Is single visit endodontic treatment considered quality dental care?

[Khaled Balto]

Is single visit endodontitc treatment considered quality care?

[Khaled Balto]

I have seen many many cases done here and there in single visit...I did re-treatment in many of them...and upon interviewing the patients...they said the doctor did it in single visit. Some of them were impressed and lots of them were surprised....is this enough !!!

It seems there is a growing trend for dentists to work against the clock in doing RCTs. I wanted to present this clinical behavior for discussion.....is doing such an approach considered to be among the standards of care? I mean in the way I presented above.

[nehal_sharaf]

Hi Dr.Khaled

I think the problem with the quality of treatment and experience of dr. not with the no. of visits, also it depend on the case.
The problem now that most famous prof. shifted to single visit ttt, so other doctors think that the cause of their prof.success is the single visit, so they try to imitate them although they don't have enough experience to do that.

Thanks dr.

[Khaled Balto]

I completely agree Nehal with you, however, there are factors involved to get the biological and mechanical objectives of the txt. For example, will the patient be able to keep her mouth open for more than one hour? in cases of re-treatment; where dis assembly in involved and massive dis-infection is required...can that be achieved in one visit? how about if you have busy schedule and you started to beat the O'clock to try to finish in the same visit..and you compromised your results or even end up in iatrogenesis.

I often do single visit myself...but I think the word of wisdom RCT is a journey and not a destination.....if things fall in place by the end of the visit...then fill them...but it is when you force yourself in finishing in the same visit...I think that will be below the standards of care.

[suha maddah]

Hi Dr,Balto
I still never practice endodontic treatment but enshalla next year we will start
I read about single visit root canal treatment and I found numerous advantages of single visit RCT which are:

The clinician has the most intimate awareness of the canal anatomy immediately following instrumentation.
No risk of losing important landmarks.
The canal is never cleaner than immediately after proper instrumentation
No risk of flare-up induced by leakage of the temporary seal (because obturation is completed).
Teeth are ready sooner for final restoration, diminishing the risk of a fracture necessitating extraction
Patients' pre-appointment anxiety and post-operative discomfort are limited to one episode
Time is saved for the patient and for the practitioner since the treatment is completed in one visit.

Three contradictions exist in completing a root canal treatment in one appointment:

Inability to dry the canals completely, insufficient time to complete the procedure, and possible increased stress on temporomandibular joint musculature, or increased psychological stress on patients or clinicians because of longer appointment time, or both

but I understand from you that the time is the problem and the patient can't tolerate opening his/her mouth for long time while the dentist should take his time to clean ,make instrumentation and obturate and do all the steps to reach a successful RCT
is that right?

[Khaled Balto]

You got that almost right but not quite.
In real world endodotnics; things are not always glory and easy. If you are talking about virgin teeth presented with their blood...that is easy...but I am referring to complicated cases where you are faced with the dilemma of fixing other mistakes.
It brings us to the zero point when I started this discussion; Which's beating the O'clock, forcing yourself or the patient to finish once and for all. If you are talking about having a patient in a session for 2-3 hours....I do not see a reason why not finishing in one setting ..if you can hold your concentration and the patient can hold up......!!! remember it is a journy and not a distination

[Reham Khaled]

so as i understand doc. single visit RCT is a stander of care in case of my work and the situation of the case >> if i manege to finish the case without any complication and with a cooperative patient that would be just fine, right ?
so that bring to me a question is the liability of postoperative flare up might be increasing with 1 visit RCT or not ??

otherwise if the case was complicated or a re-treatment it is better to do multiple visit RCT ...

so i am the master of my mind >> i do the decision according to the case ..
AND as you always says " it is a journy and not a distination " i like these words alot

[Ehab Heikal]

Originally Posted by Khaled Balto

Is single visit endodontitc treatment considered quality care?

Besides the proper treatment, I think we should also consider the quality from the patient's presepective. The patient cannot tell whether the treatment is perfect or not, but he looks for other attributes or dimensions to judge the quality of work.
Besides, it all depends on the ability of the dentist to sell the idea of the one visit RX to the patient. If this was not done properly, the patient might think that he was not properly treated and might go for a second opinion to check whether the treatment was performed properly or not.

[Vega]

I agree with Ehab in that we need to consider the patient's comfort-level and ability to withstand two or three hours for a RCT. While completing a RCT in one-sitting does present great advantages like Suha mentioned, we shouldn't ignore our patient's tolerance-levels and comfort. In the end, while you want to do the work in the most efficient and best manner, you also want your clients to leave happy and satisfied with not only the work but the treatment they received while undergoing a RCT. You want clients who will come back and who will recommend you to others.

[Khaled Balto]

Taking it all together.....I conclude: Single visit RCT (non-surgical) is contraindicated when:
1) A reasonable time has passed by and you are not yet finished
2) When a decision is made that microbial reduction protocol is needed

and by the way unless you are student; I do not see a reason for treating a patient more than one hour in the dental chair....it is exhaustive for both the dentist and the patient. When things get complicated or lengthy...it is always good idea to have a new fresh start next week....what do you all think?