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Abstract
Background: Postoperative pain is one of the most frequently reported and clinically significant sequelae of root canal treatment (RCT), with a reported prevalence ranging from roughly 3% to over 60% depending on the population, diagnosis, and assessment method used. Whether treatment is completed in a single visit or staged across multiple visits with an interappointment intracanal dressing remains one of the most debated procedural decisions in endodontics, and its influence on postoperative pain has been investigated extensively but inconclusively.
Aim: This review synthesizes the current evidence comparing postoperative pain, flare-up incidence, and analgesic consumption between single-visit and multiple-visit RCT, and examines the broader biological, procedural, and patient-related factors that modulate postoperative pain regardless of visit number.
Review Methods: A narrative synthesis was performed of randomized controlled trials, systematic reviews, and meta-analyses identified through PubMed, Scopus, the Cochrane Library, and Google Scholar, focusing on studies directly comparing single-visit and multiple-visit endodontic protocols and studies characterizing the mechanisms and predictors of post-endodontic pain.
Summary of Findings: The weight of current evidence, including multiple systematic reviews and meta-analyses, indicates no statistically or clinically significant difference in postoperative pain, flare-up incidence, or healing outcome between single-visit and multiple-visit RCT when instrumentation and irrigation protocols are standardized. Pain after RCT appears to be governed more strongly by factors such as preoperative pain status, pulpal and periapical diagnosis, apical extrusion of debris, instrumentation and irrigation technique, and patient-related variables than by the number of treatment visits itself.
Conclusion: Single-visit RCT can be considered a safe and effective alternative to multiple-visit RCT with respect to postoperative pain in most clinical scenarios, though case selection, operator skill, and adherence to biologically sound instrumentation and disinfection principles remain the primary determinants of patient comfort and treatment success.