Skip to main content
Toggle Menu of ADA WebSites
ADA Websites
Partnerships and Commissions
Toggle Search Area
Toggle Menu
e-mail Print Share

Associated Topics

Single versus multiple visits for endodontic treatment of permanent teeth: a Cochrane systematic review

Figini L, Lodi G, Gorni F, Gagliani M . Journal of Endodontics. 2008;34(9):1041-7

The Cochrane Collaboration promotes evidence-based healthcare decision making globally through systematic reviews of the effects of healthcare intervention. The purpose of this systematic review was to investigate whether the effectiveness and frequency of short-term and long-term complications are different when endodontic procedure is completed in one or multiple visits. Randomized and quasi-randomized controlled trials enrolling patients undergoing endodontic treatment were identified by searching biomedical databases and hand-searching relevant journals. The following outcomes were considered: tooth extraction as a result of endodontic problems and radiologic failure after 1 year, postoperative discomfort, swelling, analgesic use, or sinus track. Twelve studies were included in the review. No detectable difference was found in the effectiveness of root canal treatment in terms of radiologic success between single and multiple visits. Neither single-visit root canal treatment nor multiple-visit root canal treatment can prevent 100% of short-term and long-term complications. Patients undergoing a single visit might experience a slightly higher frequency of swelling and refer significantly more analgesic use. [References: 35]

Similar treatment outcomes when performing endodontic therapy on permanent teeth in a single visit or multiple visits

Y. Jo Wong, MS, DDS, MAGD .


Systematic Review Conclusion

Single- and multiple-visit endodontic treatments produce similar outcomes in terms of effectiveness and complications, except that patients undergoing single-visit endodontic treatments are more likely to take pain medication than those who undergo multiple visits.

Critical Summary Assessment

The results of this adequately conducted systematic review show low to moderate–quality evidence to support its conclusions.

Evidence Quality Rating

Limited Evidence

This summary is published in the Journal of the American Dental Association and can be accessed at:

Critical Summary Publication Date:


These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association © 2019

Outcomes for single- vs. multiple-visit root canal treatments similar

Hope Saltmarsh RDH, BA, MEd; Ahmed Elkhadem BDS, MS


Systematic Review Author(s)

Figini L, Lodi G, Gorni F, Gagliani M

Summary Title

Similar treatment outcomes when performing endodontic therapy on permanent teeth in a single visit or multiple visits




Key terms

Root canal treatment: treatment for an infected tooth during which the pulp, which contains the tooth's blood supply and nerves, is removed.  The tooth is usually filled with a material and sealed, or is prepared and covered with an artificial tooth (a crown).

Pulp: the inner part of a tooth that contains the blood supply and nerves.

Radiograph: a picture of the hard tissues in the body, like bones or teeth.  Commonly called an "X-ray."

Root canal treatments can be completed in one appointment--when the infected pulp is removed and the cleaned space is immediately filled and sealed--or in multiple appointments--when the infected pulp is removed and the empty space is packed with material meant to kill any remaining bacteria.  Then, at a later appointment, the packing is removed and the tooth is filled and sealed, or prepared for a crown.  The authors of this review wondered if there was any difference in the treatment outcomes or complications experienced between the two.
They reviewed 12 studies of root canal treatments done in one visit or multiple visits.  To compare the experiences, they looked at reported pain after the treatment, swelling, and the use of pain relievers.  They also compared complications that may have developed because the infection in the tooth spread.  Finally, they checked radiographs taken one year after the treatment to see if the teeth healed properly. 

Authors' findings
The authors found that teeth seemed to heal equally well, whether the treatment was done in one appointment or several. There was no real difference in complications other than slightly more frequent swelling with single visits. They did notice that patients whose root canals were done in one appointment tended to take more pain relievers than other groups of patients.

Based on the limited evidence in this review, it seems that single- and multiple-visit root canal treatments have similar outcomes. 


Clinically, does it matter whether a root canal treatment is completed in one visit or over a few visits?


People who had a root canal treatment done in one visit tended to take more medicine to relieve pain and have slightly more frequent swelling than those who had the treatment done over multiple visits.  Other than that, there was no difference between the two groups in effectiveness, complaints of pain or other complications.