Single versus multiple visits for endodontic treatment of permanent teeth

 

Abstract

Background

Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious processes, tooth cracks or chips, or dental trauma. Successful RoCT is characterised by an absence of symptoms and clinical signs in teeth without radiographic evidence of periodontal involvement. The success of RoCT depends on a series of variables related to the preoperative condition of the tooth, as well as the endodontic procedures.

Objectives

To compare the effectiveness of single- and multiple-visit RoCT, measured as tooth extraction due to endodontic problems and radiological success.
To assess the difference in short- and long-term complications between single- and multiple-visit RoCT.

Search methods

The following databases were searched for relevant trials: Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, and EMBASE. Handsearching was performed for the major oral medicine journals. References of included studies and reviews were checked. Endodontics experts were contacted through e-mail. No language limitations were imposed. Date of last search was 6th March 2007.

Selection criteria

Randomised and quasi-randomised controlled trials of patients needing RoCT were included. Surgical endodontic treatment was excluded. The outcomes considered were the number of teeth extracted for endodontic problems; radiological success after at least 1 year, that is, absence of any periapical radiolucency; postoperative pain; painkiller use; swelling; or sinus track formation.

Data collection and analysis

Data were collected using a specific extraction form. The validity of included studies was assessed on the basis of allocation concealment, blindness of the study, and loss of participants. Data were analysed by calculating risk ratios. When valid and relevant data were collected, a meta-analysis of the data was undertaken.

Main results

Twelve randomised controlled trials were included in the review. Four studies had a low risk of bias, four a moderate risk, and another four had a high risk of bias. The frequency of radiological success and immediate postoperative pain were not significantly different between single- and multiple-visit RoCT. Patients undergoing single-visit RoCT reported a higher frequency of painkiller use and swelling, but the results for swelling were not significantly different between the two groups. We found no study that included tooth loss and sinus track formation among its primary outcomes.

Authors' conclusions

No difference exists in the effectiveness of RoCT, in terms of radiological success, between single- and multiple-visit RoCT. Most short- and long-term complications are also similar in terms of frequency, although patients undergoing a single visit may experience a slightly higher frequency of swelling and are significatively more likely to take painkillers.

 

Plain language summary

Single versus multiple visits for endodontic treatment of permanent teeth

Root canal treatment or endodontic treatment, is a common procedure in dentistry. The main indications for root canal treatment are irreversible inflammation of the dental pulp (pulpitis) and death of the dental pulp caused by carious processes, tooth cracks or chips, or dental trauma. Successful root canal treatment is characterised by an absence of symptoms and clinical signs in teeth without radiographic evidence of periodontal involvement. The success of root canal treatment depends on a series of variables related to the preoperative condition of the tooth, as well as the endodontic procedures.
No difference exists in the effectiveness of root canal treatment, in terms of radiological success, between single- and multiple-visit root canal treatment. Most short- and long-term complications are also similar in terms of frequency, although patients undergoing a single visit may experience a slightly higher frequency of swelling and are significatively more likely to take painkillers.

 

摘要

背景

恆齒根管治療單次與多次看診之比較

根管治療(ROCT, Root canal treament)，或齒內治療(endodontic treatment)是牙科常見的治療項目。根管治療主要之適應症為因齲齒進程、牙齒斷裂或外傷造成之不可回復性牙髓炎及牙髓壞死。成功的根管治療為臨床上無癥候與症候以及在放射線影像上無牙周組織侵犯。根管治療的成功與否仰賴與術前牙齒狀態及根管治療過程相關的諸多變因。

目標

根據因根管問題拔牙的牙齒以及從放射線影像上證實的成功，來比較單診次與多診次根管治療的有效性。評估單診次與多診次根管治療於短期與長期併發症的差異。

搜尋策略

我們搜尋以下的電子資料庫以獲得相關試驗資料：Cochrane Oral Health Group's Trials Register、CENTRAL、MEDLINE與EMBASE。紙本方面我們搜尋各大主要口腔醫學期刊。所搜尋之研究與回顧文獻的參考資料也被審查。藉由電子郵件與牙髓病科專家連絡。沒有語言限制搜尋的範圍。最後搜尋的日期為2007年3月6日。

選擇標準

包括與需要進行根管治療的病人有關的隨機與半隨機對照試驗，而手術性根管治療是被排除的。結果評估根據因根管問題拔除的牙齒數；至少一年後放射線影像證實的成功，意即沒有根尖周圍的放射線通透性；術後疼痛；止痛藥的使用；腫脹；或廔管的形成。

資料收集與分析

使用一種特製的選取表格進行資料蒐集。所收集資料的有效性以分組隱匿、實驗的盲法以及參與者的失去追蹤之基礎作為評核。資料以計算風險比率分析。當具確實根據之資料與相關資料集合時，便進行統合分析。

主要結論

12件隨機對照試驗被囊括在這次回顧。其中4件具較低的偏差風險，4件具中度風險，以及其他4件含高度偏差風險。單診次與多診次治療對於放射線顯示成功的頻率與術後立即性疼痛方面並無統計上的差異。接受單診次治療的病人報告有較頻繁使用止痛藥與腫脹紀錄，但腫脹的結果在兩組中也無顯著差異。我們沒有發現在初期結果有牙齒喪失和廔管形成的研究。

作者結論

以放射線影像顯示成功來判定根管治療的有效性，在單診次與多診次根管治療並無差別。即使接受單診次治療的病人有較高頻率會腫脹且明顯地更會服用止痛藥，但以發生頻率而言，大部份短期與長期併發症也類似。

翻譯人

本摘要由臺灣大學附設醫院郭玟伶翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

恆齒之單診次與多診次根管治療比較 根管治療或齒內治療是牙科常見的治療項目。根管治療主要之適應症為因齲齒進程、牙齒斷裂或外傷造成之不可回復性牙髓發炎(牙髓炎)及牙髓壞死。成功的根管治療為臨床上無癥候與症候以及在放射線影像上無牙周組織侵犯。根管治療的成功與否仰賴與術前牙齒狀態及根管治療過程相關的諸多變因。以放射線影像顯示成功來判定根管治療的有效性，在單診次與多診次根管治療並無差別。即使接受單診次治療的病人有較高頻率會腫脹且明顯地更會服用止痛藥，但以發生頻率而言，大部份短期與長期併發症也類似。