Single Visit Endodontics [Detailed Explaination With Studies]

Root canal treatment entails the removal of dental pulp and the subsequent shaping, cleaning and obturation.

Single Visit Endodontics

Endodontic treatment was used to take multiple visits to complete.

Completing the endodontic treatment in a single visit is an old concept since 100 years. In the recent years single visit endodontics has gained increased acceptance as the best treatment for many cases

Many dentists nowadays are preferring single visit endodontic treatment because of many advantages

Recent studies have also shown that there is no difference in quality of treatment, incidence of post- treatment complications, or success rates between single-visit and multiple visit root canal treatment

WHAT IS SINGLE VISIT ROOT CANAL TREATMENT?

Single visit endodontic treatment is defined as the conservative ,non surgical treatment of an endodontically involved tooth consisting of complete biomechanical preparation and obturation of the root canal system in one visit.

History

The concept of a single visit root canal treatment was described as early as the 1880s.

Immediate Root Filling" was performed by Dodge (1887), Kells (1887) and Hofheinz (1892).

In 1901, Trallero described his one-visit technique using a bichloride wash, hot platinum wire sterilization, and canal filling consisting of zinc oxide, eugenol, and xeroform paste

In 1950, Ferranti advocated the use of diathermy for pulpal disinfection and hydrogen peroxide for irrigation

In 1970, Tosti reported a satisfactory result in his clinical study using a single visit approach.

Criteria For Case Selection

As a Guideline, Case should be completed in 60 minutes.

Only clinicians with enough experience should undertake one appointment endodontics

The case should be selected so that it can be finished within 60 minutes. If the time taken is longer than this it should be done in the next visit.

The dental assistant should be well experienced and quick in providing the necessary instruments and materials so that the clinician need not get up from his chair

All instruments and materials to be used should be arranged in the sequence of its use.

According to Oliet, the criteria for cash selection are:

Positive acceptance by the patient

Time should be sufficient to complete the procedure properly

Acute symptoms which require drainage through the canal and if it is a continuous flow of exudates or blood.

There should be no anatomic obstacles such as
a) calcified canals
b) Fine tortuous canals
c) Bifurcated or accessory canals
d) Ledge formations
e) Blockages
f) Perforations
g) Inadequate fills

Teeth with pre operative apical periodontitis should not be selected as they will lead to post operative problems.

Indications of Single Visits Endodontics?

Esthetic Cases

Accidental/Mechanical Pulp Exposure

Intentional RCT

Physically Disabled

Uncomplicated Vital Teeth

Sedation Cases

Contra-indications of SVE?

Anatomical Anomalies

Allergies

Acute Alveolar Abscess

Limited Access

Symptomatic cases

TMJ Disorders

Advantages

Patient comfort.

Reduced microbial contamination and flare up

Minimizes fear and anxiety.

Restorative considerations.

Lesser error in working length.

Reduced intra-appointment pain

Disadvantages

Single long appointment

Mid treatment flare up

Difficult in fine, calcified and multiple canals

Lack the expertise

Difficult to control exudation

Precautions to be taken in SVE

All the endodontic preparation should be confined within the canal

There should be no over instrumentation

If during instrumentation we discover that we have made an error by over instrumenting the tooth the canal preparation and obturation should not be done in a single sitting.

In such cases prophylactic use of Cortico-steroids is the apical medicament and the patient is called after a few days for completion

ADJUNCT THE RENDER FASTER TREATMENT IN SINGLE VISIT ENDODONTICS

1. Pain Control

Before commencing the treatment local anaesthesia should be administered to ensure painless treatment

It is preferable to use a longer acting local anaesthetic agent as the duration of sitting endodontic treatment goes on for 1 hour or little more, hence the local anaesthetic agent should act for a longer period of time.

Long acting local anaesthetic agents such as BUPIVACINE or ETIDOCAINE is used. Which also helps to control post operative pain.

Sometimes supplemental anaesthesis is indicated in case the standard injection is not completely effective.

Three supplemental techniques:

Periodontal ligament injection
Intra pulpal
Intra osseous

Pariorokh et al. has stated in 2012 that patients who receive bupivacaine as the anesthetic agent in mandibular molars for single-visit endodontic treatment of irreversible pulpitis as compared to those who had lidocaine as the local anesthetic has significantly less early postoperative pain and also used fewer analgesics.

2. Isolation

Soon after administering local anaesthesia it is very important to isolate the operating field before starting the treatment. So that there is no interference of oral fluids and so that the intracanal irrigant can be used with ease.

A rubber dam is used for isolation generally which is the visiframe and the NYGARD OSTBY frame. In the recent times an improved rubber dam frame for obtaining an endodontic operative field is proposed which is the articulated rubber dam frame. (Gasriel sauveur joe vol 23 1997) here a bindge is present in the center of the frame which enables it to be folded, which facilitates:

Taking of radiographs
Administration of additional doses of L.A.
Evacuation of therapeutic fluids.
After isolation the access is opened by preparing the access cavity with the help of a round ENDCARBIDE FISSURE BUR with high speed.

Now the next step is thorough debridement of the pulp from the coronal pulp chamber

3. Location of Canal Orifice

The canal orifice should be located in the floor of the pulp chamber. This is usually done with an endodontic probe. Recently advanced instruments have emerged such as the FIBRE OPTIC PROBE which has a tip of 1.8 mm in diameter – here the clinician can access openings better and also the pulpal floor revealing orifices of the canal and also the canal interior. The device which makes use of this is the endoscope where the image will be displayed on the computer screen. Examples of the fibre optic probe in the ORASCOPE FIBRE OPTIC PROBE.

After location of the canal orifice all of the pulp and the debris are extirpated from the canal using a barbed broach.

4. Use of Irrigants

Use of a suitable irrigant should be incorporated so as to improve the disinfection of the canal thereby enhancing the treatment outcome.

Naocl is a powerful irrigant that has been shown to readily dissolve pulp tissue in concentration of 5.25%

Studies have shown that in pre flared canals warning sodium hypochlorite to approximately 60⁰C increase the rate of effectiveness of tissue dissolution – this is done by placing a beaker of water on a hot plate and hearing it to 140⁰ F. preloaded syringes of Naocl are warmed by placing them in this beaker.

Use of EDTA, CHX, Metrogyl

5. Biomechanical Preparation and Obturation

BMP is done with the help of hand files and rotary files and Obturation of root canals.

Myths Related to SVE

Postoperative pain and swelling is greater when endodontic therapy is completed in a single visit, especially in non vital teeth

There is less healing when endodontic therapy is completed in a single visit, especially in non-vital tooth.

Multiple-visit endodontics is safer than single visit endodontics, and multiple visits mean more careful treatment

Studies On Post-Operative Complication

It was reported that there was no significant difference in flare-up rates between SVE and MVE. (Akbar et al 2013).

The prevalence of flare-ups after SVE in the published literature was none (Di Renzo et al 2002) to 3 % (Eleazer et al 1998).

Neither SVE nor MVE with intracanal medications can completely eliminate microbial colonies. (Gurgel et al 2007).

Yingying in a systemic review has quoted that patients experience less frequency of short-term post-obturation pain after single-visit than those having multiple-visit root canal treatment

At the University of Oklahoma however, Roane and his associates found that treatment completed in multiple visits had a two to one higher frequency of pain when compared to those completed in one visit.

Studies On Healing and Success Rate of SVE

Dorasani et al (2013) reported that both single visit and multiple visit treated teeth healed satisfactorily with no significant difference.

Paredes et al (2012) reported no significant difference in healing results between the two groups.

Yingying et al (2011) found that healing rate is similar for SVE and MVE.

THESE STUDIES SHOWED THAT THE SUCCESS RATES OF SINGLE VISIT AND MULTIPLE VISIT ENDODONTIC TREATMENT WERE SIMILAR.

Conclusion

“Maximum dentistry in minimum visits” has been the rule in modern dental practice

There is no statistically significant difference among the incidence of pain in single rooted and multirooted teeth with and without periapical radiolucency from 1st day to one week in SVE therapy.

The choice of treatment should be made on the basis of individuality of a case and the operator’s skill. Wherever and whenever in doubt multiple-visit endodontic therapy is still recommended.