort), whilst Dentists with a Special Interest treated 805 teeth (678 patients) (Referred cohort). The latter group were graduates of an MSc programme in Endodontics with 4–8 years of postgraduation experience. Case complexity was retrospectively determined for each tooth using the endodontic component of Restorative Index of Treatment Need (RIOTN) guidelines. Periapical healing was determined using loose radiographic criteria. The data were analysed using chi‐square tests, univariate logistic regression and Cox proportional hazards models.
Results
A significantly (p < 0.0001) larger proportion of cases of low complexity had undergone root canal treatment within the Routine versus Referred cohort. The odds of periapical healing was significantly higher within the Referred versus Routine cohort, regardless of analyses using pooled (OR = 1.17; 95% CI: 1.11, 1.22) or moderate complexity (OR = 4.71; 95% CI: 2.73, 8.11) data. Within the Routine cohort, anterior teeth had higher odds of periapical healing than posterior teeth (OR = 1.13; 95% CI: 1.04, 1.22). The 60‐month cumulative tooth survival was lower (p = 0.03) in the Routine (90.5%) than the Referred (96.0%) cohort. Within the Routine cohort, the hazard of tooth loss was higher amongst posterior teeth (HR = 4.03; 95% CI: 1.92, 8.45) but lower if posterior teeth had cast restorations (HR = 0.36; 95% CI: 0.19, 0.70). For the Referred cohort, posterior teeth restored with cast restoration (vs not) had significantly lower risk of tooth loss (HR = 0.21; 95% CI: 0.08, 0.55).
Conclusions
For UKAF patients, root canal (re)treatment provided within the Referred pathway was significantly more likely to achieve periapical healing and better tooth survival than those provided within the Routine pathway. Posterior teeth restored with an indirect restoration had a higher proportion of tooth survival. This study supported the utility of the endodontic component of RIOTN for assessing case complexity.
The aim of this study was to identify the effect of case difficulty on the number of endodontic mishaps and the number of treatment visits using 2 different instrumentation methods, hand files, and ...reciprocating engine-driven WaveOne files (Dentsply Maillefer, Ballaigues, Switzerland) in an undergraduate student clinic.
Endodontic treatment performed by fourth-year dental students using 2 different instrumentation methods was evaluated: hand files and reciprocating engine-driven WaveOne files. All cases were categorized according to the American Association of Endodontists case difficulty assessment form. Endodontic mishaps related to instrumentation and treatment visits needed to complete the treatment were recorded.
Of the 257 teeth included in the study, 141 were instrumented with hand files and 116 with WaveOne files. Eighty-two teeth (31.9%) were registered with at least 1 endodontic mishap. The most frequent endodontic mishap was overinstrumentation (17.5%). This was followed by loss of working length (8.56%), obturation more than 2 mm from the radiographic apex (8.56%), overfill with gutta-percha (6.61%), canal transportation (4.28%), instrument separation (2.33%), and lateral or strip perforation (1.56%). Several endodontic mishaps were significantly correlated. Cases in the high difficulty category had significantly more endodontic mishaps (P < .001) and required more treatment visits (P < .01). There were no significant differences in endodontic mishaps or the number of treatment visits between the hand and engine-driven groups. Several endodontic mishaps were associated with significantly more treatment visits (P < .05).
Case difficulty rather than the instrumentation method was the main determinant of endodontic mishaps in the undergraduate clinic. The American Association of Endodontists case difficulty assessment form is an important and valuable tool in undergraduate dental education to predict potential endodontic mishaps and the number of treatment visits.
Background: Root canal treatment (RCT) is a specialized and one of the most demanded procedures in the public oral health-care sector. Multiple-visit endodontic treatment is considered a conventional ...method for treating the affected teeth; however, the procedure requires a considerable amount of time to complete the treatment. The recent era is showing an escalating preference of the endodontists as well as the patients toward the single-visit RCT over multiple visits due to some advantages such as the low risk of leakages usually caused by the temporary seal. To the best of our knowledge in this systematic review and meta-analysis, we aim to evaluate the effectiveness of single-visit RCT over multiple-visit RCT in terms of the rate of flare-ups and postoperative pain in both vital and nonvital teeth. Methods: We performed an electronic search through PubMed, MEDLINE Database, Cochrane Central Register of Controlled Trials, Scopus Database, Web of Science, and LILACS Database. A systematic review was performed using the Cochrane handbook and PRISMA statement. The meta-analysis presented in this study was done by applying the random effects model in RevMan 5.4. Results: A total of 106 articles were referred. Out of these, forty articles were selected for analysis in the database, and 22 were excluded because of the absence and irrelevance of required parameters. A total of ten studies were selected for meta-analysis after the complete screening and analysis. The comparison was done between the incidence of postoperative pain among vital and nonvital teeth. The difference in postoperative pain after 24 and 48 h of single-visit RCT among studied groups was found to be nonsignificant with P = 0.49 and 0.20, respectively. Moreover, the majority of studies have shown that there was no difference in the occurrence of pain whether patients were treated through the single visit or multi-visit RCT. Conclusion: Based on the evidence, single-visit RCT appeared to be a safe treatment mode when considered for flare-ups. However, within the limitation of this study, it is also concluded that the incidence of postoperative pain is seen within 24 h of treatment which was found to reduce with the passage of time.
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