Initiating and completing an endodontic treatment in one appointment has always been surrounded by controversy. In 1982 a survey revealed that 87% of endodontists did not believe that most necrotic teeth could be treated successfully in one visit. In addition, the majority of endodontists thought that performing treatment in this fashion would cause more post-operative pain than if performed in multiple appointments. However, a growing number dentists are practicing more and more single-visit endodontics.There are numerous advantages to completing root canal therapy in one appointment:
- The clinician has the 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
- No risk of flare-up induced by leakage of the temporary seal (because obturation is completed).
- Teeth are ready sooner for final restoration, diminishing the risk of a fracture necessitating extraction
- Patients' pre-appointment anxiety and post-operative discomfort are limited to one episode
- Time is saved for the patient and for the practitioner since the treatment is completed in one visit.
Three contradictions exist in completing a root canal treatment in one appointment:
Inability to dry the canals completely, insufficient time to complete the procedure, and possible increased stress on temporomandibular joint musculature, or increased psychological stress on patients or clinicians because of longer appointment time, or both.
With so many advantages and so few disadvantages why don't more clinicians practice single appointment endodontics? It is generally believed that post-operative pain is greater when endodontic treatment is completed in a single-visit. An overwhelming number of studies show that post-operative pain resulting from treatment of nonvital teeth does not differ among patients treated in a single-visit or in multiple-visits. Furthermore, Walton and Fouad found no significant difference in flare-ups between single and multiple-visit endodontics.
Is the prognosis of the treatment compromised by performing root canal therapy in one appointment? In humans, overwhelming evidence shows that healing is the same for single and multiple-visits regardless of pulp vitality.
Aside from cost, there are two major barriers to patients visiting the dentist:
Fear of pain and time required. Completing root canal therapy in one appointment limits fear of pain to one incident and decreases the total time required to complete the treatment.
In conclusion, single-visit endodontics has been shown to be an effective treatment modality, which compared to multiple-visit therapy, is more beneficial to patients and dentists in many ways.
Successful One visit Endodontic Treatment
The following images show a successful one visit endodontic treatment done by Dr. Y. Nahmias. In the six month follow up radiograph, you can see the infection has successfully healed.
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Figure 1 -
Pre-Op XRay |
Figure 2 -
Post Op XRay |
Figure 3 -
6 Month RC |
Note from the Editor
In our practice, we have been performing very successful single visit endodontics for over 10 years. Our experience is that treatment can be done more efficiently, and with less post-operative discomfort by completing the cases in one shot.
Since the time we started doing our treatments in one appointment, we have noticed a significant decrease in the number of after hour calls from patients experiencing pain. We believe that this due to the fact that no interappointment flare-ups occur since treatment is completed in one appointment. Furthermore, patient acceptance to treatment has increased. Let's face it, no one wants to see the endodontist for more than one appointment if it is not needed. |
