ABSTRACT
Background:
Root canal treatment (RCT) is a widely performed procedure to address dental pulp infections. However, there is still an argument between the efficacy of single-visit versus multiple-visit RCT, particularly concerning success rates, post-operative pain, and patient satisfaction.
Objective:
To evaluate and compare the success rates, post-operative complications, and patient satisfaction between single-visit and multiple-visit RCTs in a clinical setting.
Methods:
A randomized clinical trial was conducted with 100 subjects requiring an RCT. Subjects were divided into two groups: single-visit (n = 50) and multiple-visit (n = 50) treatments. Success rates were evaluated through clinical symptoms and radiographic healing over a 12-month follow-up. Post-operative pain was measured using a “Visual Analog Scale (VAS)” at 24 hours, 48 hours, and 1 week. Patient satisfaction was assessed through a standardized questionnaire.
Results:
The success rates were 85% for the single-visit group and 87% for the multiple-visit group, showing no statistically significant difference (P = 0.67). Post-operative pain was slightly higher in the single-visit group at 24 hours (VAS: 4.5 vs. 3.0, P = 0.03), but pain levels were similar by the one-week mark. Patient satisfaction was higher in the single-visit group (92%) compared to the multiple-visit group (85%).
Conclusion:
Single-visit and multiple-visit RCTs demonstrated comparable success rates at 12 months. While single-visit treatments resulted in slightly higher post-operative pain initially, they were associated with higher patient satisfaction due to convenience. Both treatment modalities are effective, and the choice should depend on patient-specific factors.
KEYWORDS: Multiple-visit, patient satisfaction, post-operative pain, single-visit, success rate
INTRODUCTION
Root canal treatment (RCT) is a crucial intervention for saving teeth affected by irreversible pulpitis or necrosis. Traditionally, root canal therapy has been performed over multiple visits to ensure effective disinfection and elimination of infection within the root canal system.[1,2,3] However, advancements in endodontic materials and techniques have made single-visit RCTs increasingly popular. Proponents of the single-visit approach suggest that it reduces patient discomfort, minimizes the risk of bacterial contamination between appointments, and provides comparable long-term success rates to multiple-visit treatments.[1,4,5] Despite these claims, concerns about post-operative pain, persistent infection, and long-term outcomes remain central to the debate.
This research evaluates the success rates of single-visit versus multiple-visit RCTs through clinical outcomes, post-operative complications, and overall patient satisfaction. The analysis provides insights into the efficacy of both techniques and supports clinicians in making informed decisions.
MATERIALS AND METHODS
Research design
A randomized controlled clinical trial was conducted involving 100 subjects who required RCT. Subjects were randomly assigned to either a single-visit or multiple-visit treatment group. Both groups received standardized treatment protocols, including thorough cleaning, shaping, and filling of the root canals. The treatments were performed by experienced endodontists using modern techniques and materials.
Inclusion Criteria
Subjects aged 18–60 years
Teeth with irreversible pulpitis or pulp necrosis
No significant systemic disease affecting healing.
Exclusion Criteria
Teeth with complex anatomy or severe periodontal disease
Subjects with immune-compromising conditions.
Procedure
In the single-visit group, the entire treatment, including cleaning, shaping, and obturation, was completed in one appointment. In the multiple-visit group, the treatment was carried out over two to three appointments, with the application of an intracanal medicament between visits to ensure maximum bacterial reduction.
Outcome measures
The primary outcome was the clinical success rate, defined as the absence of symptoms (pain, swelling) and radiographic evidence of periapical healing at 6- and a year follow-ups. Secondary outcomes included post-operative pain, measured using a VAS and patient satisfaction. Data on complications such as flare-ups, reinfections, and retreatments were also collected.
Statistical analysis
Data were analyzed using statistical software, with success rates, pain scores, and complications compared between groups. A P value of < 0.05 was reasoned statistically evidential.
RESULTS
Success rates
At the 12-month follow-up, the success rates were similar between the two groups. In the single-visit group, 85% of cases demonstrated complete healing and resolution of symptoms, compared to 87% in the multiple-visit group [Table 1]. These results were not statistically significant (P = 0.67), indicating that both treatment modalities offer comparable long-term outcomes.
Table 1.
Comparison of success rates
| Parameter | Single-visit (%) | Multiple-visit (%) |
|---|---|---|
| Clinical success | 85 | 87 |
| Radiographic healing | 80 | 82 |
| Symptom-free status | 90 | 91 |
Post-operative pain
Post-operative pain was assessed at 24 hours, 48 hours, and one-week post-treatment. The single-visit group reported slightly higher pain levels at the 24-hour mark, with an average VAS score of 4.5 compared to 3.0 in the multiple-visit group (P = 0.03). However, by the 48-hour mark, pain levels in both groups had significantly decreased, and there were no notable differences between groups at the one-week follow-up (P > 0.05) [Table 2].
Table 2.
Post-operative pain levels (VAS Scores) in single-visit vs. multiple-visit RCT
| Time post-treatment | Single-visit (Mean VAS) | Multiple-visit (Mean VAS) |
|---|---|---|
| 24 h | 4.5 | 3.0 |
| 48 h | 2.0 | 1.8 |
| 1 week | 1.2 | 1.1 |
Complications and retreatment
Both groups experienced a low rate of post-operative complications, with flare-ups occurring in 5% of single-visit cases and 3% of multiple-visit cases. There were no significant differences in retreatment rates between the two groups, with both showing a retreatment rate of approximately 2% within the 12-month observation period.
Patient satisfaction
Patient satisfaction was slightly higher in the single-visit group due to the convenience of completing the treatment in one appointment. Approximately 92% of subjects in the single-visit group reported high satisfaction with the procedure, compared to 85% in the multiple-visit group. The difference in satisfaction was attributed primarily to the reduced number of dental visits rather than differences in clinical outcomes.
DISCUSSION
The findings of this clinical research align with previous research suggesting that single-visit and multiple-visit RCTs have similar long-term success rates. The success rate in both groups exceeded 85%, indicating that both approaches are effective for treating infected or necrotic teeth. However, a small increase in post-operative pain in the single-visit group was observed within the first 24 hours post-treatment. This can be attributed to the inability to place an intracanal medicament, which may reduce bacterial load and inflammation between appointments in multiple-visit treatments.[2]
Studies by Molander et al.[3] and Sathorn et al.[4] have also indicated comparable success rates between single-visit and multiple-visit treatments, with no significant differences in the long-term outcomes. However, the higher initial post-operative pain in single-visit treatments, as noted in our research, supports the hypothesis that leaving the canal open for an extended period with medicament allows for a more gradual resolution of inflammation.[5]
Despite concerns about increased bacterial growth in cases where temporary fillings are used between visits, modern advances in obturation materials and techniques may explain the negligible difference in success rates.[6] The use of biocompatible sealers and advanced irrigation protocols likely contributed to the positive outcomes in both groups.[7,8,9,10]
Patient satisfaction remains an important factor in clinical decision-making. In this research, single-visit treatments were preferred by most subjects due to the convenience of fewer visits and reduced chair time. However, clinicians should consider individual patient factors, such as the severity of infection and the patient’s pain tolerance, when deciding on the number of visits required for treatment.[8,10]
CONCLUSION
The findings of this research demonstrate that both single-visit and multiple-visit RCTs are effective in achieving high success rates. While single-visit treatments may be more convenient for subjects, they are associated with slightly higher initial post-operative pain. Ultimately, the choice between single-visit and multiple-visit RCT should be based on the patient’s clinical condition, risk of complications, and preferences. Future studies with larger sample sizes and longer follow-up periods are needed to further validate these findings.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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