single visit endodontics
TRANSCRIPT
SINGLE VISIT ROOT CANAL TREATMENT
Presented by-Dr NISHANT KHURANA
PG Final yr
Contents
Introduction
Definition
History
Advantages
Disadvantages
Indications
Contraindications
Economics of single visit endodontics Guidelines for one visit
Adjunct to Render single visit endodontics
Essential’s of single visit Recent advances in endodonticsFlare ups following single visit endodontics(Post-op
pain) Studies of single visits
Conclusion References
Introduction
• Dental practitioners are becoming more interested in completing non surgical endodontic therapy in a single visit.
• They suggest that vital teeth cause an inflammatory response, and hence an open and an unfilled canal will allow inflammatory fluids to accumulate within the canal and hence create an inflammatory pressure. In non-vital teeth, intracanal organisms may be forced beyond the CEJ with resulting infection, swelling and pain.
• Only those teeth with active fistulas are considered as candidates for single visit endodontic therapy simply because they possess a clear anatomical channel through which inflammatory pressure can be released.
• Conservative non – surgical treatment Conservative non – surgical treatment of an endodontically involved tooth , of an endodontically involved tooth , consisting of complete biomechanical consisting of complete biomechanical
preparation and obturation of the preparation and obturation of the root canal system in one visit .root canal system in one visit .
History :History :
In the late 1800’s Dodefe suggested immediate root canal filling. He described techniques which included:
root canal sterilization by hydrogen dioxide and sodium dioxideHot platinum wire sterilization Sulphuric acid irrigation
1901 – Trallero used a Bichloride washhot platinum wire sterilization and zinc oxide engenol and xeroform paste fill
1904 : Inglis – used cocaine as pulpal anesthetic, sterilized root canals with potassium permanganate & filled canals with chloropercha , sectional guttapercha or formapercha. He excluded all acute cases.
1908 : Barnes – used sulphuric acid to irrigate canals & filled it with
chloropercha . He excluded abscessed roots from treatment .
1910 : Trallero – performed single visit endodontics by using a bichloride
wash , hot platinum wire sterilization for canals & then filled canals with
zinc oxide eugenol & xeroform paste .
1912 : Zsigmondy – irrigated canals with sodium dioxide , sterilized them hot wire & dried the canal with alcohol before filling .
1959 : Ferranti – compared single visit v/s two visit – found no difference .
1959 : Sargenti & Richter – advocated use of single visit as alternative to multi visit .
1970 – Fox and associates found out that more pain occoured post operatively in
Teeth that had no radiographic areas (in female patient’s)Teeth that have been over instrumental or overfilled.
1978 – Esherd colleagues compared single and to visit endodontics in 564 vital teeth and found severe pain – 9% of the single visit of patient and severe pain – 5% of the to visit gp.
1983 : Oliet – compared single visit & two visit with respect to post operative pain , swelling & healing & he found no significant difference.
Advantages : Clinician has most intimate awareness of the canal anatomy immediately following instrumentation .
No risk of losing important landmarks .
The canal is never cleaner than immediately after proper instrumentation .
Eliminates chance of interappointment microbial contamination & flare up induced by leakage of temporary seal .
Teeth are ready sooner for final restoration diminishing risk of a
fracture necessitating extraction .
Patients preoperative anxiety & post operative pain is limited to
one episode .
Time is saved for both practitioner and patient .
Less cost .
In anterior teeth , it allows immediate use of canal space for
retention of a post & construction of an esthetic temporary crown .
Eliminates the problem of the patient who does not return to have
his case completed .
Disadvantages :
No easy access to the apical canal in case of a flare up .No easy access to the apical canal in case of a flare up . Clinicians & patient fatigue & discomfort with extended Clinicians & patient fatigue & discomfort with extended
operating time.operating time. No opportunity to place a intracanal disinfectant .No opportunity to place a intracanal disinfectant . Difficult cases with extremely fine, calcified multiple canals Difficult cases with extremely fine, calcified multiple canals
may not be treatable in one appointment .may not be treatable in one appointment . If hemorrhage or exudation occurs – may be difficult to control If hemorrhage or exudation occurs – may be difficult to control
it & complete treatment in one visit .it & complete treatment in one visit . Clinicians with lack of experience could end up causing flare ups Clinicians with lack of experience could end up causing flare ups
and finally endodontic failure.and finally endodontic failure. Follow up is not possible as in case of multiple appointmentsFollow up is not possible as in case of multiple appointments
IndicationsIndications
• Uncomplicated vital teeth i.e. teeth without any Uncomplicated vital teeth i.e. teeth without any periapical radiolucencies, in such cases it should be a periapical radiolucencies, in such cases it should be a symptomatic pulpitissymptomatic pulpitis
• Fractured anterior teeth or bicuspies, where esthetics Fractured anterior teeth or bicuspies, where esthetics is of prime concern and a temporary post or crown is of prime concern and a temporary post or crown are required – immediate esthetics of the anteriorsare required – immediate esthetics of the anteriors
Criteria for single sitting endodontics in such cases:Criteria for single sitting endodontics in such cases:
• There should be no periapical radiolucency There should be no periapical radiolucency • The tooth should not be tender on percussion (indicating The tooth should not be tender on percussion (indicating
absence of a prior periapical inflammation)absence of a prior periapical inflammation)• There should be no open exposure to cause any pulpal There should be no open exposure to cause any pulpal
infection.infection.
Precautions to be taken in such cases:Precautions to be taken in such cases:– All the endodontic preparation should be confined within the canal.
• There should be no over instrumentation.• If during instrumentation we discover that we have made an error by
over instrumenting the tooth the canal preparation and obturation should not be done in a single sitting.
• In such cases prophylactic use of cortico steroids is the apical medicament and the patient is called after a few days for completion.
• In cases when the anterior teeth are supported to be used as abutments we have to do an intentional RCT in a single sitting.
• Patients who are physically not able to return for a 2nd appointment
• Indicated in anterior teeth as they have a single and straight forward canal indicated in posterior teeth which do not have much curvature.
• Indicated in necrotic, uncomplicated teeth which have a draining sinus.
• Indicated in situations of wars where the soldier has to report back for duty and in case of patients who come from a distance to avoid repeated appointments a single sitting RCT is done and followed up.
• In the case of vital pulps where periradicular surgery has to be done
Contraindications :
Painful , necrotic teeth with no sinus tracts for drainage . Teeth with severe anatomic anomalies or cases fraught with procedural
difficulties . Calcified canals Fine tortuous canals Bifurcated or accessory canals Ledge formations Blockages perforations
Asymptomatic non vital molars with periapical radiolucency & no sinus tracts.
Patients with acute apical periodontitis with severe pain on percussion .
Most retreatments .
Cellulitis .
Acute abscess requiring incision & drainage .
Weeping canals that cannot be dried.
Difficult cases that extend beyond our alloted time & patients
tolerance .
Possible increased stress on TMJ musculature .
Increased psychological stress .
Economics of single visit endodontics :
Single visit endodontics is profitable both to the
practitioner and the patient.
Practitioner – One appointment only. It is a loss if
stretched to 2-3 appointments.
Patient – No long lost hours of work and needless travel.
Guidelines for one appointment endodonticsGuidelines for one appointment endodontics : The guidelines form a triad they are
ACCURATE DIAGNOSISPROPER CASE SELECTIONSKILLED OPERATOR
As a guideline the case must be completed within 60 min.
Oliet laid down certain criteria for case selection they are :
1) Positive patient acceptance.
2) Sufficient available time to complete the procedure properly.
3) Absence of acute symptoms requiring drainage via
the canal &of persistent continuous flow of exudate
or blood.
4) Absence of anatomical obstacles (calcified canals,
fine tortuous canals, bifurcated or accessory canals).
5) Absence of procedural difficulties (ledge formation,
blockage, perforation, inadequate fills).
ADJUNCT TO RENDER FASTER TREATMENT IN SINGLE VISIT ENDODONTICSADJUNCT TO RENDER FASTER TREATMENT IN SINGLE VISIT ENDODONTICS– Pain ControlPain Control
– Before commencing the treatment local anaesthesia should be administered to ensure painless treatment
– It is preferable to use a longer acting local anaesthetic agent as the duration of sitting endodontic treatment goes on for 1 hour or little more, hence the local anaesthetic agent should act for a longer period of time.
– Long acting local anaesthetic agents such as BUPIVACINE is used. Which also helps to control post operative pain.
– Sometimes supplemental anaesthesis is indicated in case the standard injection is not completely effective.
– Three supplemental techniques:– Periodontal ligament injection– Intra pulpal– Intra osseous
– IsolationIsolation
• Soon after administering local anaesthesia it is very important to isolate the operating field before starting the treatment. So that there is no interference of oral fluids and so that the intracanal irrigant can be used with ease. A rubber dam is used for isolation.
– After isolation the access is opened by preparing the access cavity with the help of a round ENDCARBIDE FISSURE BUR with high speed.
• Now the next step is thorough debridement of the pulp from the coronal pulp chamber.
Location of the Canal OrificeLocation of the Canal Orifice
• The canal orifice should be located in the floor of the pulp chamber. This is usually done with an endodontic probe.
• Recently advanced instruments have emerged such as the FIBRE OPTIC PROBE which has a tip of 1.8 mm in diameter – here the clinician can access openings better and also the pulpal floor revealing orifices of the canal and also the canal interior.
• The device which makes use of this is the endoscope where the image will be displayed on the computer screen. Examples of the fibre optic probe in the ORASCOPE FIBRE OPTIC PROBE.
– After location of the canal orifice all of the pulp and the debris are extripated from the canal using a barbed broach.
Sodium hypochloriteSodium hypochlorite
– NaOCl is a powerful irrigant that has been shown to readily dissolve pulp tissue in concentration of 5.25%
– They have an advantage of destroying all microorganisms upon its direct contact
– To increase the effectiveness of tissue dissolution the access cavity is filled with Naocl.
– Better starting treatment, it is better to build up teeth which are badly broken down so that the pulp chamber can retain the irrigants.
Use of checating agentsUse of checating agents
• EDTA – ETHYLENE DIAMINETETRACITIC ACID
• This is used to eliminate the problems of cleaning and shaping• Purpose:
– Lubrication– Emulsification– Holding debris in suspension
• They are available in the form of:– A viscous suspension or
• An aqueous solution form
• Root canal preparation creamRoot canal preparation cream
– This is a viscous chelator– its principal ingredient is EDTA, urea peroxide and prophyneghycol (lubricant)
– In right canals chelators are important for initial coronal enlargement, because they:
» emulsify tissue» soften dentin» minimize blockages» hold debris in suspension which can be aspired by the needle.
– R.C. preparation encourages flotation of the pulpal remenants and the dentinal mind that reduces the chances of blocking the canal.
– Irrigation with Naocl is generally followed by the use of R.C. preparation.
– Using R.C. preparation with Naocl causes the release of Nacent oxygen which kills the anaerobic bacteria.
Visualization endogramVisualization endogram• This is an experimental irrigant which contains
– 5% Naocl– 17% EDTA– Hypaque
• Hapaque: This is an aqueous solution containing– 2, Iodine salts– sodium iodide.
• This is a radiopaque contrast solution which is used to radiographically visualize root canal systems under clinical conditions. In medicine it is used as an injectable dye for angiography, urography etc.
• Advantages of using this solution:– provides the solvent action of the Naocl– Visualization in the radiograph– Improved penetration
• Used to:– Visualize the microanatomy– Verify the shape– Monitor the remaining root wall thickness during preparation
Essential’s of single visit endodonticsThe essence of single visit endodontics is quality treatment.
Two essential’s of a root canal therapy are
1. Working length (WL)
2. Working width (WW)
Working width
Working length
Working length :Definition :
“the distance from a coronal reference point to the point at which the canal preparation and obturation must terminate”.
Significance :
The calculation determines how far into the canal the instruments are placed and worked and thus how deeply into the tooth the tissues, debris, metabolites, end products and other unwanted items are removed from the canal.
It will limit the depth to which the canal filling may be placed.
It will affect the degree of pain and discomfort that the patient will feel following the appointment.
If calculated within correct limits, it will play an important role in determining the success of the treatment and conversely, if incorrectly calculated may lead the treatment to failure.
Failure to accurately determine and maintain working length may result in –
a) Length being too long – Lead to perforation through the apical constriction Over filling or over extension. Increased incidence of post operative pain. Prolonged healing period and lower success rate
owning to incomplete regeneration of cementum, pdl and alveolar bone.
b) Shaping and cleaning short of apical constriction :
Persistent discomfort associated with incomplete apical seal apical leakage bacterial entry -> failure.
Methods to determine working length :
Radiographic method
Estimation by direct digital radiography or xero radiography
By digital tactile sense
By apical periodontal sensitivity
By paper point measurement
By electronic apex locators
Working width is defined as
“The initial and post instrumentation horizontal dimensions of the root canal system at working length and other levels.”
Working width
Minimum initial working width (MIWW) corresponds determining the preoperative canal diameter by passing
consecutively larger instruments to the working length till one binds.
Min IWW
Max FWW
The maximum final working width (MFWW) corresponds to master apical file size that is generally 3 ISO sizes larger.
In a round canal it is easy to find but in canals that are oval, long oval, flattened ribbon like or irregular, discrepancy arises. With use of k-file or light speed files to measure the working width and canal preparation would lead to incomplete cleaning and produce a ‘key hole’ or a ‘dumbbell’ preparation of the root canal.
Other causes of discrepancy are due to morphologic and procedural factors such as canal shape, canal length, curvature of the canal, canal content, coronal interference and the type of instrument used.
Procedure :
Before initial working width is determined widen the orifices do early coronal flaring and additional canal flaring (crown down technique) which ensures effective irrigation and minimizes any interferences with tactile sensation.
The best method to clean the entire canal to complete working width is by doing circumferential filing manually.
To conclude the safest way to clean the canal is by using both NiTi and manual instruments.
Studies confirm that large working width apical preparation sizes remove more bacteria than small apical preparation. It also permit irrigating solutions to be placed closer to working length with easier exchange of irrigants.
Even though working width larger than the original canal size results in better cleaning but it is mostly ignored and is called the “forgotten dimension in endodontics”.
Because of advanced technology, the difficulty of instrumenting to larger (but appropriate) working width sizes, even with difficult curvatures can be overcome.
Ex: light speed – it is a non-tapered, very short bladed, NiTi instrument with superior flexibility and a non cutting pilot tip.
Recent advances that assists in forming single visit endodontic therapy include :
Use of direct digital radiography, radiovisiography, digital substraction radiography, tomography, surgical microscopes etc. we can have clear image of root canal anatomy in very minimal time.
• Ultra sonic instrumentsUltra sonic instruments– They are used to clean the root canal either during
or after canal preparation techniques.– The use of ultrasonic energy to activate irrigation
solutions in pre prepared canals by a movement called as ‘Acoustic streaming’.
– Ultrasonic instrumentation is not very effective in preparation of the root canal.
Rotary Ni Ti shaping instrumentsRotary Ni Ti shaping instrumentsImportant of flaring the coronal aspect of the root canal artifice.This is done mainly to obtain a straight line access especially in the molars.While irrigation the needle can fit passively into the root canal orifice without any obstruction and the debris can be flushed out better.
Profile Rotary instruments• ProFile 0.04 and 0.06 Taper
Rotary Instruments andProFile Orifice Shapers are proportionately sized nickel-titanium U-shaped instruments designed for use in a controlled, slow-speed, high-torque, rotary handpiece
Protaper
• ProTaper Configurations:
the ProTaper System consists of only six instrument
sizes: three shaping files and three finishing files.
ProTaper Benefits.• 1. The progressive (multiple) taper design improves flexibility and “carving” efficiency,
an important asset in curved and restrictive canals
• 2. The balanced pitch and helical angles of the instrument optimize cutting action while effectively augering debris coronally, as well as preventing the
instrument from screwing into the canal.• 3. Both the “shapers” and the “finishers” remove the debris and soft tissue from the
canal and finish the preparation with a smooth continuous taper.
• 4. The triangular cross-section of the instruments increases safety, cutting action, and tactile sense while reducing the lateral contact area between the file and the dentin
• 5. The modified guiding instrument tip can easily follow a prepared glide path without gouging side walls.
K3 Nickel-Titanium FilesK3 Nickel-Titanium Files • Positive rake angle provides the Positive rake angle provides the
active cutting action of the K3. active cutting action of the K3. • Wide radial land provides blade Wide radial land provides blade
support while adding peripheral support while adding peripheral strength to resist torsional and strength to resist torsional and rotary stresses. rotary stresses.
• The third radial land stabilizes and The third radial land stabilizes and keeps the instrument centered in keeps the instrument centered in the canal and minimizes “over the canal and minimizes “over engagement.” engagement.”
• Radial land relief reduces friction on Radial land relief reduces friction on the canal wall. the canal wall.
Simplified Colour Coding Safe-Ended Tip
Quantec SystemQuantec System
• Graduating TapersGraduating Tapers• File tapers of .02 File tapers of .02
through .06 are through .06 are incorporated to maximize incorporated to maximize the cutting efficiency and the cutting efficiency and minimize the stress on the minimize the stress on the instrument. The increasing instrument. The increasing tapers change the point at tapers change the point at which the file engages the which the file engages the canal wall.canal wall.
• Two geometries are available:Two geometries are available:LX Non-CuttingLX Non-Cutting – The LX pilot tip maintains a central axis and deflects – The LX pilot tip maintains a central axis and deflects around severe curvatures. Ideal for:around severe curvatures. Ideal for:
• Routine cases Routine cases • Severe curvatures Severe curvatures • Delicate apical regionsDelicate apical regions
• SC Safe-CuttingSC Safe-Cutting – The Quantec SC features a negotiating tip that cuts as it – The Quantec SC features a negotiating tip that cuts as it moves apically, following canal pathways and minimizing stress. Ideal for:moves apically, following canal pathways and minimizing stress. Ideal for:
• Small, tight canals Small, tight canals • Calcified canals Calcified canals • Constricted canals Constricted canals
Crown down technique
Less apical extrusion of debris
Easy preparation of apical portion of canal
Hybrid instrumentation technique
Straight line access is obtained
rotary orifice openers with large tapers are used for coronal shaping
smaller tapered instruments are used for mid root shaping and gaining apical access
working length is determined with apex locators.
apical enlargement to working length & working width is completed with light speed rotary instruments &
hand instruments.
System ‘B’ or ‘touch and heat’ to heat guttapercha.
Newer thermoplasticized injectable guttapercha that assists in rapid obturation. Ex: obtura compactor.
• Obtura IIObtura II
– In this technique the gutta-percha are available in the form of pellets and they are inserted into the heated delivery system which looks like a chalk.
– The gutta-percha is then heated to approximately 365 – 392 F.
– Then a needle or application tip (gauges 20 and 23) are used to deliver the softened Gutta-percha.
– It is introduced into the canal to the junction of the middle and apical third.
– The application tip is pre-fit to ensure that it does not bind against the walls of the canal.
MicroSeal• Developed by Dr. John McSpadden Developed by Dr. John McSpadden Includes these features:Includes these features:• Low-fusing gutta percha specifically designed to flow Low-fusing gutta percha specifically designed to flow
with pressure, heat or both. with pressure, heat or both. • Condensers are stiff enough to go full length, flexible Condensers are stiff enough to go full length, flexible
enough to slide around curvatures and easy to enough to slide around curvatures and easy to custom-fit without distortion. May also be used to custom-fit without distortion. May also be used to enhance traditional lateral and vertical techniques.enhance traditional lateral and vertical techniques.
MicroSeal Starter Kit MicroSeal Starter Kit
• MicroSeal Heater MicroSeal Heater • Microflow syringe Microflow syringe • engine and finger spreaders engine and finger spreaders • condensers condensers • Microflow Cartridges Microflow Cartridges • master conesmaster cones• paper points paper points
Flare Up’s Following Single Visit Endodontics :Morse
“swelling and pain combined or swelling alone that necessitates unscheduled emergency appointments”.
Pickenpaugh etal(2001),
“Severe postoperative pain or moderate to severe swelling that began 12 to48 hours after treatment and lasted at least 48 hours.”
Waltons • “within a few hours to a few days after a root canal
treatment procedure, a patient has either pain or swelling or a combination of both. The problem must be of sufficient severity that there is a disruption of the patient’s lifestyle such that the patient initiates contact with the dentist. Required then are both
• (A) an unscheduled visit and • (B) active treatment (incision and drainage, canal
debridement, opening for drainage etc”.
Incidence of flare up rate of teeth treated in a single visit:
• Teeth without apical periodontitis did not flare up.
• Teeth with apical periodontitis with no previous root canal treatment showed less flare ups.
• Teeth with apical periodontitis which needs retreatment showed highest incidence of flare ups.
• Various techniques for biomechanical preparation was performed to check for the incidence of flare up and post operative pain and it was seen that the incidence was the same for all the techniques leading to a conclusion that technique did not matter however it was seen that balanced force technique and double flare tenchnique produced less flare up and pain owing to less apical extrusion of debris.
• Use of ultrasonics with 2.5% NaOCl also produced less flare up as less apical extrusion of debris.
Reason for fewer flare up in one visit endodonticsPaul D.E and Kristen R.E: (J.O.E. vol. 24 Sept 1998) Paul D.E and Kristen R.E: (J.O.E. vol. 24 Sept 1998)
• Bacteria and other irritants are not allowed to remain in the empty canal isolated from the healing system.
• Deletion of the intracanal medicament that can illicit an immune reaction.
• Early sealing of the canal eliminates bacterial ingress form a leaky restoration, lateral canals or caries. Morse and co-workers carried out exhaustive clinical studies regarding single visit treatment. They concluded that one-appointment endodontics combined with prophylactic administration of antibiotics (penecillin V or erthromycin) and intentional overinstrumentation of the root canal into the approximate centre of the body lesion reduced the prevalence of flare ups from 20% to 1.5%.
Studies done on single visit endodonticsStudies done on single visit endodontics
Rudner and Oliet reported a failure rate of 10.2% in single visit cases and 11.3% in multivisit cases. Molars in both the cases had highest failure rate while premolars have the lowest. No difference was found between vital and non vital teeth in single visit category but teeth with vital pulps treated in multiple visits seemed to show a higher failure rate.
Pekruhn showed a failure rate of only 5.2% in a study of 1140 single visit cases.
It was also shown that incidence of failure was highest in retreatment cases and in those teeth with periapical extension of pulpal disease.
Those teeth with periapical extension that had not been previously opened also showed higher failure rates.
According to weine:According to weine:
• Weine has made some alterations from the routine Weine has made some alterations from the routine procedures for single visit endodontics:procedures for single visit endodontics:
• He did not select cases with pre operative apical periodontitis He did not select cases with pre operative apical periodontitis as they were more prone to post-operative problems.as they were more prone to post-operative problems.
• He preformed complete extripitation of the pulp with a He preformed complete extripitation of the pulp with a broach which was done close to the apical constriction.broach which was done close to the apical constriction.
• After pulpal extripitation he determined the working length After pulpal extripitation he determined the working length carefully without over instrumentation. According to him if he carefully without over instrumentation. According to him if he had over instrumented it, he would have preferred to not to had over instrumented it, he would have preferred to not to have completed the treatment in 1-sitting. have completed the treatment in 1-sitting.
• According to him anterior teeth are more easier to radiograph According to him anterior teeth are more easier to radiograph and offer a better chance for a 1-visit success rather than a molar and offer a better chance for a 1-visit success rather than a molar teeth (because of multiple apexes and lateral canals)teeth (because of multiple apexes and lateral canals)
• Next is the canal is prepared to a maximal size with retaining the Next is the canal is prepared to a maximal size with retaining the original shape of the canal.original shape of the canal.
• The width of the canal enlargement is important to ensure 2 The width of the canal enlargement is important to ensure 2 thingsthings– Removal of the pre-dentin layer Removal of the pre-dentin layer – Removal of residual soft tissue tags which will not provide a good seal.Removal of residual soft tissue tags which will not provide a good seal.
• He did the obturation with gutta percha using lateral He did the obturation with gutta percha using lateral condensation technique.condensation technique.
Single sitting endodontics done in operation desert storm:Single sitting endodontics done in operation desert storm:
• Study was done by: Joseph J.J. B. Ralph and Rober L.J. (Joe Study was done by: Joseph J.J. B. Ralph and Rober L.J. (Joe vol 19 Aug 1990)vol 19 Aug 1990)
– This study was done from Aug 9-21st 1990, in the 197th infantry brigade, This study was done from Aug 9-21st 1990, in the 197th infantry brigade, for Bennig for Bennig
– 167 patients were treated in a single sitting167 patients were treated in a single sitting– step-back instrumentation was done with lateral condensitation using step-back instrumentation was done with lateral condensitation using
gutta perchagutta percha– patient were called after 1-year i.e. from Sept-Dec 1997 for a follow uppatient were called after 1-year i.e. from Sept-Dec 1997 for a follow up– Findings:Findings:
» The pre existing lesion had completely healed.The pre existing lesion had completely healed.» The pre existing had completely decreased insizeThe pre existing had completely decreased insize» No pain was present or developed.No pain was present or developed.
CONCLUSION
• most studies show that one visit root canal procedures produce no more pain than multi-visit ones.
SINGLE VISIT ENDODONTICS : COMPARATIVE STUDY ON INCIDENCE OF POST-OPERATIVE PAIN AND FLARE UPS.
InvestigatorInvestigator Year Year No. of No. of casescases
1visit post-op pain (%)1visit post-op pain (%) Multivisit post-op pain (%)Multivisit post-op pain (%)None or slightNone or slight Moderate Moderate
or severeor severe None or slightNone or slight Moderate Moderate or severeor severe
FerrantiFerranti 19591959 340340 9191 99 96.296.2 3.83.8
Fox et alFox et al 19701970 270270 9090 1010 -- --
O’KeefeO’Keefe 19761976 355355 9898 22 9191 77
SoltanoffSoltanoff 19781978 282282 8181 1919 8686 1414
AshkenzAshkenz 19791979 359359 9696 44 -- --
Rudner, OlietRudner, Oliet 19811981 9898 88.588.5 11.511.5 88.588.5 11.511.5
Mulhern et alMulhern et al 19821982 3030 76.576.5 23.523.5 73.373.3 26.726.7
OlietOliet 19831983 382382 8989 1111 93.593.5 6.56.5
Roane et alRoane et al 19831983 359359 8585 1515 68.868.8 31.231.2
AlacamAlacam 19851985 212212 8686 1414 -- --
Mata et alMata et al 19851985 150150 -- -- 9898 22
Morse et alMorse et al 19861986 200200 98.598.5 1.51.5 -- --
Morse et alMorse et al 19871987 106106 93.493.4 6.66.6 -- --
Abbot et alAbbot et al 19881988 195195 97.497.4 2.62.6 -- --
FavaFava 19891989 6060 9797 3.03.0 100100 00
TropeTrope 19901990 474474 -- -- 97.497.4 2.62.6
FavaFava 19911991 120120 9595 55 -- --
Walton Walton 19921992 935935 97.497.4 2.62.6 96.396.3 3.33.3
Refrences• Endodontic Therapy-sixth edition --Franklin S.Weine
• Textbook of Endodontics --Nisha Garg
• Endodontics-Fifth edition
• A clinical evaluation of one and two appointment root canal threapy –I.E.J 1994,27,47-51
• Single visit root canal treatment: incidence of postoperative pain using three different instrumentation techniques– I.E.J 1995, 28, 103-107
• Flare-up rate in pulpally necrotic molars in one versus two-visit endodontic treatment—J.O.E 1998, 24, 9
• Endodontic working width: current concepts and techniques– Dent.Clinic N. America 2004 , 323-335
• A clinical radiographic retrospective assessment of the success rate of single visit root canal treatment.– I.E.J 2004, 37, 70-82
