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

Assoc. Prof. E. Radeva graduated in 1993 from the Faculty of Stomatology - Sofia. 

She has a specialty in Therapeutic Stomatology (1997) and General Dental Medicine (2005). In 2012 - PhD degree; since 2015 she has been an associate professor in the Department of Conservative Dentistry, FDM-Sofia, 2017 - a master's degree in "Public Health and Health Management", MU-Sofia.

Assoc. Prof. E. Radeva's scientific interests are in endodontics, operative dentistry and aesthetic dentistry.

She has over 145 publications and participation in international and national scientific forums. Over 250 citations in Bulgarian and foreign scientific dental journals. Leading researcher and participant of 11 scientific projects. Author and co-author of 2 monographs, 2 practical student books on endodontics in Bulgarian and English, co-author of 4 study books in pharmacology for dental students and 2 pharmacological reference books. Supervisor of two postgraduate students.

Since 2020 - Chairman of the General Assembly of FDM-Sofia, since 2022 - President of the Bulgarian Scientific Association of Dental Medicine (BSADM), since 2022 - Vice-President of the Bulgarian Dental Association (BgDA) and President of the Communication Commission of BgDA.

Since 2007, she has been a member of the Faculty Council, and since 2020 - a member of the Academic Council of MU-Sofia.

She has given more than 38 lectures in dental continuing education in Bulgaria, Romania, Germany, Italy, North Macedonia, and Greece.

Assoc. Prof. E. Radeva is a member of the Bulgarian Dental Association (BgDA), the Bulgarian Scientific Association of Dental Medicine (BSADM), European Society of Endodontology (ESE), Balkan Stomatologycal Society (BaSS). 

Awards – Signum Laudis on a plaque (2024), for special contributions to the development of MU-Sofia.