Single visits vs multiple visits in pulpectomy

Single visit indications

Vital teeth Teeth having pulp exposures caused by trauma,caries, or mechanical reasons, without any symptoms(tender on percussion) or peri-apical changes, are the ideal candidates for single-visit endodontic therapy Cases where a temporary seal cannot be provided between appointments Usually in vital teeth with subgingival breakdown,teeth with multiple missing coronal walls, and teeth having full coverage restorations with decayed margins, the extent of lost tooth structure is quite extensive. This makes it extremely difficult and time-consuming to secure well fitting temporary restorations on teeth.

 Fractured anterior or premolar teeth These teeth are present in the aesthetic zone of the mouth. Fracture of these teeth is thus of aesthetic concern to the patient and a temporary restoration(temporary post and crown) is often required. Cases requiring endodontic therapy for restorative reasons These include teeth that serve as overdenture abutments,mandibular anterior teeth requiring full jacket crowns and teeth with severe coronal breakdown (severe attrition) that require a restoration (whose preparation would result in pulp exposure) to obtain a desired alignment for the designed restoration.

 Medically compromised and disabled patients Physically disabled patients who cannot return for recall appointments, patients who require sedation and/or operating room treatment and patients with heart valve damage or prosthetic implants that require repeated regimens of prophylactic antibiotics, should be considered for single-visit endodontic therapy.

Single visit contraindication and Multiple visits indication

Anatomical anomalies or procedural difficulties A variety of anatomical problems such as receding pulp chambers, calcified canals, severely curved canals, bifurcated canals and dilacerations or procedural errors including broken instruments, perforations and ledge formation, make it virtually impossible at times to perform endodontic therapy in one visit. Physical or mental disabilities Patients who suffer from diseases of the muscle tissues, such as muscular dystrophy, temporomandibular joint disorders, mental illness such as attentiondeficit disorder or any other neuromuscular disorder may require longer appointments for their treatment. Long appointments may be extremely taxing to both the patient and the practitioner. Non-vital teeth with or without apical periodontitis and re-treatment cases This particular condition is probably the most controversial in terms of whether or not a single-visit

Advantages of single-visit endodontic therapy

Number of patient appointments is reduced,leading to increased level of patient comfort. The chances of inter-appointment microbial contamination and associated flare-ups caused by leakage or loss of the temporary seal are reduced An immediate aesthetic replacement can be given for anterior teeth. No need for refamiliarisation with the canal anatomy at the recall appointment. The therapy is cost-effective as there is reduction in clinic time. Patients pre-appointment anxiety, apprehension during the appointment and post-operative discomfort are minimised.

Disadvantages of single-visit endodontic therapy

A single long appointment can be tiring and uncomfortable to some patients, especially those with temporomandibular dysfunction. It is difficult to manage flare-up cases. If haemorrhaging or exudation occurs, it may be difficult to control and complete the treatment at the same visit. Treatment of difficult cases of extremely fine,calcified, multiple canals may cause undue stress for both the patient and the clinician. Expertise is required by the clinician to efficiently and properly treat a case in a single visit.