comparison of the effectiveness of single-visit and multi-visit root canal treatment on healing intra-oral sinus tract

Abstract

Comparison of the effectiveness of single-visit and multi-visit root canal treatment onhealing intra-oral sinus tractFatma Begüm Peker, Mehmet Burak GüneşerDepartment of Endodontics, School of Dentistry, Bezmialem Vakif UniversityObjective: To evaluate postoperative pain and intra-oral sinus tract healing in teeth with chronic apical periodontitistreated in a single visit and to compare the results with multi-visit root canal treatment using an intracanal calciumhydroxide.Materials-Methods: A total of 60 patients in need of non-surgical endodontic treatment participated in this study. Allpatients provided informed consent. The age range of the patients was between 18 and 65 years. The selectedteeth all had a single root and single canal, along with radiographic evidence of apical periodontitis and intra-oralsinus tracts. The patients were randomly divided into two study groups: Group 1(single-visit) and Group 2(multi-visit). Local anesthesia (Ultracaine DSForte;Aventis Pharma,Istanbul,Turkey) was administered and the tooth wasisolated with a rubber dam. Access cavities were created using sterile diamond burs. The working length of eachtooth was determined using an electronic apex locator (Propex Pixi,DentsplySirona,Ballagues,Switzerland) and asize #15 K-type stainless steel file was inserted into the root canal, confirmed radiographically. To shape the rootcanals, nickel–titanium rotary files (VDW GmbH,Munich,Germany) were used in accordance with the manufacturer’sinstructions. Rotary files with a #40 size and variable taper tips of up to 0.04 were used. In the multi-visit group,after the shaping process, calcium hydroxide was placed. All multi-visit treatments were completed one week afterthe initial visit. For all groups, the final irrigation process consisted of the following steps: 5 mL of 2.5% sodiumhypochlorite (Wizard,Ankara,Turkey), 5 mL of 17% ethylenediaminetetraacetic acid (Werax,Izmir,Turkey) and 5 mLof saline. In the single-visit group, after the final irrigation, the root canals were filled with gutta-percha and epoxyresin-based root canal sealers (Ah Plus,DentsplySirona) using the cold lateral compaction method during the samesession. For the multi-visit group, after the removal of calcium hydroxide and following the final irrigation protocol,the root canals were filled during the second appointment. Radiographic checks were performed to ensure properroot canal fillings. Coronal restorations of the teeth were carried out with resin composite material (Z250,3M ESPE).Postoperative pain was scored for the 2 days following the treatment using a visual analogue scale. In the multi-visit group, pain was also assessed at the beginning of the second appointment and patients were asked about thepresence or absence of pain between visits. All patients were scheduled for follow-up appointments and weremonitored until the day of the sinus tracts were healed (Healing means the closing of the sinus tract). Data wereanalyzed using the two sample proportion test and Pearson chi-square tests (α=0.05).Results: There were no significant differences between two groups regarding the incidence of postoperative pain(p>0.05). In the multi-visit group, greater healing was observed on the 3rd and 7th days as compared to the 14thday(p<0.05). However, the day of healing showed a homogeneous distribution in the single-visit group, and therewere no statistically significant differences between the 3rd, 7th, and 14th days(p>0.05).Conclusion: Both groups experienced similar postoperative pain. But it has been observed that a multi-visit protocolprovides earlier healing than a single-visit.Keywords: sinus tract, apical periodontitis, single-visit, multi-visit, postoperative pain