VISITS IN THE MANAGEMENT OF ENDODONTIC DISEASE

Single-Visit versus Multiple-Visits in the Management of Endodontic Disease

Single-Visit versus Multiple-Visits in the Management of Endodontic Disease

Introduction

Single- and multiple-visit root canal treatment has been the subject of long-standing debate in the endodontic community (Bergenholtz & Spångberg 2004). In fact, the attempt to complete root canal treatment in one visit has been documented since before the beginning of the twentieth century (Dodge 1887), yet there has been no definitive conclusion to the debate. Some of the unresolved issues include possible differences in clinical outcomes, microbiological concerns and pain. This controversy can be investigated more systematically with the aid of an evidence-based approach. When clinicians are faced with choices of which treatment regimen should be offered to patients, the central issues that should be considered are not only effectiveness, complications and cost (Sackett 2000) but also patient/operator comfort, preference and satisfaction. In this study comfort is defined as the feeling of content from a physical point of view after the chosen treatment was performed (i.e. less muscular strain). Satisfaction, on the other hand, includes comfort but also encompasses the mental element. It occurs when there is no cognitive dissonance and operator logic in treatment choice can be fulfilled. It has been established that the current best available evidence has failed to demonstrate a difference in therapeutic efficacy (healing rates) between these two treatment regimens (Sathorn et al. 2005, Figini et al. 2007, Ng et al. 2008). Also, compelling evidence is lacking of a significantly different prevalence of postoperative pain/flare-up of either single- or multiple-visit root canal treatment (Figini et al. 2007, Sathorn et al. 2008).

Another important consideration in treatment decision-making is the human factor. Clinicians have a strong influence on treatment decision-making; in many circumstances they are more influential than any other parties in the treatment decision. Anecdotally, endodontists are not likely to offer patients a choice between single- and multiple-visit treatments other than in exceptional circumstances, because of their clinical perceptions including treatment philosophy, rationale and preference for the different treatment options. Furthermore, root canal treatment is a skill-dependent procedure, therefore, operator skill, preference, comfort and convenience could also affect the choice of treatment.

Endodontic therapy

Endodontic therapy is a sequence of treatment for the pulp of a tooth whose end result is the elimination of infection and protection of the decontaminated tooth from future microbial invasion. Although this set of procedures is commonly referred to as a root canal, this term is imprecise; root canals and their associated pulp chamber are the anatomical hollows within a tooth which are naturally inhabited by nerve tissue, blood vessels and a number of other cellular entities, whereas endodontic therapy includes the complete removal of these structures, the subsequent cleaning, shaping and decontamination of these hollows with the use of tiny files and irrigating solutions and the obturation, or filling, of the decontaminated root canals with an inert filling, such as gutta percha and a usually eugenol-based cement. After the surgery the tooth will be "dead", and if the infection ...