Which is better to complete root canal therapy at one time or by several times
Root canal therapy is the first choice for the treatment of pulp disease and periapical disease.
It is composed of three basic steps: root canal preparation, root canal disinfection, and root canal filling. Due to the great progress in equipment and materials, contemporary root canal therapy integrates root canal cleaning, shaping, and disinfection, fully removes infectious substances in root canals through mechanical shaping and chemical flushing of root canals, and tightly fills root canals with dental gum to prevent reinfection.
The root canal treatment steps are usually divided into several times, i.e. initial diagnosis of pulpotomy and pulpotomy, simultaneous or follow-up root canal preparation, follow-up root canal filling, and disinfection drugs sealed in root canals during the diagnosis. This process usually requires patients to visit for 2-4 times, which lasts about 2-4 weeks. It brings a lot of inconvenience to patients' work and learning, and there are problems such as micro leakage of temporary sealing materials.
With the progress of root canal therapy technology and equipment, the effect of root canal cleaning and disinfection is good, and one-time root canal therapy is also increasingly used in clinical practice. The use of one-time root canal therapy for patients can significantly improve their own short-term medical effects to a large extent.
There is no significant difference between one-time root canal therapy and conventional root canal therapy in terms of indications, including various types of pulpitis, pulp necrosis, pulp calcification, internal absorption, periapical periodontitis, tooth trauma, etc. Many research results also show that there is no statistically significant difference in the success rate between one-time root canal therapy and multiple root canal therapy.
However, one-time root canal therapy can be filled immediately after root canal preparation and disinfection, which can reduce the probability of root canal reinfection caused by temporary sealing materials falling off, poor sealing and other reasons in the clinic, shorten the number of visits, improve patient compliance and improve patient experience. Therefore, contemporary root canal therapy advocates to complete root canal therapy through one visit.
However, in case of acute periapical periodontitis, difficult root canal therapy and internal and external root resorption, root canal therapy should still be completed in batches.
Some doctors are most worried about the problem of tooth pain after one-time root canal therapy. Some literatures have evaluated the impact of one-time and multiple methods on postoperative pain, and believed that multiple methods can reduce the occurrence of postoperative pain. But later, some scholars came to the conclusion that "there is not enough evidence to explain the difference between one-time method and multiple method in postoperative pain" through evidence-based research on literature.
In fact, the pain problem after root canal therapy may be caused by incomplete mechanical preparation or pushing the debris out of the root tip during preparation, or it may be the tissue immune response caused by the activation of the host prevention mechanism of the patient after receiving chemical and physical stimulation.
So in fact, both patients and doctors have some factors in the problem of postoperative pain, but it is the doctors who play a leading role. Good treatment techniques may not completely avoid postoperative pain problems, but the technology is not well grasped, and the incidence of postoperative pain will be relatively high, which must be experienced by students who just graduated.
Therefore, if we want to reduce the incidence of postoperative pain, we must strengthen the operation technology of root canal therapy and some basic theories.
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