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

Abstract

Objectives: Single-visit root canal treatment has some advantages over conventional multivisit treatment, but might increase the risk of complications. We systematically evaluated the risk of complications after single-visit or multiple-visit root canal treatment using meta-Analysis and trial-sequential analysis. Data: Controlled trials comparing single-visit versus multiple-visit root canal treatment of permanent teeth were included. Trials needed to assess the risk of longterm complications ( pain, infection, new/persisting/ increasing periapical lesions ?1 year after treatment), short-Term pain or flare-up (acute exacerbation of initiation or continuation of root canal treatment). Sources: Electronic databases (PubMed, EMBASE, Cochrane Central) were screened, random-effects meta-Analyses performed and trial-sequential analysis used to control for risk of random errors. Evidence was graded according to GRADE. Study selection: 29 trials (4341 patients) were included, all but 6 showing high risk of bias. Based on 10 trials (1257 teeth), risk of complications was not significantly different in single-visit versus multiple-visit treatment (risk ratio (RR) 1.00 (95% CI 0.75 to 1.35); weak evidence). Based on 20 studies (3008 teeth), risk of pain did not significantly differ between treatments (RR 0.99 (95% CI 0.76 to 1.30); moderate evidence). Risk of flare-up was recorded by 8 studies (1110 teeth) and was significantly higher after single-visit versus multiple-visit treatment (RR 2.13 (95% CI 1.16 to 3.89); very weak evidence). Trial-sequential analysis revealed that firm evidence for benefit, harm or futility was not reached for any of the outcomes. Conclusions: There is insufficient evidence to rule out whether important differences between both strategies exist.