Single Visit Endodontics.pptx treatment in one visit

Root canal treatment in one visit

1. Single Visit Endodontics Concepts & Controversies DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS PRESENTED BY- MALTI VERMA MDS II YEAR GUIDED BY: DR. SURUCHI SISODIA (HOD) DR. MAYUR M. KAHATE (PROFESSOR) 1

2. Contents Introduction Definition Evolution of Single Visit Endodontics Selection criteria for single visit endodontics Factors to consider before deciding on single or multi-visit treatment Indications Contraindications Advantages Disadvantages 2

3. Patient advantages Myths Adjuncts to Render Efficient and Faster Treatment in Single Visit Endodontics Single visit endodontics   vs multiple visit endodontics Conclusion References 3

4. The main objective of performing root canal therapy is to eliminate bacteria from the infected root canal system or remove inflamed pulp tissue and close it with a biologically acceptable filling material.   Mothanna Al- Rahab ,Single visit root canal treatment: Review. Saudi Endodontic Journal • May-Aug 2012 • Vol 2 • Introduction 4

5. Traditionally, root canal treatment was performed in multiple visits, with the use of extra disinfecting agents ( intracanal dressing) besides the irrigants that is used during the cleaning and shaping procedure which mainly aims to reduce or eliminate microorganisms and their by‑products from the root canal system before obturation . The most intracanal dressing researched and widely used is the calcium hydroxide ( Ca (OH)2) paste. 5

6. Single-visit endodontics is defined as “the conservative non-surgical treatment of an endodontically involved tooth consisting of complete biomechanical cleansing, shaping, and obturation of the root canal system during one visit”. Rather SH, Singh SA, Nharika N, Sah SO, Kumar SS. Single visit endodontic therapy: A review. International Journal of Scientific Development and Research. 2022;7(4):158-60. Definition 6

7. The concept of single visit root canal treatment is based on the entombing theory, which the large number of microorganisms removed during cleaning and shaping and the remaining bacteria entombed by the root canal obturation , therefore it will miss the essential elements to be survive nutrition and space . In addition, the antimicrobial activity of the sealer or the zinc (Zn) ions of gutta-percha can kill the residual bacteria. 7

8. Evolution of Single Visit Endodontics (a) Dodge JS. The 1880s: Concept of single-visit root canal management Ferranti 1950s . (b) Tosti 1970: Clinical study using a single-visit approach . (c) Rudner and oliet : 1983 described a concept and clinical technique for treating teeth in a single visit . (d) Ashkenaz . P.J. 1984 Defined and enumerated the indications and contra indications for single sitting endodontics . Praharaj N, Naik D. Endodontic Therapy in Single Visits. Indian Journal of Forensic Medicine & Toxicology. 2020 Oct 1;14(4). Evolution of Single Visit Endodontics 8

9. SELECTION CRITERIA FOR SINGLE VISIT ENDODONTICS: OLIET'S CRITERIA FOR CASE SELECTION Patient should be cooperative and prepared for single visit endodontics and non-cooperative patients with TMJ problems, limited mouth opening should be avoided for single visit endodontics : Positive patient acceptance. Sufficient time to complete procedure 9

10. Absence of acute symptoms requiring drainage through the canal and of persistent continuous flow of exudate or blood. 4. Absence of anatomic obstacles like calcification in the canals and procedural difficulties ( ledge formation, blockage, perforation , inadequate fills). 10

11. From most important to least important, factors to consider before deciding on single or multi-visit treatment include : Anatomy of the tooth being treated 2. Skill of the operator 3. Experience using modern endodontic equipment Ikram O, Neal T, Mounce R. Endodontics : single versus multiple visit. Inter Dent Afr Ed. 2021;11:26-33. 11

12. 4. Radiographic size of the periapical lesion 5. Teeth with sinus tracts 6. Cracked teeth 7. Patient factors. 12

13. Anatomy of the tooth being treated Success rates are highest if we can prepare and then close the access cavity definitively. In general, the extraction of a root canal treated teeth due to a failure of the shaping, disinfection and obturation is relatively rare in comparison to removal due to fracture ( Vire , 1991; Salehrabi and Rotstein , 2004). UL6 (upper left first molar) was previously treated and has been chronically tender to chewing for many years. CBCT revealed four canals obturated . The decision was made to attempt retreatment in one visit if possible. Access revealed coronal leakage under the previous build up as a result of an unset composite and lack of adaptation of the composite along the pulpal floor Postoperative radiograph after retreatment that was accomplished in one visit. The patient’s symptoms resolved immediately 13

14. However, when failure of root canal treatment occurs, the most common reason is unlocated anatomy (Nair, 2004; Siqueira , 2001 ). If the canal is easier to locate and clean, then single visit treatment might be a possibility. If the anatomy is complex, would be more inclined to schedule a multiple visit treatment – with the aim of the first visit being to locate and negotiate this complex anatomy and then see resolution of signs and symptoms 14

15. 2. Skill of the operator To be able to carry out root canal treatment in a manner that is efficient and of a good standard, the operator needs to negotiate the anatomy. In single visit root canal treatment, operator and patient fatigue are often high . To be able to complete single visit treatment, a chair time of approximately two hours on a conscious patient is usually the maximum for most able-bodied patients. 15

16. For single visit treatment to be an option, the operator needs to be able to perform all the treatment within this approximate time. To be able to shape, disinfect and obturate with three or more root canals in this time frame the skill of the operator must be extremely high. 16

17. 3. Experience using modern endodontic equipment There are some teeth that can be treated with low-level magnification, but the magnification and illumination of an operating microscope speeds up treatment. Use of a motor driven root canal preparation system also reduces preparation time . If a cone beam scan is taken prior to treatment then this may also help reduce the time spent looking for extra canals, such as lingual canals in lower incisor teeth, or second mesiobuccal canals in upper molar teeth. 17

18. 4. Radiographic size of the periapical lesion Teeth with periapical lesions above 5mm in diameter have a reduced success rate (Ng et al, 2011) and therefore preference for these to be treated over multiple visits so that the clinical or radiographic healing can be evaluated during the treatment. 18

19. If healing is not occurring, then the patient is free to decide whether to persist with treatment and possible apical surgery after filling the canals, or to proceed with extraction. By doing this, the patient can make an informed choice before definitive filling of the canals and restoration of the tooth. 19

20. 5. Teeth with sinus tracts Teeth with sinus tracts have a lower chance of radiographic healing (Ng et al, 2011). It is helpful to see healing of these after shaping and disinfection of the root canal system prior to filling the canals and restoring the tooth definitively. If a sinus tract does not heal or improve after eight weeks, re-medicate the canals. If it fails to heal after this, discuss the option of apical surgery with the patient further, if it is appropriate, or the possibility of extraction. 20

21. 6. Cracked teeth Due to the unpredictable nature of treating cracked teeth, preference is to see resolution of the symptoms before filling the canals and restoring the tooth. 21

22. 7. Patient factors If the patient requires antibiotic cover, intravenous sedation, general anesthetic or is travelling a long distance, -treat the patient in a single visit. On the other hand, if the patient has difficulty sitting still for long appointments – such as those with Parkinson’s disease, chronic back pain or when treating pediatric patients –perform root canal treatment over multiple visits, to reduce length of chair time. 22

23. Indications Uncomplicated vital teeth, vital pulp exposures due to caries or trauma with symptomatic pulpitis. In physically challenged patients . In patients having apprehension for treatment and requiring sedation for 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 23

24. Fractured anterior teeth with pulpal involvement and no periapical lesion or teeth with recent trauma where esthetics is the concern . Non vital teeth with sinus tract where chances of post treatment flare up are less.  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 24

25. Contraindications 1. Non vital tooth having acute inflammation; single-visit endodontic treatment should not be recommended . 2. Single-visit endodontic treatment should not be performed in teeth with weeping canals . 3. Teeth with anatomic anomalies for e.g. calcified and curved canals. 25

26. 4. Teeth with limited access. 5. Symptomatic non vital teeth . 6. Asymptomatic non vital teeth with periapical pathology and no sinus tract. 7. For most of the re-treatment cases . 8. Patients who have temporomandibular disorders and/or who cannot endure long treatment period are not suitable for single-visit endodontic treatment. 26

27. Advantages 1 ] R educed number of appointments . 2] It reduces the need for repeated episodes of antibiotics in patients with cardiovascular diseases or for medically compromised patients where premedication is needed. 3 ] reduced number of appointments allows clinicians to manage office time efficiently. Materials needed for separate visits (disposable bibs, suction tips, anaesthetic and irrigation needles and rubber dams) are saved. Medico legal risk is reduced: The likelihood of cross contamination is minimized. 27

28. 4] Single-visit endodontic treatment reduces patient discomfort and risks associated with local anesthesia. It also reduces the episodes of pain and anxiety that may arise from each appointment . 5] Single visit endodontic treatment minimizes the possible chance of iatrogenic errors ( eg , perforation, ledging , stripping, and extrusion of antimicrobial irrigants due to longer exposures in instrumentation procedures ). 6] With single-visit treatment, there is no need for provisional restoration between appointments and thus no bacterial contamination through the leakage beneath the provisional restoration. 28

29. Disadvantages 1 ] Completing treatment in a single appointment may involve time restraints and causes fatigue in both the clinician and the patient . 2] Difficult cases like calcified canals, severe curvatures, weeping canal, etc. may require more time and more number of visits. 3 ] If flare-up occurs, it is difficult to establish drainage through obturated tooth. 29

30. Patients advantages • Patient comfort – as the number of visits are reduced . • Economics – Extra cost of multiple visits, use of comparatively less chair side time, fewer materials all increase the economics to both patient as well as doctor. • Restorative considerations – In single visit endodontics , immediate placement of coronal restoration (post and core placements) ensure effective coronal seal and esthetics. Ahmed F, Thosar N, Baliga MS and Rathi N. Single Visit Endodontic Therapy: A Review. Austin J Dent. 2016; 3(2): 1035. 30

31. • Patient convenience – Patient does not have to endure the discomfort of repetitive pricking of local anesthesia and no additional appointments. • Reduced intra appointment pain: Mid treatment flare ups which are usually caused by leakage of the temporary cements which would be reduced in single visit endodontic cases. Ahmed F, Thosar N, Baliga MS and Rathi N. Single Visit Endodontic Therapy: A Review. Austin J Dent. 2016; 3(2): 1035. 31

32. Myths and facts 32

33. Postoperative pain is greater when endodontic therapy is completed in a single visit, especially in nonvital teeth .   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 Myth No.1 33

34. Overwhelming evidence shows that postoperative pain resulting from treatment of vital or nonvital teeth does not differ among patients treated in a single visit or in multiple visits. The reported findings on postoperative pain differed between studies. Wang C et al. showed no significant differences in pain after single-visit and multiple-visit treatment . Study done by Risso PA et al , surprisingly described more postoperative pain developing with conventional multiple-visit treatment. Study done by Oginni A reported significantly more postoperative pain for single-visit treatment. Fact 34

35.   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 ). 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 35

36. 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 36

37. 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 37

38. There is less healing when endodontic therapy is completed in a single visit, especially in non-vital tooth . Myth No.2 38

39. One-year follow-up time is the soonest possible to determine whether or not the lesion has healed ( Ørstavik 1996). No studies demonstrated a statistically significant difference in healing rate (therapeutic efficacy) between single- and multiple-visit treatment . In a systematic review done by C. Sathorn found that single-visit root canal treatment appeared to be slightly more effective than multiple visit, i.e. a 6.3% higher healing rate. No significant difference in radiographic evidence of healing between singlevisit and multiple visit treatment was seen by study done by Paredes-Vieyra J . Fact 39

40. 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.    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 , 2012 stated 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. 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): 40

41.   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. 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. Dorasani et al, 2013 reported that Both single-visit and multiple-visit-treated teeth healed satisfactorily with no significant differences  41

42. Post operative flare up is greater when endodontic therapy is completed in a single visit. Myth No.3 42

43. 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 must deal with . Trope defined flare up as "intolerable pain and/or swelling " . Akbar et al in his study found that there was no significant difference in the flare-up rate between single and multiple visit groups Fact 43

44. Intemational Endodontic Joumal {199l ) 24,24-27 Flare-up rate of single-visit endodontics M , TROPE Department of Endodontology , Temple University, School of Dentistry, Philadelphia, Pennsylvania, USA   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) 44

45. Canals are cleansed if an antibacterial medicament such as Ca (OH)2 'is left in the tooth . Myth No.4 45

46. Fact Efficacy of calcium hydroxide in controlling bacterial colonization has been debated. Studies 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. It is therefore generally considered that nonsetting calcium hydroxide should be used as a supplement to antibacterial irrigations. . 46

47. 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 during the interim period in case of multiple visits because of microleakage . Gesi et al 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. 47

48. Gesi et al 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 48

49. 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. 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 49

50. Multiple-visit endodontics is safer than single-visit endodontics , and multiple visits mean more careful treatment. MYTH No.5 50

51. Fact For patients at the risk of contracting bacterial endocarditis AHA recommends as many procedures as possible during antibiotic prophylaxis. By limiting these patients to single appointment they are at less risk of contracting endocarditis and of having an allergic reaction to the antibiotic . 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 ). 51

52. • 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 52

53. 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- 53

54. Patients do not mind multiple appointments and are likely to object to the fee if the procedure is completed in a single visit. Myth No.6 54

55. Fact Aside from cost, there are two other major barriers to patients visiting the dentist: fear of pain and 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. 55

56. After obturation , treating a flare-up is complicated; therefore, treatment should not be completed at the first appointment. Myth No.7 56

57. 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 57

58. 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. Fact 58

59. Adjuncts to Render Efficient and Faster Treatment in Single Visit Endodontics 59

60. Pain control It relaxes the patient and saves time. It is preferable to use a long acting local anesthetic agent such as bupivacaine or etidocaine . It also helps to control post-operative pain Sometimes supplemental anesthesia is indicated along with the standard injection . These include: i. Intra-pulpal injections ii. Intra-osseous injection iii. Periodontal ligament injection 60

61. 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 61

62. Isolation The use of the rubber dam is mandatory in root canal treatment because of its following advantages: 1. Patient is protected from aspiration of instruments, tooth debris, medicaments and irrigating solutions. 2. Soft tissues are retracted and protected. 3. A surgically operating field is isolated from saliva, blood and other tissue fluids. It also reduces the risk of cross contamination of the root canal system with the spread of infectious agents . 4. Visibility is improved. It provides a dry field and reduces mirror fogging. 5. Efficiency is increased. 62

63. Access cavity preparation While performing single visit endodontics , the objective is to perform the treatment in minimum time without compromising the quality of treatment. To achieve this goal use of conventional access cavity preparation by using hand piece and new burs along with use of ultrasonic system can be considered, as visibility will be better and also more effective in exploring canal orifices and calcifications present 63

64. Magnification & light 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. 64

65. Surgical loupes,  E ndodontic 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 65

66. 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 . 66

67. 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 67

68. 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 68

69. Irrigation Protocol During biomechanical preparation, canals were irrigated with 10 mL of 3% NaOCl with a conventional endodontic syringe. Then, the canals were flushed with 2 mL of 17% EDTA solutions for 1 minute. Final irrigation was done with sterile normal saline. Kathiria NV, Attur K, Bagda KM, Venkataraghavan KP, Patel K, Mustafa MB, Attur SK. Postendodontic Pain using single file system with different irrigation protocols in single-visit Root Canal treatment: a Randomized Control Trial. The journal of contemporary dental practice. 2024 Feb 1;25(2):181. 69

70. Use of laser Bacteria are known to penetrate depth of 600 to 10000 micro meters whereas the irrigant can penetrate a depth of around 100 micrometer . Laser has been used lately for better disinfecting of the root canal and it gives access to the deeper area of dentinal tubules of around 1000 micrometer. Thus laser improves the overall disinfection of the root canals thereby improving the treatment outcome. As per Preethee , et al. , use of LASER (908 nm diode) in conjunction with conventional chemo-mechanical techniques significantly eliminate E. Faecalis in apical third of root dentin. 70

71. RECENT ADVANCES THAT ASSISTANT IN PERFORMING SINGLE VISIT ENDODONTIC THERAPY 71

72. RECENT ADVANCES THAT ASSISTANT IN PERFORMING SINGLE VISIT ENDODONTIC THERAPY Use of direct digital radiography. Use of surgical microscope. Use of apex locators. Crown down technique is preferred because of less chance of pushing debris and bacteria into the periapical area and also for easier preparation of the apical portion of the canal. NiTi rotary instrumentation and ultrasonic will aid in rapid canal preparation. Use of NaOCl and H2O2 irrigants help in faster removal of debris. Newer thermo-plasticized injectable guttapercha can assist in rapid obturation . Rather SH, Singh SA, Nharika N, Sah SO, Kumar SS. Single visit endodontic therapy: A review. International Journal of Scientific Development and Research. 2022;7(4):158-60. 72

73. Intemational Endodontic Joumal {199l) 24,24-27 Flare-up rate of single-visit endodontics M, TROPE Department of Endodontology , Temple University, School of Dentistry, Philadelphia, Pennsylvania, USA Conclusions According to the findings of this 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 singie visit, with a low probability of a flare-up occurring; (iii) in teeth with apical periodontitis which need retreatment , the flare-up rate was highest and single-visit root treatment would be inadvisable. 73

74. One- versus Two-visit Endodontic Treatment of Teeth with Apical Periodontitis: A Histobacteriologic Study Jorge Vera, DDS,* Jose F. Siqueira , Jr , DDS, MSc, PhD,Domenico Ricucci , MD, DDS , Simona Loghin , DDS,Nancy Fernandez, DDS , Belina Flores, DDS, and Alvaro G. Cruz, DDS, MSc Conclusion , this study demonstrated that the 2-visit protocol with an interappointment medication with calcium hydroxide resulted in improved microbiological status of the root canal system when compared with a single-visit protocol . 74

75. Single visit endodontics   vs multiple visit endodontics : 75

76. The two basic parameters used for the comparison of single-visit and multiple-visit endodontic therapy are : 1.Incidence of post-operative pain and flare-ups 2.Success versus failure rates Post-operative pain Fear of post-operative pain following treatment is the biggest factor in avoiding single-visit endodontic therapy. A various number of studies and research have been done to compare the incidence of post-operative pain in single- versus multi-visit endodontic therapy. Although a number of studies in various literature showed that there is no significant difference between the two treatment protocols as far as incidence of post-operative pain is considered, there is a lack of evidence-based data to reinforce this Geethanjali et al. / IP Indian Journal of Conservative and Endodontics 2021;6(3):147–151 76

77. Success versus failure rates Long-term success of any treatment is dependent on various criteria, including case selection, treatment procedures and protocols, time management and sufficient duration of recall appointments. Long time success is based mainly on the healing of periapical lesions whenever present, and the prevention of new lesion . A study by Jurcak et al reported 89% success rate following single-visit endodontic therapy According to Peters and Wesselink ,  complete radiographic healing was observed in 81% of the cases treated in one visit and 71% of the cases treated in two visits . Geethanjali et al. / IP Indian Journal of Conservative and Endodontics 2021;6(3):147–151 77

78. The case selection should be done properly and all the indications and contraindications in each case on an individual basis that a decision should be made as to whether or not it can be completed in a single visit. Briefly, in cases of vital pulp, a single-visit treatment should be used whenever possible. This is based on the fact that the pulp is only superficially infected and the root canal is free of bacteria. Therefore, there is no apparent reason not to treat vital pulps in a single visit. If the pulp is necrotic or associated with a periradicular disease, there is ample evidence that the root canal system is infected. In these cases, the root canal system should ideally be cleaned and shaped, an intracanal medication placed, and the canal filled at a second appointment. CONCLUSION 78

79. Both single and multivisit treatments should be viewed as part of a total endodontic treatment spectrum, with the choice of one over the other being determined by the circumstances surrounding each individual case. However, when doubt exists, the multiple visit procedure should be performed. Thus, the clinician will be most effectively utilizing his time in delivering the best possible endodontic service available to the patient. 79

80. Mothanna Al- Rahab ,Single visit root canal treatment: Review. Saudi Endodontic Journal • May-Aug 2012 • Vol 2 • Rather SH, Singh SA, Nharika N, Sah SO, Kumar SS. Single visit endodontic therapy: A review. International Journal of Scientific Development and Research. 2022;7(4):158-60 . Praharaj N, Naik D. Endodontic Therapy in Single Visits. Indian Journal of Forensic Medicine & Toxicology. 2020 Oct 1;14(4 ). Ikram O, Neal T, Mounce R. Endodontics : single versus multiple visit. Inter Dent Afr Ed. 2021;11:26-33. 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) REFERENCES 80

81. Ahmed F, Thosar N, Baliga MS and Rathi N. Single Visit Endodontic Therapy: A Review. Austin J Dent. 2016; 3(2): 1035. 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 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 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 . Geethanjali et al. / IP Indian Journal of Conservative and Endodontics 2021;6(3): 147–151.0 81