ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Two-Visit and One-Visit Endodontic Treatments for Necrotic Teeth with Apical Periodontitis Have Similar Success Rates
Clinical Question In patients undergoing root canal treatment for a necrotic tooth with apical periodontitis, does treatment using a two-visit approach, as compared to a one-visit approach, produce superior results?
Clinical Bottom Line When compared to teeth treated using a one-visit treatment modality, necrotic teeth with apical periodontitis treated using a two-visit treatment modality show similar clinical success rates, with no statistical difference in success rate between the two groups.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22892729Paredes-Vieyra/2012282 necrotic teeth with apical periodontitis (146, one-visit; 136, two-visit)Randomized Controlled Trial
Key results282 teeth with apical periodontitis and a necrotic pulp were randomly assigned to be treated with one- or two-visit endodontic appointments. Two-visit appointments utilized calcium hydroxide powder as an intracanal medicament. After a two-year follow up period, 141 of 146 teeth (96.57%) treated with a one-visit protocol were classified as healed, and 121 of 136 teeth (88.97%) treated during two visits were classified as healed. No statistically significant difference existed between the two groups (P = .05).
#2) 17889679Molander/200789 asymptomatic teeth with pulpal necrosis and apical periodontitis (49, one-visit; 40, two-visit)Randomized Controlled Trial
Key results89 teeth with apical periodontitis and a necrotic pulp were randomly assigned to be treated with a two-visit appointment using calcium hydroxide as an intracanal medicament or a one-visit appointment using a 5% iodine-potassium-iodide (IPI) solution as an intracanal medicament left in the tooth for 10 minutes. After a two-year follow up period, 65% of the teeth in the one-visit group were classified as healed, and 75% of the teeth in the two-visit group were classified as healed. No statistical significance was found between the two groups (P = .75).
#3) 18291270Penesis/200863 patients having necrotic teeth with radiographic evidence of apical periodontitis (33, one-visit; 30, two-visit)Randomized Controlled Trial
Key results63 patients having a necrotic tooth with apical periodontitis were randomly assigned to have root canal treatment performed during a one-visit or two-visit appointment and were then followed up at 1 year. For those that underwent a two-visit procedure, an intracanal medicament of calcium hydroxide/chlorhexidine was used. Upon recall, 67% of the teeth in the one-visit group were classified as healed, and 70% of the teeth in the two-visit group were classified as healed. No statistical significance was found between the two groups (P = .86).
Evidence Search "two-visit"[ALL FIELDS] AND "apical periodontitis"[ALL FIELDS] AND randomized trial
Comments on
The Evidence
All three studies reviewed were randomized controlled trials and outlined steps taken to minimize bias and confounding variables. Paredes et al. and Penesis et al. point out that follow up times longer than those employed by their studies (two years and one year, respectively) would be ideal, but that patient dropouts become a more significant issue as follow-up times increase. Of the three studies reviewed, none showed any statistically significant difference between teeth treated with a one-visit vs. a two-visit endodontic approach. A randomized controlled trial with a larger patient population and/or longer follow-up time frame could possibly help identify one method as having higher clinical success.
Applicability Applicable to all clinicians performing endodontic therapy. While it appears that two-visit treatment has a slightly higher success rate, this difference is not significant. The evidence indicates that it is safe to perform one-visit endodontic treatment on necrotic teeth, even if apical periodontitis is present. The evidence suggests that it may be left to the clinician’s judgment whether treatment is performed in one visit or two, taking into consideration time available and patient preference.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords Apical periodontitis, one-visit endodontics, two-visit endodontics, calcium hydroxide, root canal treatment
ID# 2755
Date of submission: 08/18/2014spacer
E-mail ryan.gonzales@ucdenver.edu
Author Ryan Gonzales
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Ethelyn Thomason, DMD
Faculty mentor/Co-author e-mail ethelyn.thomasonlarsen@ucdenver.edu
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