In Detail description of single visit endodontics

1. Single Visit Endodontics
Presented by:-
DR. Himani Thawale (JR-
II)

2. Contents
• Introduction
• Evolution Of Single Visit Endodontics
• Case Selection For Single Visit Endodntics
• Indications
• Contraindications
• Advantages
• Disadvantages
• Myths
• Adjuncts To Render Efficient And Faster Treatment In Single Visit Endodontics
• Procedure For Single Visit Endodontics.
• Conclusion.

3. Introduction
• The main objective of endodontic therapy is thorough mechanical and chemical
debridement of the entire pulp cavity and its complete obturation with an inert
filling material.
• In other words, Endodontic success depends upon
-Localization Of Canals
- Proper Shaping And Cleaning Of Root Canal System,
-3 D Obturation Of Canal System.
Mothanna Al-Rahab ,Single visit root canal treatment: Review. Saudi Endodontic Journal • May-Aug 2012 • Vol 2 • Issue

4. • To achieve all these goals endodontic therapy used to be performed in multiple visits to
cope up with the complete infection and to make the canals free of microbes, all together
for the success of endodontic therapy.
• Multiple visit endodontics was an established norm in the field of endodontics, but it has
certain disadvantages like
- Inter appointment microbial contamination and flare ups,
- Prolonged time leading to patient fatigue
- Unable to provide esthetic restorations in time,
- Discontinued treatment leading to failures.
Mothanna Al-Rahab ,Single visit root canal treatment: Review. Saudi Endodontic Journal • May-Aug 2012 • Vol 2 •
Issue

5. DEFINITION
Single visit endodontic therapy can be defined as a
conservative, non surgical treatment of an endodontically
involved tooth consists of complete biomechanical
preparation and obturation of the root canal system in single
visit.
Textbook of endodontics, first edition, Mithra N. Hegde ,
pg no- 445.

6. Richard E. Walton 2012, reported that
78% of respondents preferred 1- visit RCT,
7% preferred 2-visit RCT and
16% would follow their dentist’s recommendation.
Although most respondents preferred 1-visit RCT regardless of success rates, many
would prefer 2-visit RCT if its success rate were greater than that of 1-visit RCT

7. Evolution Of Single Visit Endodontics
.
Dodge JS. 1880s Concept of A single-visit root canal treatment
Ferranti 1950s Use of diathermy for pulpal disinfection and
hydrogen peroxide for irrigation
Tosti 1970 Clinical study using A single-visit approach.
Rudner and oliet 1983 Described a concept and clinical technique for
treating teeth in a single visit.
Ashkenaz. P.J. 1984 Defined and enumerated the indications and
contraindications for single visit endodontics.

8. Positive patient acceptance
Absence of acute symptoms
Absence of continuous hemorrhage
or exudation
Absence of anatomical
interferences
Availability of sufficient time to
complete the case.
Absence of procedural difficulties

9. Indications
• Uncomplicated vital teeth.
• Fractured anteriors or bicuspid teeth where aesthetics is the concern.
• Teeth indicated for endodontic surgery.
• Non vital teeth with sinus tract.
• Medically compromised patients who require antibiotic prophylaxis.
• Physically compromised patients who cannot come to dental clinics frequently.
Ashkenaz. P.J. One-visit endodontics Dent Clin North Am. Oct;28(4):853-63.1984

10. • Intentional root canal therapy.
• Patients requiring full mouth rehabilitation.
• Some of the re-treatment cases.
• Accidental/Mechanical pulp exposure.
• Vital pulp exposures because of trauma with symptomatic pulpitis.
• Vital pulp exposure because of caries with symptomatic pulpitis.
• Teeth requiring immediate post placement, where esthetics is the concern.
Ashkenaz. P.J. One-visit endodontics Dent Clin North Am. Oct;28(4):853-63.1984

11. Contraindications
• Teeth with anatomic anomalies such as calcified and curved canals.
• Asymptomatic non vital teeth with periapical pathology and no sinus tract.
• Acute alveolar abscess cases with frank pus discharge.
• Patients who have acute apical periodontitis with severe pain on percussion.
• Symptomatic non vital teeth and no sinus tract.
Ashkenaz. P.J. One-visit endodontics Dent Clin North Am. Oct;28(4):853-63.1984

12. • Most of the re-treatment cases.
• Patients with allergies or previous flare ups.
• Teeth with limited access.
• Patients who are unable to keep mouth open for long
duration such as TMJ disorders.
Ashkenaz. P.J. One-visit endodontics Dent Clin North Am. Oct;28(4):853-63.1984

13. Advantages
Clinical Advantages-
• Clinicians have the most intimate awareness of canal morphology, immediately
following instrumentation and need not reorient themselves with the peculiarities of
particular teeth.
• No risk of bacterial regrowth and leakage of the temporary seal .
• No risk of flare-up induced by leakage of temporary seal.Single-Visit Versus Multiple-Visit Root Canal Treatment- A Review Article
Dr. Pradnya V. Bansode1 Dr. Seema D. Pathak2 , Dr. M. B. Wavdhane3, Dr. Shirish Khedgikar4, Dr. Priyanka P. Birage5 IOSRolume 17, Issue 11 Ver. 7 (November. 2018

14. • The small chance of a life – threatening reaction is reduced by not
repeating procedure such as local anaesthetic injection.
• For patients at risk of contracting bacterial endocarditis, the American
Heart Association (AHA) recommends completing as many procedures as
possible during the antibiotic course.
• Patient’s pre-appointment anxiety and post operative discomfort are
limited to one episode.

15. PRACTICE MANAGEMENT ADVANTAGES:
• Prosthetic work can begin without delay.
• The risk of cancelled appointments is reduced.
• The number of teeth that patients are willing to save may increase.
• Same patients will pay a premium to save time.

16. • Materials needed for separate visits (disposable bibs, suction
tips, anaesthetic and irrigation needles and rubber dams) are
saved.
• Time is saved: There is no need to reappoint patient nor
reconfirm appointments
• Medicolegal risk is reduced: AHA gudelines are followed,
the likelihood of cross contamination is minimized and
invasive procedures are fewer.

17. Patients Advantages:
• Patient convenience – Patient does not have to endure the
discomfort of repetitive local anesthesia, treatment procedure
and no additional appointments.
• Patient comfort – because of reduced number of visits and
injections.
• Reduced intra appointment pain: Mostly the mid treatment
flare ups are caused by leakage of the temporary cements.

18. • Restorative considerations – In single visit endodontics,
immediate placement of coronal restoration (post and core
placements) ensure effective coronal seal and esthetics.
• Economics – Extra cost of multiple visits, use of fewer
materials and comparatively less chair side time all increase
the economics to both patient as well as doctor.
• Minimises the fear and anxiety

19. Disadvantages
• No easy access to the apical canal if there is a flare-up.
• Clinician fatigue with extended one -appointment operating time.
• Patient fatigue - The longer single appointment may be tiring and uncomfortable for
the patient.
• Flare-ups cannot easily be treated by opening the tooth for drainage
Single-Visit Versus Multiple-Visit Root Canal Treatment- A Review Article
Dr. Pradnya V. Bansode1 Dr. Seema D. Pathak2 , Dr. M. B. Wavdhane3, Dr. Shirish Khedgikar4, Dr. Priyanka P. Birage5 IOSRolume 17, Issue 11 Ver. 7 (November. 2018

20. • If hemorrhage or exudation occurs, it may be difficult to control
• Difficult cases with extremely fine, calcified, multiple canals
may not be treatable in one appointment without causing undue
stress for both the patient and the clinician.
• The clinician may lack the expertise to properly treat a case in
one visit. This could result in failures, flare-ups, and legal
repercussions.

21. Myths

22. Post operative pain is greater when endodontic therapy is completed in a single visit,
especially in non vital teeth.
Myth No. 1

23. Bayram Incea ,2009 stated that Postoperative pain occurred in 107 (69.9%) and 106 (69.3%) teeth in
the single- and multi-visit treatment groups, respectively. There was no significant difference in
postoperative pain between the two groups (P>.01).
C. Keskin 2015 reported that there was no difference in the incidence and intensity of
postoperative pain whether treatment was completed in a single- or multiple-visits in teeth with
vital or non-vital pulps
C. Keskin, E.O. Demiryurek and T. Ozyurek, 2015. Postoperative Pain after Single-Versus-Multiple Visit
Root Canal Treatment in Teeth with Vital or Non-Vital Pulps in a Turkish Population. Asian Journal of
Scientific Research, 8: 413-420.
Bayram Incea, Ertugrul Ercan Incidence of Postoperative Pain after Single- and Multi-Visit Endodontic
Treatment in Teeth with Vital and Non-Vital Pulp . Eur J of dentistry October 2009 - Vol.3

24. Ashish patil, 2016 reported that incidence of pain after endodontic
treatment being performed in one-visit or two-visits is not significantly
different experienced by the patients 48 hours after treatment in both the
groups.
Avinash A. Patil1 , Sonal B. Joshi Incidence of Postoperative Pain after Single Visit and Two Visit Root Canal Therapy: A Randomized Controlled Trial. Journal of
Clinical and Diagnostic Research. 2016 May, Vol-10(5): ZC09-ZC12

25. There is less healing when endodontic therapy is completed in a
single visit, especially in non vital teeth.
Myth No-2

26. • In a systematic review done by C. Sathorn ,2005 found that single-visit root canal treatment
appeared to be slightly more effective than multiple visit, i.e. a 6.3% higher healing rate.
• Paredes-Vieyra J , 2012 stated that meticulously instrumented single visit root canal
treatment can be as successful as a 2-visit treatment and found that there was no significant
difference in radiographic evidence of periapical healing between 1-visit and 2-visit root
canal treatment
C. Sathorn et al, Effectiveness of single- versus multiple-visit endodontic treatment of teeth with apical
periodontitis: a systematic review and meta-analysis, International Endodontic Journal, 38, 347–355, 2005
Paredes-Vieyra J, Enriquez FJ. Success rate of single- versus two-visit root canal treatment of teeth with
apical periodontitis: a randomized controlled trial. J Endod. 2012;38(9):

27. Fabian Ocampo Acosta et al , 2018 stated that there was no significant difference in
radiographic evidence of periapical healing between single-visit and two visits root
canal treatment.
• Dorasani et al, 2013 reported that Both single-visit and multiple-visit-treated teeth healed
satisfactorily with no significant differences
Jorge Paredes Vieyra, Fabian Ocampo Acosta, Seidi Karin Nevarez Osuna (2018).
Incidence of Flare-Ups and Apical Healing after Single-Visit or two visits Treatment of
Teeth with Necrotic Pulp and Apical Periodontitis after a Two-Year Control Period. A
Randomized Clinical Trial

28. Myth No- 3
Post operative swelling is greater when endodontic therapy
is completed in a single visit.

29. • Postoperative pain or swelling are collectively described as
flare-up, which is probably one of the most concerning issues
that dentists practicing single-visit treatment mostly deal with.
• Trope defined flare up as "intolerable pain and/or swelling " .

30. According to the findings of his study:
(i) Teeth without apical periodontitis did not flare-up and
may be treated in a single visit;
(ii) Teeth with apical periodontitis but no previous root
treatment) can be treated in a single visit, with a low
probability of a flare-ups. (1.4 per cent)
(iii) Teeth with apical periodontitis which need retreatment
the flare-up rate was highest and single-visit root treatment
would be inadvisable. (13.6 per cent),

31. Krishna prasad et al in 2013, stated that ,little or no significant difference
occurred between single visit versus multi visit endodontic therapy.
ENDODONTOLOGY Volume: 25 Issue Dec 2013

32. Jorge Paredes Vieyra1 *, Fabian Ocampo Acosta2 and Seidi Karin Nevarez Osuna. Volume 4 • Issue 2 • 2018
• There was a significant difference regarding the occurrence of flare-
ups when comparing treatment cases with retreatment cases (p= 0.05).
• Moderate pain occurred in
5% of the treatment cases
16.67% of the retreatment cases.
•
This study gave evidence that a meticulously instrumentation and irrigation
performed in a single-visit root canal treatment can be as successful as a two
visits treatment

33. Myth No- 4
Canals are cleaned better ,if an antibacterial
medicament such as Ca(OH)2 'is left in the tooth.

34. • Ghoddusi ,2006 have reported that the clinical outcome of multiple-visit endodontic
treatment was better for teeth treated with the intracanal calcium hydroxide than for
those with root canals left empty.
• Despite the high alkalinity antibacterial properties of calcium hydroxide, some bacteria
species, such as E. faecalis and Candida albicans, have been found to be resistant to it.
Ghoddusi J, Javidi M, Zarrabi MH, Bagheri H. Flare-ups incidence and severity
after using calcium hydroxide as intracanal dressing. N Y State Dent J.
2006;72(4):24–28

35. • Complete elimination of bacteria is not strictly necessary, and maximum reduction of
bacteria and effective canal filling may be sufficient in terms of healing, rather than complete
eradication.
• Moreover, the tooth may also be susceptible to reinfection through the temporary filling and
dressing.
• Gesi et al 2006, stated that with proper use of aseptic operating procedures, proper
instrumentation, and filling, an inter-appointment dressing with calcium hydroxide does not
seem to influence outcome.
Gesi A, Hakeberg M, Warfvinge J, Bergenholtz G. Incidence of periapical lesions and clinical
symptoms after pulpectomy - A clinical and radiographic evaluation of 1- versus 2-session
treatment. Oral Surg Oral Med Oral Pathol Oral RadiolEndod. 2006;101:379–88.

36. Myth No- 5
Multiple-visit endodontics is safer than single-visit
endodontics, and multiple visits mean more careful
treatment.

37. • For patients at the risk of contracting bacterial endocarditis AHA recommends as
many procedures as possible during antibiotic prophylaxis.
• The small chance of a toxic reaction from medication ( analgesics, antibiotics, or
anesthetic ) is reduced by not using them repeatedly ( at multiple appointments ) an by
using a smaller dose ( enough for one appointment )
• Multiple visit treatment is more likely to cause clinicians to forget important aspects of
canal morphology and landmark.
• Clinicians are encouraged to develop three dimensional mental images of canals
during instrumentation. It is difficult to remember three dimensional images between
appointments that are week apart.

38. Amy Wai-Yee Wong 2015 Summed it up best. “Recent studies have shown
that the success rate and prevalence of postoperative pain of single-visit or
multiple-visit treatment had no significant difference. The chairside time for
single-visit treatment was shorter than multiple-visit treatment.”
Wong, A.W., Tsang, C.S., Zhang, S. et al. Treatment outcomes of single-visit
versus multiple-visit non-surgical endodontic therapy: a randomised clinical
trial. BMC Oral Health 15, 162 (2015) doi:10.1186/s12903-015-0148-x

39. Myth No- 6
Patients do not mind multiple appointments and are
likely to object to the fee if the procedure is completed
in a single visit.

40. • Aside from cost, there are two other major barriers to patients visiting the
dentist: Fear Of Pain
Time Required.
• Completing root canal therapy in one appointment limits fear of pain to one
incident and decreases the time required (the number of appointments and
total treatment time).
• Patients are more likely to, accept single-visit treatment.

41. Myth No- 7
After obturation, treating a flare-up is complicated;
therefore, treatment should not be completed at the
first appointment.

42. • Fear of a post obturation flare-up prevents clinicians from performing single-visit
endodontics, but such flareups generally are less common than inter appointment
flare-ups.
• Most flare-ups can be treated with occlusal reduction, analgesics, and antibiotics.
• In the unusual event that a problem continues, apical trephination (fistulization) can
be performed. If the canals are cleaned and filled properly, a need to remove filling
material is rare. Whether obturation is performed in a single visit or after multiple
visits, removal of gutta-percha (if necessary) usually is straight forward.

43. Adjuncts To Render Efficient And Faster
Treatment In Single Visit Endodontics:

44. Pain control
Isolation
Access cavity preperation
Light and magnification
Use of irrigants

45. • It relaxes the patient and saves time.
• It is preferable to use a long acting local anaesthetic agent.
• It also helps to control post operative pain.
• Sometimes supplemental anaesthesia is indicated along with the
standard injection.
• These includes 1. Local Infiltration
2. Intrapulpal injection
3. Intra osseous injection.
Pain Control

46. Digital Technologies In Local
Anesthesia
 Electronic Dental Anaesthesia
 Wand
Masoud Parirokh et al 2012 Stated that Patients who received bupivacaine as the
anesthetic agent for single-visit endodontic treatment of irreversible pulpitis in
mandibular molars had significantly less early postoperative pain and used fewer
analgesics than those who had lidocaine as the anesthetic.
Effect of Bupivacaine on Postoperative Pain for Inferior Alveolar Nerve Block Anesthesia after
Single-visit Root Canal Treatment in Teeth with Irreversible Pulpitis. JOE — Volume 38, Number 8,
August 2012

47. The use of the rubber dam is mandatory in root canal treatment.
The rubber dam is used in endodontics because it ensures the following:
1. Patient is protected from aspiration of instruments, tooth debris,
medicaments and irrigating solutions.
2. A surgically clean operating field is isolated from saliva, hemorrhage
and other tissue fluids.
3. Soft tissues are retracted and protected.
4. Visibility is improved.
Isolation

48. • Plastic rubber dam frames are recommended for endodontic
procedures.
• Ex- Young's Rubber Dam frame (plastic type),
The star visi frame
The Nygard Ostby ( N - 0 ) frame.
• New to endodontics is a specially designed foldable plastic frame
• The disposable handidam rubber dam system also provides a radio-
lucent plastic frame.
• The quick dam is another disposable single-isolation device with a
flexible outer ring, eliminating the need for an additional frame.

49. Access Cavity Preparation
Before access cavity preparation, Caries typically is removed early, before the pulp
chamber is entered.
The roof of the pulp chamber is best perforated with a round bur.
A. No 2 bur - anterior and premolar teeth and a
No.4 should be used in molar teeth.
B. Once the roof is perforated, A round bur, a tapered fissure bur or a safety tip diamond or
carbide bur is used
C. Tapered, Flame shaped and round ended tapered diamonds are excellent for endodontic
access..

50. An uncovering receded or calcified root canal orifice is a challenge.
• Use of low - speed smaller burs.
• These burs have an extra long, flexible shaft that allows in
visualization by the operator as the bur advances into the deeper
portions of the access preparation.
• Extended shank round burs, such as the Mueller bur(Brasseler,
Savannah, GA) are very useful for this purpose.
• To identify canal orifices and to determine canal angulation DG-16
endodontic explorer and CK-17 endodontic explorer can be used.

51. • Once the orifices have been located, they should be flared or
enlarged and blended into the axial walls of the access cavity.
• This process permits the intracanal instruments used during
shaping and cleaning to enter the canal(s) easily and effortlessly.
• Gates-Glidden burs can be used for this purpose, starting with
smaller sizes and progressing to the larger sizes.
• More recently, #.12 tapered or Sx rotary endodontic files have
been used for the flaring and blending procedure.

52. Ultrasonic unit and Tips
- An Ultrasonic unit and tips specifically designed
for endodontic procedures can be valuable aids in
the preparation of access cavities and locating
canal orifices .
- Ultrasonic systems provide excellent visibility
compared with conventional handpiece heads,
which typically obstruct vision.

53. Light And Magnification
• The use of high quality magnification in dentistry improves both the
quality and speed of treatment, hence suitable for single visit
endodontics.
• Magnification and illumination are particularly important in single visit
root canal therapy ,especially for
- Determining the location of canals,
- Negotiating constricted,
- Curved and calcified canals,
- Debriding and removing tissue and
- Calcifications from the pulp chamber.

54. • Surgical loupes, endodontic endoscopes, and DOM are
some of the commercially available instruments that can
help the clinician accomplish these goals.
• Adding a headlight to the system of surgical telescopes
significantly enhances both depth of field and magnified
resolution, greatly increasing visual activity.
• The head light provides line of straight lumination,
which is shadow less and avoids multiple adjustments to
the traditional overhead dental operating light.

55. • Dental operating microscope(DOM) is an important aid in
locating root canals, which was introduced into endodontics
to provide enhanced lighting and visibility.
• Numerous studies have shown that it significantly
improves the practitioners ability to locate and negotiate
canals.
• For example, the number of second mesiobuccal (MB-2)
canals identified in maxillary molars increased from 51%
with the naked eye to 82% with the microscope.

56. FIBRE-OPTIC ENDOSCOPE
• A recent addition to the field of visualization is a
fibre-optic endoscope designed for intra oral use.
• The Orascope uses a fiber optic probe, xenon light
source and a medical grade video monitor to
provide a magnified image of the operating field

57. Use Of
Irrigants• The concept of single visit root canal treatment is based on the
entombing theory.
• Although instrumentation of the root canal is the primary method of
canal debridement, irrigation is a critical adjunct.
• Especially in case of single visit endodontics, irrigation plays a
critical role as there is no scope of taking advantage of intracanal
medicaments.
• Irrigation serves as a physical flush to remove smear layer, debris as
well as serving as a bactericidal agent, tissue solvent and lubricant.
Shuping G, Ørstavik D, Sigurdsson A, Trope M. Reduction of intracanal bacteria using Nickel-titanium rotary instrumentation and various medications. J Endod 2000;26:751-5

58. • Of all the currently used substances, sodium hypochlorite appears to
be the most ideal.
• NaOCl is effective against endodontic microorganisms, including
those difficult to eradicate from root canals such as Enterococcus,
Actinomyces and Candida organisms.
• NaOCl solutions are used in concentrations ranging from 0.5% to
5.25%.
• Studies have shown that in warming NaOCl to approximately 60°C
(140°F) significantly increases the rate of effectiveness of tissue
dissolution.

59. Sodium hypochlorite in combinations-
• There is increasing evidence that the efficacy of NaOCl, as an
antibacterial agent is increased when it is used in combination
with other solutions such as calcium hydroxide, EDTAC or
Chlorhexidine.
• With Chlorhexidine- Kuruvilla and Kamath 1998 in a study
combined alternate use of NaOCl and Chlorhexidine gluconate
irrigants and results indicate a greater reduction of microbial
flora (84.6%) when compared with the individual use of sodium
hypochlorite (59.4%) or chlorhexidine gluconate (70%) alone.

60. • With EDTA-Goldman et al showed that the smear layer is not removed
by NaOCl irrigation alone but it is removed with EDTA.
• Ultrasonic activation of sodium hypochlorite has also been advocated,
as this would “accelerate chemical reactions, create cavitational
effects, and achieve a superior cleansing action”.

61. • It cannot dissolve inorganic dentin particles and thus prevent the formation of a smear layer
during instrumentation
• Demineralizing agents such as ethylenediamine tetraacetic acid (EDTA) and citric acid have
therefore been recommended as adjuvants in root canal therapy.
• These are highly biocompatible and are commonly used in personal care products.
• Although citric acid appears to be slightly more potent at similar concentration than EDTA,
both agents show high efficiency in removing the smear layer.

62. Procedural Sequence Of Single Visit Root Canal
Treatment
Proper restoration
obturation
Cleaning & shaping
Access opening
Radiographic
examination
Case selection

63. • To illustrate the modern endodontic procedural sequence for single
visit endodontics, an itemized sequence follows:
1. The diagnosis indicates that endodontic treatment is needed and the
tooth is anesthetized.
2. Following placement of the rubber dam, access is made.
3. Using the microscope at low to mid magnification, the pulp chamber
is thoroughly prepared using a Buc tip size 2 for inspection.
4. Under high magnification (16–24), the floor of the chamber is
examined for additional canals because more than 50% of molar teeth
have a fourth canal

64. • After the canal entrance is identified, the microscope is not needed until a
later stage. The apex is negotiated with a size 10 K file and is then
enlarged with size 15 or 20 files.
• Gates–Glidden burs are used in reverse order to enlarge the coronal
onehalf or two thirds using the crown down technique.
• During this enlargement, it is important to use irrigants (2.5%–5% sodium
hypochlorite and 17% EDTA solution) to penetrate deep into the canals.

65. • An apex locator is used to determine the canal length at this stage.
• Crown down pressureless technique is used for shaping and
cleaning with rotary and hand instrumentation combined.
• The microscope is used to check the preparation and to check
again for an additional canal or canals.
• A master gutta percha cone is selected; the canal length and solid
‘‘tug back” is assured

66. • This master cone, coated with root canal cement, is inserted into the canal, and
the coronal part of the point is seared off using System B.
• The gutta percha in the apical 3 to 4 mm is packed with S-Kondensers.
• The Obtura gutta percha compactor with an appropriate tip is inserted into the
canal up to where the master gutta percha was seared off. The thermoplasticized
gutta percha fills the canal as the tip is slowly withdrawn.
• The microscope is used again for a final check. Finally, the canal is sealed with
temporary cement.

67. • The incidence of mishaps was 7% in teeth treated in a single visit,
and
the incidence increased significantly to 16.2% and 28.3% for teeth
treated
in two and three visits, respectively.
• Single-visit treatment was significantly correlated with fewer
mishaps
Int J Dent Oral Health 2(9), 2016

68. Gamze Topcuoglu , 2016 describe 3 successful single-visit regenerative
endodontic therapy cases using Biodentine and PRP as a scaffold
material in 3 mandibular permanent molar teeth, all asymptomatic
with necrotic pulp.
• And he concluded that a single-visit regenerative endodontic
procedure may be a favorable treatment option for an asymptomatic
immature tooth with a necrotic pulp and no periapical lesion.

69. Chung et al 2019, reported that among patients with intellectual and
cognitive disabilities, the periapical health of endodontically treated teeth
was maintained throughout the observation period ( 56 months).
• Single-visit endodontic treatment under GA is applicable, especially
when a diseased tooth needs to be retained as a strategic priority
JOE — Volume 45, Number 2, February 2019

70. Richard B , 1988 evaluated the incidence of failure following single-visit endodontic
therapy and reported that the endodontic failure rate was found to be 5.2%.
• No significant difference was found between the tooth groups; however,
significant differences were found among the problem code groups (teeth with
pulpal pathosis, teeth with periapical extension of pulpal disease, endodontic
retreatments, and intentional devitalization cases).
• Also, the incidence of failure was higher in those teeth with periapical extension of
pulpal disease which had no prior access opening.
VOL. 12, NO. 2, FEBRUARY 1988

71. Conclusion

72.  With the advent of technological advancement and emergence of new gadgets,
evidence based dentistry and more scientific deliberations and the concept of
maximum dentistry in minimum visits led to a resurgent impetus towards
laying down of various protocols to enable dentists to venture into single visit
endodontics with reasonable level of outcome.
 Single visit root canal treatment versus the multiple visit root canal treatment
has been the subject of a long standing debate within the dental community,
when the clinicians are faced with choices of which treatment should be offered
to patients, the central issues that should be considered are effectiveness,
complication, cost and probably patient /operator satisfaction

73.  Careful case selection and proper and thorough
adherence to standard endodontic principles, with no
shortcuts, should result in successful one-appointment
endodontics. Practitioners should attempt one-visit root
canal treatment only after making an honest assessment
of their endodontic skills, training, and ability

74. Thank You