From no endo to pro endo in 365 days

by Dr. Stephen Gordon

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One year ago, if you had asked me to perform a live endodontic procedure in front of 300 colleagues at one of the world's largest dental meetings, I would have thought that you were crazy. Yet in November 2010 I did just that at the Greater New York Dental Meeting's live clinical theater.

Ever since dental school I had disliked performing root canals. Besides the time and effort involved, I thought there was something lacking in the techniques taught at the time.

Even recent advancements, such as rotary instrumentation or new obturation technology, did not change my thinking. In 2008, I performed a total of six root canals. In 2009, I performed two root canals. As a result, routine endo in my general practice was just not a worthwhile venture for me.

All that changed in early 2010, after I delivered a lecture at the Chicago Midwinter Meeting on soft-tissue lasers. I attended a lecture by Dr. Garry Bey on an innovative, evidence-based endodontic system.

As I listened to Dr. Bey's lecture, I felt certain this was the solution I could adopt that would help me grow an otherwise quiet part of my practice. After the Chicago trade show, I enrolled in a course on the system (Smart Endodontics, Discus, Culver City, Calif.).

During the course, we practiced on numerous extracted teeth, and cross-sectioning and viewing our work under the microscope. Seeing truly was believing.

I began treating my patients with this new system immediately, and have since completed several dozen procedures. Fees generated have paid for the system several times over, and the best part is the cash flow stays in my office.

I still refer complicated cases or special cases to my local endodontist, but I am able to do more for patients in my practice. This is something patients definitely appreciate.

The system offers a host of benefits that I have come to appreciate. Every GP should carefully consider the folllowing questions: a) What are the system's built-in safety features? Are the instruments easy to remove if they separate? b) What irrigation system is recommended? Is it safe? Does it have evidence to back it up?

In the context of my live, on-stage procedure, I could not have done it with any other system. As luck would have it, one LightSpeedLSX instrument separated during my live demonstration.

Thanks to a unique "safety release" feature, the file pulled loose at the shaft-shank junction (rather than breaking off at the tip). This gave me the chance to show just how easily the ~20 mm fragment could be removed with forceps in just a few seconds.

Safety is designed into the irrigation system as well. Most techniques use positive pressure to force irrigant into the canal that can either be dangerous (risk of apical extrusion) or ineffective (irrigants do not reach the last few millimeters).

The Discus EndoVac system, on the other hand, uses negative apical pressure. This means irrigant is suctioned from the pulp chamber to the very end of the canal and then safely evacuated away. The suctioning action at full working length ensures that I am able to completely dry the canal and then close the case in one short, on-stage visit.

Totally transformed, I now eagerly await the next root canal patient. For example, I recently removed an existing three-unit bridge with both abutment teeth having pulp exposures. The entire procedure – including removal of the existing bridge, root canal treatment of teeth Nos. 4 and 6, buildups, and placement of a temporary bridge – took less than two hours.

The incremental revenue for my practice is great, and I look forward to getting better and faster as I become more proficient with the system. Most of all, it greatly improves my ability to offer excellent patient care, and patients seem to appreciate the added convenience of having their teeth treated in one visit.

If it were not for this newfound confidence, don't even think about asking me to do a live endo demonstration –much less just 10 months after using it for the first time!

Dr. Stephen J. Gordon is a general dentist in practice since 1978. He taught as an assistant professor of restorative dentistry at the University of Illinois for 19 years. In addition to his full-time practice, Dr. Gordon lectures throughout the country on topics including the paperless office, digital radiography, minimally invasive dentistry, the PerioProtect Method™ of non-surgical periodontal therapy, and soft-tissue laser technology. Reach him at [email protected].