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Healing Outcomes of Single-visit and Two-visit Endodontic Treatment for Necrotic Teeth with Apical Periodontitis: A
Mike Sabeti1, Heather Kim1, Samah Abbaker1
1School of Dentistry, University of California, San Francisco, California.
Introduction:
This randomized clinical trial compared single-visit and two-visit root canal treatment in necrotic teeth with apical periodontitis.
Methods:
Fifty-nine patients were randomized to single-visit (n = 28) or two-visit (n = 31) treatment, with calcium hydroxide placed for 10-14 days in the two-visit group. Cone-beam computed tomography (CBCT) scans were obtained preoperatively and at follow-up. The primary outcome was combined clinical and CBCT-based radiographic healing assessed using the CBCT Periapical Index. Outcomes were categorized as strict (healed) and loose (healed + healing), both requiring absence of clinical signs and symptoms. The secondary outcome was lesion volume. Analyses used Fisher's exact, Fisher-Freeman-Halton exact, and Mann-Whitney U tests (P < .05).
Results:
At a mean follow-up of 2.8 years, 42 patients completed the study. Both groups demonstrated reductions in CBCT Periapical Index scores and lesion volumes. Strict and loose healing did not differ significantly (two-visit vs single-visit: strict 50% vs 25%, risk ratio: 2.0, 95% CI: 0.8-4.8; P = .121; loose 86.4% vs 90%, risk ratio: 0.96, 95% CI: 0.77-1.20; P = 1.000). Baseline volumes were similar (∼47 mm3), and lesion volumes decreased in both groups, with a median between-group difference in reduction of 10.3 mm3 in favor of the two-visit group (95% confidence interval: -15.3 to 27.7; P = .590).
Conclusion:
No statistically significant differences were detected between the two groups in combined clinical and CBCT-based periapical healing or lesion volume reduction. Complete healing was numerically more frequent in the two-visit group; however, these findings do not demonstrate superiority, noninferiority, or equivalence.
