this presentation includes the advantages as well as disadvantages of single and multiple visit endodontics

1. SINGLE VISIT VS MULTIPLE VISIT
ENDODONTICSENDODONTICS
DR MEENAL ATHARKAR
MDS
DEPT OF ENDODONTICS AND CONSERVATIVE DENTISTRY

2. Introduction
Definition
History
 Guidelines -Oliet’s criteria for case selection
Indications of single – Visit.Indications of single – Visit.
 Contra Indications of single – visit
Advantages of Single – Visit. Disadvantages of
Single – Visit
Patient Consent –
Systemic evaluation
and - Premeditation

3. CONTENTS
 Bio-Mechanical Techniques used
- The crown –down pressure less technique (Marshall
and Papin 1980),
- The step down technique (Goerig et al 1982),- The step down technique (Goerig et al 1982),
- The preflaring technique (Gerstein 1983),
- The double flare technique (Fava 1983) and
- The reverse flaring technique (Weine 1989). •
 Use of ultrasonics •
 Endox® Endodontic System

4.  Post-operative pain and Flare-ups
 Success rates and failures
 Survey results
One vs. Several visits One vs. Several visits

5. DEFINITION
 Single visit endodontic therapy is defined as the
conservative ,non surgical treatment of an
endodontically involved tooth consisting of complete
biomechanical preparation and obturation of the rootbiomechanical preparation and obturation of the root
canal system in one visit.

6. Guidelines for single – Visit Endodontics
 Success in endodontic therapy is based on –
o Accurate diagnosis
o Proper case selection
o Use of skilled techniques of treatmento Use of skilled techniques of treatment
These procedures are based upon known biological
principles incorporated into the technique triad,
specifically
o Biomechanical preparation of the root canal
o Debridment and disinfection
o Complete obturation of the root canal

7. Oliet’s criteria for case selection include
 Positive patients acceptance.
 Sufficient available time to complete the procedure
properly.
 Absence of any acute symptoms requiring drainage via Absence of any acute symptoms requiring drainage via
the canal and of persistent continuous flow of
exudates or blood.
 Absence of anatomical obstacles like
 calcification in the canals, and
 procedural difficulties (ledge formation, blockage,
perforation, inadequate fills)

8. Indications for single – visit
 Uncomplicated vital or non vital teeth preferably.
 Fractured anterior or bicuspid teeth where esthetics is a
concern and temporary post and crown are required.
 Patients who are physically unable to return for the Patients who are physically unable to return for the
completion.
 Patients with heart value damage or prosthetic implants
who require repeated regimens of prophylactic antibiotics .
 Necrotic, uncomplicated teeth with draining sinus tracts .
 Patients who require sedation or operating room
treatment.

9. Contra – Indications for Single – visit
 Painful, necrotic tooth with no sinus tract for drainage.
 Teeth with severe anatomic anomalies or cases with
procedural difficulties.
 Asymptomatic nonvital molars within periapical Asymptomatic nonvital molars within periapical
radiolucencies and no sinus tract.
 Patients who have acute apical periodontitis with
severe pain on percussion.
 Most of the re-treatment cases.

10. Advantages of single visit.
 It reduces the number of patient’s appointments while
achieving predictably high levels of success and
patients comfort.
 It eliminates the chance for inter appointment It eliminates the chance for inter appointment
microbial contamination and flare-ups caused by
leakage or loss of the temporary seal.
 For anterior cases it allows immediate use of the canal
space for retention of a post, and construction of an
esthetics temporary crown

11.  Allows the practitioner to prepare and fill the canals at
the same appointments without the need for the
clinician’s refamiliarization with the canal anatomy at
the next visit.the next visit.
 It minimizes fear and anxiety in the apprehensive
patients.
 It eliminates the problem of the patient who does not
return to have their case completed.

12. Disadvantages of Single – Visit.
 The longer single – visit appointment may be tiring
and uncomfortable for the patient. Some, patients
especially with TMJ disfunction or other impairments
may not be able to keep their mouth opened long
enough for a single – appointment procedure.enough for a single – appointment procedure.
 Flare-ups cannot be easily treated by opening the
tooth for drainage.
 if hemorrhage or exudation occurs, it may be difficult
to control that and to complete the case at the same
visit, and if it doesn’t stop after pulp extirpation also,
then better to go for multiple – visit.

13.  Difficult cases with extremely fine, calcified, multiple
canals may not be treatable in one appointment
without causing under stress for both the patient and
the clinician.the clinician.
 The clinician may lack the expertise to properly treat a
case in one visit. This could result in failures, flare up
etc.

14. PATIENT CONSENT
 The patient should accept the proposed single appointment
procedure - desired co-operation.
SYSTEMIC EVALUATION AND PREMEDITATION : •
 A history of Myocardial infarction within the past six months is A history of Myocardial infarction within the past six months is
contraindicated for elective dental treatment. These patients
should be treated with a stress reduction protocol which
includes short appointments ,psycosedation and pain and
anxiety control.
 Patients with a history pf Rheumatic heart disease should be
premeditated with amoxicillin ,erythromycin or clindamycin, as
per the current “American heart association guidelines”

15. TECHNIQUES FOR CLEANING AND SHAPING USED IN SINGLE – VISIT
 Cleaning and shaping of root canal system is
considered to be most important step for endodontic
therapy. The introduction of canal preparation
techniques that focus on the flaring of the canal wallstechniques that focus on the flaring of the canal walls
has significantly influenced this phase of root canal
treatment, however some disadvantages have also
been reported. One of these is extrusion of material
beyond the apical foremen.

16.  Some of the techniques involved are
 The crown –down pressure less technique (Marshall
and Papin 1980),
 The step down technique (Goerig et al 1982), The step down technique (Goerig et al 1982),
 The preflaring technique (Gerstein 1983),
 The double flare technique (Fava 1983)
 and The reverse flaring technique (Weine 1989)
These technique were designed following a series of
findings that established the basic principles which are
as follows.

17.  Removal of dentin interferences at the canal orifice
and cervical third, resulting in more direct access to
the middle and apical thirds.
 Neutralization and removal of pulp contents from the
cervical third before the preparation of middle and
apical thirds.

18. USE OF ULTRASONICS IN SINGLE – VISIT
 Ultrasonics is relatively new in our endodontic
armentarium, yet a multiplicity of uses have already
been described. Recent studies have shown ultrasonics
to be superior in debriding the root canal system whento be superior in debriding the root canal system when
compared with hand instruments. The irrigating
solution used with ultrasonics was sodium
Hypochlorite 2.5%.
J. Of endodontics : 1987

19.  The ultrasonics used with small file held free of the
canal walls, warms the solution in the canal and
resonant vibrations cause movement of aqueous
irrigants an effect called Acoustic streamingirrigants an effect called Acoustic streaming

20. POST OPERATIVE PAIN AND FLARE UP IN SINGLE VISIT ENDODONTICS
 There is a ‘myth’ that single visit endodontic treatment
causes more post operative discomfort and flare up
rates to the patients. Most studies show that single
visit root canal procedures produce no more pain thanvisit root canal procedures produce no more pain than
multiple visit ones.
 In 1970, Fox and co-workers have found that only
7% single visit cases reported of severe pain in 24
hours. They found that 90% of the teeth were free of
spontaneous pain after 24 hours.

21.  The factors that can reduce the incidence of flare-ups,
pain and swelling are
– Single visit treatment should be combined with
prophylactic antibiotics (Penicillin V or erythromycin).prophylactic antibiotics (Penicillin V or erythromycin).
– Intentional over instrumentation of root into the
approximate center of the bony lesion reduces the
prevalence of flare ups from about 20% to 1.5%. J. of
Endodontics : 1980

22.  These techniques should be followed for all single visit
appointment non vital cases without sinus tracts.
 Moderate over instrumentation past the apex of non
vital cases has long been thought, to increase thevital cases has long been thought, to increase the
likelihood for drainage and relief of pressure.
 However, over instrumentation for vital cases should
be avoided because it crushes tissues and produces
pain and inflammation.

23. SUCCESS RATES AND FAILURE OF SINGLE VISIT
 Prognostic studies have shown that there is no
substantial difference in the success rate of single and
multiple appointment cases. Alkenaz claimed that
single appointment root canals succeeded 97% of timesingle appointment root canals succeeded 97% of time
comparable to multiple visit.

24.  Determination of success or failure has been based
primarily on radiographic interpretation. But, there
are many shortcomings of utilizing the radiographs as
the sole means to determine success and failure. Tothe sole means to determine success and failure. To
avoid failures, in this study the patients who were
treated for single visit were given Anti-inflammatory
and Anti-biotics
J. of Endodontics : 1983.

25.  When the presently available best regimens of treating
infected root canals are used, about one-third remain
infected after one treatment. The number of
remaining bacterial cells is then often small, in theremaining bacterial cells is then often small, in the
range of 102 to 104 cells (Sjögren et al.,1991, 1997;
Dalton et al., 1998; Shuping et al., 2000).
 Despite these small numbers, the effect on outcome
can be significant (Sjögren et al., 1997).

26.  Other clinical studies suggest that the rate of
successful treatment outcome will decrease if the
treatment is concluded with a root filling before the
root canal is free of micro-organisms. Such data areroot canal is free of micro-organisms. Such data are
available from both prospective (Sjögrenet al., 1997)
and retrospective studies (Engström et al., 1964;Heling
and Shapira, 1978).

27. It is presently unknown if the numbers or types of
micro- organisms remaining at the time of root filling
may modify this conclusion. Therefore, if root canal
disinfection remains the goal, the treatment of a toothdisinfection remains the goal, the treatment of a tooth
with an infected necrotic pulp may require at least a
two- visit procedure.

28. CONCLUSION
 “Maximum dentistry in minimum visits” has been the
rule in modern dental practice.
 The success of endodontic therapy is dependent upon The success of endodontic therapy is dependent upon
meticulous attention and detail .a one visit root canal
treatment is attractive to a patient because it saves
time ad probably reduces cost.