Root canal appointments. How long do they take?

- How many visits are needed? | How long does each appointment last? | What steps may be needed before your appointment? | Making adjustments for pregnant women or patients with other special considerations.

How many appointments does root canal therapy take?

The number of visits it takes to complete your root canal treatment may be as few as one. With some cases, however, two or more scheduled appointments may be required.

a) The two-visit approach.

If two appointments are needed:

  • The first is typically focused on the task of cleaning and shaping the tooth's root canal system. Ideally the dentist will be able to take this process to completion during this visit.
  • The second is then use to perform the process of filling and sealing the cleansed canal space.
  • For the period between the two appointments, the dentist will place some type of medicament inside the tooth that can aid with and continue the disinfection of the root canal system. Historically the use of formocresol or monochlorphenol was common. Today, the use of calcium hydroxide paste is becoming ever more prevalent.
  • The period of time between the two appointments will typically be based on what medication has been chosen and the period of time it continues to be effective. In most cases, second visits are typically scheduled somewhere between 1 and 3 weeks following the first.

Advantages.
  • A two-visit approach offers the advantage that it may make the management of any endodontic flare-ups that occur easier and more predictable.
  • Especially when calcium hydroxide has been placed for the interval between visits, the effectiveness of the disinfection process is enhanced.
  • The duration associated with two-visit treatment also provides the dentist an opportunity to evaluate the progress of the tooth's healing process before the tooth's treatment has been fully completed.

b) Single-visit treatment.

Historically dentists usually broke the process of root canal therapy into two or more appointments. Then, starting in the 1990's, performing single-appointment therapy began to gain wide-spread acceptance.

A part of this change in approach and mindset was due to advancements in dental technology that made it easier to complete a tooth's work within a single sitting (increased treatment speed and efficiency), without concerns about compromising the quality of the tooth's work.

Advantages.

For the patient.

The obvious benefit of single-appointment therapy is that all of the patient's treatment is completed during a single sitting. (Although with multi-rooted teeth, molars in particular, that visit might need to be fairly extended, possibly running on the order of 90 minutes or so.)

Only requiring a single appointment may also offer a cost benefit for the patient.

For the dentist and the tooth's treatment.

The clinician's familiarity with the tooth root canal system is more easily maintained for the entire procedure, since all facets are performed during the same sitting. And there's no risk of bacterial leakage into the tooth between appointments (failure of the temporary restoration that's placed).

Which approach is better?

As you might expect, research studies suggest that case factors should play the biggest role in determining which approach (one or multiple visits) makes the most appropriate choice for a tooth's treatment. With one of the most important ones being the degree to which the tooth's (pretreatment) root canal system harbors infection.

That's because a two-visit approach that involves the placement of medication inside the tooth between appointments (like calcium hydroxide, mentioned above) is probably more effective in disinfecting its canal system than a single-visit one that by nature would not include this step.

 

Here are some examples of when each approach might make the most sense.

A) Single-appointment cases.

If a tooth's pathology is primarily limited to pulp tissue occupying just a portion of its root canal system (meaning much of the tooth's nerve tissue is still alive, referred to as "vital" cases), then a single-visit approach probably makes the best, even preferred, treatment choice.

Examples.

This type of scenario could include teeth that require root canal treatment due to an exposure of their nerve tissue during a dental procedure, or exposure that has resulted from tooth fracture. Or teeth that are still in the early stages of nerve tissue degeneration.

B) Multi-appointment cases.

A dentist performing endodontic therapy for a patient.

In those cases where the entire root canal system harbors bacteria, single-visit treatment may, or may not, make an appropriate choice. As case examples, this would include teeth whose pulp tissue has died (non-vital, necrotic teeth), teeth with active infections, and retreatment cases.

Common guidelines.

As a general rule, if the patient is experiencing pain, tenderness or swelling at the time of their appointment, the dentist will be less likely to choose single-visit treatment.

They will also be more likely to choose a multi-appointment approach for complex cases because they simply take more time to complete. This might include teeth that have multiple root canals (molars), or teeth that have canals that are generally difficult to find, access or negotiate.

And as mentioned above, in cases where extensive microbial contamination of the tooth's root canal system has occurred, a two-visit approach offers the substantial advantage of allowing further disinfection of the tooth between visits via the placement of calcium hydroxide.

How long does a root canal appointment take?

Over the last few decades, new techniques and new types of equipment have been developed that have improved the efficiency with which endodontic therapy can be performed. And these improvements are one reason why single-visit treatment has now become so much more commonplace.

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Appointment length.

As a ballpark estimate, you can expect that any single root canal appointment will last somewhere between 30 and 60 minutes. With more involved cases, the time needed might rise to as long as an hour and a half.

A more precise answer is given by a study by Wong. As a part of its investigation, it measured root canal treatment time as a function of the type of tooth being treated, with the number of root canals being the primary determinant.

  • Teeth having single canals - Incisors, canines (eyeteeth, cuspids), some premolars (bicuspids).

    The study reported that on average it took 37 minutes for the tooth's root canal appointment, with 68% of cases (one standard deviation unit) lying within plus or minus 18 minutes.

    That suggests a procedure time frame ranging from 19 to 55 minutes for most cases.

  • Teeth having multiple canals - Molars, some premolars (bicuspids).

    The study reported that on average it took 74 minutes for the tooth's root canal appointment, with 68% of cases lying within plus or minus 32 minutes.

    That suggests a procedure time frame ranging from 42 to 106 minutes for most cases.

Opting for shorter appointments.

If as the patient you have a preference or a need for comparatively shorter appointments (with the understanding that you will need to schedule more of them), you should let your dentist know. This might include people who have TMJ (jaw-joint) problems, or have trouble sitting still for extended periods of time.

If you do, your overall treatment time can be expected to modestly increase. The Wong study mentioned above determined that the total procedure time (for all types of teeth grouped together) on average increased from 56 minutes to 63 when multiple visits were involved.

Generally speaking, it can be expected that a root canal specialist can complete cases more rapidly than a general dentist. So if the services of an endodontist are available to you, you might consider that option.

Steps that may need to be taken before your root canal appointment.

a) Controlling acute infection.

A dentist won't perform the actual steps of the root canal process on teeth that have an active (acute) infection. Here are some reasons why:

  • The presence of infection can inhibit the effectiveness of local anesthetic. Injecting anesthetic into areas of infection creates the risk of spreading it. (Why anesthetic is affected by infection.)
  • The inability of the dentist to control the movement of infection byproducts (pus) means that it will be impossible for them to effectively cleanse the tooth's root canal system.
  • The course an acute infection will follow postoperatively is completely unpredictable, with endodontic flare-up being a possible outcome.

As a means of controlling infection, a dentist may utilize one or both of the following approaches prior to the patient's actual endodontic therapy appointment:

  • Pretreatment antibiotics - Oral antibiotics are often used to bring periods of acute infection under control.

    Common regimens involve taking the prescribed antibiotic over the course of about a week. The dentist will then want to wait some days beyond that period before performing the tooth's treatment.

  • Opening the tooth - "Opening" a tooth refers to the process of creating an access cavity in it through which pus can vent.

    After the acute (pus production) phase of the infection has subsided, the dentist will then want to "close" the tooth (place a temporary filling in it) and allow it to remain sealed for some days before performing the tooth's endodontic therapy.

In both cases, the wait period allows the dentist to confirm that the acute phase of the tooth's associated infection has subsided.

b) Making a decision about the use of sedation for your appointment.

Apprehensive dental patients may opt for the use of some type of sedation technique during their procedure.

  • The use of some medications requires pre-appointment planning. (Taking the medication before your arrival, making plans for someone to transport and accompany you, arranging for someone to monitor you postoperatively, etc...)
  • Nitrous oxide (laughing gas) can typically be opted for at the time of the appointment.

c) NSAID premedication.

Your dentist may suggest that taking a nonsteroidal anti inflammatory drug (NSAID) prior to your appointment may help reduce your potential for post-treatment discomfort.


How pregnancy can affect root canal appointments.

Women who are expecting can undergo root canal treatment. However, the timing of their appointments, and the way their treatment is performed, may need to be altered in consideration for their pregnancy.

In all cases, any woman who is pregnant, or even anticipates that she is, should advise her dentist of such before any type of dental treatment is begun.

Issues that must be considered.

Here are some of the issues that must be taken into consideration when root canal treatment is planned for a pregnant woman:

» The use of radiographs (x-rays).

When utilizing modern radiographic technique, and standard radiation protection (including the use of a leaded apron and thyroid collar), the dental x-rays needed to perform root canal treatment should not place a patient's fetus at risk.

As further precaution, the treating dentist will strive to keep the number of x-rays taken to a minimum.

» Appointment length and number of visits.

It may be difficult for a pregnant patient to remain physically comfortable while sitting in their dentist's dental chair. Instead of one relatively longer appointment, their root canal treatment may need to be divided up into two or more shorter visits.

» Treatment timing.

In those situations where the patient is experiencing discomfort or has signs of an active infection, immediate attention may be required. In cases where urgency is less of an issue, the treating dentist may prefer to delay the patient's endodontic therapy until a particular trimester (typically the second), or wait until after their child has been delivered.

» The use of medications.

A patient's pregnancy will influence the selection of medications used for their treatment.

A dentist giving a dental injection.

As an example, root canal treatment typically requires the use of a local anesthetic (the medicine that is used to "numb up" a tooth). A few different types of anesthetics have been approved by the FDA for use with pregnant women. And, in fact, they are common ones and are typically found and routinely used in essentially all dental offices.

Some endodontic cases will also require the use of an antibiotic and/or analgesic (pain reliever). Once again, products approved by the FDA for use with women who are pregnant are readily available.

(Ingle JI, et al. - linked above.)

 

Last revision/review: 12/13/2018 - Page revision. Content added.

 
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