Single visit vs. multi-visit root canal treatment
Root canal treatment can either be done single or multi-visit. Which one is the better choice? How do ou decide? Historically root canal treatment was performed in multiple visits mainly to ensure sterility of root canal system before obturation. As complete sterilization was not possible with biomechanical preparation and irrigation, intracanal medicaments were used to ensure the total eradication of bacteria.
In addition to killing bacteria, these agents, primarily phenolic compounds, were also highly irritating to the peri-radicular tissues. Overzealous use of these medicaments led to postoperative complications that were erroneously identified as persistent peri-radicular infections. Hence, this led to the inappropriate and excessive use of antibiotics to control infections. Finally, the deleterious effects of these medicaments were identified, and their routine clinical use was discontinued. This led to one of the two course of treatment either treat the root canal in one visit or seek an intracanal medicament that does not injure the peri-radicular tissues.
A common myth: Root canal treatment doesn't cause pain — it relieves it! Most patients see their dentist when they have a severe toothache. The toothache can be caused by damaged tissues in the tooth. Root canal treatment removes this damaged tissue from the tooth, thereby relieving the pain you feel.Most patients see their dentist when they have a severe toothache. The toothache can be caused by damaged tissues in the tooth. Root canal treatment removes this damaged tissue from the tooth, thereby relieving the pain you feel.
Those who believe that successful root canal treatment can be completed in one visit have a rationale in literature. Studies concerning postoperative pain as well as healing rates show the treatment outcome to be similar whether finished in one or multiple visits. In addition to this, treatment in one visit offers many advantages.
Briefly, in cases of vital pulp, a single-visit treatment should be used whenever possible. There is no apparent reason not to treat vital pulps in a single visit. However, if the pulp is necrotic and/or associated with a periapical 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 intra-canal medication placed, and the canal filled at a second appointment.
Proponents of multiple visit procedures contend that antimicrobial property of inter-appointment calcium hydroxide placement is required to ensure successful peri-radicular healing, although predictable levels of bacterial reduction via refined cleaning and shaping techniques is one appointment may negate this need
Root canal procedure step by step
Root canal treatment consists of several steps that take place over several office visits, depending on the situation.
1-Preparing for The Root Canals
First, an opening is made through the back of a front tooth or the crown of a molar or premolar. After the infected pulp is removed , the pulp chamber and root canals are cleaned, and shaped in preparation for being filled. Your dentist's goal will be to treat the entire length of your tooth's nerve space but not beyond. To be able to work within these confines, your dentist must measure the length of each of your tooth's root canals. This measurement is typically calculated to the nearest 1/2 mm.
2-Placing Root Filling
A tapered, rubbery material called gutta-percha is inserted into each of the canals and is often sealed into place with cement. Root canal fillings are selected that will exactly fit into the freshly prepared canals. Usually a rubber-like material called gutta-percha is used to fill the canal space. It is a thermoplastic material , which literally is heated and then compressed into and against the walls of the root canals to seal them. Together with adhesive cement called a sealer, the gutta-percha fills the prepared canal space. Sealing the canals is critically important to prevent them from becoming re-infected with bacteria. After the procedure, an antibiotic may be prescribed to treat or prevent infection. Be sure to follow the instructions of your dentist or endodontist carefully. After-effects of treatment are minimal, generally lasting from a couple of days to about a week. It is normal to have some minor discomfort after treatment including slight soreness that can usually be managed with over-the-counter (aspirin, ibuprofen) medications or prescription (codeine-type) drugs, or a combination of the two.
3-Placing A Final Restoration On The Tooth
Your tooth will need a permanent restoration — a filling or a crown — to replace lost tooth structure, and provide a complete seal to the top of the tooth. This step is of particular importance since many studies show that if the filled root canals are decontaminated with bacteria from the mouth, there could be a recurrence of infection around the tooth.
How long does a root canal appointment take?
Over the last few decades, new techniques and new types of equipment have been developed that have improved the efficiency with which endodontic therapy can be performed. And these improvements are one reason why single-visit treatment has now become so much more commonplace.
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