Effectiveness of single-versus multiple-visit endodontic treatment of teeth with apical periodontitis: A systematic review and meta-analysis

Department of Restorative Dentistry, School of Dental Science, The University of Melbourne, Melbourne, Vic., Australia.
International Endodontic Journal (Impact Factor: 2.97). 07/2005; 38(6):347-55. DOI: 10.1111/j.1365-2591.2005.00955.x
Source: PubMed


The clinical question this review aimed to answer is: does single-visit root canal treatment without calcium hydroxide dressing, compared to multiple-visit treatment with calcium hydroxide dressing for 1 week or more, result in a lower healing (success) rate (as measured by clinical and radiographic interpretation)?
CENTRAL, MEDLINE, EMBASE and HEALTH STAR databases were used. Reference lists from identified articles were scanned. A forward search was undertaken on the authors of the identified articles. Papers that had cited these articles were also identified through Science Citation Index to identify potentially relevant subsequent primary research.
The included studies were randomized controlled clinical trials (RCTs) comparing healing rate of single- and multiple-visit root canal treatment in humans. The outcome measured was healing of radiographically detectable lesions. Data in those studies were independently extracted.
Only three RCTs were identified and included in the review, covering 146 cases. Sample size of all three studies was small; none demonstrated a statistically significant difference in healing rates. Risk differences of included studies were combined using the inverse variance-weighted method (RD(Pooled) = -6.3%; 95% CI: -20.3-7.8).
Based on the current best available evidence, single-visit root canal treatment appeared to be slightly more effective than multiple visit, i.e. 6.3% higher healing rate. However, the difference in healing rate between these two treatment regimens was not statistically significant (P = 0.3809).

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    • "Probably elimination of bacteria is not strictly necessary and maximum reduction of bacteria and effective canal filling may be sufficient in terms of healing, rather than complete eradication. The advantages of single visit endodontic include reduction in time and cost of treatment and prevention of inter-appointment flare ups and as well as low incidence of postoperative pain when compared to multiple visit treatment.[1516] "
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    ABSTRACT: Aims: The aim of this study was to assess the outcome of single sitting root canal treatment (RCT) of asymptomatic teeth with periapical cysts. Materials and Methods: Ten maxillary anterior teeth showing periapical lesion on the radiograph was further screened by ultrasound with color power Doppler (CPD) for confirmation of a cyst. The average dimension of the lesions ranged from 1.3 to 1.9 cm. Single sitting RCT was performed on all the selected teeth. Postoperative healing was monitored at regular interval of 3 months, 6 months, and 1 year by using subjective feedback, radiograph, and ultrasound with CPD study. Results: Eight among the ten cases showed either signs of complete healing or healing in progress by the end of 6-12 months. Conclusions: It was observed that single sitting nonsurgical endodontic management of asymptomatic teeth with periapical cyst confirmed by ultrasound was successful in selected cases.
    04/2014; 5(2):195-202. DOI:10.4103/0976-237X.132321
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    • "Based on the currently available evidence, single-visit root canal treatment appeared to be slightly more effective than multiple visits, i.e. a 6.3% higher healing rate. However, the difference in healing rate between these two treatment regimens is not statistically significant.[192428] Our results showed that each group of intra-canal dressing [Ca(OH)2 + 2% CHX gel, Ca(OH)2 + 0.9% NaCl, and 2% CHX gel] did not significantly improve the disinfection, which is in agreement with Manzur et al.,[29] who had already observed that in cases with necrotic pulp. "
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    ABSTRACT: Objective: The aim of this study was to investigate in vivo microorganisms detected in root-filled teeth with post-treatment apical periodontitis and quantify colony-forming units (CFU) during endodontic retreatment. Materials and Methods: Fifteen root-filled teeth had their previous gutta-percha removed and were randomly instrumented before being divided into three groups and medicated with either [Ca(OH)2 + 2% CHX gel], [Ca(OH)2 + 0.9% NaCl] or 2% CHX gel. Samples were taken after removal of gutta-percha (S1), after chemomechanical preparation using 2% CHX gel (S2), and after inter-appointment dressing (S3) for 7 or 14 days later. Cultivable bacteria recovered from infected root canals at the three stages were counted and identified by means of culture and PCR assay (16S rDNA). Quantitative data were statistically analyzed by using Mann-Whitney test in which pairs of groups were compared (P < 0.05). Results: CFU counts decreased significantly from S1 to S2 (P < 0.05). No significant difference was found between S2 and S3 (P = 0.3093) for all three experimental groups. Chemomechanical preparation and intra-canal dressing promoted significant median reductions of 99.61% and 99.57%, respectively, in the number of bacteria compared to S1 samples. A total of 110 cultivable isolates were recovered by culture technique from 32 different species and 7 different genera. Out of the 13 target species-specific primer of bacteria analyzed, 11 were detected during endodontic retreatment. Conclusion: The great majority of taxa found in post-treatment samples were Gram-positive bacteria, although Gram-negative bacteria were found by molecular methods. Moreover, our results showed that gutta-percha removal and chemomechanical preparation are effective for root canal disinfection, whereas additional intra-canal dressing did not improve disinfection.
    European journal of dentistry 07/2013; 7(3):302-9. DOI:10.4103/1305-7456.115414
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    • "It has also been reported that it is possible that Ca(OH) 2 diminishes TNF-a local concentrations , because it has been shown to denature proteins (Khan et al. 2008). Despite all these advantages, Ca(OH) 2 has limitations (Trope et al. 1999, Shuping et al. 2000, Peters & Wesselink 2002, Sathorn et al. 2005, Waltimo et al. 2005, Figini et al. 2007) and, as an alternative, 2% chlorhexidine digluconate gel (CHX) has emerged (Barbosa et al. 1997, Manzur et al. 2007, Paquette et al. 2007, Wang et al. 2007), but is by far much less well studied. Anaerobic bacteria, either strict or facultative, have been shown to be the most prevalent in primary root canal infections on several epidemiological studies (Baumgartner & Falkler 1991, Fouad et al. 2002, Munson et al. 2002, Abdullah et al. 2005, Ferrari et al. 2005, Blome et al. 2008, € Ozok et al. 2012). "
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    ABSTRACT: Aim: To quantify bacterial equivalents before and after chemomechanical preparation using 3% sodium hypochlorite (NaOCl) and intracanal dressing with calcium hydroxide paste (Ca(OH)2 ) or 2% Chlorhexidine digluconate gel (CHX) in necrotic pulps associated or not with apical periodontitis and to further compare this quantification with counts of anaerobic microorganisms. Methodology: Prospective clinical trial in 69 single-rooted adult teeth (strict inclusion criteria); CHX group: 34; Ca(OH)2 group: 35. Bacteria samples were taken at baseline (S1), after chemomechanical preparation (S2) and after 14 days of intracanal dressing (S3). Bacterial equivalents were assessed by broad-range real-time polymerase chain reaction (qPCR), and live viable bacteria measured with conventional anaerobic culture (CFU/mL). Descriptive/inferential analysis was performed with spss vs. 20.0 (α = 0.05) using the Kruskal-Wallis, Mann-Whitney and chi-squared tests and Spearman's correlation coefficients. Results: Both groups showed a significant decrease between S1 and S2 (Mann-Whitney U-test; P < 0.001) both in qPCR and in culture. In the Ca(OH)2 -group, no variation was observed between S2 and S3 by qPCR and culture. In contrast, the CHX group showed a significant increase from S2 to S3 by both techniques. The two groups were only significantly different in S3 (Mann-Whitney U-test; P ≤ 0.001), with a worse performance in the CHX group. Again, these results were congruent by both approaches. Data from both approaches correlate reasonably (rS < 0.5). Conclusions: Infected root canals contained a high bacterial load, and the chemomechanical root canal preparation reduced bacterial equivalents by 99.1% and anaerobic counts by 98.5%. Intracanal dressings were not efficient at reducing bacterial load, but the 14-day intracanal dressing with Ca(OH)2 performed significantly better than CHX, particularly in cases with apical periodontitis.
    International Endodontic Journal 04/2013; 47(1). DOI:10.1111/iej.12122 · 2.97 Impact Factor
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