Endodontik Tedavide Seans Yaklaşımları
Özet
Endodontik tedavide seans sayısının belirlenmesi, uzun yıllardır tartışılan ve klinik karar sürecinde birçok faktörün birlikte değerlendirilmesini gerektiren bir konudur. Tek seans endodontik tedavi, kök kanal sisteminin kemomekanik preparasyonu, irrigasyonu ve obturasyonunun aynı randevuda tamamlanmasını içerirken; çok seanslı yaklaşımda seanslar arasında intrakanal medikament kullanımıyla ek dezenfeksiyon sağlanmakta ve obturasyon sonraki randevuda gerçekleştirilmektedir.
Tek seans tedavi; hasta konforunun artması, tedavi süresinin kısalması, koronal mikrosızıntı riskinin azalması ve klinik verimliliğin artması gibi avantajlar sunmaktadır. Buna karşılık, özellikle yoğun enfeksiyon varlığı, aktif eksudasyon veya kompleks kanal anatomisi bulunan vakalarda çok seanslı yaklaşım intrakanal medikament kullanımı sayesinde enfeksiyon kontrolünü destekleyebilmektedir. Güncel sistematik derlemeler ve klinik çalışmalar, tek seans ve çok seans endodontik tedaviler arasında genel klinik başarı, periapikal iyileşme ve postoperatif ağrı açısından belirgin bir üstünlük bulunmadığını göstermektedir. Bu nedenle seans sayısının belirlenmesinde tek bir standart yaklaşım yerine, dişin pulpal ve periapikal durumu, enfeksiyonun derecesi, kanal anatomisi, hastanın sistemik durumu ve klinisyenin deneyimi gibi faktörlerin birlikte değerlendirilmesi gerekmektedir. Sonuç olarak, uygun vaka seçimi ve etkili dezenfeksiyon protokolleri sağlandığında hem tek seans hem de çok seans endodontik tedaviler başarılı ve güvenilir klinik seçenekler olarak değerlendirilmektedir.
The determination of the number of visits in endodontic treatment has long been a subject of discussion and requires the evaluation of multiple factors within the clinical decision-making process. Single-visit endodontic treatment involves the completion of chemomechanical preparation, irrigation, and obturation of the root canal system in a single appointment, whereas in the multiple-visit approach additional disinfection is achieved through the use of intracanal medicaments between appointments and obturation is performed at a subsequent visit. Single-visit treatment offers several advantages, including increased patient comfort, reduced treatment time, decreased risk of coronal microleakage, and improved clinical efficiency. However, in cases with severe infection, persistent exudation, or complex canal anatomy, a multiple-visit approach may support infection control through the use of intracanal medicaments during the inter-appointment period. Current systematic reviews and clinical studies indicate that there is no clear superiority between single-visit and multiple-visit endodontic treatments in terms of overall clinical success, periapical healing, or postoperative pain. Therefore, rather than adopting a universal approach, the number of treatment visits should be determined by considering several factors, including the pulpal and periapical status of the tooth, the degree of infection, canal anatomy, the patient’s systemic condition, and the clinician’s experience. In conclusion, when appropriate case selection and effective disinfection protocols are applied, both single-visit and multiple-visit endodontic treatments can be considered reliable and successful clinical options.
Referanslar
Mergoni G, Ganim M, Lodi G, et al. Single versus multiple visits for endodontic treatment of permanent teeth. Cochrane Database of Systematic Reviews. 2022; doi:10.1002/14651858.CD005296.pub4(12).
Ørstavik D. Time‐course and risk analyses of the development and healing of chronic apical periodontitis in man. International endodontic journal. 1996;29(3):150-5. doi: https://doi.org/10.1111/j.1365-2591.1996.tb01361.x
Endodontology E S o. Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. International endodontic journal. 2006;39(12):921-30. doi: https://doi.org/10.1111/j.1365-2591.2006.01180.x
Sathorn C, Parashos P, Messer H. Effectiveness of single‐versus multiple‐visit endodontic treatment of teeth with apical periodontitis: a systematic review and meta‐analysis. International endodontic journal. 2005;38(6):347-55. doi: https://doi.org/10.1111/j.1365-2591.2005.00955.x
Jha S, Jose E C, Chandana N, et al. Single-visit root canal treatment: an efficient clinical approach or merely a time-saving strategy? – A review of the current evidence. International Journal of Applied Dental Sciences. 2025;11(3):194-8. doi: https://www.doi.org/10.22271/oral.2025.v11.i3c.2207
Wong A W, Zhang C, Chu C H. A systematic review of nonsurgical single-visit versus multiple-visit endodontic treatment. Clinical, cosmetic and investigational dentistry. 2014;6:45-56. doi: https://doi.org/10.2147/CCIDE.S61487
Naoum H, Chandler N P. Temporization for endodontics. International endodontic journal. 2002;35(12):964-78. doi: https://doi.org/10.1046/j.1365-2591.2002.00600.x
Nair P N. On the causes of persistent apical periodontitis: a review. Int Endod J. 2006;39(4):249-81. doi: https://doi.org/10.1111/j.1365-2591.2006.01099.x
Choudhari S, Solete P, Jeevanandan G, et al. Single-visit versus multi-visit endodontic retreatment: A systematic review of outcomes in patients with secondary endodontic infection. Saudi Endodontic Journal. 2024;14(3):301-11. doi: 10.4103/sej.sej_225_23
Schwendicke F, Göstemeyer G. Single-visit or multiple-visit root canal treatment: systematic review, meta-analysis and trial sequential analysis. BMJ open. 2017;7(2):e013115. doi: https://doi.org/10.1136/bmjopen-2016-013115
Vera J, Siqueira J F, Jr., Ricucci D, et al. One- versus Two-visit Endodontic Treatment of Teeth with Apical Periodontitis: A Histobacteriologic Study. Journal of Endodontics. 2012;38(8):1040-52. doi: https://doi.org/10.1016/j.joen.2012.04.010
Ricucci D, Siqueira Jr J F. Biofilms and apical periodontitis: study of prevalence and association with clinical and histopathologic findings. Journal of endodontics. 2010;36(8):1277-88. doi: https://doi.org/10.1016/j.joen.2010.04.007
Ordinola-Zapata R, Noblett W C, Perez-Ron A, et al. Present status and future directions of intracanal medicaments. Int Endod J. 2022;55 Suppl 3(Suppl 3):613-36. doi: https://doi.org/10.1111/iej.13731
Zou X, Zheng X, Liang Y, et al. Expert consensus on irrigation and intracanal medication in root canal therapy. International journal of oral science. 2024;16(1):23. doi: https://doi.org/10.1038/s41368-024-00280-5
Bassam S, El-Ahmar R, Salloum S, et al. Endodontic postoperative flare-up: An update. The Saudi dental journal. 2021;33(7):386-94. doi: https://doi.org/10.1016/j.sdentj.2021.05.005
Siqueira Jr J F, Rôças I N. Clinical implications and microbiology of bacterial persistence after treatment procedures. Journal of endodontics. 2008;34(11):1291-301. e3. doi: https://doi.org/10.1016/j.joen.2008.07.028
Zmener O, Banegas G, Pameijer C H. Coronal microleakage of three temporary restorative materials: an in vitro study. J Endod. 2004;30(8):582-4. doi: https://doi.org/10.1097/01.DON.0000121610.63000.F2
Yassen G H, Vail M M, Chu T G, et al. The effect of medicaments used in endodontic regeneration on root fracture and microhardness of radicular dentine. Int Endod J. 2013;46(7):688-95. doi: https://doi.org/10.1111/iej.12046
Alovisi M, Mirra D, Berutti E, et al. Working length variation during multiple-visit endodontic treatment: An observational study. Australian Endodontic Journal. 2023;49(S1):107-12. doi: https://doi.org/10.1111/aej.12703
Kumar G, Jena S, Manila N, et al. Incidence of postoperative pain after single-visit and multiple-visit root canal therapy: a systematic review. BMC Oral Health. 2025;25(1):47. doi: https://doi.org/10.1186/s12903-024-05412-1
Peters L, Wesselink P. Periapical healing of endodontically treated teeth in one and two visits obturated in the presence or absence of detectable microorganisms. International endodontic journal. 2002;35(8):660-7. doi: https://doi.org/10.1046/j.1365-2591.2002.00541.x
Manfredi M, Figini L, Gagliani M, et al. Single versus multiple visits for endodontic treatment of permanent teeth. Cochrane Database of Systematic Reviews. 2016;10.1002/14651858.CD005296.pub3(12). doi: https://doi.org/10.1002/14651858.CD005296.pub3
Penesis V A, Fitzgerald P I, Fayad M I, et al. Outcome of one-visit and two-visit endodontic treatment of necrotic teeth with apical periodontitis: a randomized controlled trial with one-year evaluation. Journal of endodontics. 2008;34(3):251-7. doi: https://doi.org/10.1016/j.joen.2007.12.015
Kirci H K, Karataslioglu E. Assessment of fractal dimension changes in periapical trabecular patterns following single-visit and multi-visit nonsurgical endodontic treatment with different medicaments: a retrospective study. Acta Odontologica Scandinavica. 2025;84:45201. doi: https://doi.org/10.2340/aos.v84.45201
Mattigatti S, Srinivas S, Metkar C S, et al. Knowledge, Attitude and Beliefs on Single Visit vs Multi-Visit Endodontics of Dental Practitioners. Int J Cur Res Rev| Vol. 2021;13(03):75. doi: https://doi.org/10.31782/IJCRR.2021.13320
Bedene L N R, Leonardi D P, Couto J S, et al. Assessment of Postoperative Pain After Single- or Multiple-Visit Endodontic Therapy and Its Molecular Aspects: A Randomised Controlled Study. Australian Endodontic Journal. 2025;51(3):668-76. doi: https://doi.org/10.1111/aej.12982
Szczurowski P, Gronkiewicz K, Czopik B. Factors Influencing the Healing of Maxillary Sinusitis of Endodontic Origin After Non-Surgical Endodontic Treatment. Journal of Clinical Medicine. 2025;14(19):6778. doi: https://doi.org/10.3390/jcm14196778
Almeida D O, Chaves S C, Souza R A, et al. Outcome of single-vs multiple-visit endodontic therapy of nonvital teeth: a meta-analysis. J Contemp Dent Pract. 2017;18(4):330-6. doi: https://doi.org/10.5005/jp-journals-10024-2041
Su Y, Wang C, Ye L. Healing rate and post-obturation pain of single-versus multiple-visit endodontic treatment for infected root canals: a systematic review. Journal of endodontics. 2011;37(2):125-32. doi: https://doi.org/10.1016/j.joen.2010.09.005
Gill G, Bhuyan A, Kalita C, et al. Single Versus Multi-visit Endodontic Treatment of Teeth with Apical Periodontitis: An In vivo Study with 1-year Evaluation. Annals of medical and health sciences research. 2016;6(1):19-26. doi: https://doi.org/10.4103/2141-9248.180265
Dorasani G, Madhusudhana K, Chinni S K. Clinical and radiographic evaluation of single-visit and multi-visit endodontic treatment of teeth with periapical pathology: An: in vivo: study. Journal of Conservative Dentistry and Endodontics. 2013;16(6):484-8. doi: 10.4103/0972-0707.120933
Drouri S, Laslami K, Dhaim S, et al. Influence of number of visits on the outcome of endodontic treatment. Journal of Conservative Dentistry and Endodontics. 2024;27(12):1211-20. doi: 10.4103/JCDE.JCDE_688_24
Karaoğlan F, Kiziltaş Gül A, Çalışkan M K. Postoperative Pain Following Single-Visit Versus Two-Visit Endodontic Retreatment – A Comparison of Inter-Appointment and Post-Obturation Periods: Randomised Clinical Trial. Australian Endodontic Journal. 2025;51(3):706-14. doi: https://doi.org/10.1111/aej.70004
AL-Omiri M K, Iqbal A, Akbar I. Flare-up rate in molars with periapical radiolucency in one-visit vs two-visit endodontic treatment. The journal of contemporary dental practice. 2013;14(3):414-8. doi: 10.5005/jp-journals-10024-1337
Yoldas O, Topuz A, Isçi A S, et al. Postoperative pain after endodontic retreatment: single-versus two-visit treatment. Oral surgery, oral medicine, oral Pathology, oral Radiology, and endodontology. 2004;98(4):483-7. doi: https://doi.org/10.1016/j.tripleo.2004.03.009
Hepsenoglu Y E, Eyuboglu T F, Özcan M. Postoperative pain intensity after single-versus two-visit nonsurgical endodontic retreatment: a randomized clinical trial. Journal of endodontics. 2018;44(9):1339-46. doi: https://doi.org/10.1016/j.joen.2018.05.017
Referanslar
Mergoni G, Ganim M, Lodi G, et al. Single versus multiple visits for endodontic treatment of permanent teeth. Cochrane Database of Systematic Reviews. 2022; doi:10.1002/14651858.CD005296.pub4(12).
Ørstavik D. Time‐course and risk analyses of the development and healing of chronic apical periodontitis in man. International endodontic journal. 1996;29(3):150-5. doi: https://doi.org/10.1111/j.1365-2591.1996.tb01361.x
Endodontology E S o. Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. International endodontic journal. 2006;39(12):921-30. doi: https://doi.org/10.1111/j.1365-2591.2006.01180.x
Sathorn C, Parashos P, Messer H. Effectiveness of single‐versus multiple‐visit endodontic treatment of teeth with apical periodontitis: a systematic review and meta‐analysis. International endodontic journal. 2005;38(6):347-55. doi: https://doi.org/10.1111/j.1365-2591.2005.00955.x
Jha S, Jose E C, Chandana N, et al. Single-visit root canal treatment: an efficient clinical approach or merely a time-saving strategy? – A review of the current evidence. International Journal of Applied Dental Sciences. 2025;11(3):194-8. doi: https://www.doi.org/10.22271/oral.2025.v11.i3c.2207
Wong A W, Zhang C, Chu C H. A systematic review of nonsurgical single-visit versus multiple-visit endodontic treatment. Clinical, cosmetic and investigational dentistry. 2014;6:45-56. doi: https://doi.org/10.2147/CCIDE.S61487
Naoum H, Chandler N P. Temporization for endodontics. International endodontic journal. 2002;35(12):964-78. doi: https://doi.org/10.1046/j.1365-2591.2002.00600.x
Nair P N. On the causes of persistent apical periodontitis: a review. Int Endod J. 2006;39(4):249-81. doi: https://doi.org/10.1111/j.1365-2591.2006.01099.x
Choudhari S, Solete P, Jeevanandan G, et al. Single-visit versus multi-visit endodontic retreatment: A systematic review of outcomes in patients with secondary endodontic infection. Saudi Endodontic Journal. 2024;14(3):301-11. doi: 10.4103/sej.sej_225_23
Schwendicke F, Göstemeyer G. Single-visit or multiple-visit root canal treatment: systematic review, meta-analysis and trial sequential analysis. BMJ open. 2017;7(2):e013115. doi: https://doi.org/10.1136/bmjopen-2016-013115
Vera J, Siqueira J F, Jr., Ricucci D, et al. One- versus Two-visit Endodontic Treatment of Teeth with Apical Periodontitis: A Histobacteriologic Study. Journal of Endodontics. 2012;38(8):1040-52. doi: https://doi.org/10.1016/j.joen.2012.04.010
Ricucci D, Siqueira Jr J F. Biofilms and apical periodontitis: study of prevalence and association with clinical and histopathologic findings. Journal of endodontics. 2010;36(8):1277-88. doi: https://doi.org/10.1016/j.joen.2010.04.007
Ordinola-Zapata R, Noblett W C, Perez-Ron A, et al. Present status and future directions of intracanal medicaments. Int Endod J. 2022;55 Suppl 3(Suppl 3):613-36. doi: https://doi.org/10.1111/iej.13731
Zou X, Zheng X, Liang Y, et al. Expert consensus on irrigation and intracanal medication in root canal therapy. International journal of oral science. 2024;16(1):23. doi: https://doi.org/10.1038/s41368-024-00280-5
Bassam S, El-Ahmar R, Salloum S, et al. Endodontic postoperative flare-up: An update. The Saudi dental journal. 2021;33(7):386-94. doi: https://doi.org/10.1016/j.sdentj.2021.05.005
Siqueira Jr J F, Rôças I N. Clinical implications and microbiology of bacterial persistence after treatment procedures. Journal of endodontics. 2008;34(11):1291-301. e3. doi: https://doi.org/10.1016/j.joen.2008.07.028
Zmener O, Banegas G, Pameijer C H. Coronal microleakage of three temporary restorative materials: an in vitro study. J Endod. 2004;30(8):582-4. doi: https://doi.org/10.1097/01.DON.0000121610.63000.F2
Yassen G H, Vail M M, Chu T G, et al. The effect of medicaments used in endodontic regeneration on root fracture and microhardness of radicular dentine. Int Endod J. 2013;46(7):688-95. doi: https://doi.org/10.1111/iej.12046
Alovisi M, Mirra D, Berutti E, et al. Working length variation during multiple-visit endodontic treatment: An observational study. Australian Endodontic Journal. 2023;49(S1):107-12. doi: https://doi.org/10.1111/aej.12703
Kumar G, Jena S, Manila N, et al. Incidence of postoperative pain after single-visit and multiple-visit root canal therapy: a systematic review. BMC Oral Health. 2025;25(1):47. doi: https://doi.org/10.1186/s12903-024-05412-1
Peters L, Wesselink P. Periapical healing of endodontically treated teeth in one and two visits obturated in the presence or absence of detectable microorganisms. International endodontic journal. 2002;35(8):660-7. doi: https://doi.org/10.1046/j.1365-2591.2002.00541.x
Manfredi M, Figini L, Gagliani M, et al. Single versus multiple visits for endodontic treatment of permanent teeth. Cochrane Database of Systematic Reviews. 2016;10.1002/14651858.CD005296.pub3(12). doi: https://doi.org/10.1002/14651858.CD005296.pub3
Penesis V A, Fitzgerald P I, Fayad M I, et al. Outcome of one-visit and two-visit endodontic treatment of necrotic teeth with apical periodontitis: a randomized controlled trial with one-year evaluation. Journal of endodontics. 2008;34(3):251-7. doi: https://doi.org/10.1016/j.joen.2007.12.015
Kirci H K, Karataslioglu E. Assessment of fractal dimension changes in periapical trabecular patterns following single-visit and multi-visit nonsurgical endodontic treatment with different medicaments: a retrospective study. Acta Odontologica Scandinavica. 2025;84:45201. doi: https://doi.org/10.2340/aos.v84.45201
Mattigatti S, Srinivas S, Metkar C S, et al. Knowledge, Attitude and Beliefs on Single Visit vs Multi-Visit Endodontics of Dental Practitioners. Int J Cur Res Rev| Vol. 2021;13(03):75. doi: https://doi.org/10.31782/IJCRR.2021.13320
Bedene L N R, Leonardi D P, Couto J S, et al. Assessment of Postoperative Pain After Single- or Multiple-Visit Endodontic Therapy and Its Molecular Aspects: A Randomised Controlled Study. Australian Endodontic Journal. 2025;51(3):668-76. doi: https://doi.org/10.1111/aej.12982
Szczurowski P, Gronkiewicz K, Czopik B. Factors Influencing the Healing of Maxillary Sinusitis of Endodontic Origin After Non-Surgical Endodontic Treatment. Journal of Clinical Medicine. 2025;14(19):6778. doi: https://doi.org/10.3390/jcm14196778
Almeida D O, Chaves S C, Souza R A, et al. Outcome of single-vs multiple-visit endodontic therapy of nonvital teeth: a meta-analysis. J Contemp Dent Pract. 2017;18(4):330-6. doi: https://doi.org/10.5005/jp-journals-10024-2041
Su Y, Wang C, Ye L. Healing rate and post-obturation pain of single-versus multiple-visit endodontic treatment for infected root canals: a systematic review. Journal of endodontics. 2011;37(2):125-32. doi: https://doi.org/10.1016/j.joen.2010.09.005
Gill G, Bhuyan A, Kalita C, et al. Single Versus Multi-visit Endodontic Treatment of Teeth with Apical Periodontitis: An In vivo Study with 1-year Evaluation. Annals of medical and health sciences research. 2016;6(1):19-26. doi: https://doi.org/10.4103/2141-9248.180265
Dorasani G, Madhusudhana K, Chinni S K. Clinical and radiographic evaluation of single-visit and multi-visit endodontic treatment of teeth with periapical pathology: An: in vivo: study. Journal of Conservative Dentistry and Endodontics. 2013;16(6):484-8. doi: 10.4103/0972-0707.120933
Drouri S, Laslami K, Dhaim S, et al. Influence of number of visits on the outcome of endodontic treatment. Journal of Conservative Dentistry and Endodontics. 2024;27(12):1211-20. doi: 10.4103/JCDE.JCDE_688_24
Karaoğlan F, Kiziltaş Gül A, Çalışkan M K. Postoperative Pain Following Single-Visit Versus Two-Visit Endodontic Retreatment – A Comparison of Inter-Appointment and Post-Obturation Periods: Randomised Clinical Trial. Australian Endodontic Journal. 2025;51(3):706-14. doi: https://doi.org/10.1111/aej.70004
AL-Omiri M K, Iqbal A, Akbar I. Flare-up rate in molars with periapical radiolucency in one-visit vs two-visit endodontic treatment. The journal of contemporary dental practice. 2013;14(3):414-8. doi: 10.5005/jp-journals-10024-1337
Yoldas O, Topuz A, Isçi A S, et al. Postoperative pain after endodontic retreatment: single-versus two-visit treatment. Oral surgery, oral medicine, oral Pathology, oral Radiology, and endodontology. 2004;98(4):483-7. doi: https://doi.org/10.1016/j.tripleo.2004.03.009
Hepsenoglu Y E, Eyuboglu T F, Özcan M. Postoperative pain intensity after single-versus two-visit nonsurgical endodontic retreatment: a randomized clinical trial. Journal of endodontics. 2018;44(9):1339-46. doi: https://doi.org/10.1016/j.joen.2018.05.017
