ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Root Canal Therapy on Infected Teeth Can Be Done In Single And Multiple-Visits With No Significant Difference In Post-Operative Pain Or In Healing Rate
Clinical Question With patients undergoing endodontic therapy on necrotic teeth, do multiple visits compared to a single visit result in a better long-term prognosis and reduced post-operative pain?
Clinical Bottom Line For patients undergoing endodontic therapy on necrotic teeth, there is no difference between single and multiple visit endodontic treatment in long-term prognosis or post-operative pain. This is supported by a systematic review of ten randomized controlled trials comparing the healing rate and post- operative pain after single and multiple visit endodontic treatment.
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) 21238790Su/201110 randomized controlled trials (6 for healing rate, 4 for post-operative pain)Systematic review of randomized trials
Key resultsThere is no difference in the healing rate or medium-term post-operative pain between single- versus multiple-visit endodontic treatment in infected teeth (80.1 vs 80.0% with 95% confidence interval). There is a higher incidence of short-term post-operative pain in multiple-visit (37%) than in single-visit (26%) (P<0.05) endodontic procedures.
Evidence Search "single"[All Fields] AND visit[All Fields] AND ("endodontics"[MeSH Terms] OR "endodontics"[All Fields]) AND multiple[All Fields] AND visit[All Fields] AND ("endodontics"[MeSH Terms] OR "endodontics"[All Fields]) AND "systematic review"[All Fields]
Comments on
The Evidence
Strict inclusion and exclusion criteria were applied. The overall level of evidence included for analysis is considered high as they are all randomized or quasi randomized controlled clinical trials with low to moderate risk of bias. The outcome measure used for healing assessment was a minimum of 1 year healing rate based on radiographic appearance and clinical symptoms; however, only 2 of the studies had observation periods less than 2 years. The outcome measure for post-operative pain was defined as an increase in swelling or pain that the patient could not control. While this was the defined outcome measure, it was not the outcome evaluated in the included studies. The studies included used some variation of a VAS, pooling all pain evaluations (slight to severe). No mention is made in these studies of an evaluation of increased swelling or uncontrolled pain. The analysis showed that there is no significant difference in healing rates of infected root canals whether therapy is completed in one or multiple visits. However, there appears to be a reduced incidence of short-term post-operative pain with single visit therapy. This is contrary to what was traditionally believed with necrotic teeth.
Applicability Endodontic treatment of necrotic teeth, with or without periapical radiolucencies, exhibits no difference in healing whether treatment is carried out in a single visit or over multiple visits. There appears to be less post-operative pain in single visit therapy. If multiple visits are necessary due to various clinical factors (inability to dry the canal, time constrictions, etc) then an intracanal antibacterial medicament, such as calcium hydroxide, is indicated.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords Infection, multiple-visit, post-obturation pain, root canal treatment, single-visit, systematic review
ID# 2915
Date of submission: 11/24/2015spacer
E-mail constance.quintero@ucdenver.edu
Author Constance Quintero
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
Basic Science Rationale
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