One of the most common clinical questions in endodontics is still a very practical one:
Should I complete the root canal in one visit or multiple visits — and will it change post-operative pain?
A recent umbrella review brings together evidence from multiple systematic reviews to look at this question more clearly.
What Was Evaluated
The review included 12 systematic reviews comparing single-visit and multiple-visit root canal treatment in permanent teeth.
Post-operative pain was assessed in most studies using:
Visual analogue scales (VAS)
Numeric rating scales (NRS)
Some studies also looked at pain incidence and flare-ups, although definitions and reporting of these outcomes varied significantly.
The methodological quality of the included reviews was assessed using established tools (AMSTAR 2 and ROBIS), and overlap between primary studies was also considered.
What the Evidence Shows
Across the higher-quality reviews, the findings were consistent:
There was no clear or clinically meaningful difference in post-operative pain between single-visit and multiple-visit root canal treatment.
This applied across different time intervals and outcome measures.
Flare-up data were less consistent, mainly because of variability in how flare-ups were defined and reported across studies.
Interpreting This Clinically
From a chairside perspective, the takeaway is straightforward.
If the concern is post-operative pain alone, current evidence does not strongly support choosing one protocol over the other.
In other words:
Completing treatment in a single visit does not appear to increase pain.Spacing treatment over multiple visits does not appear to reduce it in a clinically significant way.
The review also highlights some limitations:
Variability in how pain was measured
Differences in follow-up time points
Inconsistent definitions of flare-ups
Overlap of the same primary studies across multiple reviews
These factors reduce the certainty of the conclusions, even though the overall direction of evidence remains similar.
What This Means for Practice
Since post-operative pain does not appear to differ meaningfully between the two approaches, the decision can be guided by other clinical factors:
Case complexity
Presence of infection or exudate
Patient symptoms
Time and scheduling considerations
Patient preference
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