Single Visit Endodontics

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CONTENTS

INTRODUCTION

The concept of single visit endodontics started at least 100 years back . Initiating and completing an endodontic treatment in one appointment  has always been  surrounded by controversy

         The majority of endodontists thought that performing treatment in this manner would  cause more  postoperative pain than if performed in multiple appointment

DEFINITION

Single visit endodontics implies to cleaning , shaping and disinfection of a root canal system followed by obturation of the root canal at the same appointment

FACTORS  FOR NOT PERFORMING SVE

1. Doubt of post operative pain
2. Fear of failure of the endodontic therapy
3. Discomfort to patient because  he or she has to keep the mouth open for a long period of time
4. Lack of time
5. Lack of experience and equipment

CRITERIA OF CASE SELECTION

1. COMPETENCE OF CLINICIAN

       Clinician should have ability to perform all the steps of root canal treatment in single visit without compromising quality of the treatment

       An inexperienced clinician should not attempt single visit endodontics

2. POSITIVE PATIENT ACCEPTANCE

       Patients should be cooperative to allow single visit treatment

       Non-cooperative patients like patients with TMJ problems , limited mouth opening should be avoided for single visit endodontics

3. ABSENCE OF ANATOMICAL INTERFERENCES

       Anatomical problems like presence of fine, curved or calcified canals require more than usual time for the treatment

       Teeth with such canals should be better treated in multiple visits rather than single visit

4. ACCESSIBILITY

       Teeth for single visit should have sufficient accessibility and visibility

       Anterior tooth are more accessible than posterior teeth , so they should be treated before attempting treatment in posterior teeth

5. AVAILABILITY OF SUFFICIENT TIME TO COMPLETE THE   CASE

       Teeth for single visit should have sufficient accessibility and visibility

       Anterior tooth are more accessible than posterior teeth , so they should be treated before attempting treatment in posterior teeth

6. PULP STATUS

       Vital teeth are better candidate for single visit treatment than the non vital teeth because of less flare – ups in teeth  with vital pulp

7. CLINICAL SYMPTOMS

       Teeth with acute alveolar abscess  should not be treated by single visit 

       Whereas teeth with sinus  tract are good candidate for single visit endodontics because presence of sinus acts as safety valve and prevents build up of  pressure  , so these teeth seldom show flare-ups

Oliet criteria of case selection

Positive patient acceptance Absence of acute symptoms Absence of continuous haemorrhage or exudation Absence of anatomical interferences like presence of fine , 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

1. Vital teeth
2. Fractured anteriors where esthetics is the concern
3. Patients who require sedation every time
4. Nonvital teeth with sinus tract
5. Teeth with limited access
6. Nonsurgical retreatment cases
7. Medically compromised patients who require antibiotics prophylaxis
8. Physically compromised patients who cannot come to dental clinics frequently

ADVANTAGES OF SINGLE VISIT ENDODONTICS

1.       Convenience

   Patient does not have to endure the discomfort of  repeative local anesthesia ,treatment procedure and post operative recovery 

2.    Efficiency

    Clinician does not have to refamilarize himself / herself to patients particular  anatomy or landmark

3.       Patient comfort

     Because of reduced number of visits or injection

4.    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

5.             Reduced intra – appointment pain

      Mostly the mild treatment flare-up are caused by leakage of the temporary cements.This figure has seen to be reduced in SVS cases

6.             Minimize the fear and anxiety

   Specially beneficial for patients who have psychological trauma and fear of dentist

7.             Reduces incomplete treatment

    Some patiants donot return to complete the root canal therapy , SVE reduces this risk

8.    Lesser error In working length

    Some patiants donot return to complete the root canal therapy , SVE reduces this risk

9. Restorative consideration

In SVE , immediate placement of coronal restoration ( post and core placements) ensure effective coronal seal and esthetics

DISADVANTAGES OF SINGLE VISIT ENDODONTICS

1. It is tiring for patients to keep their mouth open for long durations
2. If mid treatment flare-ups happen to occur , it is easier to establish drianage in a tooth which is not obturated . In case of obturated tooth, it is difficult to remove filling material
3. Clinician may lack the proficiency to properly tret a case in single visit
4. Some case cannot be treated by single visit

CONDITIONS WHERE SVE CANNOT BE PERFORMED

1. Teeth with anatomic anomalies such as calcified and curved canals
2. Asymptomatic  nonvital teeth with periapical pathology and no sinus tract
3. Acute alveolar abscess cases with frank pus discharge
4. Patients with acute apical periodontitis
5. Symptomatic nonvital teeth and no sinus tract
6. Retreatment cases
7. Patients with allergies or previous flare ups
8. Teeth with limited access
9. Patients who are unable to keep mouth open for long duration such as patients with TMJ disorders

  CONCLUSION

Single visit endodontics has been shown to be an effective treatment modality , which compared to multiple visit therapy , is more beneficial to patients and dentists in many ways provided there is careful case selection and adherence to standard endodontic principles.

                  The prevention and elimination of apical periodontitis are the goals of a successful endodontics therapy , once the way to accomplish these goals is determined , the decision to provide treatment in multiple visits or single visit will follow itself