Single-visit or multiple-visit root canal treatment: systematic review, meta-analysis and trial sequential analysis

Area of Science:

• Endodontics
• Dental Surgery
• Evidence-Based Dentistry

Background:

• Single-visit root canal treatment offers convenience but may pose risks.
• Conventional multiple-visit root canal treatment is the standard approach.
• Systematic evaluation of complication risks is crucial for treatment decision-making.

Purpose of the Study:

• To systematically evaluate and compare the risk of complications between single-visit and multiple-visit root canal treatments.
• To assess both short-term (pain, flare-up) and long-term (periapical lesions) complications.
• To determine the certainty of evidence regarding treatment outcomes.

Main Methods:

• Systematic review and random-effects meta-analysis of controlled trials.
• Inclusion of trials comparing single-visit versus multiple-visit root canal treatment in permanent teeth.
• Application of trial-sequential analysis to control for random errors and GRADE for evidence grading.

Main Results:

• No significant difference in overall complications (Risk Ratio [RR] 1.00) or pain (RR 0.99) between single-visit and multiple-visit root canal treatments.
• A significantly higher risk of flare-ups was observed after single-visit treatment (RR 2.13), though with very weak evidence.
• Trial-sequential analysis indicated insufficient evidence to confirm benefits, harm, or futility for any outcome.

Conclusions:

• Insufficient evidence exists to definitively rule out important differences between single-visit and multiple-visit root canal treatments.
• Given the potential for increased flare-ups, multiple-visit root canal treatment may be preferred for specific teeth, particularly those with periapical lesions.