Dental Practice - February 2017 | Page 35

SINGLE VERSUS MULTIPLE VISIT ENDODONTIC TREATMENT A BRIEF REVIEW

BY TIM SUNNUCKS BDS MSC DRDP
Tim Sunnucks is a registered specialist in Endodontics based in Central London ( mainly at the Thayer Street Practice ). Tim lectures and runs hands on courses on both Restorative Dentistry and Endodontics . His MSc thesis was on Single versus Multiple Visit Endodontics .

T he issue of whether endodontics can and should be carried out over a single or multiple visits is a point of heated debate in the endodontic world and has significant implications for both clinicians and patients . The debate is not a new one and attempts to carry out endodontic treatment in a single visit is documented as far back as 1887 ( Dodge 1887 )!

The reasons for the choice of approach are not always clear cut , even amongst endodontic specialists , and there are a huge number of factors that may influence whether a clinician decides to carry out treatment over single or multiple visits . This decision-making process really opens up questions about how we carry out all aspects of our endodontic treatment from diagnosis , to techniques for canal preparation , irrigation regimes , allocation of time and even coronal restoration .
It is obviously a considerable advantage to both patient and clinician if we could predictably carry out endodontic treatment in a single visit . It is less traumatic physically and psychologically for the patient as well as preferable time wise and logistically . It speeds up the restoration of the tooth , which has advantages from the point of view of sealing the tooth as well as preventing fracture and there are obvious efficiency and cost benefits , all of which are obviously also advantageous for the clinician .
While many studies have looked at after-pain and success rates in single vs . multiple visit endodontics , few have looked at the reasoning behind the decision-making process . In terms of success rates , there is little evidence in the literature that root canal treatment is more successful when carried out over multiple visits ( e . g . Sathorn et al . 2005 , Ng et al . 2008 ) and little evidence that there is an increase in after pain ( e . g . Figini et al . 2007 , Sathorn et al . 2008 ).
PREVENTING RE-INFECTION – THE AIM
The main objective of endodontic treatment is to remove as many bacteria as possible from the canal system and seal the canal system as thoroughly as possible to prevent reinfection . In practice this is of course somewhat difficult and the best we can achieve is probably reducing the bacteria below a ‘ critical mass ’ at the end of our disinfection stage and entombing any bacteria that remain to prevent further activity ( Happasalo ).
The elimination of bacteria is therefore the key to successful endodontics and whether we carry this out in 1 or more visits is less relevant than the fact that we actually achieve this aim .
Any techniques affecting the efficacy of cleaning will therefore impact heavily on whether we should be trying to carry out endodontics in single or multiple visits . Many endodontists are increasingly happy to carry out single visit treatment in many situations , but this is probably only because they are going to such great lengths of try to achieve the most thorough disinfection possible . It is important then not to just hear the ‘ single visit treatment works ’ message without knowing what needs to be done to make it successful and it has been noted in several studies that success rates of single visit endodontics are very operator ( and therefore presumably technique ) dependent .
PREVENTING RE-INFECTION – THE TECHNIQUES Meticulous technique is crucial to success and limiting after-pain and we will look at some of the techniques and the influence they have .
As always , accurate diagnosis is crucial . Apart from the basic , but not always straightforward , issues of what tooth is involved , if a pulpitis is reversible or irreversible , whether the tooth is restorable and whether there is a fracture present , it is also important to consider in cases of failed u
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