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  06.16.05 Issue #171

   
Six Simple Systems for Everyday, Practical Endodontics

By Arthur “Kit” Weathers, Jr., D.D.S.

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One of the greatest frustrations for a busy dentist is to begin a scheduled root canal treatment and find surprises as to the difficulty or the amount of time required to complete the treatment. At my two-day, hands-on Practical Endodontics Root Camps, we spend a lot of time helping a doctor attain the knowledge and skills required to avoid treatment surprises. In this article, I break down six critical considerations for assuring your endo treatment will be efficient, predictable, and of high quality.

1. Careful Case Selection

Efficient endo must begin with proper case selection. You must know your limitations and select cases based on these limitations. For simplicity, I've listed on the chart below a comparison to help you more accurately select the cases you choose to treat in your office.

Endo Case Selection Chart

Better Worse
Vital Necrotic
Anterior Posterior
Maxillary anterior Mandibular anterior
Mandibular molar Maxillary molar
First molar Second molar
Gradual canal curve Sharp canal curve
Large pulp Calcification
Average length roots Long roots
No crown in place Crown in place
No swelling Swelling
First endo treatment Retreatment
Non-strategic tooth Abutment

If you don't have a high confidence level in your endo skills, you should definitely limit your cases to those listed in the “Better” column. You'll find that you will still have plenty of endo to do, even if you limit yourself to only those cases. The last thing you want to happen in a busy dental practice is to get “bogged down” with a root canal that takes much longer than anticipated. Worse, you don't want to begin a root canal treatment that you later discover you can't complete.

2. Proper Access

I cannot over-emphasize the importance of proper, straight-line access for safe and efficient endodontics. You should be able to see the openings of every root canal with one eye closed and without moving your head or the mirror. If you can't find ‘em, you can't fill ‘em. Not establishing straight-line access (which means the rotary file is bending as it enters the canal) is one of the leading causes of rotary file breakage.

3. The Rubber Dam

The rubber dam is one of the most low-tech tools we have in our office. It's also one of the most important for the safety of our patients. I've found that I can place a rubber dam on any tooth in the mouth using one of only three clamps. The 12A is appropriate for the lower right and upper left molars; the 13A is designed for the lower left and upper right molars; and the 9M works great for all anterior teeth. Also, you'll find the Aseptico Handidam (available from EndoSolutions 800-215-4245) to be a real time saver, since the rubber dam and the frame are made as one disposable unit.

4. The Electronic Apex Locator

The apex locators currently on the market show remarkable accuracy. They can improve your speed and precision in determining the correct root canal length. Two great units that have withstood the test of time are the J. Morita Root ZX, and my personal favorite, the Elements Apex Locator by Sybron Endo.

5. Digital Radiography

Without question, digital radiography can easily trim 7 to 21 minutes from the total treatment time. Once you've had this valuable efficiency tool in your practice, you wonder how you ever practiced without it. With the quality now equaling that of film, and the return-on-investment to be less than one year, it no longer makes sense to put off implementing digital radiography in your office, especially if you do endo. Dexis is the unit we're currently using at our Endo Root Camps.

6. Efficient Instrumentation

The introduction of rotary instrumentation in endo 13 years ago revolutionized the way we perform endo. Besides allowing us to increase our speed of treatment, rotary instrumentation has made it significantly easier to thoroughly clean and shape canals. Often, cases that we used to dread treating with hand instrumentation are now fast and fun.

The chart below, illustrates the impact of incorporating rotary instrumentation with your root canal techniques. The “Time Before” column indicates the endo treatment times that our “Root Camp” attendees reported prior to attending Root Camp. The “Time After” column is an average of the times they reported just months after finishing their two-day training.

Average Root Canal Treatment Times Before and After Root Camp Training

Tooth Time Before (min) Time After (min)
Anterior 56 40.7
Bicuspid 72 54
Molar 106 77.6

It's amazing how rapidly such improvement can be accomplished using these new techniques. In fact, we see an increase in endo production, on average, between $184/hr to $242/hr, depending upon which tooth is being treated. The greatest increase in efficiency occurs in treating anterior teeth. Following training, our doctors are producing $787 per hour performing anterior endodontics.

Certainly, many factors can affect the efficiency of your root canal treatment. The tips I've outlined here are not all-inclusive, but they should serve as a guide to improving your efficiency when doing endodontics.

To Order Dr. Kit Weather's Practical Endodontics Root Camp Home Study Course click here.

Dr. Weather's can be reached at 770-227-3636 or drkit@ce-magic.com

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