1 or 2 Visit Root Canals?

June 27, 2019

As you may have noticed in a previous post, dentists sometimes like to argue…and if you’ve ever taken part in an academic debate, it can get pretty intense. Like, insulting your mother or sister tense, which is a little weird considering the crowd (not really classic MMA type people, ya know?). I spent a weekend in Connecticut several years ago, attending an endodontic meeting where the topic of single visit endodontics was discussed. Vigorously. As in, the room quickly divided into “single visit root canal treatment is fine,” or “it’s for total nincompoops!” At the end, I believe the only thing accomplished is that everyone was more entrenched in their a priori view of the subject. For the record, if you ever have the chance to visit Avon, Connecticut, you should go. It’s beautiful countryside.

The question remains: which is better, 1 or 2 visit root canals. There is no shortage of scientific literature on this topic. In fact, PubMed runneth over with articles on this very subject, so what so all of these studies say? Well, it depends on the nature of your question: Are you concerned about post-operative pain? Then 2 visits are probably the way to go as many people report decreased post-operative pain when root canals are performed in 2 visits. I have to point out that, yes, there are studies that show single visit root canals have decreased post-operative pain that 2 visits, but the available evidence, including Cochrane systematic reviews (the highest level of evidence) report that single visit root canals have increased post-operative pain. Are you interested in overall success? Root canals performed in a single visit have pretty much the same success rate as those performed in two. Is the tooth infected? Again, single and multiple visit endodontics have pretty much the same success rate.

The list goes on seemingly forever, so what is a person to do? In my office, many factors dictate whether a root canal is performed in 1 or 2 (3 or 4??) visits. How complex is the case? Teeth with severe curvature, constricted canals, difficult to access areas or someone is severe pain will often be completed in multiple visits. Think of a tooth like a road: straight, wide open roads invite you to hit the gas. Tight, windy roads force you to slow down, take your time and exercise caution, unless you love heartache. Difficult teeth take more time and it’s really hard for most people to remain propped open for more than an hour. Large infection? Maybe consider 2 visits as there will often be drainage. Are you unsure of healing? Multiple visits will offer confidence in your chances of success, so sometimes it’s better to slow down. Everyone would rather have their root canal completed in a single visit than multiple visits, but I like to tell people that I’d rather perform treatment correctly than quickly. On that, I believe, we can all agree.

Ultimately, there is no universally correct answer to this question, because no two patients are exactly alike, no two dentists are exactly alike and no two teeth are exactly alike. Expertise, case complexity, patient compliance, access to the tooth, drainage, treatment goals, time constraints and an almost endless list of factors will drive 1 versus 2 visits.


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Single versus multiple visits for endodontic treatment of permanent teeth.

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