Cochrane · intervention · CD005296
Single versus multiple visits for endodontic treatment of permanent teeth
Mergoni, G, Ganim, M, Lodi, G, et al. · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
12
current version
GRADE rated
9
No studies
0
Included studies
47
as reported
No studies 0 · 0%Ungraded 3 · 25%Very low 5 · 41.7%Low 2 · 16.7%Moderate 2 · 16.7%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Participants aged 10 years or above who required RoCT. All participants had teeth with a completely formed apex and without internal resorption. | We found 47 studies suitable for inclusion in this review. A total of 5805 participants were enrolled in the 47 studies included in this review, and a total of 5693 teeth were analysed. |
| Intervention | RoCT in a single visit or multiple visits (i.e. two or more appointments). Root canal retreatment was also included. Treatments had to meet the current standard of care (rubber dam isolation, use of sodium hypochlorite as irrigant). Any systemic medical treatment (antibiotics, non-steroidal anti-inflammatory drugs or analgesics) was to be the same in both groups. | Single visit root canal treatment (n=47) |
| Comparison | Multiple visit root canal treatment | Multiple visit root canal treatment (n=47) |
| Outcomes | Tooth extraction (binary, yes/no); Radiological failure after at least one year (i.e. the presence of any periapical radiolucency) (binary, yes/no); Postoperative pain (binary, yes/no; continuous); Swelling or flare-up (binary, yes/no); Analgesic use (binary, yes/no); Presence of sinus tract or fistula after at least one month (binary, yes/no) | Tooth extraction due to endodontic problems (n=2); Radiological failure (n=13); Pain in the immediate postoperative period (n=12); Pain at one week (n=9); Swelling or flare-up (n=6); Analgesic use (n=6); Persistent sinus track or fistula (n=5) |
| Study designs | We included randomised controlled trials and quasi-randomised controlled trials (i.e. those using an alternative assignment based on, for example, birthdate). We also considered split-mouth and split-cluster studies. We excluded studies that did not measure and report at least one of our outcomes. | NR |
| Timing | Follow up varied from one year to five years for radiological outcomes | Follow up varied from one year to five years for radiological outcomes |
Search date: 25 April 2022. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid
Questions and results
Current version onlySingle-visit root canal treatment vs Multiple-visit root canal treatment (two or more visits)
Population: People aged 10 years or above requiring root canal treatment; permanent teeth with completely formed apex and without internal resorption
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Postoperative pain in the immediate postobturation period (up to 72 hours) Up to 72 hours postobturation | RR 0.97 [0.81, 1.16] 507 per 1000 vs 492 per 1000 | 12 studies · 1329 participants | Low Downgraded: risk of bias, inconsistency |
Tooth extraction due to endodontic problems | RR 0.46 [0.09, 2.50] 21 per 1000 vs 10 per 1000 | 2 studies · 402 participants | Very low Downgraded: risk of bias, imprecision |
Analgesic (painkiller) use | RR 1.25 [0.75, 2.09] 149 per 1000 vs 186 per 1000 | 6 studies · 540 participants | Very low Downgraded: risk of bias, imprecision |
Pain at two weeks (postobturation) Two weeks postobturation | RR 0.56 [0.07, 4.69] | 2 studies · 288 participants | Ungraded |
Post-treatment pain within 1 week (from first session) Within 1 week of treatment (from first session) | RR 1.55 [1.14, 2.09] 206 per 1000 vs 320 per 1000 | 5 studies · 638 participants | Moderate Downgraded: risk of bias |
Swelling or flare-up | RR 0.56 [0.16, 1.92] 27 per 1000 vs 15 per 1000 | 6 studies · 605 participants | Very low Downgraded: risk of bias, imprecision |
Pain at 12 months or more (long-term postobturation pain) 12 to 18 months | Pain at 12 months or more reported by 2 studies (de Castro Rizzi-Maia 2016 at 12 months; Wong 2015 at 18 months). de Castro Rizzi-Maia 2016: no participant reported pain. Wong 2015: 1/117 single-visit vs 1/103… | 2 studies | Ungraded |
Sinus tract or fistula formation After at least 1 month | RR 1.00 [0.24, 4.28] 9 per 1000 vs 9 per 1000 | 5 studies · 650 participants | Very low Downgraded: risk of bias, imprecision |
Postoperative pain intensity in the immediate postobturation period (up to 72 hours), continuous (VAS) Up to 72 hours postobturation | MD 0.26 [-4.76, 5.29] | 12 studies · 1258 participants | Low Downgraded: risk of bias, inconsistency |
Pain at 1 month 1 month | One study (Dhyani 2022) reported pain at 1 month: 60 teeth (all vital at enrolment, mechanical NiTi), 0 events (no participant reported pain at 1 month); no meta-analysis | 1 study · 60 participants | Ungraded |
Postobturation pain at 1 week 1 week postobturation | RR 1.05 [0.67, 1.67] 179 per 1000 vs 188 per 1000 | 9 studies · 1139 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Radiological failure (periapical radiolucency) after at least 1 year At least 1 year (range 1 to 5 years) | RR 0.93 [0.81, 1.07] 232 per 1000 vs 216 per 1000 | 13 studies · 1505 participants | Moderate Downgraded: risk of bias |
Single-visit root canal treatment vs Multiple-visit root canal treatment (two or more visits)
Population: People receiving endodontic treatment of permanent teeth (aged over 10 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Tooth extraction due to endodontic problems | RR 0.44 [0.04, 4.78] 19 per 1000 vs 9 per 1000 | 1 study · 220 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Postoperative pain in the immediate postobturation period (up to 72 hours) Up to 72 hours postobturation | RR 0.99 [0.84, 1.17] 379 per 1000 vs 375 per 1000 | 9 studies · 1560 participants | Moderate Downgraded: risk of bias |
Postobturation pain at 1 week 1 week postobturation | RR 1.50 [0.99, 2.28] 109 per 1000 vs 164 per 1000 | 8 studies · 1383 participants | Low Downgraded: risk of bias, inconsistency |
Pain at 12 months or more (long-term postobturation pain) 18 months | RR 0.88 [0.06, 13.90] | 1 study · 220 participants | Ungraded |
Postoperative pain intensity in the immediate postobturation period (up to 72 hours), continuous (VAS) Up to 72 hours postobturation | MD 0.12 [-0.59, 0.82] | 4 studies · 414 participants | Ungraded |
Pain at 1 month 1 month | Two studies reported pain at 1 month; no participant had persistent pain (0 events); 513 participants, 2 studies; meta-analysis not possible | 2 studies · 513 participants | Ungraded |
Sinus tract or fistula formation | RR 0.98 [0.15, 6.48] 12 per 1000 vs 12 per 1000 | 2 studies · 345 participants | Low Downgraded: risk of bias, imprecision |
Analgesic (painkiller) use | RR 2.35 [1.60, 3.45] 97 per 1000 vs 228 per 1000 | 4 studies · 648 participants | Moderate Downgraded: risk of bias |
Any complication (composite) Within 1 month | RR 0.92 [0.77, 1.11] 286 per 1000 vs 263 per 1000 | 10 studies · 1686 participants | Moderate Downgraded: risk of bias |
Radiological failure (periapical radiolucency) after at least 1 year At least 1 year (range 1 to 5 years) | RR 0.91 [0.68, 1.21] 146 per 1000 vs 132 per 1000 | 11 studies · 1493 participants | Low Downgraded: risk of bias, imprecision |
Swelling or flare-up | RR 1.36 [0.66, 2.81] 81 per 1000 vs 110 per 1000 | 4 studies · 281 participants | Low Downgraded: risk of bias, imprecision |
Single-visit root canal treatment vs Multiple-visit root canal treatment (two or more visits)
Population: People aged over 10 years requiring root canal treatment; permanent teeth with completely formed apex and without internal resorption
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Analgesic (painkiller) use | RR 2.42 [1.62, 3.62] | 3 studies · 559 participants | Ungraded |
Tooth extraction due to endodontic problems | No study reported tooth extraction due to endodontic problems | 0 studies | No studies |
Pain at 1 month 1 month | Two studies reported pain at 1 month; no patient had persistent pain (0 events); 513 participants, 2 studies; meta-analysis not possible | 2 studies · 513 participants | Ungraded |
Postobturation pain at 1 week 1 week postobturation | RR 1.07 [0.72, 1.57] | 5 studies · 936 participants | Ungraded |
Radiological failure (periapical radiolucency) after at least 1 year At least 1 year (range 1 to 5 years) | RR 0.85 [0.59, 1.23] | 5 studies · 657 participants | Ungraded |
Sinus tract or fistula formation | No study reported fistula or sinus track formation | 0 studies | No studies |
Postoperative pain in the immediate postobturation period (up to 72 hours) Up to 72 hours postobturation | RR 0.99 [0.83, 1.18] | 6 studies · 1047 participants | Ungraded |
Swelling or flare-up | RR 1.40 [0.67, 2.93] | 3 studies · 192 participants | Ungraded |
Single-visit root canal treatment vs Multiple-visit root canal treatment (two or more visits)
Population: Adults aged over 18 years requiring root canal treatment; permanent teeth with completely formed apex and without internal resorption
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR Minimum 12 months follow-up (planned) | Protocol only; no studies included. Planned outcomes: tooth loss, radiological success, postoperative pain, swelling, fistula formation, tenderness after percussion, unscheduled/emergency visit, painkiller/antibiotic use | 0 studies | No studies |