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Title Two-Visit Endodontic Treatment Versus One-Visit Endodontic Treatment For Necrotic Teeth With Periapical Periodontitis
Clinical Question For a patient presenting with periapical periodontitis, does an endodontic treatment completed in one visit take longer to heal than a two-visit endodontic treatment with placement of calcium hydroxide in the instrumented canal between visits?
Clinical Bottom Line One-visit endodontic treatment is as effective in healing periapical lesions compared to two-visit endodontic treatment with placement of calcium hydroxide between visits. This is true in cases where effective disinfection can be achieved in one appointment. (See Comments on the CAT below)
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) 18291270Penesis/200863 patients with evidence of periapical periodontitis; 33 in a one-visit group; 30 in a two-visit grouprandomized controlled trial
Key resultsBoth groups exhibited equally favorable periapical healing at 12 months, with no statistically significant differences between the groups. The primary outcome measure was the change in periapical bone density.
#2) 15910469Sathorn/20053 RCT were foundsystematic review and meta-analysis
Key resultsBased on the current best available evidence, single-visit root canal treatment appeared to be slightly more effective than multiple visit, i.e. 6.3% higher healing rate. However, the difference in healing rate between these two treatment regimens was not statistically significant (P = 0.3809).
Evidence Search Pubmed; (("Periapical Periodontitis"[Mesh] AND "Root Canal Therapy"[Mesh]) AND "Treatment Outcome"[Mesh]) AND "Office Visits"[Mesh]
Comments on
The Evidence
The meta-analysis found 3 RCT that were all of small sample sizes, and the healing rates of a one-visit versus multi-visit endodontic appointment were not statistically significant.
Applicability If healing rates of periapical periodontitis is similar for one-visit versus two-visits then in a practice setting it would be clinically acceptable to complete root canal therapy in one visit. The benefit to the patient is only one visit without risk of prolonged healing of the periapical lesion. And for the dentist this means successful treatment in less appointments.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords periapical periodontitis; calcium hydroxide; multi-visit endodontics; one-visit endodontics; root canal therapy; office visits; treatment outcome
ID# 488
Date of submission: 01/07/2010spacer
E-mail naomiseverdds@gmail.com
Author Nicholas Sager
Co-author(s) Naomi Sever
Co-author(s) e-mail
Faculty mentor/Co-author Kenneth Hargreaves, DDS, PhD
Faculty mentor/Co-author e-mail HARGREAVES@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Jonathan Fu (San Antonio, TX) on 07/09/2012
After using identical search terms as this CAT, the current literature still supports the findings of this CAT. The Randomized Clinical Trial from 2008 by Penesis et. al., is still the best study to support the CAT.
by Sang Do (San Antonio, TX) on 04/16/2012
The PubMed search I conducted on this topic April 2012 and found a more recent in vivo study that have the same findings as the published CAT: PubMed ID 21838499.

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