Single Visit Endodontics.pptx root canal treatment in one visit

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ENDODONTICS
CONCEPTS &
CONTROVERSIES
DEPARTMENT OF CONSERVATIVE DENTISTRY AND
ENDODONTICS
PRESENTED BY- MALTI VERMA
MDS II YEAR
GUIDED BY: DR. SURUCHI SISODIA (HOD)
DR. MAYUR M. KAHATE (PROFESSOR)

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Contents
 Introduction
 Definition
 Evolution of Single Visit Endodontics
 Selection criteria for single visit endodontics
 Factors to consider before deciding on single or multi-visit treatment
 Indications
 Contraindications
 Advantages
 Disadvantages

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 Patient advantages
 Myths
 Adjuncts to Render Efficient and Faster Treatment in
Single Visit Endodontics
 Single visit endodontics vs multiple visit endodontics
 Conclusion
 References

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The main objective of performing root
canal therapy is to eliminate bacteria
from the infected root canal system or
remove inflamed pulp tissue and close it
with a biologically acceptable filling
material.
Mothanna Al-Rahab ,Single visit root
canal treatment: Review. Saudi
Endodontic Journal • May-Aug 2012 •
Vol 2 •
Introduction

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Traditionally, root canal treatment was
performed in multiple visits, with the use of
extra disinfecting agents (intracanal dressing)
besides the irrigants that is used during the
cleaning and shaping procedure which mainly
aims to reduce or eliminate microorganisms
and their by products from the root canal
‑
system before obturation.
The most intracanal dressing researched and
widely used is the calcium hydroxide
(Ca(OH)2) paste.

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Single-visit endodontics is defined as “the
conservative non-surgical treatment of an
endodontically involved tooth consisting
of complete biomechanical cleansing,
shaping, and obturation of the root canal
system during one visit”.
Rather SH, Singh SA, Nharika N, Sah SO, Kumar SS. Single
visit endodontic therapy: A review. International Journal of
Scientific Development and Research. 2022;7(4):158-60.
Definition

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The concept of single visit root canal treatment is based
on the entombing theory, which the large number of
microorganisms removed during cleaning and shaping
and the remaining bacteria entombed by the root canal
obturation, therefore it will miss the essential elements
to be survive nutrition and space.
In addition, the antimicrobial activity of the sealer or
the zinc (Zn) ions of gutta-percha can kill the residual
bacteria.

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Evolution of Single Visit Endodontics
(a) Dodge JS. The 1880s: Concept of single-visit root
canal management Ferranti 1950s.
(b) Tosti 1970: Clinical study using a single-visit
approach.
(c) Rudner and oliet: 1983 described a concept and
clinical technique for treating teeth in a single visit.
(d) Ashkenaz. P.J. 1984 Defined and enumerated the
indications and contra indications for single sitting
endodontics.
Praharaj N, Naik D. Endodontic Therapy in Single Visits. Indian
Journal of Forensic Medicine & Toxicology. 2020 Oct 1;14(4).
Evolution of Single Visit Endodontics

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SELECTION CRITERIA FOR SINGLE
VISIT ENDODONTICS:
OLIET'S CRITERIA FOR CASE
SELECTION
Patient should be cooperative and prepared for single
visit endodontics and non-cooperative patients with
TMJ problems, limited mouth opening should be
avoided for single visit endodontics:
1. Positive patient acceptance.
2. Sufficient time to complete procedure

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3. Absence of acute symptoms requiring drainage
through the canal and of persistent continuous
flow of exudate or blood.
4. Absence of anatomic obstacles
like calcification in the canals
and procedural difficulties (ledge
formation, blockage, perforation,
inadequate fills).

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From most important to least important,
factors to consider before deciding on single
or multi-visit treatment include:
1. Anatomy of the tooth being treated
2. Skill of the operator
3. Experience using modern endodontic
equipment
Ikram O, Neal T, Mounce R. Endodontics: single versus
multiple visit. Inter Dent Afr Ed. 2021;11:26-33.

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4. Radiographic size of the periapical
lesion
5. Teeth with sinus tracts
6. Cracked teeth
7. Patient factors.

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1.Anatomy of the tooth
being treated
Success rates are highest if we
can prepare and then close the
access cavity definitively.
In general, the extraction of a
root canal treated teeth due to
a failure of the shaping,
disinfection and obturation is
relatively rare in comparison
to removal due to fracture
(Vire, 1991; Salehrabi and
Rotstein, 2004).
UL6 (upper left first molar) was previously treated and has
been chronically tender to chewing for many years. CBCT
revealed four canals obturated. The decision was made to
attempt retreatment in one visit if possible. Access revealed
coronal leakage under the previous build up as a result of
an unset composite and lack of adaptation of the composite
along the pulpal floor
Postoperative radiograph after retreatment that
was accomplished in one visit. The patient’s
symptoms resolved immediately

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However, when failure of root canal treatment
occurs, the most common reason is unlocated
anatomy (Nair, 2004; Siqueira, 2001).
If the canal is easier to locate and clean, then
single visit treatment might be a possibility. If
the anatomy is complex, would be more inclined
to schedule a multiple visit treatment – with the
aim of the first visit being to locate and negotiate
this complex anatomy and then see resolution of
signs and symptoms

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2. Skill of the operator
To be able to carry out root canal treatment in a
manner that is efficient and of a good standard,
the operator needs to negotiate the anatomy.
In single visit root canal treatment, operator and
patient fatigue are often high.
To be able to complete single visit treatment, a
chair time of approximately two hours on a
conscious patient is usually the maximum for
most able-bodied patients.

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For single visit treatment to be an option, the
operator needs to be able to perform all the
treatment within this approximate time.
To be able to shape, disinfect and obturate
with three or more root canals in this time
frame the skill of the operator must be
extremely high.

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3. Experience using modern endodontic
equipment
There are some teeth that can be treated with low-level magnification,
but the magnification and illumination of an operating microscope
speeds up treatment.
Use of a motor driven root canal preparation system also reduces
preparation time.
If a cone beam scan is taken prior to treatment then this may also
help reduce the time spent looking for extra canals, such as lingual
canals in lower incisor teeth, or second mesiobuccal canals in upper
molar teeth.

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4. Radiographic size of the periapical
lesion
Teeth with periapical lesions above 5mm in
diameter have a reduced success rate (Ng et al,
2011) and therefore preference for these to be
treated over multiple visits so that the clinical or
radiographic healing can be evaluated during the
treatment.

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If healing is not occurring, then the patient is
free to decide whether to persist with
treatment and possible apical surgery after
filling the canals, or to proceed with extraction.
By doing this, the patient can make an
informed choice before definitive filling of the
canals and restoration of the tooth.

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5. Teeth with sinus tracts
Teeth with sinus tracts have
a lower chance of radiographic
healing (Ng et al, 2011). It is helpful to see healing of
these after shaping and disinfection of the root canal
system prior to filling the canals and restoring the tooth
definitively.
If a sinus tract does not heal or improve after eight
weeks, re-medicate the canals.
If it fails to heal after this, discuss the option of apical
surgery with the patient further, if it is appropriate, or
the possibility of extraction.

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6. Cracked teeth
Due to the unpredictable
nature of treating cracked
teeth, preference is to see
resolution of the symptoms
before filling the canals and
restoring the tooth.

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7. Patient factors
If the patient requires antibiotic cover, intravenous
sedation, general anesthetic or is travelling a long
distance, -treat the patient in a single visit.
On the other hand, if the patient has difficulty
sitting still for long appointments – such as those
with Parkinson’s disease, chronic back pain or when
treating pediatric patients –perform root canal
treatment over multiple visits, to reduce length of
chair time.

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Indications
 Uncomplicated vital teeth, vital pulp exposures due to
caries or trauma with symptomatic pulpitis.
 In physically challenged patients .
 In patients having apprehension for treatment and
requiring sedation for root canal treatment.
A Review Article Dr. Pradnya V.
Bansode1 Dr. Seema D. Pathak2 , Dr. M.
B. Wavdhane3, Dr. Shirish Khedgikar4,
Dr. Priyanka P. Birage5 IOSRolume 17,
Issue 11 Ver. 7 (November. 2018

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Fractured anterior teeth with pulpal
involvement and no periapical lesion or
teeth with recent trauma where esthetics
is the concern .
Non vital teeth with sinus tract where
chances of post treatment flare up are less.
A Review Article Dr. Pradnya V.
Bansode1 Dr. Seema D. Pathak2 , Dr. M.
B. Wavdhane3, Dr. Shirish Khedgikar4,
Dr. Priyanka P. Birage5 IOSRolume 17,

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Contraindications
1. Non vital tooth having acute inflammation;
single-visit endodontic treatment should not be
recommended.
2. Single-visit endodontic treatment should not be
performed in teeth with weeping canals.
3. Teeth with anatomic anomalies for e.g. calcified
and curved canals.

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4. Teeth with limited access.
5. Symptomatic non vital teeth.
6. Asymptomatic non vital teeth with
periapical pathology and no sinus tract.
7. For most of the re-treatment cases.
8. Patients who have temporomandibular
disorders and/or who cannot endure long
treatment period are not suitable for single-
visit endodontic treatment.

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Advantages
1] Reduced number of appointments.
2] It reduces the need for repeated episodes of
antibiotics in patients with cardiovascular diseases or
for medically compromised patients where
premedication is needed.
3] reduced number of appointments allows clinicians
to manage office time efficiently. Materials needed for
separate visits (disposable bibs, suction tips,
anaesthetic and irrigation needles and rubber dams)
are saved.
Medico legal risk is reduced: The likelihood of cross
contamination is minimized.

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4] Single-visit endodontic treatment reduces
patient discomfort and risks associated with local
anesthesia. It also reduces the episodes of pain
and anxiety that may arise from each
appointment.
5] Single visit endodontic treatment minimizes
the possible chance of iatrogenic errors (eg,
perforation, ledging, stripping, and extrusion of
antimicrobial irrigants due to longer exposures in
instrumentation procedures).
6] With single-visit treatment, there is no need
for provisional restoration between appointments
and thus no bacterial contamination through the
leakage beneath the provisional restoration.

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Disadvantages
1] Completing treatment in a single appointment
may involve time restraints and causes fatigue in
both the clinician and the patient.
2] Difficult cases like calcified canals, severe
curvatures, weeping canal, etc. may require more
time and more number of visits.
3] If flare-up occurs, it is difficult to establish
drainage through obturated tooth.

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Patients advantages
• Patient comfort – as the number of visits are
reduced .
• Economics – Extra cost of multiple visits, use of
comparatively less chair side time, fewer materials
all increase the economics to both patient as well
as doctor.
• Restorative considerations – In single visit
endodontics, immediate placement of coronal
restoration (post and core placements) ensure
effective coronal seal and esthetics.
Ahmed F, Thosar N, Baliga MS and Rathi N. Single Visit
Endodontic Therapy: A Review. Austin J Dent. 2016; 3(2):
1035.

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• Patient convenience – Patient does not have to
endure the discomfort of repetitive pricking of
local anesthesia and no additional appointments.
• Reduced intra appointment pain: Mid
treatment flare ups which are usually caused by
leakage of the temporary cements which would be
reduced in single visit endodontic cases.
Ahmed F, Thosar N, Baliga MS and
Rathi N. Single Visit Endodontic
Therapy: A Review. Austin J Dent. 2016;
3(2): 1035.

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Postoperative pain is
greater when endodontic
therapy is completed in a
single visit, especially in
nonvital teeth.
A Review Article Dr. Pradnya V. Bansode1 Dr. Seema D. Pathak2 , Dr. M. B.
Wavdhane3, Dr. Shirish Khedgikar4, Dr. Priyanka P. Birage5 IOSRolume 17,
Myth No.1

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Overwhelming evidence shows that postoperative pain
resulting from treatment of vital or nonvital teeth does not
differ among patients treated in a single visit or in multiple
visits. The reported findings on postoperative pain differed
between studies.
Wang C et al. showed no significant differences in pain
after single-visit and multiple-visit treatment.
Study done by Risso PA et al, surprisingly described more
postoperative pain developing with conventional multiple-
visit treatment.
Study done by Oginni A reported significantly more
postoperative pain for single-visit treatment.
Fact

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Bayram Incea ,2009 stated that Postoperative
pain occurred in 107 (69.9%) and 106 (69.3%)
teeth in the single- and multi-visit treatment
groups, respectively. There was no significant
difference in postoperative pain between the two
groups (P>.01).
Bayram Incea, Ertugrul Ercan Incidence of
Postoperative Pain after Single- and Multi-Visit
Endodontic Treatment in Teeth with Vital and
Non-Vital Pulp . Eur J of dentistry October 2009 -
Vol.3

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Ashish patil, 2016 reported that incidence of pain
after endodontic treatment being performed in
one-visit or two-visits is not significantly different
experienced by the patients 48 hours after
treatment in both the groups.
Avinash A. Patil1 , Sonal B. Joshi Incidence of
Postoperative Pain after Single Visit and Two Visit
Root Canal Therapy: A Randomized Controlled
Trial. Journal of Clinical and Diagnostic Research.
2016 May, Vol-10(5): ZC09-ZC12

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C. Keskin 2015 reported that there was no difference in the
incidence and intensity of postoperative pain whether
treatment was completed in a single- or multiple-visits in
teeth with vital or non-vital pulps
C. Keskin, E.O. Demiryurek and T. Ozyurek, 2015.
Postoperative Pain after Single-Versus-Multiple Visit Root
Canal Treatment in Teeth with Vital or Non-Vital Pulps in a
Turkish Population. Asian Journal of Scientific Research, 8:
413-420

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There is less healing when endodontic therapy is
completed in a single visit, especially in non-vital
tooth.
Myth No.2

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One-year follow-up time is the soonest possible to
determine whether or not the lesion has healed
(Ørstavik 1996).
No studies demonstrated a statistically significant
difference in healing rate (therapeutic efficacy) between
single- and multiple-visit treatment.
In a systematic review done by C. Sathorn found that
single-visit root canal treatment appeared to be slightly
more effective than multiple visit, i.e. a 6.3% higher
healing rate.
No significant difference in radiographic evidence of
healing between singlevisit and multiple visit treatment
was seen by study done by Paredes-Vieyra J .
Fact

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In a systematic review done by C. Sathorn ,2005
found that single-visit root canal treatment
appeared to be slightly more effective than multiple
visit, i.e. a 6.3% higher healing rate.
C. Sathorn et al, Effectiveness of single- versus multiple-visit
endodontic treatment of teeth with apical periodontitis: a
systematic review and meta-analysis, International Endodontic
Journal, 38, 347–355, 2005
Paredes-Vieyra J , 2012 stated that meticulously
instrumented single visit root canal treatment can be as
successful as a 2-visit treatment and found that there was
no significant difference in radiographic evidence of
periapical healing between 1-visit and 2-visit root canal
treatment.
Paredes-Vieyra J, Enriquez FJ. Success rate of single- versus two-visit root
canal treatment of teeth with apical periodontitis: a randomized controlled
trial. J Endod. 2012;38(9):

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Fabian Ocampo Acosta et al , 2018 stated that there
was no significant difference in radiographic evidence of
periapical healing between single-visit and two visits
root canal treatment.
Jorge Paredes Vieyra, Fabian Ocampo Acosta, Seidi Karin Nevarez
Osuna (2018). Incidence of Flare-Ups and Apical Healing after Single-
Visit or two visits Treatment of Teeth with Necrotic Pulp and Apical
Periodontitis after a Two-Year Control Period. A Randomized Clinical
Trial.
Dorasani et al, 2013 reported that Both
single-visit and multiple-visit-treated
teeth healed satisfactorily with no
significant differences

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Post operative flare up is greater when
endodontic therapy is completed in a
single visit.
Myth No.3

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Postoperative pain or swelling are collectively described
as flare-up, which is probably one of the most concerning
issues that dentists practicing single-visit treatment must
deal with.
Trope defined flare up as "intolerable pain and/or
swelling " .
Akbar et al in his study found that there was no
significant difference in the flare-up rate between single
and multiple visit
groups
Fact

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Intemational Endodontic Joumal {199l) 24,24-27
Flare-up rate of single-visit endodontics M, TROPE Department
of Endodontology,
Temple University, School of Dentistry, Philadelphia,
Pennsylvania, USA
According to the findings of his study:
(i) Teeth without apical periodontitis did not flare-up and may be
treated in a single visit;
(ii) Teeth with apical periodontitis but no previous root treatment)
can be treated in a single visit, with a low probability of a flare-ups.
(1.4 per cent)
(iii) Teeth with apical periodontitis which need retreatment the
flare-up rate was highest and single-visit root treatment would be
inadvisable. (13.6 per cent)

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Canals are cleansed if an
antibacterial medicament such as
Ca(OH)2 'is left in the tooth.
Myth No.4

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Fact
Efficacy of calcium hydroxide in controlling bacterial
colonization has been debated. Studies have reported that the
clinical outcome of multiple-visit endodontic treatment was
better for teeth treated with the intracanal calcium hydroxide
than for those with root canals left empty .
Despite the high alkalinity antibacterial properties of calcium
hydroxide, some bacteria species, such as E. faecalis and
Candida albicans, have been found to be resistant to it. It is
therefore generally considered that nonsetting calcium
hydroxide should be used as a supplement to antibacterial
irrigations.
.

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 Complete 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.
 Moreover, the tooth may also be susceptible to
reinfection through the temporary filling and dressing
during the interim period in case of multiple visits
because of microleakage.
 Gesi et al stated that with proper use of aseptic
operating procedures, proper instrumentation, and
filling, an inter-appointment dressing with calcium
hydroxide does not seem to influence outcome.

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 Gesi et al stated that with proper use of aseptic operating
procedures, proper instrumentation, and filling, an inter-
appointment dressing with calcium hydroxide does not seem to
influence outcome.
Gesi A, Hakeberg M, Warfvinge J, Bergenholtz G. Incidence of
periapical lesions and clinical symptoms after pulpectomy - A
clinical and radiographic evaluation of 1- versus 2-session
treatment. Oral Surg Oral Med Oral Pathol Oral RadiolEndod.
2006;101:379–88

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Ghoddusi ,2006 have reported that the clinical outcome of multiple-visit
endodontic treatment was better for teeth treated with the intracanal
calcium hydroxide than for those with root canals left empty.
Ghoddusi J, Javidi M, Zarrabi MH, Bagheri H. Flare-ups incidence and
severity after using calcium hydroxide as intracanal dressing. N Y State
Dent J. 2006;72(4):24–28

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Multiple-visit endodontics is safer than
single-visit endodontics, and multiple
visits mean more careful treatment.
MYTH No.5

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Fact
For patients at the risk of contracting bacterial
endocarditis AHA recommends as many procedures as
possible during antibiotic prophylaxis. By limiting
these patients to single appointment they are at less
risk of contracting endocarditis and of having an
allergic reaction to the antibiotic.
The small chance of a toxic reaction from medication
( analgesics, antibiotics, or anesthetic ) is reduced by
not using them repeatedly ( at multiple appointments )
an by using a smaller dose ( enough for one
appointment ).

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• Multiple visit treatment is more likely to
cause clinicians to forget important aspects of
canal morphology and landmark.
• Clinicians are encouraged to develop three
dimensional mental images of canals during
instrumentation. It is difficult to remember
three dimensional images between
appointments that are week apart

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Amy Wai-Yee Wong 2015 Summed it up best.
“Recent studies have shown that 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.”
Wong, A.W., Tsang, C.S., Zhang, S. et al.
Treatment outcomes of single-visit versus
multiple-visit non-surgical endodontic therapy: a
randomised clinical trial. BMC Oral Health 15,
162 (2015) doi:10.1186/s12903-015-0148-

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Patients do not mind multiple
appointments and are likely to object to
the fee if the procedure is completed in a
single visit.
Myth No.6

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Fact
Aside from cost, there are two other major
barriers to patients visiting the dentist:
fear of pain and time required.
Completing root canal therapy in one appointment
limits fear of pain to one incident and decreases
the time required (the number of appointments
and total treatment time). Patients are more likely
to, accept single-visit treatment.

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After obturation, treating a flare-up is
complicated; therefore, treatment should not
be completed at the first appointment.
Myth No.7

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Fear of a post obturation flare-up prevents
clinicians from performing single-visit
endodontics, but such flareups generally are
less common than inter appointment flare-
ups.
• Most flare-ups can be treated with occlusal
reduction, analgesics, and antibiotics.
• In the unusual event that a problem
continues, apical trephination (fistulization)
can be performed. If the canals are cleaned
and filled properly, a need to remove filling
material is rare. Whether obturation is
performed in a single visit or after multiple
visits, removal of gutta-percha (if necessary)
usually is straight forward

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Fear of a post obturation flare-up prevents clinicians
from performing single-visit endodontics, but such
flareups generally are less common than inter
appointment flare-ups. Most flare-ups can be treated
with occlusal reduction, analgesics, and antibiotics.
In the unusual event that a problem continues,
apical trephination (fistulization) can be performed.
If the canals are cleaned and filled properly, a need
to remove filling material is rare. Whether
obturation is performed in a single visit or after
multiple visits, removal of gutta-percha (if necessary)
usually is straight forward.
Fact

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Adjuncts to Render
Efficient and Faster
Treatment in Single
Visit Endodontics

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Pain control
It relaxes the patient and saves time.
It is preferable to use a long acting
local anesthetic agent such as bupivacaine or etidocaine.
It also helps to control post-operative pain
Sometimes supplemental anesthesia is indicated along with the
standard injection .
These include:
i. Intra-pulpal injections
ii. Intra-osseous injection
iii. Periodontal ligament injection

61
Masoud Parirokh et al 2012 Stated that Patients who
received bupivacaine as the anesthetic agent for single-visit
endodontic treatment of irreversible pulpitis in mandibular
molars had significantly less early postoperative pain and
used fewer analgesics than those who had lidocaine as the
anesthetic.
Effect of Bupivacaine on Postoperative Pain for Inferior
Alveolar Nerve Block Anesthesia after Single-visit Root
Canal Treatment in Teeth with Irreversible Pulpitis. JOE —
Volume 38, Number 8, August 2012

62
Isolation
The use of the rubber dam is mandatory in root canal treatment
because of its following advantages:
1. Patient is protected from aspiration of instruments, tooth debris,
medicaments and irrigating solutions.
2. Soft tissues are retracted and protected.
3. A surgically operating field is isolated from saliva, blood and
other tissue fluids. It also reduces the risk of cross contamination of
the root canal system with the spread of infectious agents.
4. Visibility is improved. It provides a dry field and reduces mirror
fogging.
5. Efficiency is increased.

63
Access cavity preparation
While performing single visit endodontics, the objective is
to perform the treatment in minimum time without
compromising the quality of treatment. To achieve this
goal use of conventional access cavity preparation by using
hand piece and new burs along with use of ultrasonic
system can be considered, as visibility will be better and
also more effective in exploring canal orifices and
calcifications present

64
Magnification & light
The use of high quality magnification in dentistry improves
both the quality and speed of treatment, hence suitable for
single visit endodontics.
Magnification and illumination are particularly important in
single visit root canal therapy ,especially for - Determining
the location of canals, - Negotiating constricted, - Curved
and calcified canals, - Debriding and removing tissue and -
Calcifications from the pulp chamber.

65
Surgical loupes,
Endodontic endoscopes, and DOM are some of the commercially
available instruments that can help the clinician accomplish these
goals. • Adding a headlight to the system of surgical telescopes
significantly enhances both depth of field and magnified resolution,
greatly increasing visual activity. • The head light provides line of
straight lumination, which is shadow less and avoids multiple
adjustments to the traditional overhead dental operating light

66
Dental operating microscope(DOM)
is an important aid in locating root
canals, which was introduced into
endodontics to provide enhanced
lighting and visibility.
• Numerous studies have shown that it
significantly improves the practitioners
ability to locate and negotiate canals.
• For example, the number of second
mesiobuccal (MB-2) canals identified in
maxillary molars increased from 51%
with the naked eye to 82% with the
microscope.

67
FIBRE-OPTIC ENDOSCOPE •
A recent addition to the field of
visualization is a fibre-optic
endoscope designed for intra oral
use.
• The Orascope uses a fiber optic
probe, xenon light source and a
medical grade video monitor to
provide a magnified image of the
operating field

68
Use Of Irrigants•
The concept of single visit root canal treatment is based on the
entombing theory.
• Although instrumentation of the root canal is the primary method of
canal debridement, irrigation is a critical adjunct.
• Especially in case of single visit endodontics, irrigation plays a critical
role as there is no scope of taking advantage of intracanal medicaments.
• Irrigation serves as a physical flush to remove smear layer, debris as
well as serving as a bactericidal agent, tissue solvent and lubricant.
Shuping G, Ørstavik D, Sigurdsson A, Trope M. Reduction of intracanal
bacteria using Nickel-titanium rotary instrumentation and various
medications. J Endod 2000;26:751-5

69
Irrigation Protocol
During biomechanical preparation, canals were irrigated with
10 mL of 3% NaOCl with a conventional endodontic syringe.
Then, the canals were flushed with 2 mL of 17% EDTA
solutions for 1 minute.
Final irrigation was done with sterile normal saline.
Kathiria NV, Attur K, Bagda KM, Venkataraghavan KP,
Patel K, Mustafa MB, Attur SK. Postendodontic Pain using
single file system with different irrigation protocols in single-
visit Root Canal treatment: a Randomized Control Trial. The
journal of contemporary dental practice. 2024 Feb 1;25(2):181.

70
Use of laser
Bacteria are known to penetrate depth of 600 to 10000
micro meters whereas the irrigant can penetrate a
depth of around 100 micrometer .
Laser has been used lately for better disinfecting of
the root canal and it gives access to the deeper area of
dentinal tubules of around 1000 micrometer. Thus
laser improves the overall disinfection of the root
canals thereby improving the treatment outcome.
As per Preethee, et al. , use of LASER (908 nm diode)
in conjunction with conventional chemo-mechanical
techniques significantly eliminate E. Faecalis in apical
third of root dentin.

71
RECENT ADVANCES THAT
ASSISTANT IN
PERFORMING SINGLE
VISIT ENDODONTIC
THERAPY

72
RECENT ADVANCES THAT ASSISTANT IN PERFORMING
SINGLE VISIT ENDODONTIC THERAPY
 Use of direct digital radiography.
 Use of surgical microscope.
 Use of apex locators.
 Crown down technique is preferred because of less chance of
pushing debris and bacteria into the periapical area and also for
easier preparation of the apical portion of the canal.
 NiTi rotary instrumentation and ultrasonic will aid in rapid
canal preparation.
 Use of NaOCl and H2O2 irrigants help in faster removal of
debris.
 Newer thermo-plasticized injectable guttapercha can assist in
rapid obturation.
Rather SH, Singh SA, Nharika N, Sah SO, Kumar SS. Single visit
endodontic therapy: A review. International Journal of Scientific
Development and Research. 2022;7(4):158-60.

73
Intemational Endodontic Joumal {199l)
24,24-27
Flare-up rate of single-visit endodontics
M, TROPE Department of
Endodontology, Temple University,
School of Dentistry, Philadelphia,
Pennsylvania, USA
Conclusions
According to the findings of this study:
(i) teeth without apical periodontitis did not flare-up and may
be treated in a single visit;
(ii) teeth with apical periodontitis but no previous root
treatment can be treated in a singie visit, with a low
probability of a flare-up occurring;
(iii) in teeth with apical periodontitis which need retreatment,
the flare-up rate was highest and single-visit root treatment
would be inadvisable.

74
One- versus Two-visit Endodontic Treatment of
Teeth
with Apical Periodontitis: A Histobacteriologic
Study
Jorge Vera, DDS,* Jose F. Siqueira, Jr, DDS, MSc,
PhD,Domenico Ricucci, MD, DDS,
Simona Loghin, DDS,Nancy Fernandez, DDS,
Belina Flores, DDS, and Alvaro G. Cruz, DDS,
MSc
Conclusion, this study demonstrated that the 2-visit protocol with an
interappointment medication with calcium hydroxide resulted in
improved microbiological status of the root canal system when
compared with a single-visit protocol.

75
Single visit
endodontics
vs
multiple visit
endodontics:

76
The two basic parameters used for the comparison of single-visit
and multiple-visit endodontic therapy are:
1.Incidence of post-operative pain and flare-ups
2.Success versus failure rates
Post-operative pain
Fear of post-operative pain following treatment is the biggest
factor in avoiding single-visit endodontic therapy. A various
number of studies and research have been done to compare the
incidence of post-operative pain in single- versus multi-visit
endodontic therapy. Although a number of studies in various
literature showed that there is no significant difference between
the two treatment protocols as far as incidence of post-operative
pain is considered, there is a lack of evidence-based data to
reinforce this
Geethanjali et al. / IP Indian Journal of Conservative and
Endodontics 2021;6(3):147–151

77
Success versus failure rates
Long-term success of any treatment is dependent on various criteria,
including case selection, treatment procedures and protocols, time
management and sufficient duration of recall appointments. Long
time success is based mainly on the healing of periapical lesions
whenever present, and the prevention of new lesion.
A study by Jurcak et al reported 89% success rate following single-
visit endodontic therapy
According to Peters and Wesselink, complete radiographic healing
was observed in 81% of the cases treated in one visit and 71% of the
cases treated in two visits.
Geethanjali et al. / IP Indian Journal of Conservative and
Endodontics 2021;6(3):147–151

78
The case selection should be done properly and all the indications
and contraindications in each case on an individual basis that a
decision should be made as to whether or not it can be completed
in a single visit. Briefly, in cases of vital pulp, a single-visit
treatment should be used whenever possible. This is based on the
fact that the pulp is only superficially infected and the root canal
is free of bacteria. Therefore, there is no apparent reason not to
treat vital pulps in a single visit.
If the pulp is necrotic or associated with a periradicular disease,
there is ample evidence that the root canal system is infected. In
these cases, the root canal system should ideally be cleaned and
shaped, an intracanal medication placed, and the canal filled at a
second appointment.
CONCLUSION

79
Both single and multivisit treatments should be viewed as part of
a total endodontic treatment spectrum, with the choice of one over
the other being determined by the circumstances surrounding each
individual case. However, when doubt exists, the multiple visit
procedure should be performed. Thus, the clinician will be most
effectively utilizing his time in delivering the best possible
endodontic service available to the patient.

80
Mothanna Al-Rahab ,Single visit root canal treatment: Review.
Saudi Endodontic Journal • May-Aug 2012 • Vol 2 •
Rather SH, Singh SA, Nharika N, Sah SO, Kumar SS. Single visit
endodontic therapy: A review. International Journal of Scientific
Development and Research. 2022;7(4):158-60.
Praharaj N, Naik D. Endodontic Therapy in Single Visits. Indian
Journal of Forensic Medicine & Toxicology. 2020 Oct 1;14(4).
Ikram O, Neal T, Mounce R. Endodontics: single versus multiple
visit. Inter Dent Afr Ed. 2021;11:26-33.
A Review Article Dr. Pradnya V. Bansode1 Dr. Seema D. Pathak2 ,
Dr. M. B. Wavdhane3, Dr. Shirish Khedgikar4, Dr. Priyanka P.
Birage5 IOSRolume 17, Issue 11 Ver. 7 (November. 2018)
REFERENCES

81
Ahmed F, Thosar N, Baliga MS and Rathi N. Single Visit Endodontic
Therapy: A Review. Austin J Dent. 2016; 3(2): 1035.
Bayram Incea, Ertugrul Ercan Incidence of Postoperative Pain after
Single- and Multi-Visit Endodontic Treatment in Teeth with Vital and
Non-Vital Pulp . Eur J of dentistry October 2009 - Vol.3
C. Keskin, E.O. Demiryurek and T. Ozyurek, 2015. Postoperative Pain
after Single-Versus-Multiple Visit Root Canal Treatment in Teeth with
Vital or Non-Vital Pulps in a Turkish Population. Asian Journal of
Scientific Research, 8: 413-420
Jorge Paredes Vieyra, Fabian Ocampo Acosta, Seidi Karin Nevarez Osuna
(2018). Incidence of Flare-Ups and Apical Healing after Single-Visit or two
visits Treatment of Teeth with Necrotic Pulp and Apical Periodontitis
after a Two-Year Control Period. A Randomized Clinical Trial.
Geethanjali et al. / IP Indian Journal of Conservative and Endodontics
2021;6(3):147–151.0

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