Whether it comes from patients or general dentists, one of the most common questions I get is: “Why do root canals take two visits sometimes? And how is it decided whether a root canal will take one appointment or multiple?”
This is an important question. My first response is usually, “Well, it depends on the case.” But after years of experience, I’ve found that several factors guide my decision as an endodontist when determining whether to treat a tooth in a single visit or multiple visits. Let’s walk through a few scenarios.
The Emergency Patient
When an emergency patient needs same-day treatment and I have to work them into my schedule, the treatment won’t be completed in one visit. The reason is simple: time constraints.
I don’t want to reschedule patients who have had appointments booked for months, so I typically don’t complete emergency cases in one session. Instead, I’ll perform a pulpectomy or full pulpal debridement to relieve pain and ensure the patient can function normally. Then, we schedule a follow-up to complete the root canal.
Retreatments
A major reason why root canals take two visits is when dealing with retreatments. Most retreatment cases involve a more serious infection than an initial root canal, requiring additional time for thorough disinfection.
Occasionally, I can complete a retreatment in one visit—particularly for anterior teeth when I want to return the patient to their general dentist quickly for a post and core. Another exception is when the retreatment is due to coronal leakage without significant periapical radiolucency. In such cases, I simply refresh the gutta-percha and finish the procedure in one visit. But generally, retreatments are two-visit procedures.
The Symptomatic Patient
If a patient arrives in severe pain, it’s often best to complete the root canal in two visits.
Why? Because I want my patients to return to their general dentist pain-free. If a patient is highly symptomatic before treatment, I usually medicate the tooth with calcium hydroxide and allow them time to recover before the final restoration. This ensures they can function normally and minimizes post-treatment discomfort.
Swelling and Drainage
When a patient presents with swelling or drainage, I prefer two visits. I want the infection to be fully resolved before obturating the canal.
It’s always ideal to ensure the canals are completely dry before sealing them. If there’s any sign of persistent infection, I schedule an additional appointment to ensure the best possible healing.
Pain During Treatment
If a patient experiences pain during the procedure—even with adequate anesthesia—I extend the treatment to two visits.
This is rare, but when it happens, I prefer to take more time rather than rush through the case. One of the best things about root canal therapy is that you can always close the tooth and return later to complete treatment. Ensuring the patient is comfortable is a priority.
Large Periapical Radiolucency
When a periapical radiolucency is particularly large, I often schedule two visits. In some cases, these lesions won’t heal with root canal therapy alone and may require surgical intervention.
If I anticipate a post-operative flare-up due to lesion size, a two-visit approach is typically more effective.
Special Cases
Some teeth require additional time due to anatomical complexities—such as resorption or C-shaped canals. When a case presents with an uncommon challenge, I schedule multiple visits to ensure careful planning and execution.
Difficult Teeth
Not every root canal is straightforward. Sometimes, cases that appear simple on the radiograph turn out to be far more challenging once treatment begins. If I encounter difficulties, I spread the treatment over two visits to ensure the best possible outcome.
Managing Patient Expectations
When I evaluate a patient and explain their procedure, I set expectations by letting them know that a two-visit root canal is possible, but I’ll attempt to complete it in one. I never promise a single visit, though I achieve it about 85% of the time.
Root canals are highly technique-sensitive, and my goal is always to take my time, do it right, and provide the highest quality care. I want to ensure that once a tooth is treated by me, the patient never has to return for the same issue.
Final Thoughts
While some root canals can be completed in one visit, many require two to ensure thorough cleaning, pain control, and long-term success. My priority is delivering the best possible outcome while minimizing risks.
If you have any questions about root canal treatment planning or scheduling, feel free to reach out. How do you discuss treatment plans with your patients? Let me know in the comments!
Comments