This document discusses the rationale for multiple visit endodontic treatment. It notes that multiple visits allow time for symptoms like pain to lessen, and for doctors to assess teeth with doubtful prognoses. Multiple visits also allow for positive effects of intracanal medications and avoid time constraints. Indications for multiple visit treatment include acute symptoms, retreatment cases, complex cases, trauma cases, non-vital teeth, chronic lesions, cases where canals cannot be dried, and patients with TMJ disorders. The document reviews literature finding lower flare up and post-obturation pain rates with multiple visits compared to single visits. It concludes that multiple visits are more effective at eliminating bacteria and endotoxins than single visits.

1. Prof Dr Sunil M Eraly
Head of Department
Conservative Dentistry and Endodontics
Malabar Dental College and Research Centre

4. • Most commonly
followed & traditionally
accepted protocol

5. Debridement & neutralization of any tissue, bacteria,
or inflammatory products within the root canal
system (GUTMANN)

6. Why multiple visit endodontics???
Allow time for lessening of
symptoms such as pain

7. Why multiple visit endodontics???
Tooth with doubtful prognosis can
be easily assessed
Positive effects of the intra canal
medicaments during appointments

8. Why multiple visit endodontics???
Patient or doctor time constraints

9. Indications
 Tooth with acute symptoms

10. Indications
 Retreatment cases

11. Indications
 complex cases requiring significant
time commitment

12. Indications
 Endodontic therapy following
trauma

13. Indications
 Non vital teeth & acute
inflammation

14. Indications
 chronic periapical
lesions

15. Indications
 Root canals that cannot be dried due
to persistent apical exudates

16. Indications
 Patients with TMJ disorders

17. Steps in multiple visit
endodontics
Access opening &
cleaning & shaping
Intracanal
medicament
placement
Obturation & post
endodontic
restoration

18. • Allows to determine the effect of therapy
on inflamed tissues
• Shorter initial visit for the emergency
patient
• Thorough disinfection of root canals

19. • No time restraints and fatigue for both
the clinician and the patient
• When flare-ups occur during multiple-
visit procedures, they can be addressed
prior to obturation.

20. Review of literature
• Flare ups in single-visit group at a rate of 18.3% and
in the multiple-visit group at 8.1%.
• Higher incidences for postobturation pain  single-
visit treatment (Oginni and Udoye, 2004)

21. Review of literature
• Multiple-visit root canal treatment was more
effective in completely eliminating pain than
was single-visit treatment of previously
symptomatic teeth. (Yoldas et al, 2004)

22. Review of literature
• More post operative pain for single visit
endodontics. (Wong et al,2014)

23. Review of literature
• Swelling appeared to be less common with
multiple-visit RCT than with single-visit
RCT
(Figni et al,2008)

24. Review of literature
• Both single-visit and multiple-visit
endodontic treatment were effective in
reducing bacteria and endotoxins. Two visits
were more effective than one visit in
reducing endotoxins. (Xavier et al, 2014)

25. “You can convince everyone to do one
appointment Endodontics, the hard thing
is to convince bacteria to die in 2 hours.”
Rinaldo Mattar, Ricardo Affonso Bernardes

26. THANK YOU