Single Visit Endodontics Notes

Single Visit Endodontics Notes

Single-visit endodontics (SVE) is defined as the conservative, nonsurgical treatment of an endodontically involved tooth consisting of cleaning, shaping, and obturation of the root canal system in one visit.

The most common factors that appear to be responsible for not performing SVE are as follows:

• Doubt about postoperative pain
• Fear of failure of the endodontic therapy
• Discomfort to the patient because he/she has to keep the mouth open for a long period of time
• Lack of time
• Lack of experience and equipment

Read And Learn More: Endodontics Notes

Advantages of Single-Visit Endodontics

• Convenience: The patient does not have to endure the discomfort of repetitive local anesthesia, treatment procedures, and postoperative recovery
• Efficiency: The clinician does not have to refamiliarize to the patient’s particular anatomy or landmarks
• Patient comfort: Because of the reduced number of visits and injections, it is more comfortable for the patient
• Reduced intra-appointment pain: Due to reduced chances of leakage of temporary cement, there are fewer chances of intra-appointment pain
• Economics: Extra cost of multiple visits, and the use of fewer materials make single-visit endodontics cost-effective for both the operator and patient
• Minimizes the fear and anxiety: Especially beneficial for patients who have psychological trauma and fear of the dentist
• Reduces incomplete treatment: Some patients do not return to complete the root canal therapy; SVE reduces this risk
• Lesser errors in working length: In multiple visits, chances of losing reference points due to fracture or grinding in case of fire-up are more, resulting in loss of actual working length
• Restorative consideration: In SVE, immediate placement of coronal restoration ensures effective coronal seal and esthetics

Disadvantages Of Single-Visit Endodontics

• It is tiring for the patient to keep their mouth open for a long duration
• If a flare-up occurs, it is easier to establish drainage in a tooth which is not obturated
• Clinicians may lack proficiency to do SVE
• Some cases cannot be treated by a single visit, for example, cases with very fine, curved, calcified, multiple canals and teeth with weeping canals

Criteria Of Case Selection

• Competence of the clinician: Clinician should be able to perform all steps of the root canal in a single visit without compromising the quality of the treatment
• Positive patient acceptance: The patient should be cooperative for SVE. For uncooperative patients and patients with TMJ problems, limited mouth opening should be avoided for SVE
• Absence of anatomical interferences: Anatomical problems like the presence of fine, curved or calcified canals require more than usual time for the treatment and thus should be treated in multiple visits rather than a single visit
• Accessibility: Teeth for a single visit should have optimal accessibility and visibility
• Availability of sufficient time to complete the case: Both clinicians, as well as patients, should have sufficient time for SVE
• Pulp status: Vital teeth are better candidates for SVE than nonvital teeth because of fewer chances of flare-ups
• Clinical symptoms: Teeth with acute alveolar abscess should not be treated by a single visit. But teeth with a sinus tract are good candidates for SVE because the presence of a sinus acts as a safety valve and prevents the buildup of pressure, so these teeth seldom show flare-ups

Criteria of case selection as given by Oliet include

• Positive patient acceptance
• Absence of acute symptoms
• Absence of continuous hemorrhage or exudation
• Absence of anatomical interferences like the presence of fie, curved or calcified canals
• Availability of sufficient time to complete the case
• Absence of procedural difficulties like canal blockage, ledge formation or perforations

Indications of Single-Visit Endodontics

• Vital teeth
• Fractured interiors where esthetics is the concern
• Uncomplicated vital teeth
• Patients who require sedation every time
• Non vital teeth with sinus tract
• Nonsurgical retreatment cases
• Teeth with accidental pulp exposure
• Medically compromised patients who require antibiotics prophylaxis
• Physically compromised patients who cannot come to dental clinics frequently

Contraindications Of Single-Visit Endodontics

• Teeth with anatomic anomalies such as calcified and curved canals
• Asymptomatic nonvital teeth with periapical pathology and no sinus tract
• Acute alveolar abscess cases with frank pus discharge
• Patients with acute apical periodontitis
• Symptomatic nonvital teeth and no sinus tract
• Patients with allergies or previous flare-ups
• Teeth with limited access
• Patients who are unable to keep their mouth open for long durations such as patients with TMJ disorders

1. (A) Preoperative radiograph;
2. (B) Working length;
3. (C) Post obturation radiograph.

1. (A) Preoperative radiograph;
2. (B) Post-operative radiograph.