One-visit Root Canal Therapy Research Articles

Comparison of nerve block anesthesia and local infiltration anesthesia with lidocaine hydrochloride in primary root canal treatment of mandibular molars

Purpose: To investigate and compare the analgesic effects of nerve block anesthesia and local infiltration anesthesia in one-visit root canal therapy of mandibular molars. 
 Methods: A total of 120 patients who underwent one-visit root canal therapy for mandibular molars were divided into nerve block group (n = 76) and local infiltration group (n = 44). Lidocaine was used to anesthetize the two groups. Perioperative heart rate (HR), diastolic blood pressure (DBP) and systolic blood pressure (SBP) were determined in the two groups. Visual analogue scale (VAS) and Ramsay sedation scale were used to assess postoperative pain and sedation in the two groups. The occurrence of adverse reactions was also compared. 
 Results: The success rate of the anesthesia in the nerve block group was significantly higher than that in local infiltration group (9 7.37 vs 88.64 %; p < 0.05). There were no significant differences in HR, DBP and SBP levels between the two groups. Over time, VAS and Ramsay scores decreased in both groups, while the VAS and Ramsay scores in the nerve block group were significantly lower than those in the local infiltration group (p < 0.05). The incidence of adverse reactions in the nerve block group was 5.26 %, which was not significantly different from 13.64 % incidence rate in local infiltration group (p > 0.05). 
 Conclusion: Both anesthesia methods have little effect on hemodynamics in patients undergoing one-visit root canal therapy for mandibular molars, but lidocaine nerve block anesthesia is more effective and has stronger analgesic and sedative effects than lidocaine local infiltration anesthesia.

Evaluation of the perception of single-visit root canal treatment and the reasons for taking the decision among the dental practitioners

Introduction: Even though the idea and technology behind doing root canal treatment (RCT) in a single appointment is not new, the majority of the currently approved methods focus on multivisit systems. A tooth’s root canals can be instrumented, cleaned, and sealed all in a single appointment with one-visit root canal therapy. The length of time a patient must visit an endodontist in order to finish a root canal procedure is a hotly contested topic in the field of endodontics. When it comes to this topic, people have a lot of diverse points of view. Objective: The purpose of this research was to learn how and why dentists decide to do root canals in a single appointment. Materials and Methods: After reaching out to all 200 dentists on file at the practice, we were able to secure the participation of 150 dentists, who were then sent a questionnaire to fill out in their own time. Economic and social factors, current therapeutic cycles, rationales, and proactive dispositions were also taken into account. Results: Majority of pulp vitality was cited as the primary reason for opting for the one-visit RCT by 65% of dentists, with patient preference accounting for 25%, patent and normal roots accounting for 5%, a non-vital tooth with a sinus for 3%, and other reasons accounting for 2%. When pulp vitality is not at risk, more dentists opt for a single-visit root canal procedure.

Management of merged external/internal root resorption using CEM cement: a case report.

Chronic pulpal inflammation and infection are the main predisposing factors for internal and external root resorption (IRR & ERR); however, merging of IRR and ERR is a rare lesion which rigorously alters the anatomy of root canals. This study reports a case of merged IRR and ERR in an asymptomatic maxillary left central incisor in a 33-year old Caucasian woman that was managed by one-visit root canal therapy (RCT) using calcium-enriched mixture (CEM) cement. Radiographic examination showed a short root with under-filled root canal obturation associated with ERR/IRR and an apical lesion. After thorough chemo-mechanical preparation, the root canal was obturated with CEM cement; one week later, the access cavity was permanently restored. Clinical/radiographic examinations at 1-year follow-up revealed uneventful healing, reestablishment of lamina dura and stabilization of the resorptive defects. The treatment outcome demonstrates that one-visit RCT using CEM cement may be a viable treatment option in cases with merged external/internal root resorption. Further clinical trials with a larger number of cases are suggested to document a higher level of evidence.

Clinical study on one-visit root canal therapy in chronic apical periodontitis

Objective To observe long-term effect and evaluate clinical feasibility of one-visit root canal therapy in chronic apical periodontitis.Methods 228 molars with chronic apical periodontitis were selected.Group Ⅰ (120 molars) was treated by one-visit root canal therapy,while group Ⅱ (108 molars) was treated with multi-visit root canal therapy.Two groups both took crown down root canal preparation method,root canals irrigated with 0.3％ sodium hypochlorite and 17％ EDTA and obturated by means of lateral condensation technique.A comparison of clinical effect was done between two groups after 2 years.Result The cure rate of group Ⅰ was 88.79％ (95/120),while that of group Ⅱ was 92.08％ (93/108),without statistical difference between two groups (x 2 =0.649,P ＞ 0.05).Conclusion There was no difference in long-term treatment effect between two kinds of treatment methods. Key words: Chronic apical periodontitis; One-visit root canal therapy; Long-term effect

Three kinds of root canal sealers in one-visit root canal therapy: a comparison of clinical outcomes

Objective To evaluate the clinical outcomes of three different sealers for one-visit root canal therapy.Methods A total of 362patients/425teeth diagnosed as pulpitis were randomly divided into three groups:group A,including 120patients/121teeth,treated with zinc oxide engenol(ZOE);group B,including 121patients/151teeth,treated with Cortisomol;and group C,including 121patients/153teeth,treated with 2Seal easymiX.All the teeth were filled with gutta percha by cold lateral condensation.The post-treatment pain and the one-year successful rate were observed.Results The incidence rate of post-treatment pain in group A(15.7%[19/121])were significantly higher than those in group B(5.3%[8/151],P0.01)and group C(6.5%[10/153],P0.05);and there was no significant difference between group B and C.The one-year successful rates were not significantly different between group A(94.0%[110/117]),B(96.5%[137/142])and C(97.9%[142/145]).Conclusion The three kinds of root canal sealers can all achieve satisfactory one-year successful rate in one-visit root canal therapy;moreover,Cortisomol and 2Seal easymiX can also reduce post-treatment pain,making them ideal root canal sealers.

Two-year results of vital pulp therapy in permanent molars with irreversible pulpitis: an ongoing multicenter randomized clinical trial

Oral healthcare expenses are increasing rapidly as a result of the growth of high-cost health technologies worldwide. In many developing/developed countries, low-cost tooth extraction is the alternative treatment option for a high-cost root canal therapy (RCT) for management of human molars with irreversible pulpitis. Vital pulp therapy with calcium-enriched mixture cement (VPT/CEM) as a new alternative treatment option has demonstrated excellent treatment outcomes up to 1 year; if 2-year radiographic/clinical effectiveness as well as cost-effectiveness of the VPT/CEM is also non-inferior compared with RCT, it can serve as a viable treatment for mature molars with irreversible pulpitis. In this prospective, multicenter (n = 23), non-inferiority clinical trial, 407 patients were randomized to either one-visit RCT (n = 202) or VPT/CEM (n = 205) for 27 months. In this part of study, the primary outcome measure was the 2-year clinical and radiographic treatment outcomes. Cost-effectiveness was also analyzed. Mean follow-up times were 24.62 ± 0.72 and 24.61 ± 0.69 months in RCT (n = 166) and VPT/CEM (n = 166) arms, respectively. Clinical success rates in the two study arms were equal (98.19%); however, radiographic success rates were 79.5 and 86.7% in RCT and VPT/CEM arms, respectively, with no statistical difference (P = 0.053). The treatment time span mean was approximately three times greater in the RCT than in the VPT/CEM arm (94.07 vs. 31.09 min; P < 0.001). RCT had a cost of 171.5K per molar tooth compared with 44.5K for VPT. VPT/CEM reduced time and cost spent. When considering clinical as well as cost-effectiveness of VPT/CEM, this treatment option is not only non-inferior but also superior to RCT in mature permanent molar teeth with established irreversible pulpitis. Vital pulp therapy with CEM is a cost-effective and reliable biological technique for endodontic treatment of permanent molar teeth with irreversible pulpitis and can be recommended for general clinical practice.

One-year results of vital pulp therapy in permanent molars with irreversible pulpitis: an ongoing multicenter, randomized, non-inferiority clinical trial

Root canal therapy (RCT) and tooth extraction have been conventional treatment options for management of human mature teeth with irreversible pulpitis. Excellent short-term treatment outcomes of vital pulp therapy with calcium-enriched mixture cement (VPT/CEM), as a new treatment option, on postoperative pain relief was demonstrated; if intermediate- and long-term treatment outcomes of the new treatment are also non-inferior compared to RCT, then VPT/CEM may become a viable treatment option for management of mature teeth with irreversible pulpitis. In 23 healthcare centers, 407 9- to 65-year-old patients were randomly allocated into two study arms including one-visit RCT (reference treatment; n = 202) and VPT/CEM (alternative treatment; n = 205). Six- and twelve-month clinical and radiographic successes were assessed. Mean follow-up times at 6- and 12-month follow-ups were "6.70 ± 0.68 and 6.72 ± 0.71 months" and "12.96 ± 0.67 and 12.90 ± 0.66 months" in the available cases of RCT and VPT/CEM arms, respectively. Favorable clinical success rates in the two study arms did not show statistical difference; however, the radiographic success rate in the VPT/CEM was significantly greater than RCT arm at the two follow-ups (P < 0.001). The patients' age had no effect on the treatment outcomes (P = 0.231). Treatment outcomes of VPT/CEM may be superior to RCT in mature molars with irreversible pulpitis. The performance of biomaterials such CEM cement may assist in the shift towards more biologic treatments. VPT/CEM may be a realistic alternative treatment for human mature molar teeth with symptoms of irreversible pulpitis; the use of VPT/CEM is highly beneficial for patients as well as general dentists.

Retraction

Asgary S, Eghbal MJ (2010). A Clinical Trial of Pulpotomy vs. Root Canal Therapy of Mature Molars. J Dent Res 89:1080-1085. (Original DOI: 10.1177/0022034510374057) The JDR Editor-in-Chief and Editorial Team have determined the article “A Clinical Trial of Pulpotomy vs. Root Canal Therapy of Mature Molars” by S. Asgary and M.J. Eghbal, published in the Journal of Dental Research (2010, 89:1080-1085) includes substantially similar content as an article titled “The effect of pulpotomy using a Calcium-Enriched Mixture cement versus one-visit root canal therapy on postoperative pain relief in irreversible pulpitis: a randomized clinical trial” by the same authors published in Odontology (2010, 98:126-133). The JDR Editor-in-Chief and Editorial Team have concluded that the two papers were submitted simultaneously to both journals resulting in a redundant publication. The publisher and editor have retracted the article (DOI: 10.1177/0022034510374057) from the issue. William V. Giannobile Editor-in-Chief, Journal of Dental Research

Pulpotomy Versus Root Canal Therapy: A Randomized Multicenter Noninferiority Trial

Introduction The aims were to compare postoperative pain relief as well as clinical and radiographic success rates of root canal therapy (RCT) versus pulpotomy with calcium-enriched mixture (CEM) cement or MTA in permanent molar teeth with irreversible pulpitis. Methods A total of 615 patients met the inclusion criteria. The patients were randomly allocated into three arms including one-visit RCT (ORCT: n = 202) as the reference treatment, pulpotomy with CEM (PCEM: n = 205), and pulpotomy with MTA (PMTA: n = 208), as two alternatives of treatment. A numeric rating scale questionnaire was used by patients to record pain intensity (PI). Success was assessed clinically and radiographically 6 and 12 months after treatment. The data were analyzed statistically using analysis of variance, Kaplan-Meier, analysis of covariance, chi-square, Cohen kappa, and t tests. Results Despite no statistically significant difference between the mean PI at baseline, the changes during first week showed significant difference in the three study arms ( p < 0.001). In this regard, patients in the ORCT arm suffered significantly more pain than those in pulpotomy arms ( p < 0.001); such a difference was also observed with percussion tests ( p < 0.001). Clinical success after 6 and 12 months did not show a statistical difference between the three arms; but surprisingly, the radiographic success rates in the pulpotomy arms were significantly greater than the ORCT arm ( p < 0.001). Conclusions Pulpotomy is a realistic alternative treatment option to RCT in human permanent mature molars with irreversible pulpitis. PMTA and PCEM had favorable success rates at the 1-year follow-up. The clinical ease of pulpotomy and the promising reduction in cost of CEM are factors that advocate significant weight to this treatment dilemma at least for developing nations.

The effect of pulpotomy using a Calcium-Enriched Mixture cement versus one-visit root canal therapy on postoperative pain relief in irreversible pulpitis: a randomized clinical trial

The purpose of this noninferiority trial was to compare postoperative pain relief after one-visit root canal therapy (ORCT) with a pulpotomy performed with a new endodontic calcium-enriched mixture cement (PCEM) in human permanent molars with irreversible pulpitis. A total of 407 selected patients were randomly allocated into the ORCT group (n = 202) or the PCEM group (n = 205). Numerical Rating Scale questionnaires were used to record pain intensity (PI) by the patients during the first 7 days after treatment. While there was no statistically significant difference in the mean PI at baseline between the two study groups (P = 0.45), changes in mean PI were significantly different between them (P < 0.001). In the ORCT group, pain relief was achieved after 36 h [95% confidence interval (CI), 27.00-45.00], compared to 18 h in the PCEM group (95% CI, 15.00-21.00), a significant difference (P < 0.01). Comparison of the mean PI sum recorded over 7 days showed that patients in the ORCT group experienced significantly more pain than those in the PCEM group (P < 0.001); a similar difference was observed for pain in response to percussion tests (P < 0.001). Treatment with PCEM thus had the better pain-reducing effects than ORCT in irreversible pulpitis cases.

A Clinical Trial of Pulpotomy vs. Root Canal Therapy of Mature Molars

Root canal therapy (RCT) and tooth extraction are the main treatment options for irreversible pulpitis or its sequelae. Pulpotomy is an alternative treatment; however, more evidence is required. If outcomes of pulpotomy with a calcium-enriched mixture (PCEM) are non-inferior for mature molars with irreversible pulpitis compared with those from one-visit RCT (ORCT), this may be a beneficial treatment option. Four hundred seven individuals met the inclusion criteria and were randomly allocated [PCEM (n = 205), ORCT (n = 202)]. We used NRS questionnaires to record pain intensity. Six-month clinical and radiographic successes were assessed. Individuals in the ORCT arm reported significantly more post-operative pain than those in the PCEM arm (P < 0.001). Clinical success rates in the two arms showed no statistically significant difference; however, the radiographic success rates were significantly greater in the PCEM arm (P < 0.001). This trial suggests PCEM as an alternative for treatment of irreversible pulpitis. If long-term results confirm initial ones, PCEM may revolutionize oral health worldwide.

A short-term clinical study of one-visit endodontic treatment for infected root canals

To clinically evaluate the postoperative pain level and short-term healing of one-visit endodontic treatment for infected root canals. 100 infected cases were included in one-visit root canal therapy group and 42 infected cases in two-visit group using calcium hydroxide as an interappointment medicament. A comparison of the clinical results was done between the two groups. The main assessments included postoperative pain evaluated by patients and by clinical examination, and the six months' healing response. There was no statistically significance between the groups regarding pain 7 days after operation (one visit 60.0%, two visit 57.1%, P > 0.05) and six months' healing response (one visit 67.9%, two visit 61.5%, P > 0.05). The pain in the one-visit group was quickly relaxed postoperatively, as the pain in the two-visit group was given a rise because of the second treatment. One-visit endodontic treatment for infected root canals has the same clinical efficacy as two-visit in regarding to postoperative pain level and short-term healing.