0 penilaian0% menganggap dokumen ini bermanfaat (0 suara)
1K tayangan47 halaman
This document discusses and compares single-visit versus multiple-visit endodontic treatment. It reviews several studies that found no significant differences in post-operative pain or failure rates between the two approaches when performed by skilled practitioners. Guidelines are presented for case selection and criteria for one-appointment treatment. Both advantages like convenience and disadvantages like inability to drain flare-ups are addressed. Teeth with complex anatomy like maxillary molars are identified as ones not suitable for single-visit treatment.
Deskripsi Asli:
send feedback at amitk.sharmadr@gmail.com
Judul Asli
Comparison of One Versus Multi Visit tic Treatment
This document discusses and compares single-visit versus multiple-visit endodontic treatment. It reviews several studies that found no significant differences in post-operative pain or failure rates between the two approaches when performed by skilled practitioners. Guidelines are presented for case selection and criteria for one-appointment treatment. Both advantages like convenience and disadvantages like inability to drain flare-ups are addressed. Teeth with complex anatomy like maxillary molars are identified as ones not suitable for single-visit treatment.
Hak Cipta:
Attribution Non-Commercial (BY-NC)
Format Tersedia
Unduh sebagai PPT, PDF, TXT atau baca online dari Scribd
This document discusses and compares single-visit versus multiple-visit endodontic treatment. It reviews several studies that found no significant differences in post-operative pain or failure rates between the two approaches when performed by skilled practitioners. Guidelines are presented for case selection and criteria for one-appointment treatment. Both advantages like convenience and disadvantages like inability to drain flare-ups are addressed. Teeth with complex anatomy like maxillary molars are identified as ones not suitable for single-visit treatment.
Hak Cipta:
Attribution Non-Commercial (BY-NC)
Format Tersedia
Unduh sebagai PPT, PDF, TXT atau baca online dari Scribd
ENDODO NT ICS In the past few years, many operators have claimed high rates of success with one sitting endodontic therapy, particularly when their patients come from great distance and would be considerably inconvenienced by return trips.
Some dental schools are currently teaching one sitting
treatment in every case and some are teaching it in selected cases. A number of skilled practioners regularly perform therapy in this manner, European dentists use it more frequently then do those from United States.
Endodontists have been treating patients in one-
appointment visits for some time. And 86% of the directors of postgtaduate endodontic programs, when surveyed, reported that nonsurgical one-visit treatment was part of their program.(Landers 1980) When questioned, however, most dentists reply that they reserve one-appointment treatment for vital pulp and immediate periradicular surgery cases. (Ingle)
In 1982 only 12.8% of dentists queried thought
necrotic teeth would be successfully treated in one appointment.(Calhoun) Wh at ha s he ld b ack o ne- app oi ntm en t end od ont ic s? major consideration has been concern about pain and failure.
less evident causes are fear of both
professional rejection of the practice and justification of multi-appointment fees for one- appointment therapy. These hidden reasons are gradually fading, however, as more and more dentists are practicing and accepting single-visit therapy.
Competition will take care of the fee problem;
more patients will be seen in a shorter time. Po st operative Pa in The fear that patients will probably develop postoperative pain and that the canal has been irretrievably sealed has probably been the greatest deterrent to single-visit therapy.
Yet the literature shows no real difference in
pain experienced by patients treated with multiple appointment. 40 % of the endodontic course directors surveyed were of the opinion that necrotic cases treated in one visit have more flareups.(Calhoun 1982) Galberry did not find this to be true in Louisiana nor did Nakamuta and Nagasawa in Japan who had only a 7.5% pain incidence after treating 106 infected cases in single appointments.
Moreover, the symptoms the patients
experienced were mild and needed no drugs or emergency treatment. Oliet reported that only 3% of his sample of 264 patients receiving single-appointment treatment had severe pain, Compared with 2.4% of the 123 patients treated in two visits. Wolch's records of over 2000 cases treated at a single appointment showed that less than I % of patients indicated any severe reaction.
Pekruhn reported no statistically significant
difference between his two groups. Mulhern and Patterson reported no significant difference in the incidence of pain between 30 single rooted teeth with necrotic pulps treated in one appointment, and 30 similar teeth treated in three appointments. More recent reports from Brazil and from the Netherlands found no difference in the incidence of pain between one and two-visit cases.
Trope reported no flare ups in one-
appointment cases with no apical lesions. One might expect pain from any case as reported by Harrison from Baylor University. Out of 229 patients treated twice, 55.5% had no inter-appointmet pain, 28.8% had slight pain, and 15.7% had moderate to severe pain. In light of these studies pain does not appear to be a valid reason to avoid single- appointment root canal therapy. Fear o f fa ilu re Pekruhn - failure was higher (15.3%) in teeth with periradicular lesions that had had no prior access opening. If this type of case had been previously opened, the incidence of failure dropped to 6.5%.
Symptomatic cases were twice as likely to fail
as were asymptomatic cases (10.6% vs 5.0%). A Japanese study followed one-visit cases for as long as 40 months and reported an 86% success rate.
Oliet again found no statistical significance
between his two groups. The majority of the postgraduate directors of endodontics felt that the chance of successful healing was equal for either type of therapy. "In the treatment of any disease, a cure can only be effected if the cause is removed, Since endodontic diseases originate from an infected or affected pulp, it is axiomatic that the root canal must be thoroughly and carefully debrided and obturated." (Wolch) Guidelines for one-appoint ment endodontics
One-appointment endodontics should not be
undertaken by inexperienced clinicians. The dentist must possess a full understanding of endodontic principles and the ability to exercise these principles fully and efficiently. There can be no shortcuts to success. The endodontic competence of the practicing dentist should be the overriding factor in undertaking one- visit treatment.
As a guideline, the case should be one that can
be completed within 60 minutes.
Treatments that take considerably longer should be
done in multiple visits. Oliet' s cr iteria for cas e select ion positive patient acceptance sufficient available time to complete the procedure properly absence of acute symptoms requiring drainage via the canal and of persistent continuous flow of exudate or blood absence of anatomical obstacles (calcified canals, fine tortuous canals, bifurcated or accessory canals) and procedural difficulties (ledge formation, blockage, perforations, inadequate fills). Indic atio n
Uncomplicated vital teeth.
Fractured anterior or bicuspid teeth where esthetics
is a concern and a temporary post and crown are required.
Patients who are physically unable to return for the
completion. Patients with heart valve damage or prosthetic implants who require repeated regimens of prophylactic antibiotics.
Necrotic, uncomplicated teeth with draining sinus
tracts.
Patients who require sedation or operating room
treatment. Co ntra ndication
Painful, necrotic tooth with no sinus tract for
drainage.
Teeth with severe anatomic anomalies or cases
fraught with procedural difficulties.
Asymptomatic nonvital molars with periapical
radiolucencies and no sinus tract. Patients who have acute apical periodontitis with severe pain on percussion.
Most retreatments. Ad van tag es o f o ne app oi ntm en t th era py Patient convenience – no additional appointment.
Immediate familiarity with the internal anatomy, canal
shape, and contour facilitates obturation.
No risk of bacterial leakage beyond a temporary coronal
seal between appointments.
Reduction of clinic time.
It minimizes fear and anxiety in the apprehensive patient .Few patients ever request to have root canal treatment completed in several appointments. It eliminates the problem of the patient who does not return to have his case completed. For anterior cases it allows immediate use of the canal space for retention of a post and construction of an esthetic temporary crown. Disa dva nta ges The longer single appointment may be tiring and uncomfortable for the patient.( patients, especially those with temporomandibular dysfunction or other impairments ) Flare-ups cannot easily be treated by opening the tooth for drainage. If hemorrhaging or exudation occurs, it may be difficult to control that and to complete the case at the same visit. Difficult cases with extremely fine, calcified, multiple canals may not be treatable in one appointment without causing undue stress for both the patient and the clinician.
The clinician may lack the expertise to properly treat
a case in one visit. This could result in failures, flare- ups, and legal repercussions. Careful case selection and proper and thorough adherence to standard endodontic principles, with no shortcuts, should result in successful one- appointment endodontics.
Practitioners should attempt one-visit root canal
treatment only after making an honest assessment of their endodontic skills, training, and ability. COM PARIS ON OF ONE VERSUS MU LTIV ISIT END OD ON TIC T REATME NT Single-appointment root canal therapy has become a common practice. If the pulp is necrotic and the canal is filled at the first appointment, facultative anaerobes may multiply in the new environment and cause exacerbation.i.e no easy access to apical canal if there is a flare up. An ability to relieve pain quickly and efficiently is the major reason for not completing endodontic therapy in one sitting.
There is no opportunity to place intracanal
disinfectant (other than allowing NaOCl to disinfect during the treatment). TEE TH T HA T SH OULD NOT BE COMPLETE D IN ONE APP OI NTM EN T
Many studies on canal configuration of maxillary
molars indicate that four canals are present more often than three canals.
Location and preparation of the fourth canal (second
canal in the mesiobuccal root) may take considerable time and must not be rushed, particularly when the pulp was involved in an acute pulpitis and concomitant bleeding is present. Time necessary to locate the additional canal, which is quite posterior in the arch, the patient must keep open widely for a significant time which is uncomfortable.
Mandibular first molar often has four canals (usually
the mesiolingual canal) too, although not as frequently as the maxillary molars. The second condition for which multiple appointments involves the treatment of a patient who suffers from physical and/or mental condition that makes longer appointments extremely taxing to both the patient and the practioner.
This problem may be due to diseases of the muscle
tissues such as muscular dystrophy or mental disease including attention deficit disorder. If it is discovered during the preparation that much over instrumentation has occurred by error the tooth should not be completed in one appointment. Case selection is quiet important to rule out with preoperative apical periodontitis because they are more prone to postoperative problems. Anterior teeth which are easier to radiograph offer a better chance for one visit success than do molar teeth. One step treatment is less expensive very well accepted by patients and has been shown to result in a lower flare up rate according to: Trope M.Flare up rate of single visit endodontics J endo 1991;24:24-7
Jureak et al 1993 performed one-visit endodontics on 167
patients regardless of pain, swelling,sinus tract, or radiogarphic lesions. They reported that one visit was no more uncomfortable than multiple visit and showed same success rate. Oliet et al and Fava et al 1989 reported little or no differenec in the post treatment complications between single and multiple visit. Pekrunh RB et al1986 reported that the incidence of failure after one appointment endodontics was higher in those teeth with periapical extension of pulpal disease. In more recent times, and in marked contrast to these positive reports, Sjogren and his associates (1997) in Sweden sounded a word of caution. At a single appointment, they cleaned and obturated 55 single- rooted teeth with apical periodontitis. All of the teeth were initially infected. After cleaning and irrigating with sodium hypochlorite and just before obturation, they cultured the canals. Using advanced anaerobic bacteriologic techniques, they found that 22 (40%) of the 55 canals tested positive and the other 33 (60%) tested negative Periapical healing was then followed for 5 years. Complete periapical healing occurred in 94% of the 33 cases that yielded negative cultures! But in those 22 cases in which the canals tested positive prior to root canal filling, “the success rate of healing had fallen to just 68%”, a statistically significant difference. In other words, if a canal is still infected before filling at a single dental appointment, there may be a 26% greater chance of failure than if the canal is free of bacteria. Their conclusions emphasized the importance of eliminating bacteria from the canal system before obturation and that this objective could not be achieved reliably without an effective intracanal medicament. Kyoko Inamoto et al 2002 reported that in a survey conducted among 738 United States endodontists 55.8% carried out single visit endodontics and 34.2% indicated that their patients had experienced some trouble after root canal obturation at first visit. The original investigators in this field, Fox et al., Wolch, Soltanoff, and Ether et al.(1981), were convinced that single visit root canal therapy could be just as successful as multiple-visit therapy. None, however, treated the acutely infected or abscess case with a single visit. Walton and Fouad et al1992 treated 946 patients and then examined the correlating factors that cause flare up after root canal treatment. They reported that the cause of flare up after root canal treatment had no correlation between patients demographics or systemic conditions, number of appointments, treatment procedures or taking antibiotics. TH ANK YO U
If the patients tooth is worth saving it is also
Evaluation of Mineral Trioxide Aggregate (MTA) Versus Calcium Hydroxide Cement (Dycal ) in The Formation of A Dentine Bridge: A Randomised Controlled Trial