Single visit endodontics

In Detail description of single visit endodontics

1. Single Visit Endodontics Presented by:- DR. Himani Thawale (JR-II)

2. Contents Introduction Evolution Of Single Visit Endodontics Case Selection For Single Visit Endodntics Indications Contraindications Advantages Disadvantages Myths Adjuncts To Render Efficient And Faster Treatment In Single Visit Endodontics Procedure For Single Visit Endodontics. Conclusion.

3. Introduction The main objective of endodontic therapy is thorough mechanical and chemical debridement of the entire pulp cavity and its complete obturation with an inert filling material. In other words, Endodontic success depends upon -Localization Of Canals - Proper Shaping And Cleaning Of Root Canal System, -3 D Obturation Of Canal System. Mothanna Al‑Rahab ,Single visit root canal treatment: Review. Saudi Endodontic Journal • May‑Aug 2012 • Vol 2 • Issue

4. To achieve all these goals endodontic therapy used to be performed in multiple visits to cope up with the complete infection and to make the canals free of microbes, all together for the success of endodontic therapy. Multiple visit endodontics was an established norm in the field of endodontics, but it has certain disadvantages like - Inter appointment microbial contamination and flare ups, - Prolonged time leading to patient fatigue - Unable to provide esthetic restorations in time , - Discontinued treatment leading to failures. Mothanna Al‑Rahab ,Single visit root canal treatment: Review. Saudi Endodontic Journal • May‑Aug 2012 • Vol 2 • Issue

5. DEFINITION Single visit endodontic therapy can be defined as a conservative, non surgical treatment of an endodontically involved tooth consists of complete biomechanical preparation and obturation of the root canal system in single visit. Textbook of endodontics, first edition, Mithra N. Hegde , pg no- 445.

6. Richard E. Walton 2012 , reported that 78% of respondents preferred 1- visit RCT , 7% preferred 2-visit RCT and 16% would follow their dentist’s recommendation. Although most respondents preferred 1-visit RCT regardless of success rates, many would prefer 2-visit RCT if its success rate were greater than that of 1-visit RCT

7. Evolution Of Single Visit Endodontics . Dodge JS. 1880s Concept of A single-visit root canal treatment Ferranti 1950s Use of diathermy for pulpal disinfection and hydrogen peroxide for irrigation Tosti 1970 Clinical study using A single-visit approach. Rudner and oliet 1983 Described a concept and clinical technique for treating teeth in a single visit. Ashkenaz . P.J. 1984 Defined and enumerated the indications and contraindications for single visit endodontics.

8. Indications • Uncomplicated vital teeth. • Fractured anteriors or bicuspid teeth where aesthetics is the concern. • Teeth indicated for endodontic surgery. • Non vital teeth with sinus tract. • Medically compromised patients who require antibiotic prophylaxis. • Physically compromised patients who cannot come to dental clinics frequently. Ashkenaz. P.J. One-visit endodontics Dent Clin North Am. Oct;28(4):853-63.1984

9. Intentional root canal therapy. Patients requiring full mouth rehabilitation. Some of the re-treatment cases. Accidental/Mechanical pulp exposure. Vital pulp exposures because of trauma with symptomatic pulpitis. Vital pulp exposure because of caries with symptomatic pulpitis. Teeth requiring immediate post placement, where esthetics is the concern. Ashkenaz. P.J. One-visit endodontics Dent Clin North Am. Oct;28(4):853-63.1984

10. Contraindications Teeth with anatomic anomalies such as calcified and curved canals. Asymptomatic non vital teeth with periapical pathology and no sinus tract. Acute alveolar abscess cases with frank pus discharge. Patients who have acute apical periodontitis with severe pain on percussion . Symptomatic non vital teeth and no sinus tract. Ashkenaz. P.J. One-visit endodontics Dent Clin North Am. Oct;28(4):853-63.1984

11. Most of the re-treatment cases. Patients with allergies or previous flare ups. Teeth with limited access. Patients who are unable to keep mouth open for long duration such as TMJ disorders . Ashkenaz. P.J. One-visit endodontics Dent Clin North Am. Oct;28(4):853-63.1984

12. Advantages Clinical Advantages- Clinicians have the most intimate awareness of canal morphology, immediately following instrumentation and need not reorient themselves with the peculiarities of particular teeth. No risk of bacterial regrowth and leakage of the temporary seal . No risk of flare-up induced by leakage of temporary seal. Single-Visit Versus Multiple-Visit Root Canal Treatment- A Review Article Dr. Pradnya V. Bansode1 Dr. Seema D. Pathak2 , Dr. M. B. Wavdhane3, Dr. Shirish Khedgikar4, Dr. Priyanka P. Birage5 IOSRolume 17, Issue 11 Ver. 7 (November. 2018

13. The small chance of a life – threatening reaction is reduced by not repeating procedure such as local anaesthetic injection. For patients at risk of contracting bacterial endocarditis , the American Heart Association (AHA) recommends completing as many procedures as possible during the antibiotic course. Patient’s pre-appointment anxiety and post operative discomfort are limited to one episode.

14. PRACTICE MANAGEMENT ADVANTAGES: • Prosthetic work can begin without delay. • The risk of cancelled appointments is reduced. The number of teeth that patients are willing to save may increase. Same patients will pay a premium to save time.

15. Materials needed for separate visits (disposable bibs, suction tips, anaesthetic and irrigation needles and rubber dams) are saved. Time is saved: There is no need to reappoint patient nor reconfirm appointments Medicolegal risk is reduced : AHA gudelines are followed, the likelihood of cross contamination is minimized and invasive procedures are fewer.

16. Patients Advantages : • Patient convenience – Patient does not have to endure the discomfort of repetitive local anesthesia , treatment procedure and no additional appointments. • Patient comfort – because of reduced number of visits and injections. • Reduc ed intra appointment pain: Mostly the mid treatment flare ups are caused by leakage of the temporary cements.

17. • Restorative considerations – In single visit endodontics, immediate placement of coronal restoration (post and core placements) ensure effective coronal seal and esthetics . • Economics – Extra cost of multiple visits, use of fewer materials and comparatively less chair side time all increase the economics to both patient as well as doctor. • Minimises the fear and anxiety

18. Disadvantages No easy access to the apical canal if there is a flare-up. Clinician fatigue with extended one -appointment operating time. Patient fatigue - The longer single appointment may be tiring and uncomfortable for the patient. Flare-ups cannot easily be treated by opening the tooth for drainage Single-Visit Versus Multiple-Visit Root Canal Treatment- A Review Article Dr. Pradnya V. Bansode1 Dr. Seema D. Pathak2 , Dr. M. B. Wavdhane3, Dr. Shirish Khedgikar4, Dr. Priyanka P. Birage5 IOSRolume 17, Issue 11 Ver. 7 (November. 2018

19. If hemorrhage or exudation occurs, it may be difficult to control • Difficult cases with extremely fine, calcified, multiple canals may not be treatable in one appointment without causing undue stress for both the patient and the clinician. • The clinician may lack the expertise to properly treat a case in one visit. This could result in failures, flare-ups, and legal repercussions.

20. Myths

21. Post operative pain is greater when endodontic therapy is completed in a single visit, especially in non vital teeth . Myth No. 1

22. Bayram Incea ,2009 stated that Postoperative pain occurred in 107 (69.9%) and 106 (69.3%) teeth in the single- and multi-visit treatment groups, respectively. There was no significant difference in postoperative pain between the two groups (P>.01). C. Keskin   2015 reported that there was no difference in the incidence and intensity of postoperative pain whether treatment was completed in a single- or multiple-visits in teeth with vital or non-vital pulps C. Keskin , E.O. Demiryurek and T. Ozyurek , 2015. Postoperative Pain after Single-Versus-Multiple Visit Root Canal Treatment in Teeth with Vital or Non-Vital Pulps in a Turkish Population.  Asian Journal of Scientific Research, 8: 413-420. Bayram Incea , Ertugrul Ercan Incidence of Postoperative Pain after Single- and Multi-Visit Endodontic Treatment in Teeth with Vital and Non-Vital Pulp . Eur J of dentistry October 2009 - Vol.3

23. Ashish patil , 2016 reported that incidence of pain after endodontic treatment being performed in one-visit or two-visits is not significantly different experienced by the patients 48 hours after treatment in both the groups. Avinash A. Patil1 , Sonal B. Joshi Incidence of Postoperative Pain after Single Visit and Two Visit Root Canal Therapy: A Randomized Controlled Trial. Journal of Clinical and Diagnostic Research. 2016 May, Vol-10(5): ZC09-ZC12

24. There is less healing when endodontic therapy is completed in a single visit, especially in non vital teeth. Myth No-2

25. In a systematic review done by C. Sathorn ,2005 found that single-visit root canal treatment appeared to be slightly more effective than multiple visit, i.e. a 6.3% higher healing rate. Paredes- Vieyra J , 2012 s tated that meticulously instrumented single visit root canal treatment can be as successful as a 2-visit treatment and found that there was no significant difference in radiographic evidence of periapical healing between 1-visit and 2-visit root canal treatment C. Sathorn et al, Effectiveness of single- versus multiple-visit endodontic treatment of teeth with apical periodontitis: a systematic review and meta-analysis, International Endodontic Journal, 38, 347–355, 2005 Paredes- Vieyra J, Enriquez FJ. Success rate of single- versus two-visit root canal treatment of teeth with apical periodontitis: a randomized controlled trial. J Endod . 2012;38(9):

26. Fabian Ocampo Acosta et al , 2018 stated that there was no significant difference in radiographic evidence of periapical healing between single-visit and two visits root canal treatment. Dorasani et al, 2013 reported that Both single-visit and multiple-visit-treated teeth healed satisfactorily with no significant differences Jorge Paredes Vieyra , Fabian Ocampo Acosta, Seidi Karin Nevarez Osuna (2018). Incidence of Flare-Ups and Apical Healing after Single-Visit or two visits Treatment of Teeth with Necrotic Pulp and Apical Periodontitis after a Two-Year Control Period. A Randomized Clinical Trial

27. Myth No- 3 Post operative swelling is greater when endodontic therapy is completed in a single visit.

28. Postoperative pain or swelling are collectively described as flare-up , which is probably one of the most concerning issues that dentists practicing single-visit treatment mostly deal with. Trope defined flare up as "intolerable pain and/or swelling " .

29. According to the findings of his study: ( i ) Teeth without apical periodontitis did not flare-up and may be treated in a single visit; (ii) Teeth with apical periodontitis but no previous root treatment ) can be treated in a single visit, with a low probability of a flare-ups. (1.4 per cent) (iii) Teeth with apical periodontitis which need retreatment the flare-up rate was highest and single-visit root treatment would be inadvisable. ( 13.6 per cent) ,

30. Krishna prasad et al in 2013, stated that ,little or no significant difference occurred between single visit versus multi visit endodontic therapy. ENDODONTOLOGY Volume: 25 Issue Dec 2013

31. Jorge Paredes Vieyra1 *, Fabian Ocampo Acosta2 and Seidi Karin Nevarez Osuna. Volume 4 • Issue 2 • 2018 There was a significant difference regarding the occurrence of flare-ups when comparing treatment cases with retreatment cases (p= 0.05). Moderate pain occurred in 5% of the treatment cases 16.67% of the retreatment cases. This study gave evidence that a meticulously instrumentation and irrigation performed in a single-visit root canal treatment can be as successful as a two visits treatment

32. Myth No- 4 Canals are cleaned better ,if an antibacterial medicament such as Ca(OH)2 'is left in the tooth.

33. Ghoddusi ,2006 have reported that the clinical outcome of multiple-visit endodontic treatment was better for teeth treated with the intracanal calcium hydroxide than for those with root canals left empty. Despite the high alkalinity antibacterial properties of calcium hydroxide, some bacteria species, such as E. faecalis and Candida albicans, have been found to be resistant to it. Ghoddusi J, Javidi M, Zarrabi MH, Bagheri H. Flare-ups incidence and severity after using calcium hydroxide as intracanal dressing. N Y State Dent J. 2006;72(4):24–28

34. Complete elimination of bacteria is not strictly necessary, and maximum reduction of bacteria and effective canal filling may be sufficient in terms of healing, rather than complete eradication. Moreover, the tooth may also be susceptible to reinfection through the temporary filling and dressing. Gesi et al 2006 , stated that with proper use of aseptic operating procedures, proper instrumentation, and filling, an inter-appointment dressing with calcium hydroxide does not seem to influence outcome. Gesi A, Hakeberg M, Warfvinge J, Bergenholtz G. Incidence of periapical lesions and clinical symptoms after pulpectomy - A clinical and radiographic evaluation of 1- versus 2-session treatment. Oral Surg Oral Med Oral Pathol Oral RadiolEndod . 2006;101:379–88.

35. Myth No- 5 Multiple-visit endodontics is safer than single-visit endodontics, and multiple visits mean more careful treatment.

36. For patients at the risk of contracting bacterial endocarditis AHA recommends as many procedures as possible during antibiotic prophylaxis. The small chance of a toxic reaction from medication ( analgesics, antibiotics, or anesthetic ) is reduced by not using them repeatedly ( at multiple appointments ) an by using a smaller dose ( enough for one appointment ) Multiple visit treatment is more likely to cause clinicians to forget important aspects of canal morphology and landmark. Clinicians are encouraged to develop three dimensional mental images of canals during instrumentation. It is difficult to remember three dimensional images between appointments that are week apart.

37. Amy Wai-Yee Wong 2015 Summed it up best. “Recent studies have shown that the success rate and prevalence of postoperative pain of single-visit or multiple-visit treatment had no significant difference. The chairside time for single-visit treatment was shorter than multiple-visit treatment.” Wong, A.W., Tsang, C.S., Zhang, S.  et al.  Treatment outcomes of single-visit versus multiple-visit non-surgical endodontic therapy: a randomised clinical trial.  BMC Oral Health   15,  162 (2015) doi:10.1186/s12903-015-0148-x

38. Myth No- 6 Patients do not mind multiple appointments and are likely to object to the fee if the procedure is completed in a single visit.

39. Aside from cost, there are two other major barriers to patients visiting the dentist: Fear Of Pain Time Required . Completing root canal therapy in one appointment limits fear of pain to one incident and decreases the time required (the number of appointments and total treatment time). Patients are more likely to, accept single-visit treatment.

40. Myth No- 7 After obturation, treating a flare-up is complicated; therefore, treatment should not be completed at the first appointment .

41. Fear of a post obturation flare-up prevents clinicians from performing single-visit endodontics, but such flareups generally are less common than inter appointment flare-ups. Most flare-ups can be treated with occlusal reduction, analgesics, and antibiotics. In the unusual event that a problem continues, apical trephination ( fistulization ) can be performed. If the canals are cleaned and filled properly, a need to remove filling material is rare. Whether obturation is performed in a single visit or after multiple visits, removal of gutta-percha (if necessary) usually is straight forward.

42. Adjuncts To Render Efficient And Faster Treatment In Single Visit Endodontics:

43. It relaxes the patient and saves time. It is preferable to use a long acting local anaesthetic agent. It also helps to control post operative pain. Sometimes supplemental anaesthesia is indicated along with the standard injection. These includes 1. Local Infiltration 2. Intrapulpal injection 3. Intra osseous injection. Pain Control

44. Digital Technologies In Local Anesthesia Electronic Dental Anaesthesia Wand Masoud Parirokh et al 2012 Stated that Patients who received bupivacaine as the anesthetic agent for single-visit endodontic treatment of irreversible pulpitis in mandibular molars had significantly less early postoperative pain and used fewer analgesics than those who had lidocaine as the anesthetic. Effect of Bupivacaine on Postoperative Pain for Inferior Alveolar Nerve Block Anesthesia after Single-visit Root Canal Treatment in Teeth with Irreversible Pulpitis. JOE — Volume 38, Number 8, August 2012

45. The use of the rubber dam is mandatory in root canal treatment. The rubber dam is used in endodontics because it ensures the following: Patient is protected from aspiration of instruments, tooth debris, medicaments and irrigating solutions. A surgically clean operating field is isolated from saliva, hemorrhage and other tissue fluids. Soft tissues are retracted and protected. Visibility is improved. Isolation

46. Plastic rubber dam frames are recommended for endodontic procedures. Ex- Young's Rubber Dam frame (plastic type), The star visi frame The Nygard Ostby ( N - 0 ) frame. New to endodontics is a specially designed foldable plastic frame The disposable handidam rubber dam system also provides a radio-lucent plastic frame. The quick dam is another disposable single-isolation device with a flexible outer ring, eliminating the need for an additional frame.

47. Access Cavity Preparation Before access cavity preparation, Caries typically is removed early, before the pulp chamber is entered. The roof of the pulp chamber is best perforated with a round bur. No 2 bur - anterior and premolar teeth and a No.4 should be used in molar teeth. B. Once the roof is perforated, A round bur, a tapered fissure bur or a safety tip diamond or carbide bur is used C . Tapered, Flame shaped and round ended tapered diamonds are excellent for endodontic access..

48. An uncovering receded or calcified root canal orifice is a challenge . Use of low - speed smaller burs . These burs have an extra long, flexible shaft that allows in visualization by the operator as the bur advances into the deeper portions of the access preparation. Extended shank round burs, such as the Mueller bur ( Brasseler , Savannah, GA) are very useful for this purpose. To identify canal orifices and to determine canal angulation DG-16 endodontic explorer and CK-17 endodontic explorer can be used.

49. Once the orifices have been located, they should be flared or enlarged and blended into the axial walls of the access cavity. This process permits the intracanal instruments used during shaping and cleaning to enter the canal(s) easily and effortlessly. Gates-Glidden burs can be used for this purpose, starting with smaller sizes and progressing to the larger sizes. More recently, #.12 tapered or Sx rotary endodontic files have been used for the flaring and blending procedure.

50. Ultrasonic unit and Tips An Ultrasonic unit and tips specifically designed for endodontic procedures can be valuable aids in the preparation of access cavities and locating canal orifices . Ultrasonic systems provide excellent visibility compared with conventional handpiece heads, which typically obstruct vision.

51. Light And Magnification The use of high quality magnification in dentistry improves both the quality and speed of treatment, hence suitable for single visit endodontics. Magnification and illumination are particularly important in single visit root canal therapy ,especially for - Determining the location of canals, - Negotiating constricted, - Curved and calcified canals, - Debriding and removing tissue and - Calcifications from the pulp chamber .

52. Surgical loupes, endodontic endoscopes, and DOM are some of the commercially available instruments that can help the clinician accomplish these goals. Adding a headlight to the system of surgical telescopes significantly enhances both depth of field and magnified resolution, greatly increasing visual activity. The head light provides line of straight lumination, which is shadow less and avoids multiple adjustments to the traditional overhead dental operating light.

53. Dental operating microscope(DOM) is an important aid in locating root canals, which was introduced into endodontics to provide enhanced lighting and visibility. Numerous studies have shown that it significantly improves the practitioners ability to locate and negotiate canals. For example, the number of second mesiobuccal (MB-2) canals identified in maxillary molars increased from 51% with the naked eye to 82% with the microscope.

54. FIBRE-OPTIC ENDOSCOPE A recent addition to the field of visualization is a fibre-optic endoscope designed for intra oral use. The Orascope uses a fiber optic probe, xenon light source and a medical grade video monitor to provide a magnified image of the operating field

55. Use Of Irrigants The concept of single visit root canal treatment is based on the entombing theory. Although instrumentation of the root canal is the primary method of canal debridement, irrigation is a critical adjunct. Especially in case of single visit endodontics, irrigation plays a critical role as there is no scope of taking advantage of intracanal medicaments. Irrigation serves as a physical flush to remove smear layer, debris as well as serving as a bactericidal agent, tissue solvent and lubricant. Shuping G, Ørstavik D, Sigurdsson A, Trope M. Reduction of intracanal bacteria using Nickel‑titanium rotary instrumentation and various medications. J Endod 2000;26:751‑5

56. Of all the currently used substances, sodium hypochlorite appears to be the most ideal. NaOCl is effective against endodontic microorganisms, including those difficult to eradicate from root canals such as Enterococcus, Actinomyces and Candida organisms. NaOCl solutions are used in concentrations ranging from 0.5% to 5.25%. Studies have shown that in warming NaOCl to approximately 60°C (140°F) significantly increases the rate of effectiveness of tissue dissolution.

57. Sodium hypochlorite in combinations- There is increasing evidence that the efficacy of NaOCl , as an antibacterial agent is increased when it is used in combination with other solutions such as calcium hydroxide, EDTAC or Chlorhexidine. With Chlorhexidine- Kuruvilla and Kamath 1998 in a study combined alternate use of NaOCl and Chlorhexidine gluconate irrigants and results indicate a greater reduction of microbial flora (84.6%) when compared with the individual use of sodium hypochlorite (59.4%) or chlorhexidine gluconate (70%) alone.

58. With EDTA - Goldman et al showed that the smear layer is not removed by NaOCl irrigation alone but it is removed with EDTA. Ultrasonic activation of sodium hypochlorite has also been advocated, as this would “accelerate chemical reactions, create cavitational effects, and achieve a superior cleansing action”.

59. It cannot dissolve inorganic dentin particles and thus prevent the formation of a smear layer during instrumentation Demineralizing agents such as ethylenediamine tetraacetic acid (EDTA) and citric acid have therefore been recommended as adjuvants in root canal therapy. These are highly biocompatible and are commonly used in personal care products. Although citric acid appears to be slightly more potent at similar concentration than EDTA, both agents show high efficiency in removing the smear layer.

60. Various irrigation agitation devices can also be used such as:- NaviTip FX & NaviTip Rotary brushes Endoactivator Endovac system Rinse endo system Vatea System Gentle wave system

61. Procedural Sequence Of Single Visit Root Canal Treatment

62. To illustrate the modern endodontic procedural sequence for single visit endodontics, an itemized sequence follows: The diagnosis indicates that endodontic treatment is needed and the tooth is anesthetized. 2. Following placement of the rubber dam, access is made. 3. Using the microscope at low to mid magnification, the pulp chamber is thoroughly prepared using a Buc tip size 2 for inspection. 4. Under high magnification (16–24), the floor of the chamber is examined for additional canals because more than 50% of molar teeth have a fourth canal

63. After the canal entrance is identified, the microscope is not needed until a later stage. The apex is negotiated with a size 10 K file and is then enlarged with size 15 or 20 files. Gates–Glidden burs are used in reverse order to enlarge the coronal onehalf or two thirds using the crown down technique. During this enlargement, it is important to use irrigants (2.5%–5% sodium hypochlorite and 17% EDTA solution) to penetrate deep into the canals.

64. An apex locator is used to determine the canal length at this stage. Crown down pressureless technique is used for shaping and cleaning with rotary and hand instrumentation combined. The microscope is used to check the preparation and to check again for an additional canal or canals. A master gutta percha cone is selected; the canal length and solid ‘‘tug back” is assured

65. This master cone, coated with root canal cement, is inserted into the canal, and the coronal part of the point is seared off using System B. The gutta percha in the apical 3 to 4 mm is packed with S- Kondensers . The Obtura gutta percha compactor with an appropriate tip is inserted into the canal up to where the master gutta percha was seared off. The thermoplasticized gutta percha fills the canal as the tip is slowly withdrawn. The microscope is used again for a final check. Finally, the canal is sealed with temporary cement.

66. The incidence of mishaps was 7% in teeth treated in a single visit, and the incidence increased significantly to 16.2% and 28.3% for teeth treated in two and three visits, respectively. Single-visit treatment was significantly correlated with fewer mishaps compared to multiple-visit treatment Int J Dent Oral Health 2(9), 2016

67. Gamze Topcuoglu , 2016 describe 3 successful single-visit regenerative endodontic therapy cases using Biodentine and PRP as a scaffold material in 3 mandibular permanent molar teeth, all asymptomatic with necrotic pulp. And he concluded that a single-visit regenerative endodontic procedure may be a favorable treatment option for an asymptomatic immature tooth with a necrotic pulp and no periapical lesion.

68. Chung et al 2019 , reported that among patients with intellectual and cognitive disabilities, the periapical health of endodontically treated teeth was maintained throughout the observation period ( 56 months). Single-visit endodontic treatment under GA is applicable, especially when a diseased tooth needs to be retained as a strategic priority JOE — Volume 45, Number 2, February 2019

69. Richard B , 1988 evaluated the incidence of failure following single-visit endodontic therapy and reported that the endodontic failure rate was found to be 5.2%. No significant difference was found between the tooth groups; however, significant differences were found among the problem code groups (teeth with pulpal pathosis, teeth with periapical extension of pulpal disease, endodontic retreatments, and intentional devitalization cases). Also, the incidence of failure was higher in those teeth with periapical extension of pulpal disease which had no prior access opening. VOL. 12, NO. 2, FEBRUARY 1988

70. Conclusion

71. With the advent of technological advancement and emergence of new gadgets, evidence based dentistry and more scientific deliberations and the concept of maximum dentistry in minimum visits led to a resurgent impetus towards laying down of various protocols to enable dentists to venture into single visit endodontics with reasonable level of outcome. Single visit root canal treatment versus the multiple visit root canal treatment has been the subject of a long standing debate within the dental community, when the clinicians are faced with choices of which treatment should be offered to patients, the central issues that should be considered are effectiveness, complication, cost and probably patient /operator satisfaction

72. Careful case selection and proper and thorough adherence to standard endodontic principles, with no shortcuts, should result in successful one-appointment endodontics. Practitioners should attempt one-visit root canal treatment only after making an honest assessment of their endodontic skills, training, and ability

73. Thank You

74. LASERS IN SINGLE VISIT ENDODONTICS TREATMENT In this sense lasers, which is one of the modern advances are being used as a coadjuvant tool in endodontic therapy, for bacterial reduction , and to modify the root canal surface. In 1971, at the University of Southern California, Weichman and Johnson were probably the first researchers to suggest the use of lasers in endodontics. Laser delivery systems : flexible hollow waveguide or tube glass fiber optic cable