Same Visit Obturation

Until recently the most accepted technique of doing endodontic treatment stresses multiple visit procedures. Most schools also concentrated upon teaching the multivisit concept. However, it has now been reported that the procedure of single visit treatment is advocated by at least 70% of schools in all geographical areas.

Some of the problems of root canal treatment are post-obturation pain, interappointment pain and swelling. Although these in most cases do not last long, but could be a source of embarrassment to the dentist and annoying for the patient, more so if the tooth was symptomless before the commencement of treatment.

Literature review revealed varied opinions on the incidence and severity of postobturation pain. Some authors reported slightly more post-obturation pain following single visit than with multiple visit procedures. Others found no significant differences in the post-obturation pain experienced by patients following single or multiple visit treatment procedures. Some authors however, proposed a correlation between pretreatment pain and post-obturation discomfort. The rate of endodontic flare-ups was reported to be more following multiple visits than for the single visit.

Some studies have reported a positive correlation between flare-ups and multiple appointments, peri-radicular pain prior to treatment and presence of radiolucent lesions. Others reported no correlation between post-obturation flare-ups and the status of the pulp. However, few reported a significantly higher incidence of flareups in necrotic teeth than in vital teeth. One study showed that female patients had more post-operative pain than did males. Factors of age, bacteriologic status, tooth position and type of filling material showed no clear effect upon postoperative results.

Three contradictions exist in completing a root canal treatment in one appointment:

A) Inability to dry the canals completely.

B) Insufficient time to complete the procedure.

C) Increased psychological stress on patients or clinicians because of longer appointment time, or both.

Now the question is what should you do?

What is the hurry? It is best to start with a multiple visit endodontic treatment. It takes many cases for you to develop your confidence in root canal treatment. 2-3 cases of post obturation tenderness in 2-3 days of time can very well shake your confidence and patient's moral to under go the treatment or to recommend to any one else.

If you can follow the complete protocol of root canal treatment including use of rubber dam, use of apex locater, engine driven rotatory with autoclaved files and spend good amount of time in bio-mechanical preparation and obturation, you may think of a single sitting root canal treatment.