Strength of recommendation for single‐visit root canal treatment: grading the body of the evidence using a patient‐centred approach

De‐Deus, Gustavo; Canabarro, Antônio

doi:10.1111/iej.12621

Cited by 10 publications

(6 citation statements)

References 43 publications

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“…Intracanal medicaments have conventionally been recommended as root canal dressing between appointments. However, with the increasing trend towards single visit endodontics, and the lack of a clear advantage of multiple visit treatments over single visit [ 127 , 128 , 129 ], the role of inter-appointment dressings is questionable and may wane with time. Nevertheless, considering the present evidence base (or lack of, thereof) to support one approach over the other, this section will briefly focus on the role of intracanal medicaments in root canal disinfection.…”

Section: Removal Of Endodontic Biofilms During Root Canal Treatmenmentioning

confidence: 99%

Biofilms in Endodontics—Current Status and Future Directions

Neelakantan

Romero

Vera

et al. 2017

IJMS

183

136

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Microbiota are found in highly organized and complex entities, known as biofilms, the characteristics of which are fundamentally different from microbes in planktonic suspensions. Root canal infections are biofilm mediated. The complexity and variability of the root canal system, together with the multi-species nature of biofilms, make disinfection of this system extremely challenging. Microbial persistence appears to be the most important factor for failure of root canal treatment and this could further have an impact on pain and quality of life. Biofilm removal is accomplished by a chemo-mechanical process, using specific instruments and disinfecting chemicals in the form of irrigants and/or intracanal medicaments. Endodontic research has focused on the characterization of root canal biofilms and the clinical methods to disrupt the biofilms in addition to achieving microbial killing. In this narrative review, we discuss the role of microbial biofilms in endodontics and review the literature on the role of root canal disinfectants and disinfectant-activating methods on biofilm removal.

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Section: Removal Of Endodontic Biofilms During Root Canal Treatmenmentioning

confidence: 99%

Biofilms in Endodontics—Current Status and Future Directions

Neelakantan

Romero

Vera

et al. 2017

IJMS

183

136

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“…A number of reviews have compared single-visit versus multiple-visit root canal treatment. 3 5–8 Some of these are outdated, 3 6 others investigate only short-term pain as outcome, 5 again others build on evidence beyond controlled trials like cohort studies or expert opinions, 7 or pooled short-term and long-term outcomes, which does not allow to weigh them against each other. 8 The present review aimed to comprehensively compare the currently available controlled trial data on short-term and long-term complications of single-visit versus multiple-visit root canal treatment.…”

Section: Introductionmentioning

confidence: 99%

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

Schwendicke

Göstemeyer

2017

BMJ Open

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ObjectivesSingle-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.DataControlled trials comparing single-visit versus multiple-visit root canal treatment of permanent teeth were included. Trials needed to assess the risk of long-term 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).SourcesElectronic 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 selection29 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.ConclusionsThere is insufficient evidence to rule out whether important differences between both strategies exist.Clinical significanceDentists can provide root canal treatment in 1 or multiple visits. Given the possibly increased risk of flare-ups, multiple-visit treatment might be preferred for certain teeth (eg, those with periapical lesions).

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“…In this context, the simplicity of the SORT system is very welcome and can be regarded as a consequence of the major dichotomy (disease-oriented versus patient-oriented evidence) proposed by the system (9). Patient-oriented evidence that matters (POEM) allows clinicians to filter relevant information from the medical literature and focus only on what is indeed important for the patient (45). Disease-oriented evidence (DOE) includes intermediate, histopathological, physiological, or surrogate endpoints, such as probing depth reduction and x-ray changes in bone density, which may or may not reflect real improvement in patient outcomes (44).…”

Section: Discussionmentioning

confidence: 99%

Use of the Strength of Recommendation Taxonomy (SORT) to assess full-mouth treatments of chronic periodontitis

2015

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Previous studies have not resolved whetherscaling and root planing with a full-mouth (with or without antiseptics) or quadrant approach is better for treatment of chronic periodontitis. We identified relevant studies and used Strength of Recommendation Taxonomy (SORT) criteria to critically interpret the results of all relevant studies. A literature search was performed using the PubMed, EMBASE, and Cochrane databases up to July 2015. Selected studies were stratified according to their quality, quantity, and consistency. In total, 377 studies were identified, and 36 articles selected for retrieval were stratified according SORT criteria, as follows: no level 1 studies, 15 level 2 studies, and 21 level 3 studies (which were excluded from subsequent analysis). Among the selected level 2 studies, including seven randomized clinical trials and three systematic reviews, 67% showed no significant difference between scaling and root planing with a full-mouth or quadrant approach. In conclusion, on the basis of the best available data, the strength of evidence is grade B (consistent, lowquality evidence) for full-mouth (with or without antiseptics) and quadrant scaling and root planing for treatment of chronic periodontitis. (J Oral Sci 57, [345][346][347][348][349][350][351][352][353] 2015)

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Strength of recommendation for single‐visit root canal treatment: grading the body of the evidence using a patient‐centred approach

Cited by 10 publications

References 43 publications

Biofilms in Endodontics—Current Status and Future Directions

Biofilms in Endodontics—Current Status and Future Directions

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

Use of the Strength of Recommendation Taxonomy (SORT) to assess full-mouth treatments of chronic periodontitis

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