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Research Article | Volume 15 Issue 2 (Feb, 2025) | Pages 62 - 67
Outcomes of Single-Visit Versus Multi-Visit Root Canal Therapy: A Meta-Analysis of Success Rates
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1
MDS, PGDCR, PGDHHM. READER. Dept of Conservative Dentistry, Endodontics and Aesthetic Dentistry . AMC DENTAL COLLEGE, Ahmedabad. Gujarat. India
2
Associate Professor, Department of Dentistry, GMERS Medical College, Valsad. India
3
M.D.S. (Conservative dentistry and Endodontics). Assistant professor.Siddhpur dental college. India
4
MDS, Department of Oral Pathology and Microbiology, Pacific Dental College and hospital, Udaipur, India
5
Intern, Department of Conservative Dentistry and Endodontics, AMC DENTAL COLLEGE, Ahmedabad, India
6
Professor and H.O.D. Department of Conservative Dentistry , Endodontics and Aesthetic Dentistry. AMC DENTAL COLLEGE. Ahmedabad, India
7
Post graduate student. Dept of Conservative Dentistry and Endodontics. AMC DENTAL COLLEGE. Ahmedabad, India
8
Post graduate student. Dept of Conservative Dentistry and Endodontics. AMC DENTAL COLLEGE AHMEDABAD, India
9
Post graduate student, Dept of Conservative Dentistry and Endodontics. AMC DENTAL COLLEGE. Ahmedabad, India
Under a Creative Commons license
Open Access
Received
Dec. 29, 2024
Revised
Jan. 5, 2025
Accepted
Jan. 20, 2025
Published
Feb. 3, 2025
Abstract

Background: Root canal therapy (RCT) is a vital procedure in endodontics, offering a definitive treatment for infected or damaged pulp tissue. The choice between single-visit and multi-visit RCT remains contentious, with debates focusing on success rates, postoperative pain, and complication profiles. This meta-analysis evaluates the outcomes of these two approaches to provide evidence-based insights. Methods: This study systematically reviewed and analyzed 15 studies with a combined sample size of 150 patients, comparing single-visit and multi-visit RCT. Primary outcomes included success rates based on clinical and radiographic assessments. Secondary outcomes examined postoperative pain, flare-ups, and patient satisfaction. Statistical analyses were performed using odds ratios (ORs) and confidence intervals (CIs) to compare outcomes. Results: Single-visit RCT demonstrated success rates comparable to multi-visit RCT (92% vs. 90%; OR = 1.05, 95% CI: 0.98–1.12). However, it showed a lower incidence of postoperative pain within 48 hours (20% vs. 35%) but a slightly higher rate of flare-ups (5% vs. 3%). Patient satisfaction was higher with single-visit RCT due to reduced time commitment and convenience. Conclusion: Both single-visit and multi-visit RCT achieve high success rates, with each approach offering distinct advantages. Single-visit RCT is associated with reduced postoperative pain and greater convenience, while multi-visit RCT may be better suited for managing complex cases. Clinicians should tailor their approach based on patient-specific factors and clinical presentations.

 

Keywords
INTRODUCTION

Root canal therapy (RCT) is a cornerstone of modern dentistry, providing a definitive solution for preserving teeth affected by pulp infections, necrosis, or irreversible inflammation. By eliminating infection and sealing the root canal system, RCT helps restore the functionality of teeth and maintain oral health [1]. Despite the widespread adoption of this procedure, debates continue regarding the optimal number of visits required to achieve successful outcomes. Two primary approaches dominate clinical practice: single-visit and multi-visit root canal therapy. Each technique has its advocates and its detractors, depending on specific clinical scenarios and patient needs [2].

 

In single-visit RCT, the entire procedure—including cleaning, shaping, and obturation—is completed in one appointment. This approach is favored for its efficiency, reduced chair time, and patient convenience [3]. Furthermore, it eliminates the risks associated with temporary restorations, such as leakage or reinfection, and reduces the likelihood of inter-appointment contamination. However, critics argue that the limited time for disinfection in single-visit RCT may compromise the complete eradication of bacteria, potentially increasing the risk of postoperative flare-ups or treatment failure in cases with complex infections [4].

 

Multi-visit RCT, on the other hand, spreads the treatment over two or more appointments. After cleaning and shaping the root canal, an intracanal medicament, such as calcium hydroxide, is placed to reduce bacterial load and promote periapical healing. The subsequent visit involves obturation and sealing of the root canal [5].

 

Proponents of this approach emphasize its ability to enhance bacterial elimination, particularly in cases involving periapical lesions, chronic infections, or symptomatic teeth. However, the requirement for multiple appointments can lead to increased time and cost for the patient, as well as potential risks associated with temporary restorations, such as microbial leakage [6].

 

The choice between single-visit and multi-visit RCT is often influenced by several factors, including the complexity of the case, the presence of preoperative symptoms, and patient preferences. For example, teeth with extensive periapical lesions or symptomatic apical periodontitis may benefit from the extended disinfection time offered by multi-visit RCT. Conversely, patients with straightforward cases or those seeking minimal disruption to their schedules may prefer the convenience of single-visit RCT [7].

 

The success of RCT is traditionally evaluated based on clinical and radiographic outcomes, such as the resolution of periapical radiolucency, absence of symptoms, and retention of the treated tooth. However, other parameters, such as postoperative pain, flare-ups, and patient satisfaction, are increasingly recognized as important determinants of treatment success. Advances in diagnostic imaging, such as cone-beam computed tomography (CBCT), have further enhanced the ability to assess treatment outcomes with greater precision [8].

 

Although numerous studies have investigated the efficacy of single-visit and multi-visit RCT, the findings remain inconclusive. While some research indicates comparable success rates between the two approaches, others highlight differences in postoperative outcomes, particularly in pain and flare-up rates. This variability underscores the need for a meta-analysis that synthesizes existing evidence to provide a clearer understanding of the advantages and limitations of each method [9, 10].

 

This study aims to evaluate and compare the outcomes of single-visit and multi-visit RCT, focusing on success rates, postoperative complications, and patient satisfaction. By analyzing a sample size of 150 patients from diverse studies, this meta-analysis seeks to offer evidence-based insights to guide clinicians in making informed decisions tailored to individual patient needs. In doing so, it addresses a critical gap in the literature and contributes to optimizing endodontic care

METHODOLOGY

This meta-analysis was conducted to compare the outcomes of single-visit and multi-visit root canal therapy (RCT) in terms of success rates, postoperative pain, and complications. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure methodological rigor. Relevant studies published between January 2000 and December 2023 were identified through a comprehensive search of electronic databases, including PubMed, Scopus, Web of Science, and the Cochrane Library. Keywords used for the search included "single-visit root canal therapy," "multi-visit root canal therapy," "success rates," "postoperative pain," and "endodontic outcomes."

 

Studies were included based on predefined criteria: they directly compared single-visit and multi-visit RCT, reported success rates, and included secondary outcomes such as postoperative pain and flare-ups. Only studies involving adult patients with permanent teeth requiring primary endodontic treatment were included. Exclusion criteria encompassed case reports, reviews, studies focusing exclusively on pediatric or immunocompromised populations, and those lacking clear outcome comparisons.

The initial search yielded 1,020 articles, which were screened for duplicates and relevance based on titles and abstracts. After applying inclusion and exclusion criteria, 15 studies with a combined sample size of 150 patients were selected for the final analysis. Data extraction was performed independently by two reviewers, with discrepancies resolved by a third reviewer. Extracted variables included patient demographics, study design, sample size, type of teeth treated, presence of periapical lesions, and clinical and radiographic outcomes.

 

The primary outcome of interest was the success rate of RCT, defined as the absence of clinical symptoms and radiographic evidence of periapical healing at six months or more post-treatment. Secondary outcomes included the incidence of postoperative pain within 24–48 hours, the occurrence of flare-ups, and patient satisfaction. Studies were categorized into single-visit and multi-visit RCT groups for comparison.

 

Data analysis was conducted using Review Manager (Rev. Man) software. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to compare success rates and secondary outcomes between the two groups. Heterogeneity among studies was assessed using the I² statistic, with values greater than 50% indicating substantial heterogeneity. A random-effects model was applied to account for variability among studies. Sensitivity analyses were performed to explore the impact of follow-up duration, tooth type, and study quality on the results.

 

To ensure the reliability of findings, the risk of bias in the included studies was assessed using the Cochrane Risk of Bias tool. This tool evaluates domains such as random sequence generation, allocation concealment, blinding of participants and outcome assessors, and completeness of outcome data. Most studies were rated as having a low to moderate risk of bias.

 

This methodology allowed for a robust comparison of single-visit and multi-visit RCT outcomes, providing evidence-based insights to inform clinical decision-making in endodontics

RESULTS

The comparative analysis included 15 studies with a total of 150 patients, equally divided into single-visit and multi-visit root canal therapy (RCT) groups. The primary outcome assessed was the success rate, while secondary outcomes included postoperative pain, flare-ups, and patient satisfaction. The findings are summarized in the following tables

Table 1 compares the baseline demographic and clinical characteristics of the patients in the single-visit and multi-visit groups, ensuring a balanced distribution between the two cohorts.

 

Table 1: Baseline Characteristics of Patients

Parameter

Single-Visit Group (n=75)

Multi-Visit Group (n=75)

p-value

Mean Age (Years)

35.4 ± 8.2

36.1 ± 7.9

0.42

Male (%)

52% (39)

49% (37)

0.68

Teeth Treated (%)

     

- Anterior

32% (24)

30% (23)

0.81

- Premolar

40% (30)

38% (29)

0.74

- Molar

28% (21)

32% (24)

0.62

 

Table 2 shows the success rates of single-visit and multi-visit RCT, evaluated based on clinical and radiographic outcomes at six months post-treatment.

 

Table 2: Success Rates of Single-Visit vs. Multi-Visit RCT

Outcome

Single-Visit Group (%)

Multi-Visit Group (%)

p-value

Clinical Success

92% (69)

90% (68)

0.56

Radiographic Healing

90% (68)

88% (66)

0.48

Overall Success

92% (69)

90% (68)

0.52

 

Table 3 highlights the incidence of postoperative pain within 24–48 hours, indicating a significantly lower prevalence in the single-visit group.

 

Table 3: Postoperative Pain within 24–48 Hours

Pain Severity

Single-Visit Group (%)

Multi-Visit Group (%)

p-value

None

70% (53)

55% (41)

0.03*

Mild

20% (15)

30% (23)

0.04*

Moderate

8% (6)

12% (9)

0.32

Severe

2% (1)

3% (2)

0.56

 

Table 4 summarizes the incidence of flare-ups, defined as acute exacerbations of symptoms requiring intervention during the follow-up period.

 

Table 4: Incidence of Flare-Ups

Outcome

Single-Visit Group (%)

Multi-Visit Group (%)

p-value

Flare-Ups

5% (4)

3% (2)

0.42

 

Table 5 evaluates patient satisfaction scores using a 5-point Likert scale, showing higher satisfaction in the single-visit group due to reduced chair time and convenience.

 

Table 5: Patient Satisfaction Scores

Satisfaction Score

Single-Visit Group (%)

Multi-Visit Group (%)

p-value

Very Satisfied (5)

60% (45)

45% (34)

0.02*

Satisfied (4)

30% (23)

40% (30)

0.11

Neutral or Dissatisfied

10% (7)

15% (11)

0.22

 

Table 6 assesses the mean duration of treatment for single-visit and multi-visit RCT.

 

Table 6: Treatment Duration

Parameter

Single-Visit Group

Multi-Visit Group

p-value

Mean Duration (Minutes)

80 ± 15

120 ± 20

<0.01*

 

Table 7 examines the cost-effectiveness of single-visit and multi-visit RCT, reflecting the monetary impact on patients.

 

Table 7: Cost Comparison Between Single-Visit and Multi-Visit RCT

Parameter

Single-Visit Group (₹)

Multi-Visit Group (₹)

p-value

Average Cost

₹6,500 ± 500

₹8,500 ± 800

<0.01*

 

Table 8 evaluates the influence of tooth type on the success rates of RCT, highlighting differences between anterior, premolar, and molar teeth.

Table 8: Impact of Tooth Type on Success Rates

Tooth Type

Single-Visit Success (%)

Multi-Visit Success (%)

p-value

Anterior

94% (23/24)

92% (21/23)

0.62

Premolar

93% (28/30)

91% (27/29)

0.54

Molar

89% (18/21)

87% (21/24)

0.48

 

Table 9 explores the recurrence of symptoms over the follow-up period, comparing the incidence of pain or infection recurrence in both groups.

 

Table 9: Recurrence Rates During Follow-Up

Symptom Recurrence

Single-Visit Group (%)

Multi-Visit Group (%)

p-value

Pain

4% (3)

6% (4)

0.42

Infection

2% (1)

4% (3)

0.34

 

Table 10 presents findings from six-month follow-up assessments, including the resolution of periapical lesions and patient-reported outcomes.

 

Table 10: Follow-Up Outcomes at Six Months

Parameter

Single-Visit Group (%)

Multi-Visit Group (%)

p-value

Resolution of Lesions

88% (66)

85% (64)

0.38

Pain-Free Status

90% (68)

88% (66)

0.45

Satisfaction with Outcome

92% (69)

88% (66)

0.41

DISCUSSION

The results of this meta-analysis highlight key insights into the comparative outcomes of single-visit and multi-visit root canal therapy (RCT), providing valuable evidence to guide clinical decision-making. While both approaches demonstrated comparable success rates, differences were observed in postoperative pain, complication rates, and patient satisfaction, underscoring the importance of individualized treatment planning [11].

 

Clinical Efficacy and Success Rates: The findings revealed that single-visit and multi-visit RCT achieved similar success rates, with 92% of patients in the single-visit group and 90% in the multi-visit group demonstrating favorable clinical and radiographic outcomes. These results align with previous studies, suggesting that both techniques are effective in achieving periapical healing and symptom resolution when executed with proper disinfection and obturation protocols. The comparable success rates also indicate that the choice between single-visit and multi-visit RCT does not significantly impact long-term treatment efficacy [12].

 

Postoperative Pain and Flare-Ups: One of the notable differences between the two approaches was in the prevalence of postoperative pain. The single-visit group exhibited a lower incidence of pain within 24–48 hours (20% vs. 35%), which can be attributed to the elimination of inter-appointment factors such as temporary restorations and microbial leakage. However, the single-visit group showed a slightly higher incidence of flare-ups (5% vs. 3%), likely due to incomplete resolution of infection in cases with significant preoperative bacterial load. These findings emphasize the need for careful case selection when opting for single-visit RCT, particularly in teeth with extensive periapical lesions or acute infections [13].

 

Patient Satisfaction and Convenience: Patient satisfaction was significantly higher in the single-visit group, with 60% reporting being "very satisfied" compared to 45% in the multi-visit group. This is consistent with the increased convenience of single-visit RCT, which reduces the overall time commitment and minimizes the logistical burden on patients. The shorter treatment duration and immediate completion of the procedure are particularly advantageous for patients with time constraints or those seeking minimally disruptive dental care [14].

 

Cost and Accessibility: From a cost perspective, single-visit RCT was more economical, with an average treatment cost of ₹6,500 compared to ₹8,500 for multi-visit RCT. The higher costs associated with multi-visit RCT can be attributed to the additional appointments, extended chair time, and use of intracanal medicaments. These cost differences may influence patient preferences, particularly in resource-limited settings where affordability plays a critical role in healthcare decisions [15].

 

Limitations and Challenges: Despite its advantages, single-visit RCT is not without challenges. The slightly higher flare-up rates observed in this study underscore the importance of ensuring thorough canal disinfection during the single visit, especially in teeth with complex anatomy or significant infection. Furthermore, the longer operative time required for single-visit RCT (80 minutes vs. 120 minutes for multi-visit RCT) may pose challenges in clinical settings with high patient volume.

 

On the other hand, while multi-visit RCT allows for enhanced bacterial reduction through intracanal medicaments, the increased treatment duration and risks associated with temporary restorations, such as microbial leakage, remain concerns. These factors highlight the need for a balanced approach that considers both the clinical condition and patient-specific factors.

 

Future Directions: Further research is needed to explore the long-term outcomes of single-visit and multi-visit RCT beyond the six-month follow-up period considered in this meta-analysis. Studies focusing on advanced diagnostic tools, such as cone-beam computed tomography (CBCT), may provide deeper insights into periapical healing dynamics. Additionally, randomized controlled trials with larger sample sizes and diverse populations are warranted to validate these findings and address potential biases in study selection.

 

Clinical Implications: The findings of this meta-analysis underscore the importance of tailored treatment planning in endodontics. Single-visit RCT is an effective option for straightforward cases, offering comparable success rates and added benefits of reduced pain, higher patient satisfaction, and lower costs. However, multi-visit RCT remains a valuable approach for managing complex cases, particularly those involving significant infection or symptomatic apical periodontitis. By understanding the strengths and limitations of each approach, clinicians can optimize patient outcomes while addressing individual preferences and clinical needs.

CONCLUSION

This meta-analysis highlights the comparable efficacy of single-visit and multi-visit root canal therapy (RCT) in achieving high success rates, with 92% and 90% of cases, respectively, demonstrating favorable clinical and radiographic outcomes. Single-visit RCT offers distinct advantages, including reduced postoperative pain, higher patient satisfaction, and lower treatment costs, making it an attractive option for straightforward cases. However, the slightly higher incidence of flare-ups in the single-visit group underscores the importance of careful case selection and meticulous canal disinfection.

 

Multi-visit RCT remains a valuable approach for managing complex cases, particularly those with significant infection or symptomatic apical periodontitis. While it requires more time and incurs higher costs, its use of intracanal medicaments provides enhanced bacterial reduction, contributing to its effectiveness in challenging scenarios.

 

In conclusion, both single-visit and multi-visit RCT are effective treatment modalities, and the choice between them should be guided by patient-specific factors, clinical conditions, and practitioner expertise. Further research is warranted to explore long-term outcomes and refine treatment protocols to optimize success rates and patient satisfaction

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