[Clinical and radiographic assessment of single-appointment endodontic treatment in teeth with chronic periapical lesions]

Analysis of Post-Operative Pain Following Single Sitting Root Canal Treatment

Background

The objective of root canal therapy is the complete cleansing and sealing of the entire root canal system, encompassing all of its elements. This current study was undertaken to evaluate the occurrence of postoperative pain in the patients during single-session RCT.

Materials and Methods

A total of 70 maxillary central incisor teeth from 55 patients, representing both genders, were chosen for a one-session root canal procedure. Postoperative discomfort was measured using the Visual Analog Scale (VAS) at the following time intervals: 6 hours, 12 hours, 24 hours, and 48 hours following the treatment.

Results

Among the 55 patients, there were 35 males and 20 females. The average VAS scores at various time points were as follows: 6 hours (7.4), 12 hours (5.2), 24 hours (3.4), and 48 hours (2.5). These differences were found to be statistically significant (P < 0.05).

Conclusion

The authors observed a significant reduction in postoperative pain following a one-session RCT.

Single versus Multiple Sitting Endodontic Treatment: Incidence of Postoperative Pain - A Randomized Controlled Trial

AIMS AND OBJECTIVES

The aim of the study is to assess any considerable differences in the incidence and severity of postobturation pain after single- and multiple-visit root canal treatment.

MATERIALS AND METHODS

We carried our study on 400 successive patients who needed root canal treatment. They were randomly categorized into two groups of 200 each. First group underwent single-visit treatment and the other group underwent multiple-visit therapy. Visual analog scale was employed to evaluate pain preoperatively and postoperatively at 6, 12, 24, and 48 h after obturation. The Statistical Package for the Social Sciences version 20 was employed for analysis.

RESULTS

There was a male predominance (235; 60.26%). Of 390 cases, 167 were vital and 223 were nonvital. There was an insignificant difference between the preoperative and postoperative pain levels of vital and nonvital teeth of both the groups at different time intervals.

CONCLUSION

There was a less incidence of pain in multiple visit group than single-visit one, which was statistically significant.

Strength of recommendation for single-visit root canal treatment: grading the body of the evidence using a patient-centred approach

AIM

To identify, search for and critically interpret the results from clinical studies on single- versus multiple-visit root canal treatment in the light of an evidence-based paradigm. For that purpose, the quality of the available body of evidence was assessed using the SORT 'grade' - Strength of Recommendation Taxonomy.

METHODOLOGY

A protocol was followed including all aspects of the review methods: (i) search strategy, (ii) inclusion criteria for studies, (iii) screening methods, (iv) quality assessment, (v) data synthesis of the selected studies, and (vi) the assessment of quality of the body of evidence available by the means of the SORT 'grade'. An extensive search of recent biomedical literature was performed in PubMed (up to May, 2014), EMBASE (dating from 1980 to May 2014) and Cochrane databases with appropriate headings and keywords related to single- and multiple-visit root canal treatment. Selected studies were stratified according to their level of evidence using the SORT criteria: (i) quality - Level A high-quality evidence, Level B medium/low-quality evidence and Level C no evidence; (ii) degree of consistency - consistent, when most studies found a similar conclusion, or inconsistent, when there was considerable variation amongst study findings.

RESULTS

After the digital and manual searches, 246 studies were indentified. Two hundred and seven studies were eliminated by exclusion criteria, resulting in a yield of 39 articles that were selected for retrieval. Of the 39 articles, only 11 could be classified as Level 2 (B); the other 28 articles did not obey the criteria to be considered as real patient-oriented evidence; thus, they were classified as Level 3 (C). No studies were ranked as Level 1 because they did not obey the minimum standard to be considered as both good-quality research and patient-oriented evidence. Despite this, all of the selected Level B studies reported no significant differences between single- and multiple-visit treatments.

CONCLUSION

There is B-level (mid-level) evidence to confirm there is no difference between the two different treatments, based on research addressing clinical outcomes and using some consistent but limited-quality methods of scientific investigation. More studies focused on evaluating patient-centred outcomes are urgently required.

The prevalence of postoperative pain and flare-up in single- and multiple-visit endodontic treatment: a systematic review

AIM

The aim of this systematic review was to assess the evidence regarding postoperative pain and flare-up of single- or multiple-visit root canal treatment.

METHODOLOGY

CENTRAL, MEDLINE and EMBASE databases were searched. Reference lists from identified articles were scanned. A forward search was undertaken on the authors of the identified articles. Papers that had cited these articles were also identified through Science Citation Index to identify potentially relevant subsequent primary research.

REVIEW METHODS

The included clinical studies compared the prevalence/severity of postoperative pain or flare-up in single- and multiple-visit root canal treatment. Data in those studies were extracted independently.

RESULTS

Sixteen studies fitted the inclusion criteria in the review, with sample size varying from 60 to 1012 cases. The prevalence of postoperative pain ranged from 3% to 58%. The heterogeneity amongst included studies was far too great to conduct meta-analysis and yield meaningful results.

CONCLUSION

Compelling evidence indicating a significantly different prevalence of postoperative pain/flare-up of either single- or multiple-visit root canal treatment is lacking.

Single versus multiple visits for endodontic treatment of permanent teeth

BACKGROUND

Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious processes, tooth cracks or chips, or dental trauma. Successful RoCT is characterised by an absence of symptoms and clinical signs in teeth without radiographic evidence of periodontal involvement. The success of RoCT depends on a series of variables related to the preoperative condition of the tooth, as well as the endodontic procedures.

OBJECTIVES

To compare the effectiveness of single- and multiple-visit RoCT, measured as tooth extraction due to endodontic problems and radiological success.To assess the difference in short- and long-term complications between single- and multiple-visit RoCT.

SEARCH STRATEGY

The following databases were searched for relevant trials: Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, and EMBASE. Handsearching was performed for the major oral medicine journals. References of included studies and reviews were checked. Endodontics experts were contacted through e-mail. No language limitations were imposed. Date of last search was 6th March 2007.

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials of patients needing RoCT were included. Surgical endodontic treatment was excluded. The outcomes considered were the number of teeth extracted for endodontic problems; radiological success after at least 1 year, that is, absence of any periapical radiolucency; postoperative pain; painkiller use; swelling; or sinus track formation.

DATA COLLECTION AND ANALYSIS

Data were collected using a specific extraction form. The validity of included studies was assessed on the basis of allocation concealment, blindness of the study, and loss of participants. Data were analysed by calculating risk ratios. When valid and relevant data were collected, a meta-analysis of the data was undertaken.

MAIN RESULTS

Twelve randomised controlled trials were included in the review. Four studies had a low risk of bias, four a moderate risk, and another four had a high risk of bias. The frequency of radiological success and immediate postoperative pain were not significantly different between single- and multiple-visit RoCT. Patients undergoing single-visit RoCT reported a higher frequency of painkiller use and swelling, but the results for swelling were not significantly different between the two groups. We found no study that included tooth loss and sinus track formation among its primary outcomes.

AUTHORS' CONCLUSIONS

No difference exists in the effectiveness of RoCT, in terms of radiological success, between single- and multiple-visit RoCT. Most short- and long-term complications are also similar in terms of frequency, although patients undergoing a single visit may experience a slightly higher frequency of swelling and are significatively more likely to take painkillers.

Effectiveness of single- versus multiple-visit endodontic treatment of teeth with apical periodontitis: a systematic review and meta-analysis

AIM

The clinical question this review aimed to answer is: does single-visit root canal treatment without calcium hydroxide dressing, compared to multiple-visit treatment with calcium hydroxide dressing for 1 week or more, result in a lower healing (success) rate (as measured by clinical and radiographic interpretation)?

METHODOLOGY

CENTRAL, MEDLINE, EMBASE and HEALTH STAR databases were used. Reference lists from identified articles were scanned. A forward search was undertaken on the authors of the identified articles. Papers that had cited these articles were also identified through Science Citation Index to identify potentially relevant subsequent primary research.

REVIEW METHODS

The included studies were randomized controlled clinical trials (RCTs) comparing healing rate of single- and multiple-visit root canal treatment in humans. The outcome measured was healing of radiographically detectable lesions. Data in those studies were independently extracted.

RESULTS

Only three RCTs were identified and included in the review, covering 146 cases. Sample size of all three studies was small; none demonstrated a statistically significant difference in healing rates. Risk differences of included studies were combined using the inverse variance-weighted method (RD(Pooled) = -6.3%; 95% CI: -20.3-7.8).

CONCLUSION

Based 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).

Effect of biomechanical preparation and calcium hydroxide pastes on the antisepsis of root canal systems in dogs

In the endodontic treatment of root canals with necrotic pulps associated with periapical radiolucent areas, one of the main objectives of treatment consists in eliminating the microorganisms spread throughout the ramifications of the root canal system. The scope of this study was to evaluate the antiseptic efficacy of biomechanical preparation and two calcium hydroxide-based pastes, in dogs' teeth with experimentally induced chronic periapical lesions. After initial microbiological sampling, instrumentation of the root canals was undertaken using the conventional technique, using K type files used in conjunction with a solution of 5.25% sodium hypochlorite. After ninety-six hours, further microbiological sampling was undertaken and Calen/CPMC or Calasept pastes were applied for 15 and 30 days. Ninety six hours after the removal of the medication, the third microbiological sampling was undertaken and finally histomicrobiological analysis followed using Brown & Brenn staining. The results were analyzed using the Kruskall-Wallis test, with a level of significance established at 5% (p<0.05). It was shown that the biomechanical preparation significantly reduced the number of colony forming units of microorganisms in root canals. In contrast, there was no significant difference between the antiseptic action of long-term dressings over two periods of action, although 30 days produced a greater reduction in the quantity of microorganisms and of positive microbiological cultures. In histological sections of the four experimental groups, similar microbiological patterns were shown (p>0.05), characterized by an elevated incidence of cocci, bacilli and filaments, predominantly gram-positive, in root canals, secondary canals and accessories, apical cementoplasts and dentinal tubules, but with a low incidence of microorganisms in areas of cementum resorption and the periapical lesion. The biomechanical preparation and intracanal dressing based on calcium hydroxide were important in the antisepsis of the root canal; however, both procedures did not produce significant changes in the microbiological aspects of the root canal system.