A Tale of Two Treatments: Unraveling Endodontic Strategies for Apical Periodontitis Healing

Abstract

Objective:
This study aimed to compare the efficacy of two common nonsurgical endodontic treatment protocols—single-visit and multi-visit root canal therapy—in promoting healing of apical periodontitis (AP) in teeth with confirmed periapical lesions.

Materials and Methods:

A total of 60 teeth with radiographically confirmed periapical lesions were included, divided into three groups: single-visit treatment (Group 1, n=21), two-visit treatment with calcium hydroxide dressing (Group 2, n=18), and two-visit treatment with Vitapex dressing (Group 3, n=21). The healing progress was assessed using the Periapical Index (PAI) score at baseline and after a 12-month follow-up. Inter-rater agreement was evaluated with the Intraclass Correlation Coefficient (ICC), with values indicating a high level of concordance among examiners. Statistical analysis was performed to assess the changes in PAI scores and differences in healing among groups.

Results:
All groups exhibited statistically significant reductions in PAI scores from baseline to the 12-month follow-up (P < 0.001). The mean PAI score reduction was 1.42 for Group 1, 1.28 for Group 2, and 1.67 for Group 3. The proportion of teeth classified as “healed” (PAI ≤ 2) was 76.2% in Groups 1 and 3, while Group 2 showed a 66% healing rate. No statistically significant difference in healing was observed among the groups. Group 3 (Vitapex) exhibited the greatest reduction in PAI scores, although it was not statistically significant.

Conclusion:
Both single-visit and multi-visit endodontic treatment protocols effectively reduced periapical inflammation and promoted healing in teeth with apical periodontitis over a 12-month period. The results suggest that, with appropriate aseptic protocols and instrumentation, the use of an inter-appointment dressing does not significantly impact the healing outcome in AP treatment. Larger studies are recommended to validate these findings and investigate potential differences across varied clinical settings.