Title	Single-Visit and Multiple Visit Endodontics Provide Same Healing Rates in Healthy Patients
Clinical Question	Should I treat the patient in one visit without a calcium hydroxide dressing or in two visits with a calcium hydroxide dressing placed in the canals for at least 1 week between appointments?
Clinical Bottom Line	Current best evidence suggests that single-visit root canal treatment without a calcium hydroxide dressing is slightly more effective than multiple visits; the difference in healing between these two treatment regimens, however, is not statistically significant. These results are only applicable to healthy patients and may not relate to immune-compromised patients or patients with acute exacerbations or diffuse swelling related to periapical periodontitis. (See Comments on the CAT below)
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 15910469 Sathorn/2005 146 cases from 3 randomized controlled trials. Meta-analysis of randomized controlled trials Key results Single visit root canal therapy was slightly more effective than multiple visit (6.3% higher healing rate), however, the difference in healing rate was not statistically significant (p=0.3809)
Evidence Search	PubMed - “endodontics” and “single visit” and “calcium hydroxide” and (meta-analysis [ptyp] or randomized controlled trial[ptyp])
Comments on The Evidence	Although this study was a meta-analysis, only 3 randomized controlled trials met the inclusion criteria and the resulting 146 cases represent a very small sample. The results seem to create a cognitive dissonance. We know that bacterial infection causes periapical periodontitis and that calcium hydroxide is antibacterial. Placing the slow-release calcium hydroxide directly into the site of infection should decrease bacterial loads and lead to higher success rates. According to this study, however, the opposite was true; the teeth without calcium hydroxide placement actually responded slightly better. Perhaps this cognitive dissonance can be accounted for by leaking temporary restorations allowing additional bacteria to enter the root canal system in the multiple treatment groups. Additionally, perhaps our chemo-mechanical debridement techniques decrease bacterial loads below a threshold level where our body can take control of the remaining bacteria without the adjunct of calcium hydroxide.
Applicability	The treatment regimens and assessment of healing in the studies used for this meta-analysis are similar to standard practices in the US. Furthermore, the recall rates of each included study were very high (92 – 100%) adding validity to the results. Not included in the studies, however, are patients with immune-compromising conditions such as diabetes, elderly patients, HIV/AIDS patients etc. These patients may benefit from calcium hydroxide/multiple-visit treatments.
Specialty	(Endodontics) (General Dentistry)
Keywords	Endodontics, Single visit, and calcium hydroxide
ID#	290
Date of submission	11/11/2009
E-mail	schmoldt@livemail.uthscsa.edu
Author	Steven J. Schmoldt, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor	David Cox, DDS
Faculty mentor e-mail	CoxD@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?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Jennifer Chau (San Antonio, TX) on 04/12/2012 A PubMed search on this topic was completed in April 2012. The publication listed in this CAT is the most recent one of the highest level of evidence related to this clinical question.