Multi-visit treatment of endodontic infection – clinical aspects

In long-standing root canal infection with presence of sinus tract formation, preoperative swelling and pain, or large size of periapical lesion, as well a patients factors, multi-visit treatment is indicated. During the first visit, instrumentation and irrigation of the root canals is performed, due to the bacterial biofilm and smear layer being an obstruction for the efficacy of fthe following intracanal desinfection. After proper root canals cleaning and shaping, disinfecting medication is placed between visits to achieve a reduction of microbial numbers and restrict bacterial growth. Intracanal medication influences inflammation, helps eliminate periapical exudate, protects roots from resorption, and plays an important role in preventing re-infection of the periapical tissue. Pain relief, absence of percussion sensitivity, healing of a sinus tract, absence of exudation are clinical signs for successful endodontic treatment and the tooth can be filled and restored.

There is insufficient evidence in the literature for significant differences between a single – visit or multi – visit root canal treatment. It is necessary to assess carefully the existing risk of exacerbation and to prefer multi-visit treatment in teeth where the risk of complications is increased.

The lecture will focus on the present status of intracanal medicaments, main characteristics and clinical indications for their application during multi-visit treatment. Discussions related to the condition of the tissues in the apical area and the possibilities for healing processes will be included.

Ass. Prof. Dr. Elka Radeva, MD