Association Of Irreversible Pulpitis And Single Visit Root Canal Treatment

Keywords

Irreversible Pulpitis; Single-Visit RCT; Multi Visit RCT; Male Predominance.

Introduction

Irreversible pulpitis, is characterised by acute and intense pain and is one of the most frequent reasons for patients to attend emergency dental care. Apart from extraction, the customary way of relieving the pain of irreversible pulpitis is by removing the inflamed pulp and cleaning the root canal [1].

The symptoms usually include a history of spontaneous pain which may also involve an exaggerated response to hot or cold that lingers after the stimulus is removed [2]. Any tooth may be affected by irreversible pulpitis. It is not restricted to any particular age group and it usually occurs as a direct result of dental caries, cracked teeth or trauma and thus tends to occur more frequently in older patients. The involved tooth is usually not sensitive to percussion, and palpation tests do not produce any reaction. The characteristics of irreversible pulpitis are a vital pulp which responds to cold and electric pulp testing. Cold may actually alleviate the pain of irreversible pulpitis and thus, can be used as a diagnostic test [3]. A number of variations of irreversible pulpitis have been recognised. These include acute, subacute, chronic, partial or total, infected or sterile, however it is not possible to clearly differentiate these clinically and can be differentiated only by histopathological methods [4].

Pulp vitality plays an important role in routine dental practice [5]. Pulp vitality tests are the valuable diagnostic tool which aids the clinician towards the accurate diagnosis and appropriate treatment planning. Diagnosing the exact pulpal status by direct examination is uncertain due to the fact that the pulp is enclosed within a hard tissue. In order to identify the actual pulp status surrogate test must be performed [6]. Disease of the pulp can be infectious or inflammatory. In such conditions, the healthy pulp attempts to counteract the inflammatory response as a defence mechanism in order to restore the integrity of the pulp [7]. Therefore, the presence of blood flow within the pulp is a reliable indicator as it can reflect the degree of pulpal disease. The tests which record the blood flow within the pulp are termed as pulp vascularity tests as it is the only true indicator in assessing the actual pulp status [8].

Root canal therapy (RCT) and tooth extraction have been conventional treatment options for management of human mature teeth with irreversible pulpitis [9]. Root canal treatment in a common procedure in dentistry. The main indications for RCT are irreversible pulpitis and necrosis of dental pulp due to caries or dental trauma [10].

Single visit treatment is an approach when in access opening, cleaning and shaping with irrigation and obturation is done in a single setting. Whereas multi visits but they are carried out in 3 to 4 appointments help to reduce chances of error and infection [11]. Intracanal medicaments have been used to disinfect root canals between appointments and reduce the interappointment pain [12]. After root canal treatment, teeth can experience short/long term complications. Short term complication includes postoperative inflammation of periapical tissue leading to mild pain and flare up, pain and swelling associated with instrumentation and irrigation transporting medium [13]. Long term outcome includes persisting inflammation and infection, resulting in abscess,since track formation, periapical bone resorption [14].

Previously our team had conducted numerous clinical trials [15- 17], in vitro studies [18-21] and surveys [12, 22] and reviewed [10, 23-27]. Various aspects of endodontics and conservative dentistry over the past five years. Now we are focusing on retrospective studies, the idea for which has stemmed from the current interest in our community. The aim of this study was to find out the association of irreversible pulpitis and single visit root canal treatment.

Materials And Methods

Study population

A retrospective study was carried out in patients who visited University in Chennai with irreversible pulpitis and underwent single visit root canal treatment. The data were collected from patients records between June 2019-March 2020. The data contains details of patients, intraoral photographs and treatment being done.

Inclusion criteria

● Patients with irreversible pulpitis
● Patients undergoing root canal treatment
● Above 17 years

Exclusion criteria

● Patient with reversible pulpitis
● Patients with periradicular disease
● Pulp necrosis

Sample size

Sample size [N=2329] is the total number of patients who visit University in Chennai with irreversible pulpitis and underwent single visit root canal treatment. Their distribution according to age,gender, teeth number were recorded.

Ethical approval

Ethical clearance was obtained from the Institutional Ethical Committee and Scientific Review Board [SRB] of University in Chennai.

Data analysis

The data collected were entered in an Excel sheet and subjected to statistical analysis using SPSS software. Descriptive statistics was done i.e frequency and cross tabulation. A chi square test was done between age and teeth number, gender and teeth number. Mean and standard deviation was done for age and gender. Independent variables are age and gender while dependent variables are teeth number. The level of significance was p<0.05.

Results And Discussion

A total of 5366 patients were diagnosed with irreversible pulpitis, among which 2329 patients underwent single visit RCT (43.40%) and 3037 patients had undergone multi visit RCT (56.60%) [Figure 1]. Among 2329 patients 1182 were females (50.73%) and 1147 were males (49.27%) [Figure 2]. Females (22.03%) mostly underwent single visit root canal treatment when compared to males [21.38%] and Male (30.62%) patients mostly underwent multiple visit root canal treatment when compared to female patients (25.98%) which was found to be statistically significant [Figure 3, Table 1]. Most number of single visit RCT (19.47%) and multi visit RCT (34.87%) are seen in the age group of 18-38 years and were found to be statistically significant [Figure 4 Table 2]. Single visit RCT was higher in maxillary first molar followed by maxillary central incisors while multi visit RCT was higher in mandibular first molars followed by maxillary first molars which was found to be statistically significant [Figure 5, Table 3].

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The current study shows that the incidence of single visit RCT was among 43.40% of the population. There was no previous literature showing the incidence of single and multi visit RCT but did show the postoperative complication of both [28].

A study by R.B Pekruhn et al,shows that failure rates in single visit RCT was 5.2% [29]. Another study by Lara figini et al states that patients undergoing single visit RCT showed higher rates of swelling [30]. According to Wai-lee yong et al, the success rate of single and multi visit endodontic treatments had no significance difference [31]. This was also supported by Wong A W et al,who stated that postoperative complications of single visit and multiple visit RCT were similar [32]. A study done by Alomaym et al concludes that less incidence of pain in multi visit root canal treatment than single visit group,which is statistically significant [33]. A study done by Adbel Hameed et al., concludes that no significant difference exists in post operative pain after single visit or multi visit root canal treatment [34]. The limitation of this study is that it was confined to a specific population and geographic location. The future scope of this study is to compare the prognosis and failure rates of single visit and multi visit RCT and to conduct the study among a larger population.

Conclusion

Within the limitation of this study, it can be concluded that female patients were highly diagnosed with irreversible pulpitis and underwent single visit root canal treatment. More number of single visit root canal treatments were seen in the 18-38 age group. Maxillary first molar and maxillary central incisors are frequently affected with irreversible pulpitis underwent single visit RCT. Female patients underwent more number of single visit root canal treatments when compared to male patients. Although multi visit RCT is considered the conventional technique, single visit takes less time, is cost effective, prevents RC contamination bacterial regrowth, less stressful to patients regarding anesthesia and instrumentation related to treatment; and studies have shown that success rates are similar in both techniques.

Author Contributions

All authors have equal contributions in bringing out this research work.

Acknowledgement

This study was supported by Saveetha Dental College and Hospitals, Chennai.