Single or multiple visit root canal therapy?

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Root canal treatment (RoCT) is a commonly performed dental procedure usually undertaken following the death and necrosis of the dental pulp to relieve symptoms and avoid extraction of the tooth. RoCT has been undertaken using single and multiple visit approaches with similar outcomes being reported with single visit treatment offering potential cost benefits.

The aim of this Cochrane review update was to assess 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 patients aged over 10 years.

Methods

Searches were conducted in the Cochrane Oral Health’s Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, ClinicalTrials.gov and the World Health Organisation International Clinical Trials Registry Platform databases without restriction on language or publication date. Randomised controlled trials (RCTs) and quasi-RCTs of people needing RoCT were considered. The primary outcomes were extraction due to endodontic problems and radiological failure after at least one year. Secondary outcomes included postoperative pain, swelling, painkiller use, Sinus track or fistula formation etc. Standard Cochrane data collection and analytic approaches were followed.

Results

  • 47 studies involving 5805 patients (5693 teeth) were included.
  • 10 studies were considered to be at low risk of bias, 17 at high risk and 20 at unclear risk
  • With the exception of patients reporting pain within one week in in single-visit groups compared to multiple visit group no differences between single and multiple visit treatments were seen (see table below)
Outcome No. of studies (teeth) Risk ratio (95%CI) Quality of evidence
Tooth extraction 2 (402) 0.46 (0.09 to 2.50) Very low
Radiological failure 13 (1505) 0.93 (0.81 to 1.07) Moderate
Pain within one week 5 (638) 1.55 (1.14 to 2.09)* Moderate
Pain until 72 hours post obturation 12 (1329) 0.97 (0.81 to 1.16) Low
Pain at one-week post obturation 9 (1139) 1.05 (0.67 to 1.67) Very low
Swelling or flare-up incidence 6 (605) 0.56 (0.16 to 1.92) Very low
Analgesic use 6 (540) 1.25 (0.75 to 2.09) Very low
Sinus tract or fistula presence 5 (650) 1.00 (0.24 to 4.28) Very low

Conclusions

The authors concluded: –

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.

Comments

This Cochrane review updated the 2016 version and included 27 new studies. However as 5 studies included in the previous version were excluded as they did not use rubber dam isolation or use sodium hypochlorite irrigation this version includes 22 additional studies. As noted by the authors only 10 of the 4 studies had an overall low risk of bias although encouragingly a majority of these were newly added in this version.  As with the previous version of this review the evidence suggests no difference in outcomes between single and multiple visits RoCT with the exception of an increase in pain reporting at one week. The previous version of this review also suggested an increased use of pain killers in single-visit groups however no difference in use was seen in this version.

Links

Primary Paper

Mergoni G, Ganim M, Lodi G, Figini L, Gagliani M, Manfredi M. Single versus multiple visits for endodontic treatment of permanent teeth. Cochrane Database Syst Rev. 2022 Dec 13;12(12):CD005296. doi: 10.1002/14651858.CD005296.pub4. PMID: 36512807; PMCID: PMC9747194.

Other references

Dental Elf – 5th Dec 2016

Root canal treatment: single or multiple visits?

Dental Elf  – Endodontic Blogs

 

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. He is a former editor of the Evidence-Based Dentistry Journal, the chief blogger for the Dental Elf website and a past president of the British Association for the Study of Community Dentistry. He has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Retired from the NHS he is currently a part-time senior lecturer at Dundee Dental School.

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