Download evaluation of single and multiple visit root canal therapy

CLINICAL DENTISTRY AND RESEARCH 2012; 36(3): 59-63
EVALUATION OF SINGLE AND MULTIPLE VISIT ROOT CANAL
THERAPY: A RANDOMIZED CLINICAL CASES
Zeliha Yılmaz, DDS, PhD
Department of Endodontics,
Faculty of Dentistry, Hacettepe University,
Ankara, Turkey.
ABSTRACT
The purpose of this case report series was to evaluate the
radiographic healing of teeth with periradicular disease
treated in single-visit or multiple-visits with an inter-
H. Özgür Özdemir, DDS, PhD
appointment dressing of Ca(OH)2. A randomization procedure
Private Practice, Ordu, Turkey
allocated five teeth in single-visit treatment and five teeth in
multiple-visit treatment in Hacettepe University, Faculty of
Ömer Görduysus, DDS, PhD
Dentistry, Department of Endodontics. The medical histories
Professor, Department of Endodontics,
of the patients were noncontributory and the patients
Faculty of Dentistry, Hacettepe University,
were asymptomatic at the time of treatment. The cases
Ankara, Turkey
were completed by the same endodontist and evaluated
radiographically as long as two year by three months intervals.
The patients reported no symptoms at the end of the first year
in both groups. The results were similar to healing of periapical
radiolucency between teeth that were treated in single-visit
and multiple-visit with inclusion of Ca(OH)2. If the cleaning and
shaping procedures are completed efficiently, good results may
be observed in a single visit treatment.
Correspondence
Zeliha Yılmaz, DDS, PhD
Department of Endodontics,
Faculty of Dentistry,
Hacettepe University,
06100 Sıhhıye, Ankara, Turkey.
Phone: +90 312 3052260
Fax: +90 312 3104440
Key words: Calcium Hydroxide, Root Canal Treatment,
Single-Visit
E-mail: [email protected]
Submitted for Publication: 10.05.2011
[email protected]
Accepted for Publication : 05.14.2012
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CLINICAL DENTISTRY AND RESEARCH
INTRODUCTION
Endodontic therapy essentially is directed toward two
specific aims; to create an environment for good favorable
healing eliminating bacteria from the infected root canal
system and prevents apical periodontitis.1 A growing
perception in endodontic circles is that endodontic therapy
requires single-visit treatment only. However the number of
visit to treat infected root canals is the most controversial
issues in endodontics.2 Generally patients are requesting
that their endodontic therapy is being completed in a
single-visit. Treatment in single-visit certainly has many
advantages to the both clinician and patient. It is less timeconsuming, resulting in less cost for the patient, less painful
and less traumatic than multi-visit treatment. And also it
may prevent the risks of contamination or recontamination
of the root canal system.3 In addition, numerous studies have
shown that postoperative pain is lower when the treatment
is performed in single-visit.4-6 The fact that some dentists
object to single-visit therapy from the point of infection
control, flare-ups and besides all those lack of possible
pain control procedures after the single-visit root canal
treatment and lack of the possibility for inter-appointment
dressings and their benefits. However, some practitioners
perform endodontic procedures in multiple-visit.
It is generally believe that remaining bacteria can be
eliminate or be prevented from repopulating by introducing
an inter-appointment dressing such as calcium hydroxide
(Ca(OH)2) in the root canal.7,8 Therefore, if the pulp is
necrotic and/or associated with periradicular disease, the
root canal system is infected, in these cases, the root canal
system should ideally be cleaned, placed the intra-canal
medication, and then the canal should be filled at multiplevisit.7,9 However it has been shown that Ca(OH)2 fails to
consistently produce sterile root canals and even allows regrowth in some cases.10 Thus root canal treatment with an
inter-appointment Ca(OH)2 dressing gives no guarantee of
healing in all cases.11,12
The purpose of this case report series was to evaluate the
radiographic healing of teeth with periradicular disease
treated in single-visit or multiple-visits with an interappointment dressing of Ca(OH)2.
CASE REPORTS
The experimental study was conducted on ten adult
patients aged between 25 and 35 years who were referred
to the Hacettepe University, Department of Endodontics,
60
Turkey, for endodontic treatment. During the first visit,
ethical approval was requested and granted, and informed
consent was obtained from all patients. The diagnosis was
confirmed by clinical and radiographic examinations. The
clinical findings include necrotic and/or associated with
periradicular disease, negative response to the pulp tests
(electrical and cold), and without swelling or any symptoms
were recorded along with the date of the treatment of the
affected tooth. In the radiographic finding, the teeth which
had got chronic apical lesion were selected.
Each tooth was cleaned of plaque, calculus and attachments.
All decay and unsupported tooth structure were removed,
canal orifices were localized after access cavity preparation
and the working length was established radiographically.
Both of root canals in group single- visit and group multiplevisit were prepared between size ISO #40 and #60 with
step-back technique, depending on size of the root. The
canals were irrigated with 0.5 ml 2.5% NaOCl after each
file. Chemo-mechanical preparation was completed at the
same appointment in all cases. After the instrumentation,
5 ml 2.5 % NaOCl was applied as a final flush then the
each canal was dried by using sterile paper point (Spident,
Incheon, Korea). After chemo-mechanical preparation, for
the single-visit group, the canals were obturated with
gutta-percha (Diadent, Seoul, Korea) and AH 26 root canal
sealer (Dentsply Detrey, Konstanz, Germany) using cold
lateral compaction technique.
For the multiple-visit group, root canals were filled with
Ca(OH)2 (SURE-Paste, Korea) in the first visit. Ca(OH)2 paste
was placed in the canals by means of lentulo spiral filler and
packed with a cotton pellet at the level of canal entrance.
A radiograph was taken to ensure proper placement of
the paste in the canal. Then the access cavities were filled
with at least 4 mm thickness of a temporary filling material
(Nucavfil; PSP Dental, Belvedere, Kent, UK). The second
appointment was scheduled for one week thereafter for
multiple-visit teeth. At this time, the toot isolated with
rubber-dam, the operative field disinfected. Ca(OH)2 paste
rinsed out of the canal by using 2.5% NaOCl and master
apical files. After the removing of Ca(OH)2 paste, 5 ml 2.5%
NaOCl was applied as a final flush. Subsequently, the canals
were filled with gutta-percha and AH 26 root canal sealer
using cold lateral compaction technique. The tooth was
temporized with glass ionomer cement and a permanent
restoration planned.
Single and multiple-visit root canal treatment
Radiographic Assessments and Follow-up
DISCUSSION
The pre/postoperative periapical radiographs were taken
using an x-ray machine (Prostyle- Intra, Planmeca, Helsinki,
Finland) and radiovisiography (Hilux xraymax, Benlioglu,
Ankara, Turkey). All radiographs were evaluated two years
postoperatively under optimal conditions where the
surrounding light could be controlled for the best possible
radiographic contrast (Figures 1 and 2). The size of periapical
radiolucency was assessed by measuring with a ruler (to the
nearest millimeter) its largest horizontal and vertical width.
Apical periodontitis is an inflammatory disease of microbial
etiology caused by infection of the root canal system.13
The major aim of the root canal treatment is prevent to the
apical periodontitis or treat to existing apical periodontitis.
The healing of apical periododontitis are affected some
factors such as different regimes of endodontic treatment,14
systemic disorders15 and the microbial factors.16 Apical
periodontitis is caused by bacteria within root canals.17
It is widely accepted that reducing the bacterial count in
Figure 1. Pre/post-operative radiographs in single-visit treated root canals.
Figure 2. Pre/post-operative radiographs in multiple-visit treated root canals.
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CLINICAL DENTISTRY AND RESEARCH
infected root canals is accomplished by a combination of
mechanical instrumentation, various irrigation solutions,
and antibacterial medicaments or dressings placed into
the canal. Ca(OH)2 is the most widely used intra-canal
dressing material in endodontics due to its antibacterial
and biological properties.18 However it has been shown
that Ca(OH)2 is not always effective and that it is action is
unreliable in the some studies.19-21 In this present study, a
randomization procedure allocated five teeth to single-visit
treatment and five teeth to multiple-visit treatment. At the
end of the study period, the present study gave evidence
that similar healing results might be obtained through
single-and multiple-visit treatment in the radiographic and
clinical evaluations. The probability of success increased
continuously over time for both treatment groups. Similar
to the result of our study, there are some reports show
that the healing potential of teeth that treated in single or
multiple visits with placement of Ca(OH)2 dressing appear
similar.12,22,23 Other studies evaluating the healing of teeth
with necrotic pulps, the success rate was between 75% and
90% for both one and two visit root canal treatment.24-26
In the literature base the controversies about number of
visiting still not concluded. Those controversies generally
have been focused on the applications efficiencies, their
advantages and disadvantages and also chair-side time,
possible complications and outcomes of treatment.
However, recently the single-visit root canal therapy became
more popularized clinically. It has been stressed that the
case selection and accurate diagnosis are important factors
for single visit treatment by most authorities. It is believed
that the vital teeth with either a mechanical or traumatic
pulp exposure are indicated for single visit treatment, while
necrotic pulps with periapical pathosis or acute symptoms
are contraindicated for single visit treatment.27 In these
clinical cases serial, we treated five teeth with necrotic
pulps and without acute symptoms in single visit.
The healing of periapical lesions can be established by
radiographic, clinical and subjective measures. Long term
healing was based mainly on the radiographic appearance of
a periapical lesion. Under this condition, evaluation methods
very depend on the investigator’s visual perception. Most
of the studies comparing the success rate of endodontic
therapy performed in single or multiple visits have been
poorly defined criteria of evaluation.28 In this study it was
not defined criteria for evaluation of apical periodontitis.
The size of periapical radiolucency was assessed by
62
measuring with a ruler in the periapical radiographs and the
clinical examination also was performed intraoral. Pekruhn29
concluded that there were significantly fewer failures in the
multiple-visit treatment than in the single-visit treatment
group. As in our study, this study used the undefined criteria.
The study by Trope et al.12, the well-controlled study, it was
investigated radiographic healing of teeth with periradicular
disease treated in single or multiple visit. In the multiple
visit group root canals were medicated with Ca(OH)2 for
at least one week. After one year follow up evaluation the
additional disinfecting action of Ca(OH)2 resulted in a 10%
increase in healing rates.
CONCLUSION
Within the limitations of this study, the results were similar
to healing of periapical radiolucency between teeth that
were treated in single and multiple-visits with inclusion of
Ca(OH)2. Indeed, if the cleaning and shaping procedures are
completed efficiently, good results may be observed in a
single visit treatment.
REFERENCES
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CLINICAL DENTISTRY AND RESEARCH
Erratum
Görduysus MÖ, Yılmaz Z, Görduysus M, Kaya C, Gülmez
D, Emini L, Hoxha V. Bacterial Reduction in Infected Root
Canals Treated with Calcium Hydroxide Using Hand and
Rotary Instrument: An In-vivo Study. Clinical Dentistry and
Research 2012;36(2):15-21.
Page 17. In the first paragraph of results section last two
sentenced should be replaced by the following:
“Most observed aerobic bacteria were alpha hemolitic
streptococci with a ratio of 30.8%. Most observed anaerobe
bacteria species was Veillonella spp with a ratio of 22.9%.”
Page 18. Table 1 sholud be replaced by the following table:
Table 1. The total distribution of bacterial types in the first visit and second visit
Aerobic bacteria
Patient
Cfu
Prevalance
n
%
Alpha hemolytic streptococci
39.96
270600
30.760484
Coagulase negative staphylococci
29.14
420800
47.83449
Neisseria spp.
14.54
10400
1.182221
Diphtheroids
5.46
24100
2.73957
Other
10.90
153800
17.48323
Total
100
879700
100
Anaerobic bacteria
Patient
Cfu
Prevalance (%)
64
n
%
Veillonella spp.
34.70
16870
22.86837
Actinomyces spp.
8.69
6000
8.13388
Fusobacterium spp.
13.17
8200
11.13563
Eubacterium limosum
4.34
10000
13.55565
Peptostreptococcus spp.
8.69
11500
15.58899
Bacteroides capillosus
4.34
5000
6.777823
Prevotella spp.
4.34
5300
7.184492
Other
21.73
10900
14.77565
Total
100
73770
100