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. 2022 Dec 13;12(12):CD005296.
doi: 10.1002/14651858.CD005296.pub4.

Single versus multiple visits for endodontic treatment of permanent teeth

Giovanni Mergoni  1 , Martina Ganim  1 , Giovanni Lodi  2 , Lara Figini  3 , Massimo Gagliani  4 , Maddalena Manfredi  1
Affiliations

Single versus multiple visits for endodontic treatment of permanent teeth

Giovanni Mergoni et al. Cochrane Database Syst Rev. .

Abstract

Background: Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious processes, coronal crack or fracture, or dental trauma. Successful RoCT is characterised by an absence of symptoms (i.e. pain) and clinical signs (i.e. swelling and sinus tract) in teeth without radiographic evidence of periodontal involvement (i.e. normal periodontal ligament). The success of RoCT depends on a number of variables related to the preoperative condition of the tooth, as well as the endodontic procedures. RoCT can be carried out with a single-visit approach, which involves root canal system obturation (filling and sealing) directly after instrumentation and irrigation, or with a multiple-visits approach, in which the treatment is completed in two or more sessions and obturation is performed in the last session. This review updates the previous versions published in 2007 and 2016.

Objectives: To evaluate the benefits and harms of completion of root canal treatment (RoCT) in a single visit compared to RoCT over two or more visits, with or without medication, in people aged over 10 years.

Search methods: We used standard, extensive Cochrane search methods. The latest search date was 25 April 2022.

Selection criteria: We included randomised controlled trials and quasi-randomised controlled trials in people needing RoCT comparing completion of RoCT in a single visit compared to RoCT over two or more visits. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were 1. tooth extraction and 2. radiological failure after at least one year (i.e. periapical radiolucency). Our secondary outcomes were 3. postoperative and postobturation pain; 4. swelling or flare-up; 5. analgesic use and 6. presence of sinus track or fistula after at least one month. We used GRADE to assess certainty of evidence for each outcome. We excluded five studies that were included in the previous version of the review because they did not meet the current standard of care (i.e. rubber dam isolation and irrigation with sodium hypochlorite).

Main results: We included 47 studies with 5805 participants and 5693 teeth analysed. We judged 10 studies at low risk of bias, 17 at high risk of bias and 20 at unclear risk of bias. Only two studies reported data on tooth extraction. We found no evidence of a difference between treatment in one visit or treatment over multiple visits, but we had very low certainty about the findings (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.09 to 2.50; I2 = 0%; 2 studies, 402 teeth). We found no evidence of a difference between single-visit and multiple-visit treatment in terms of radiological failure (RR 0.93, 95% CI 0.81 to 1.07; I2 = 0%; 13 studies, 1505 teeth; moderate-certainty evidence). We found evidence of a higher proportion of participants reporting pain within one week in single-visit groups compared to multiple visit groups (RR 1.55, 95% CI 1.14 to 2.09; I2 = 18%; 5 studies, 638 teeth; moderate-certainty evidence). We found no evidence of a difference in the proportion of participants reporting pain until 72 hours postobturation (RR 0.97, 95% CI 0.81 to 1.16; I2 = 70%; 12 studies, 1329 teeth; low-certainty evidence), pain intensity until 72 hours postobturation (mean difference (MD) 0.26, 95% CI -4.76 to 5.29; I2 = 98%; 12 studies, 1258 teeth; low-certainty evidence) or pain at one week postobturation (RR 1.05, 95% CI 0.67 to 1.67; I2 = 61%; 9 studies, 1139 teeth; very low-certainty evidence). We found no evidence of a difference in swelling or flare-up incidence (RR 0.56 95% CI 0.16 to 1.92; I2 = 0%; 6 studies; 605 teeth; very low-certainty evidence), analgesic use (RR 1.25 95% CI 0.75 to 2.09; I2 = 36%; 6 studies, 540 teeth; very low-certainty evidence) or sinus tract or fistula presence (RR 1.00, 95% CI 0.24 to 4.28; I2 = 0%; 5 studies, 650 teeth; very low-certainty evidence). Subgroup analysis found no differences between single-visit and multiple-visit RoCT for considered outcomes other than proportion of participants reporting post-treatment pain within one week, which was higher in the single-visit groups for vital teeth (RR 2.16, 95% CI 1.39 to 3.36; I2 = 0%; 2 studies, 316 teeth), and when instrumentation was mechanical (RR 1.80, 95% CI 1.10 to 2.92; I2 = 56%; 2 studies, 278 teeth).

Authors' conclusions: As in the previous two versions of the review, there is currently no evidence to suggest that one treatment regimen (single-visit or multiple-visit RoCT) is more effective than the other. Neither regimen can prevent pain and other complications in the 12-month postoperative period. There was moderate-certainty evidence of higher proportion of participants reporting pain within one week in single-visit groups compared to multiple-visit groups. In contrast to the results of the last version of the review, there was no difference in analgesic use.

PubMed Disclaimer

Conflict of interest statement

GM: none.

MGan: none.

GL: none known. I am an Editor with Cochrane Oral Health but was not involved in the editorial process for this review.

LF: none.

MGag: none.

MM: none.

Figures

1
1
Study flow diagram: review update.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
5
5
Forest plot of comparison: 1 Primary outcomes, outcome: 1.2 Radiological failure.
6
6
Funnel plot of comparison: 2 Signs, outcome: 2.3 Radiological failure.
7
7
Funnel plot  – pain (continuous) in the immediate postobturation period (until 72 hours postobturation).
8
8
Funnel plot – pain (dichotomous) in the immediate postobturation period (until 72 hours postobturation)
1.1
1.1. Analysis
Comparison 1: Single versus multiple visits for endodontic treatment of permanent teeth – primary outcomes, Outcome 1: Extraction due to endodontic problems
1.2
1.2. Analysis
Comparison 1: Single versus multiple visits for endodontic treatment of permanent teeth – primary outcomes, Outcome 2: Radiological failure
2.1
2.1. Analysis
Comparison 2: Single versus multiple visits for endodontic treatment of permanent teeth – secondary outcomes, Outcome 1: Pain (dichotomous)
2.2
2.2. Analysis
Comparison 2: Single versus multiple visits for endodontic treatment of permanent teeth – secondary outcomes, Outcome 2: Pain (continuous)
2.3
2.3. Analysis
Comparison 2: Single versus multiple visits for endodontic treatment of permanent teeth – secondary outcomes, Outcome 3: Swelling or flare‐up
2.4
2.4. Analysis
Comparison 2: Single versus multiple visits for endodontic treatment of permanent teeth – secondary outcomes, Outcome 4: Analgesic use
2.5
2.5. Analysis
Comparison 2: Single versus multiple visits for endodontic treatment of permanent teeth – secondary outcomes, Outcome 5: Presence sinus tract or fistula
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

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Xu 2017 {published data only}
    1. Xu Y. Analysis of the curative effect of multiple root canal treatment and one-time root canal treatment of dental pulp disease [多次法根管治疗与一次性根管治疗牙体牙髓病的 疗效分析]. China and Foreign Medical Treatment 2017;32:53-4, 57.
Xue 2018 {published data only}
    1. Xue X. Clinical analysis of multiple root canal treatment and one-time root canal treatment [多次法根管治疗与一次性根管治疗 牙体牙髓病的临床分析]. General Journal of Stomatology 2018;5(11):21, 24.
Yang 2016 {published data only}
    1. Yang B. The effect of one-time root canal treatment on patients with chronic apical inflammation in old age [老年前牙慢性根尖炎患者一次法根管治疗术的效果]. Medical Equipment 2016;29(18):118.
Yang 2019 {published data only}
    1. Yang W. Analysis of the clinical effect of one-time root filling for acute pulpitis after pulp treatment after permanent tooth trauma [恒牙外伤后的牙髓处理急性牙髓炎 一次性根充治疗的临床效果分析]. Electronic Journal of General Stomatology 2019;6(29):56,60.
Ye 2016 {published data only}
    1. Ye C. The clinical effect of two different root canal treatments on patients with dental pulp disease [两种不同的根管治疗法对牙体牙髓病患者的临床疗效 研究]. Contemporary Medicine 2016;22(17):83-4.
Yi 2016 {published data only}
    1. Yi S. Clinical observation of multiple root canal treatment and one-time root canal treatment of dental pulp disease [多次法根管治疗与一次性根管治疗牙体牙髓病 临床疗效观察]. Frontiers of Medicine 2016;6(15):85-6.
You 2014 {published data only}
    1. You X, Shi L, Huang Y, Hao Y, Dong J. Analysis of the clinical effect of oral root canal treatment for acute pulpitis [急性牙髓炎运用 口腔根管治疗的临床效果分析]. China Journal Modern Drug Application 2014;8(11):73.
Yuan 2019 {published data only}
    1. Yuan Q. The therapeutic effect of multiple root canal therapy and one-time root canal therapy on dental pulp disease [多次法根管治疗与一次性根管治疗牙体牙髓病 的治疗作用探讨]. Dietary Science 2019;18:226.
Yue 2017 {published data only}
    1. Yue L. Observation of the clinical efficacy of immediate root canal treatment for acute pulpitis and periapical periodontitis [急性牙髓炎和 根尖周炎 即刻根管治疗 的临床疗效观察]. Guide of China Medicine 2017;15(22):107-8.
Zhang 2014 {published data only}
    1. Zhang W. Clinical observation of multiple root canal therapy and one-time root canal treatment of dental pulp disease [多次根管疗法与一次性根管治疗牙体牙髓病的临床疗效观察]. Zhilin Medical Science 2014;35(13):2883-4.
Zhang 2016 {published data only}
    1. Zhang Y. Comparison of clinical efficacy of one-time root canal filling and two-time root canal treatment for pulpitis of permanent molars [恒磨牙牙髓炎一次根管充填法与两次根管治疗法临床 疗效对照]. Contemporary Medicine 2016;22(29):68-9.
Zhanghuan 2014 {published data only}
    1. Zhanghuan. Comparison of pain in the near future after secondary and secondary completion of root canal treatment of baby teeth [次性和二次性完成乳牙根管治疗术后 近期内疼痛情况的比较]. Practical Clinical Medicine 2014;15(8):76-7.
Zhen 2018 {published data only}
    1. Zhen Z. Analysis of the clinical effect of one-time root canal treatment on patients with dental pulp disease [次性根管治疗牙体牙髓病患者后的临床效果分析]. General Journal of Stomatology 2018;5(5):16-7.
Zou 2012 {published data only}
    1. Zou H. Clinical observation of apical periodontitis treated with single root canal therapy [次性根管治疗术治疗根尖周 炎 的临床观 察]. Journal of Clinical and Experimental Medicine 2012;11(23):1864-5, 1868.

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