Single Visit Endodontics Research Articles

Root canal medicaments

The ultimate goals of endodontic treatment are complete removal of bacteria, their byproducts and pulpal remnants from infected root canals and the complete seal of disinfected root canals. Intracanal medicaments have been thought an essential step in killing the bacteria in root canals; however, in modern endodontics, shaping and cleaning may be assuming greater importance than intracanal medicaments as a means of disinfecting root canals. Until recently, formocresol and its relatives were frequently used as intracanal medicaments, but it was pointed out that such bactericidal chemicals dressed in the canal distributed to the whole body from the root apex and so might induce various harmful effects including allergies. Furthermore, as these medicaments are potent carcinogenic agents, there is no indication for these chemicals in modern endodontic treatment. Today, biocompatibility and stability are essential properties for intracanal medicaments. The more modern meaning of intracanal dressing is for a blockade against coronal leakage from the gap between filling materials and cavity wall. Calcium hydroxide has been determined as suitable for use as an intracanal medicament as it is stable for long periods, harmless to the body, and bactericidal in a limited area. It also induces hard tissue formation and is effective for stopping inflammatory exudates. Single-visit endodontics, where intracanal medicaments are not used, is generally not now contraindicated and various reports have shown that the clinical outcomes between single- and multiple- visit endodontics are similar. There is no reason to counsel against single-visit endodontics: however, if multiple-visit endodontics is chosen, calcium hydroxide is recommended to be used as an intracanal medicament.

Role of single visit endodontics in contemporary dental practice – A review

The main objective of performing root canal therapy is to eliminate the bacteria from the root canal and seal it with various newer filling materials. If the treatment is thoroughly done it helps in faster periapical healing. Single visit endodontic treatment had numerous drawbacks primarily about the post-operative pain and failure of the treatment effect. With recent advances in endodontics the single visit therapy has become more predictable and lessened intraoperative procedure and has increased operators comfort. In this review article indications and contraindications of single visit endodontics, success rates and myths related to it are discussed.

Frequency and distribution of maxillary teeth treated by a single visit and multiple visit endodontics in an Indian population – A retrospective study

Controversy exists as to the completion of endodontic procedures in a single visit or in multiple visits. Analyzing the frequency and distribution of single and multiple visit endodontics carried out based on demographic data can give us an insight towards the success of the treatment. This retrospective study aimed to analyse the frequency and distribution of maxillary teeth treated by single or multiple visit endodontics in an Indian population. Data for the study were collected retrospectively. Patient records of 86000 patients that reported to the institution between June 2019 and March 2020 were reviewed. Excel sheet tabulations were made involving age, gender, tooth number and number of visits. Descriptive statistics were applied using SPSS software. Association between each demographic data and the number of visits was analyzed by Chi-Square Test. A total of 4493 RCT procedures were done, of which 48.6% were single visit procedures and 51.4% were multi-visit procedures. The age group of 18-30 years (31.7%) and 31-40 years (29.3%) underwent the highest number of procedures, followed by 41-50 years (21%) and >50 years (18%). 51% 0f the procedures were done in males and 49% in females. Statistically, a significant association was observed between age, gender and tooth with a type of treatment (single or multiple visit endodontics), p<0.05. A statistically significant association between age, gender and tooth was observed with the type of treatment (single and multiple visit endodontics). Younger age group, males and maxillary central incisors showed the highest predilection to multi-visit endodontics. In general, more multi-visit procedures than single visit procedures were done in maxillary teeth.

To compare post obturation endodontic flare-ups following single and multiple visit root canal treatment.

Objective: To compare post obturation endodontic flare-ups following single and multiple visit root canal treatment. Study Design: Quasi experimental study. Setting Operative dentistry department, DOW university hospital Karachi. Period: 2nd October 2017 to 2nd April 2018. Material & Methods: A total of 100 patients of permanent exposed anterior teeth with positive pup response / vital, either gender were included. Patients divided into two groups according to single and multiple visit root canal treatment. At each post obturation recall visit the patients were interviewed and inspected to determine whether or not there are symptoms. Results: A total of 100 patients came for root canal treatment. At 1st post obturation day, out of 50 patients treated in one visit, four experienced a flare-up (8%). Out of 50 patients treated in two visits, eight experienced a flare-up (16%) (P-value=0.12). At 3rd post obturation day, out of 50 patients treated in one visit, three experienced a flare-up (6%). Out of 50 patients treated in two visits, five experienced a flare-up (10%) (P-value=0.37). Conclusion: We conclude that almost same results for single and multiple visit endodontics were achieved not statistically significant.

Comparative evaluation of low level laser therapy in post endodontic pain management - A quasi experimental trial

Introduction: Low level lasers have an average output power range between 5 and 500 mW. Low level lasers have shown nonthermal, and bio-stimulatory effects. The most common complication of single visit endodontics is a flare-up that results in pain and swelling. Aim:The aim of this clinical study was to evaluate the effect of Low Level Laser Therapy in pain management after single visit endodontic treatment pain. Materials and methods: Thirty subjects with symptomatic apical periodontitis in their lower premolars were divided randomly into 3 groups. Group A was administered Low level Laser for 5 minutes prior to the procedure at the apex of the tooth through buccal mucosa and into the canal after pulp space preparation. Group B was given 600 milligrams of ibuprofen half an hour prior to the start of the treatment and given Low level Laser just prior to the treatment and into the canal after the completion of pulp space preparation. Group C was kept as a control group which was neither given analgesics nor laser preoperatively.Intensity of pain after treatment was noted down on a visual analog scale at four hour, eight hour,twelve hour and twenty four hour interval. Results: Results were obtained after statistical analysis. Conclusion: LLLT group showed less pain levels than the control group after single visit endodontics.

An In Vivo Comparative Evaluation of Postoperative Complications in Single- versus Multiple-Visit Endodontic Therapy: 18-Month Follow-Up

Abstract Objective The goal of root canal therapy is thorough disinfection and obturation of the root canal system in all its dimensions. Success of endodontic treatment is highly related to the elimination of postendodontic pain, tenderness, and swelling.Single-visit endodontic therapy has several advantages such as increased patient acceptance, less overhead costs, and only single time local anesthesia administration is required.Multiple-visit endodontic (MVE) treatment allows the clinician to determine the effect of the therapy on the inflamed tissues and shorter appointments.This in vivo study was undertaken to compare the postoperative incidence of pain, swelling, tenderness, and radiographic evaluation of periapical pathology following single- versus multiple-visit endodontic therapy in vital as well as nonvital teeth. Materials and Methods A total of 60 subjects in the age group of 15 to 50 years were selected for the study. The patients were divided into four groups:• Group 1 (n = 15): Single-visit endodontic (SVE) therapy with vital pulp involvement without periapical rarefaction.• Group 2 (n = 15): SVE therapy of asymptomatic pulpless teeth with periapical rarefaction as observed in radiographic evaluation.• Group 3 (n = 15): MVE of vital pulp involvement without periapical rarefactions.• Group 4 (n = 15): MVE therapy of asymptomatic pulpless teeth with periapical rarefaction as observed radiographically.Access cavity was prepared, working length was taken. Biomechanical preparation was done with Protaper universal rotary file system and obturation was done immediately in single-visit cases.In multivisit cases, Ca (OH)2 is placed as an intracanal medicament and obturation was done with the help of AH plus sealer and gutta-percha.Postobturation pain levels, swelling, and tenderness on percussion were assessed till 6 weeks. The radiographic parameter was studied till 18 months follow-up. Results Among the different experimental groups, maximum patients in MVE without periapical rarefaction showed no pain according to visual analog scale (VAS) scale, swelling, and tenderness and in SVE with periapical rarefaction showed maximum number of patients reported with pain, tenderness, and swelling.At 4 and 6 weeks postoperatively, patients in all the groups exhibited no pain, swelling, and tenderness to percussion.As periapical rarefaction, healing of periapical lesion was evident in all the patients after 18 months.

Anesthetic efficacy of anterior middle superior alveolar injection in single-visit endodontic therapy: an in vivo study.

To evaluate and compare the anesthetic efficacy of anterior middle superior alveolar (AMSA) injection in single-visit endodontic therapy, an in vivo study. Teeth in the maxillary anterior segment (N= 60) requiring single-visit endodontic (SVE) therapy were selected. A conventional syringe with 26-guage needle containing 1.5ml lignocaine with 1:80,000 epinephrine was used for the AMSA injection. The SVE therapy was performed using standard protocol. Profoundness of anesthesia during therapy was evaluated at 15-, 30-, 60-, and 90-min intervals using pain rating score and marked on visual analogue scale. In patients who reported pain/ineffectiveness of anesthesia during the course of endodontic therapy, additional supplemental anesthesia (buccal/labial infiltration) was administered. Depending on effectiveness of anesthesia with the AMSA injection alone or the need for additional supplementary injections, patients were divided as: group I-only AMSA and group II-AMSA with one or two supplemental anesthesia. The AMSA injection was effective in 91.67% of the patients undergoing the SVE therapy and the duration of anesthesia for the AMSA injection alone was adequate until the completion of the SVE therapy. Supplementary injections were required in 8.33% of cases at 15-min interval to achieve profound anesthesia. The AMSA injection technique could be used as an alternative to the conventional infiltration technique for anesthetizing teeth in maxillary anterior segment during the SVE therapy. The AMSA injection provides profound pulpal anesthesia of teeth in maxillary anterior segment during endodontic therapy.

Surgical single visit apexification with biodentine and single visit root canal treatment - A case report

Traumatic injuries are very common in both adolescence and in adults. Traumatic injuries of the permanent teeth often results in crown fracture with or without associated fracture of root. Inflammatory periapical lesion should be initially treated with conservative nonsurgical procedures.(Lin.et al). A 23 year old male patient reported to the department of Conservative Dentistry and Endodontics of AICRS with the chief complaint of broken tooth and pain in upper front teeth region. Non surgical single visit endodontic treatment done in 11 and 12. Single visit apexification in 21 with the help of Bio-dentine had also been done on same visit. In this clinical study, Bio-dentine showed promising result when used for apexification of non-vital immature tooth with open apex. Single visit endodontics proved to be effective for the management of periapical lesion. Keywords: Traumatic injuries, Periapical lesion, Apexification, Single visit, Non surgical, Bio-dentin.

Periapical Healing in Single-visit Endodontics under General Anesthesia in Special Needs Patients

IntroductionThe aim of this study was to determine the prognostic factors of periapical healing of teeth after single-visit nonsurgical endodontic treatment under general anesthesia in special needs patients. MethodsThis retrospective study collected 448 teeth from 241 patients (mean age = 27.4 years, standard deviation = 13.9 years). A total of 271 teeth (60.5%) with clinical and radiographic follow-up records longer than 12 months (mean [standard deviation] = 56.1 [27.9]) were included in the outcome analysis. Demographic, systemic, and dental information about the cases were compared between the healed and nonhealed groups using the Pearson chi-square test. Factors contributing to periapical healing were determined with multivariate logistic regression analysis. ResultsComplete periapical healing without clinical signs was observed in 221 teeth (81.5%), uncertain healing with decreased size of the periapical lesion was shown in 43 teeth (15.9%), and no reduction in lesion size was observed in 7 cases (2.6%). In the multivariate analysis, diet type, oral hygiene maintenance, pulp vitality, and root filling length were detected as contributing factors for complete resolution of periapical lesions (P < .05). ConclusionsSuccessful outcomes of single-visit endodontic treatment under general anesthesia were shown in special needs patients. The prognoses were influenced by the clinical circumstances of the patients and the preoperative conditions of their teeth.

Single-Visit versus Dual-Visit Endodontics— A Comparative Study

Traditionally root canal treatment was completed in multiple visits so as to eradicate microorganisms and maintain sterility of prepared canals. Currently evidence based studies have shown that there no difference in healing potentiality of single visit as opposed to dual or multiple visits. Modern concepts and protocols in diagnosis, instrumentation, disinfection and obturation systems have made single visit endodontics (SVE) a faster regimen with a predictive outcome. Clinical study aimed to investigate the effectiveness of single visit as compared with dual visit endodontics was conducted. 399 adult patients with pulpal and periapical diseases of endodontic origin who were selected for endodontic therapy in various dental centres in Delhi were included in the study. 201 cases underwent single sitting (Group A) and 198 were treated in two visits (Group B). Endodontic failure rate of 3.68% was observed in single visit group as opposed to 4.78% in dual visit. Though statistically there was no significant difference in outcome of both protocols, the advantages of SVE outweigh those of dual visit. Thus single visit endodontics can serve as an acceptable, alternative treatment modality as compared to dual or multiple visit endodontics.

Intracanal medicaments – Their use in modern endodontics: A narrative review

The main goal of an endodontic treatment is complete removal of bacteria, their byproducts, and pulpal remnants from infected root canals and the complete sealing of disinfected root canals. Intracanal medicaments have been thought as an important step in killing the bacteria in root canals; however, in modern endodontics, shaping and cleaning has been emphasized greater importance than intracanal medicaments as a means of disinfecting root canals. Furthermore, biocompatibility and stability are essential properties for intracanal medicaments. The more modern meaning of intracanal dressing is for a blockade against coronal leakage from the gap between filling materials and cavity wall. Calcium hydroxide has been determined as suitable for use as an intracanal medicament as it is stable for long periods, harmless to the body, and bactericidal in a limited area. Single-visit endodontics, where intracanal medicaments are not used, is nowadays indicated, and various reports have shown that the clinical outcomes between single- and multiple-visit endodontics are almost similar. There is no reason to counsel against single-visit endodontics. however, if multiple-visit endodontics is chosen, an intracanal medicament is strongly recommended. Therefore, the aim of this review is to critically appraise the need for an ideal intracanal medicament and to select cases requiring intracanal medicament instead of using it for each and every case.

Comparison of various sealers on postoperative pain in single-visit endodontics: A randomized clinical study

Aim: The aim of this study is to evaluate the effect of bioceramic-based sealers on postendodontic pain following single-visit endodontics. Materials and Methods: Ninety patients requiring primary endodontic treatment were selected for the study. Patients were treated in single visit endodontically using three different bioceramic-based sealers: Group 1: obturation done using mineral trioxide aggregate plus sealer, Group 2: obturation done using EndoSequence BC sealer, and Group 3: iRoot SP sealer. Postendodontic pain was measured for 48 h postoperatively. Results: No significant difference was found in postendodontic pain scores between the sealers groups. Conclusion: Postendodontic pain was reduced in all treatment groups. Any of the three bioceramic sealers can be used for single-visit endodontics without fear of postoperative pain.

Effect of preoperative ibuprofen in controlling postendodontic pain with and without low-level laser therapy in single visit endodontics: A randomized clinical study.

The aim of this study is to evaluate the effect of low-level laser irradiation and ibuprofen in reducing the onset and severity of postoperative pain following single visit endodontics. One hundred and twenty patients were recruited for this study. Group A (n = 30) patients were administered 400 mg of ibuprofen orally 1 h before the institution of an endodontic procedure. Group B (n = 30) patients were given irradiation of a low-level laser at 50 Hz for 3 min after the standard endodontic procedure at the periapical region on both buccal and lingual aspect. Group C (n = 30) patients were given preoperative ibuprofen followed with a low-level laser at 50 Hz for 3 min after endodontic treatment. Group D (n = 30) patients were administered no preoperative ibuprofen nor low-level laser irradiation after the endodontic procedure. The patient immediately recorded his/her pain perception on the Heft Parker pain survey after completion of the appointment and at 4, 8, 12, 24, and 48 h postoperatively. Inter group analysis was carried out using the analysis of variances with "least significant difference" post hoc test. For intra group analysis, Student's t-test was used. Chi-square test was applied for nonparametric data. Pain was significantly reduced in all the treatment groups postoperatively. Ibuprofen showed significant pain reduction at 4 h and 8 h period. The combination of low-level laser and ibuprofen showed the best results in terms of postoperative pain reduction. This study proved that low-level laser therapy can be an effective alternative for conventional use of nonsteroidal anti-inflammatory drugs in controlling postendodontic pain thereby eliminating the adverse effects of such drugs on the patients.

Comparison of the incidence of postoperative pain after using a continuous rotary system, a reciprocating system, and a Self-Adjusting File system in single-visit endodontics: A prospective randomized clinical trial.

Aim:The aim of this study is to compare the incidence of postoperative pain using the ProTaper Next (PTN), WaveOne Gold (WOG), and Self-Adjusting File (SAF) systems.Materials and Methods:Two hundred and fourteen patients with irreversible pulpitis were selected for single-visit endodontics. The teeth were blindly assigned to three groups based on the instrumentation system used: Group A (PTN), Group B (WOG), and Group C (SAF). Participants were asked to note the incidence of the pre- and postoperative pain on a visual analog scale at different time intervals. Paired t-test and one-way ANOVA were used along with post hoc Tukey's test.Results:The greatest mean pain in Group A (PTN) and Group B (WOG) was found to be maximum in the first 24 h with a significant reduction in pain at the subsequent observation time points of 48 h, 72 h, and 7 days. Group C (SAF) showed minimum pain followed by Group B followed by Group A which showed comparatively higher pain scores even at the end of 7 days.Conclusions:In single-visit endodontics, SAF system may prove to be a better system compared with PTN and WOG as it produces minimal postoperative pain, thus improving the overall acceptance of endodontic treatment.

Conservative management of complicated crown root fractures: a clinical case report

Trauma to the anterior teeth often has a severe impact on the social and psychological well being of a patient. Complicated crown root fracture is a type of dental trauma involving enamel, dentin, cementum and pulp often occurring below the gingival margin. Several therapeutic procedures can be indicated to treat teeth with complicated crown-root fracture, depending on fracture location. The case reports here describes a surgical approach for reattachment of fractured maxillary anterior tooth. The fractured tooth was stabilized with composite resin followed by single visit endodontics. Surgical exposure was done as the fracture extended subgingivally. The fractured segment was removed carefully and reattached using a fiber post and resin cement. The post surgical healing phase remained uneventful. On recall after 3 months, the tooth remains functional and esthetically sound. The extent of fracture in the subgingival direction was one of the main factors influencing the treatment plan.

Comparative evaluation of single-visit endodontic treatment with and without the use of iodine potassium iodide as an endodontic irrigant: In vivo study

Introduction: The root canal treatment in asymptomatic necrotic teeth in single visit has been an area of discussion for long. The purpose of this study was to compare the single-visit root canal treatment of asymptomatic nonvital mature mandibular molars with and without the use of 5% iodine potassium iodide (IKI) as an endodontic irrigant with the minimal use of postoperative medications. Materials and Methods: Sixty patients requiring root canal treatment on asymptomatic nonvital mandibular molars were included in the study and were randomly allocated into two groups of thirty each. In Group I, no IKI was used and in Group II, 5% IKI was used as an irrigant. The complete treatment was done in single visit. The occurrence of postoperative pain and swelling was noted at various time intervals. Results: Mann–Whitney U-test showed no statistically significant difference between the two groups regarding both the parameters. In Group I, 20% of patients experienced moderate-to-severe pain during the first 24 h (P = 0.25463) while only 10% of patients experienced moderate pain in Group II. In Group I, 20% of patients developed swelling after 24 h while none of the patients in Group II had any postoperative swelling (P = 0.09342). Conclusion: Irrigants with better disinfection properties, penetration, and quick action such as 5% IKI are important adjunct to complete the disinfection of root canal system in single-visit endodontics.

Treatment of Acute Apical Abscess in Diabetic Patient by Single Visit Endodontics- A Case Report

Treatment of Acute Apical Abscess in Diabetic Patient by Single Visit Endodontics- A Case Report

A systematic review of nonsurgical single-visit versus multiple-visit endodontic treatment.

Conventional endodontic treatment used to require multiple visits, but some clinicians have suggested that single-visit treatment is superior. Single-visit endodontic treatment and multiple-visit endodontic treatment both have their advantages and disadvantages. This paper is a literature review of the research on nonsurgical single-visit versus multiple-visit endodontic treatment. The PubMed database was searched using the keywords (endodontic treatment OR endodontic therapy OR root canal treatment OR root canal therapy) AND (single-visit OR one-visit OR 1-visit). Review papers, case reports, data studies, and irrelevant reports were excluded, and 47 papers on clinical trials were reviewed. The studies generally had small sample sizes, and the endodontic procedures varied among the studies. Meta-analysis on the selected studies was performed, and the results showed that the postoperative complications of the single-visit and multiple-visit endodontic treatment were similar. Furthermore, neither single-visit endodontic treatment nor multiple-visit treatment had superior results over the other in terms of healing or success rate. Results of limited studies on disinfection of the root canals using low-energy laser photodynamic therapy is inconclusive, and further studies are necessary to show whether laser should be used in endodontic treatment. This review also found that that neither single-visit endodontic treatment nor multiple-visit treatment could guarantee the absence of postoperative pain. Since the study design of many studies displayed significant limitation and the materials and equipment used in endodontic treatment have dramatically changed in recent years, prospective randomized clinical trials are needed to further verify the postoperative pain and success rates of single-visit versus multiple-visit endodontic treatment.

Single visit root canal treatment: A prospective study

The aim was to determine the success rate of single visit root canal treatment (RCT) and thus encourage clinicians to offer this treatment option appropriately. This was a longitudinal clinical study involving all teeth of the secondary dentition except third molars in the upper and lower jaws. Teeth having irreversible pulpitis, pulp necrosis or periapical periodontitis were included in the study. RCT and obturation was done at a single visit. The patients were monitored over 6 months. Forty-five teeth were treated in 21 females and 24 males, aged 18-56 years (34.4+/-12.7). Preoperatively, pain was present in 84.4%, tenderness to percussion in 53.3%, and periapical radiolucency in 24.4% teeth. Forty percent had irreversible pulpitis and 60% had apical periodontitis. Post-operatively, pain reduced to 51.1% on day 1, 15.5% at 1 week, and 0% for the rest of the period. Tenderness to percussion reduced to 15.6% at 1 week and 0% by 1 month. Periapical radiolucency reduced to 9.5% at 6 months. Favorable outcome of 33.3% was recorded on day 1 and increased to 90.5% at 6 months. Six months success rate for teeth which had irreversible pulpitis was 100% and 83.3% for apical periodontitis. The mean time needed to complete a single visit RCT ranged from 77 min for a tooth having one canal to 132 min for one having four canals. Single visit RCT is a viable treatment option for teeth having irreversible pulpitis or apical periodontitis irrespective of tooth type or number of canals. A lot of patients are lost to follow-up visits for teeth requiring RCT once the pulp is extirpated at the first visit due to cessation of pain, subsequently leading to treatment failure. Single visit endodontics eliminates the need for follow-up visits and improves treatment prognosis.

Incidence of post-operative pain following single visit endodontics in vital and non-vital teeth: An in vivo study

This clinical study was conducted to compare the post-operative pain following single visit endodontics in vital and non-vital teeth, with and without periapical radiolucency. A total of 60 adult patients requiring root canal therapy in anterior and premolar teeth were selected for this study. Single sitting root canal treatment was carried out and the subjects were recalled after 2 weeks and instructed to fill out a series of self-report questionnaires for responses about pain in the interim after 1 day, 2 day, 3 day, 1 week and 2 weeks. In vital teeth (Group I) 60% of the treated cases had pain, of which 36% had mild pain (non-significant) and 24% had moderate pain (significant). In non-vital teeth without periapical radiolucency (Group II) 64% of cases had pain, of which 48% had mild pain (non-significant) and 16% had moderate pain (significant). In non-vital teeth with periapical radiolucency (Group III) 32% of the cases had pain of which 24% had mild pain (non-significant) and 8% had moderate pain (significant). None of the teeth in any of the groups had severe pain. There was no statistical difference between incidence of pain in vital and non-vital teeth without periapical radiolucency. Non-vital teeth with periapical radiolucency exhibited relatively less pain as compared with non-vital teeth without periapical radiolucency, but the pain continued in a significant percent of teeth even after 2 weeks. Pain incidence dropped significantly within a period of 1 day to 2 weeks in vital teeth and non-vital teeth without periapical radiolucency. There was a tendency for less incidence of significant pain after a single visit root canal treatment in these groups. Results obtained were comparable with those obtained by several investigators.