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: 2.27). 07/2005; 38(6):347-55. DOI: 10.1111/j.1365-2591.2005.00955.x
Source: PubMed

ABSTRACT 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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    • "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; DOI:10.1111/iej.12122 · 2.27 Impact Factor
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    • "Root canal treatment might compromise the biomechanical properties of teeth (Trope et al. 1986, Cobankara et al. 2008). Root filled teeth are more susceptible to fracture as a result of increased brittleness (Sathorn et al. 2005) and are often weakened as a result of coronal destruction from dental caries (Hü rmü zlü et al. 2003), access cavity preparation, instrumentation of the root canal, loss of moisture in dentine and previous restorations or endodontic therapy (Tang et al. 2010). "
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    ABSTRACT: To investigate ex vivo the influence of gamma irradiation therapy and restorative material on fracture resistance, fracture mode and strain of root filled human premolars. Sixty extracted human maxillary premolar teeth were randomly divided into six groups (n = 10) determined by two study factors: (i) restorative materials: sound teeth, root filled teeth restored with composite resin, root filled teeth restored with amalgam; (ii) gamma irradiation: irradiated (subjected to 60 Gy of gamma irradiation in daily increments of 2 Gy) and nonirradiated. For the strain gauge test, two strain gauges per sample were attached on the buccal and palatal cusp surfaces (n = 5). Strain values were recorded during loading of 0-150 N. Fracture resistance (N) was assessed in a mechanical testing machine (n = 10). Strain gauge for each cusp and fracture resistance data were analysed by two-way anova (3 × 2) followed by the Tukey's honestly significant difference test (α = 0.05). The failure mode was evaluated using an optical stereomicroscope and classified according to the location of the failure. Gamma radiation therapy significantly reduced the fracture resistance of intact teeth. The strain was higher for teeth restored with amalgam than for those restored with composite resin. The teeth restored with composite resin had similar strain values to sound teeth. Nonirradiated teeth had more restorable failures than irradiated teeth. Gamma irradiation significantly reduced fracture resistance and increased cusp strain. The use of composite resin resulted in better biomechanical behaviour than amalgam for restoring root filled teeth whether or not they were submitted to radiotherapy.
    International Endodontic Journal 07/2011; 44(11):1047-54. DOI:10.1111/j.1365-2591.2011.01920.x · 2.27 Impact Factor
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    • "In a randomized controlled clinical trial, Penesis et al. (2008) compared radiographic periapical healing after root canal treatment completed in one visit or two visits with an interim calcium hydroxide/ CHX paste dressing and concluded that both treatment options exhibited equally favourable periapical healing at 12 months, with no statistically significant difference . In a systematic review, Sathorn et al. (2005) compared the healing rate (as measured by clinical and radiographic parameters) of single-visit root canal treatment without calcium hydroxide dressing to multiple-visit treatment with calcium hydroxide dressing for 1 week. Single-visit root canal treatments were marginally more effective than multiple visits, i.e. 6.3% higher healing rate. "
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    ABSTRACT: Calcium hydroxide has been included within several materials and antimicrobial formulations that are used in a number of treatment modalities in endodontics. These include, inter-appointment intracanal medicaments, pulp-capping agents and root canal sealers. Calcium hydroxide formulations are also used during treatment of root perforations, root fractures and root resorption and have a role in dental traumatology, for example, following tooth avulsion and luxation injuries. The purpose of this paper is to review the properties and clinical applications of calcium hydroxide in endodontics and dental traumatology including its antibacterial activity, antifungal activity, effect on bacterial biofilms, the synergism between calcium hydroxide and other agents, its effects on the properties of dentine, the diffusion of hydroxyl ions through dentine and its toxicity. Pure calcium hydroxide paste has a high pH (approximately 12.5-12.8) and is classified chemically as a strong base. Its main actions are achieved through the ionic dissociation of Ca(2+) and OH(-) ions and their effect on vital tissues, the induction of hard-tissue deposition and the antibacterial properties. The lethal effects of calcium hydroxide on bacterial cells are probably due to protein denaturation and damage to DNA and cytoplasmic membranes. It has a wide range of antimicrobial activity against common endodontic pathogens but is less effective against Enterococcus faecalis and Candida albicans. Calcium hydroxide is also an effective anti-endotoxin agent. However, its effect on microbial biofilms is controversial.
    International Endodontic Journal 05/2011; 44(8):697-730. DOI:10.1111/j.1365-2591.2011.01886.x · 2.27 Impact Factor
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