Root canal treatment (RoCT) is a commonly performed dental procedure. It is carried out following the death and necrosis of the dental pulp to relieve symptoms and avoid extraction of the tooth.  Treatment involving either a single visit or multiple visit approaches have been recommended and a single visit was as safe and effective as  a multiple visit technique it would reduce costs.

The aim of this Cochrane review update was to determine whether completion of root canal treatment (RoCT) in a single visit or over two or more visits, with or without medication, makes any difference in term of effectiveness or complications.

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 Organization 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 analytic approaches were followed.

Results

• 25 RCTs  involving 3780 patients were included.
• 14 studies were considered to be at high risk of bias, 8 at unclear risk and 3 at low risk.
• No differences were seen between single and multiple visits for a range of outcomes ( see table).

Outcome	No. of studies (patients)	Odds ratio (OR) or Risk Ratio(RR)	95% Confidence interval	Quality of evidence
tooth extraction	1 (220)	OR = 0.44	0.04- 4.78	very low
radiological failure	11 (1493)	RR = 0.91	0.68 – 1.21	low
immediate postoperative pain	9 (1560)	RR= 0.99	0.84 – 1.17	moderate
swelling or flare-up incidence	4 (281)	RR=1.36	0.66 – 2.81	low
sinus tract or fistula formation	2 (345)	RR= 0.98	0.15 – 6.48	low
complications	10 (1686)	RR= 0.92	0.77 – 1.11	moderate

 

• 8 studies ( 1383 patients) providing low quality evidence suggest that people undergoing RoCT in a single visit may be more likely to experience pain in the first week than those whose RoCT was over multiple visits;  RR=1.50 (95% CI; 0.99 – 2.28).
• Moderate quality evidence (4 studies, 648 patients) showed people undergoing RoCT in a single visit were more likely to use painkillers than those receiving treatment over multiple visits; RR= 2.35 (95%CI; 1.60 – 3.45) .

Conclusions

The authors concluded

There is no evidence to suggest that one treatment regimen (single-visit or multiple-visit root canal treatment) is better than the other. Neither can prevent all short- and long-term complications. On the basis of the available evidence, it seems likely that the benefit of a single-visit treatment, in terms of time and convenience, for both patient and dentist, has the cost of a higher frequency of late postoperative pain (and as a consequence, painkiller use).

Comments

 This Cochrane review updates the earlier 2007 version adding a number of new studies two of these we have covered in previous blogs review (Dental Elf –  5^th Feb 2016 & 27^th Aug 2012). This well conducted review provides no evidence to suggest that one approach, single- visit or multiple-visit root canal treatment is better than another, based on moderate evidence.  However while  the single visit approach is more convenient and less time consuming it may results in more post-operative pain and increased use of pain killers.

Links

Primary paper

Manfredi, M, Figini L, Gagliani, M, Lodi, G. Single versus multiple visits for endodontic treatment of permanent teeth. Cochrane Database of Systematic Reviews 2016, Issue 12. Art. No.: CD005296. DOI: 10.1002/14651858.CD005296.pub3.

Other references

Cochrane Oral Health Group Blog -Should root canal treatment be performed in one dental visit or over several visits?

 

Dental Elf –  5^th Feb 2016

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

Dental Elf –  27^th Aug 2012

One or two visit root canal treatment –new study finds little difference