One- versus Two-visit Endodontic Treatment of Teeth with Apical Periodontitis: A Histobacteriologic Study
Jorge Vera, DDS,* Jos e F. Siqueira, Jr, DDS, MSc, PhD,† Domenico Ricucci, MD, DDS,‡ Simona Loghin, DDS,‡ Nancy Ferna ndez, DDS,§ Belina Flores, DDS,k
and Alvaro G. Cruz, DDS, MSc¶
Introduction: This study analyzed the in vivo micro- biological status of the root canal systems of mesial roots of mandibular molars with primary apical perio- dontitis after 1- or 2-visit endodontic treatment. Methods: Mesial root canals were instrumented by using either a combination of K3 and LightSpeed instru- ments (mesiobuccal canals) or the ProTaper system (mesiolingual canals), with 5% NaOCl irrigation. Patency files were used. Smear layer was removed, and a final rinse with 5 mL of 2% chlorhexidine was performed. In the 2-visit group (7 roots, 14 canals), canals were medicated with calcium hydroxide for 1 week and then obturated by using the continuous wave of compaction technique. In the 1-visit group (6 roots, 12 canals), canals were immediately obturated after chemomechanical procedures. Teeth were extracted 1 week after root canal instrumentation and processed for histobacteriologic analysis. Results: In the 1-visit group, no case was completely free of bacteria; residual bacteria occurred in the main root canal (5 of 6 cases), isthmus (5 of 6), apical ramifications (4 of 6), and dentinal tubules (5 of 6). In the 2-visit group, 2 cases were rendered bacteria-free; residual bacteria were found in the main canal only in 2 cases (none of them with persistent dentinal tubule infection), in the isthmus (4 of 7 cases), and in ramifications (2 of 7). The 2 instrumentation techniques performed simi- larly. When filling material was observed in ramifica- tions, it was usually intermixed with necrotic tissue, debris, and bacteria. Conclusions: The 2-visit protocol by using an interappointment medication with calcium hydroxide resulted in improved microbiological status of the root canal system when compared with the 1- visit protocol. Residual bacteria were more frequent and abundant in ramifications, isthmuses, and dentinal tubules when root canals were treated without an interappointment medication. Apical ramifications and isthmuses were never completely filled. The use of an antibacterial interappointment agent is necessary to maximize bacterial reduction before filling.
(J Endod 2012;38:1040–1052)
Key Words
Calcium hydroxide, endodontic infection, endodontic treatment, 1-visit endodontics,
sodium hypochlorite
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