Root canal treatment – no differences between single or multiple visit approaches


Root canal treatment (RoCT) is a commonly performed dental treatment that can be followed by a number of short and long term complications. Treatments using either single or multiple visits have been recommended and there is evidence both from systematic reviews that there is little difference between the two approaches.

The main aim of this study was to evaluate the treatment outcomes of non-surgical primary endodontic treatment root canal therapy using either single-visit or multiple-visit endodontic treatment performed by general dentists


Patients with periodontally health permanent teeth that required RoCT with at half of the coronal structure remaining and no history of acute pulpitis with facial swelling or systemic infection, severe systemic disease, increased stress on the temporomandibular joint musculature or increased psychological stress were considered.

Treatments were performed by standardised and calibrated dentists. RoCT was performed under local anaesthetic and rubber dam with canals being cleaned and shaped using Ni-Ti rotary files and canals obturated using a core-carrier technique. Teeth randomised to multiple visit treatment were dressed with 5% non-setting calcium hydroxide and temporarily restored with resin-modified zinc oxide and eugenol cement. Final restorations were of amalgam or composite.   Patients were advised to take 500-1000 mg paracetamol 4-6 hrs if needed.

Patients were reviewed clinically and radiographically 1 week after obturation and then 6 monthly. Pain was assessed on 10 point Likert scale. Success was graded when there were no clinical signs/symptoms and no radiographic radiolucency found in the periapical radiographs.


  • 228 patients with 256 teeth were recruited (115 patients 128 teeth-single visit; 113 patients 128 teeth multiple visit).
  • Dropout rate was 14.1 %. (10 patients 11 teeth-single visit; 24 patients, 25 teeth- multiple visit).
  • The overall success rate of endodontic treatment was 88.2 % (88.9% for single visit; 87.4% for multiple)
  • There was no significant different in prevalence of postoperative pain at 1 week or at least 18 months between single-visit and multiple-visit treatment.
  • Prevalence of postoperative pain after 1 week of the single-visit and multiple-visit were 21 and 12 % and 0.9 and 1.0 %, respectively after18 months.
  • Mean chairside time was 62.0 ± 23.5 min for single visit and 92.9 ± 37.8 min for multiple visits.


The authors concluded:

The success rate and prevalence of postoperative pain of single-visit or multiple-visit treatment had no significant difference. The chairside time for single-visit treatment was shorter than multiple-visit treatment.


This trial found no difference in outcomes between single and multiple visits root canal therapy. This supports the findings of a similar sized 2012 study by Paredes-Vieyra and Enriquez (Dental Elf 27th Aug 2012) and earlier systematic reviews. One of these reviews was a Cochrane review by Figini et al which concluded:-

 No difference exists in the effectiveness of RoCT, in terms of radiological success, between single- and multiple-visit RoCT. Most short- and long-term complications are also similar in terms of frequency, although patients undergoing a single visit may experience a slightly higher frequency of swelling and are significantly more likely to take painkillers.


Primary paper

Wong AW, Tsang CS, Zhang S, Li KY, Zhang C, Chu CH. Treatment outcomes of single-visit versus multiple-visit non-surgical endodontic therapy: a randomised clinical trial. BMC Oral Health. 2015 Dec 19;15(1):162. doi: 10.1186/s12903-015-0148-x. PubMed PMID: 26687126; PubMed Central PMCID: PMC4684923.

Other references

Original Trial Registration

Dental Elf – 27thAug 2012- One or two visit root canal treatment –new study finds little difference

Figini L, Lodi G, Gorni F, Gagliani M. Single versus multiple visits for endodontic treatment of permanent teeth. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005296. DOI: 10.1002/14651858.CD005296.pub2

Wong AW, Zhang C, Chu CH. A systematic review of nonsurgical single-visit versus multiple-visit endodontic treatment. Clin Cosmet Investig Dent. 2014 May 8;6:45-56. doi: 10.2147/CCIDE.S61487. eCollection 2014. Review. PubMed PMID: 24855389; PubMed Central PMCID: PMC4020891.


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