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Authors: Dr. Annil Dhingra

INTRODUCTION

Today the face of endodontics has totally changed with the evolution of newer techniques, instruments, materials and better understanding of canal anatomy. In addition to this single visit root canal therapy has emerged as the latest concept.1 Traditionally, root canal treatment was performed in multiple visits, with medication between root canal preparation and obturation, so as to reduce or eliminate microorganisms and their by-products from the root canal system before obturation which is well-accepted as a safe and one of the common therapy. However, with the recent invention of rotary nickel-titanium systems, irrigation systems and delivery systems have not only facilitated the mechanical instrumentation and disinfection of the root canal, has made the single-sitting root canal treatment more convenient than before. In Addition to this it is timesaving, cost effectiveness,has better patient acceptance, and reduction of the inter-appointment infection risks, making single-visit root canal treatment more acceptable treatment regimen.2

DEFINITION

Ashkenaz PJ (1984) defined as the conservative, non surgical treatment of an endodontically involved tooth consisting of complete biomechanical preparation and obturation of the root canal system in one visit.3

INDICATIONS
  1. Uncomplicated vital or non vital teeth preferably.
  2. Fractured anterior or bicuspid teeth where esthetics is a concern and temporary post and crown are required.
  3. Teeth requiring endodontics for restorative reasons and not because of pulp exposures or removal of pathologic pulp tissue.
  4. Patients who are physically unable to return for the completion.
  5. Patients with heart valve damage or prosthetic implants who require repeated regimens of prophylactic antibiotics.
  6. Necrotic, uncomplicated teeth with draining sinus tracts.
  7. Patients who require sedation or operating room treatment.4
CONTRAINDICATIONS
  1. Cellulitis
  2. Acute apical abscess requiring incision and drainage
  3. Severe pain when the tooth is lightly touched
  4. A weeping canal that cannot be dried
  5. Difficult cases that extend beyond our allotted time and the patient’s tolerance
  6. Patients with acute apical periodontitis
  7. Molars with necrotic pulps and periradicular radiolucencies
  8. Symptomatic Root canal re treatment
  9. Patients with TMJ disorders and inability to open the mouth (5).
ADVANTAGES
  1. Patient comfort: The major reason for the increased patient acceptance is the reduced number of visits to the dental clinic.
  2. No inter appointment pain: In a study done by Torabinejad, 50% of patients undergoing multiple visit Endodontics required an inter appointment visit because of pain or swelling.
  3. Saves time
  4. Minimizes fear and anxiety
  5. Familiarity of the canal anatomy: Multiple visits would require re-familiarization leading to loss of time and frustration.
  6. Constant working length: When doing multiple visit Endodontics, most clinicians note down the working length but make no note of what the reference point was. The reference point could be a thin cusp tip which could chip off between appointments. Failure to note down stable reference points could lead to incorrect working length determination and related flare-ups. These mishaps are avoided with single visit Endodontics.
  7. Esthetics: For patients who report to the clinic with fractured anteriors, an esthetic restoration can be placed immediately after single visit Endodontics.
DISADVANTAGES

A Dentist who is used to single visit Endodontics would see no disadvantages in single visit Endodontics. However, from an impartial view the following could be classified as disadvantages:

  1. Tiring for the patient: The longer single appointment could be tiring for some patients.
  2. Inexperienced clinician: As discussed earlier, an inexperienced clinician may lack the skill to complete the Endodontic therapy in one visit.
  3. Flare-ups: If a flare-up occurs, it is easier to establish drainage in a tooth which is not obturated.
  4. Not possible in all cases: Difficult cases like calcified canals, severe curvatures, weeping canal, etc... may require more time and subsequent visits.6
DISCUSSION

The basic biologic rationale for achieving ultimate success with root canal treatment consists of eliminating micro-organisms from the entire root canal system and creating an environment that is most favorable for healing.7

From the past decade, invention of new instruments in the field of dentistry have helped practitioners perform endodontic procedures more effectively and efficiently than ever before. This also resulted in the increase incidence of single-visit Endodontics in the dental clinics and the rational for this treatment regime are less stressful and only one anesthesia is needed, which makes it very well accepted by the patient, less time‑consuming,reduces the risk of inter‑appointment contaminations, less expensive and more productive for the clinician.8

It is suggested that decisions on the use of single or multiple-visit treatment should be based solely on the diagnosis and not the time available for treatment. Studies have found no difference in the incidence of postoperative pain between one and multiple visit endodontics9 whereas fewer failures were noted in the two visit treatment group than in the one visit treatment group.10 In ability to dry canals completely, insufficient time for the procedure, long appointment induced stress on patient,the operator skill, root canal anatomy and instrument availability should also be considered while deciding upon single visit treatment. In a vital pulp, the infection is superficial therefore pulp extirpation and the root filling are best completed in a single visit treatment. Flare up induced by the leakage of the temporary seal is reduced and the teeth are ready sooner for final restoration diminishing a risk of a fracture. Completing root canal treatment in one appointment is an effective and time saving procedure in selected cases.

BIBLIOGRAPHY
  1. Walton R, Fouad A. Endodontic interappointmentflareups: a prospective study of incidence and related factors. J Endod 1992; 18(4):172-177.
  2. Sathorn C, Parashos P, Messer H. Australian endodontists’ perceptions of single and multiple visit root canal treatment. IntEndod J 2009;42: 811–8.
  3. Ashkenaz PJ One-visit endodontics. Dent Clin North Am1984 Oct;28(4):853-63.
  4. Mohammadi Z, Farhad A, M Tabrizizadeh. One visit versus multiple visit endodontic therapy – A Review, Int Dent J 2006;56:289-93.
  5. Figini L, Lodi G, Gorni F, Gagliani M. Single versus multiple visits for endodontic treatment of permanent teeth: A Cochrane review. J Endod 2008;34(9):1041-47.
  6. Siju Jacob. Single Visit Endodontics. Famdent Practical Dentistry Handbook 2006;6(4):1-6.
  7. Mohammad Asnaashari, ShadiMohebi ,PayamPaymanpour. Pain reduction using low level laser irradiation in single visit endodontic treatment; J Lasers Med Sci. 2011; 2(4):139-43.
  8. Al‑Rahabi and Abdulkhayum. Single visit root canal treatment. Saudi Endodontic Journal.May-Aug 2012; 2(2):80-84.
  9. Trope M. Flare up rate of single visit endodontics. IntEndod J. 1991; 24:24-7.
  10. Pekruhn RB. The incidence of failure following single visitendodontic therapy. J Endod 1986; 12:68-72.

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