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Dental Tribune Middle East & Africa Edition | 3/2017 ENDO TRIBUNE A4 Making endo work in practice: is it worth it? By Dr. Bob Philpott, UK When we look at our outcomes in endodontics, ‘is it actually worth it?’ is a question I often ask myself. Hav- ing worked in NHS, private, general and specialist endodontics both in the UK and abroad, I understand the stresses and strains on practitioners and my aim is to try and apply some of this knowledge in order to come up with solutions for dentists to see how we can improve efficiency dur- ing endodontic treatment. Endodontic ‘four-handed dentistry’ requires reassurance and efficiency With patient expectations set pretty low, endodontics is a rarely appreci- ated discipline. There’s no doubt that root canal treatment is a ‘hard sell’ and we have to make the experience for patients as pleasant as possible. Involving your team to help reas- sure patients helps to reduce stress, improve efficiency and deliver bet- ter outcomes. Ensure your set up is simple, minimise your kit and have your nurse working closely with you. Think of endodontics as ‘four-hand- ed dentistry’, especially when work- ing under magnification; without your nurse on board you’ll struggle to do a good job. Ethically bound to our patients – know your ability and limitations If endodontics is the best treatment The same winning technique with greater fl exibility © 2015 DENTSPLY International, Inc. ADPTG Rev. 2 2/16 option, we are duty-bound to carry out that treatment for our patients, maximising productivity in prac- tice in order to get the best possible outcomes. A good starting point to achieve this is knowing your own ability and limitations – only take on cases that you can comfortably treat and refer cases that you can’t. For ac- curate diagnosis you will not only need reliable eyes, a perio probe and pulp tester, but also good light, mag- nification and a DG16 endodontic probe to locate canal orifices. area free from bacteria and saliva, improving visibility and stopping the patient’s cheeks encroaching when preparing the access cavity. Personally I never work without rub- ber dam. Adequate access is also es- sential, starting with a small hand file to get a feel of the root canal anato- my. It’s essential to spend time creat- ing an adequate glide path, which for me is a loose size 10 hand file. This allows safe passage of subsequent instruments down to the apical por- tion of the root canal. tips (Dentsply Sirona), as they offer a wide choice of options and are much less likely to break than diamond- coated tips. You need to be efficient in the use of instrumentation and understand how your endodontic tools work to avoid instrument frac- ture. Nickel titanium files offer huge advantages over stainless steel hand files, as the taper enables removal of coronial interferences. They’re also more resistant to cyclic fatigue and allow you to work in a safer, more professional and effective way. Creating an adequate glide path Clamp the tooth and quickly apply the rubber dam. This offers several advantages, including keeping the Understand and know your instruments For refinement of the coronal por- tion of the access cavity and canal orifice location I prefer to use Start-X Rotary or reciprocation? For me reciprocation is the way forward. Look at Waveone Gold (Dentsply Sirona) – one of the best improvements in endodontic file systems I’ve ever seen. Reciproca- tion also helps to reduce costs as the majority of cases can be completed using just one single primary file. For the correct obturation strategy you will need gutta percha, the gold standard for filling the canal, with hard clinical evidence behind its suc- cess. Think about the patient The restorative phase of endodontics has a big effect on the final outcome and no root canal treatment is com- plete until the restoration is placed. Indirect composite restorations may offer a secure outcome, in which it’s easier to control the margins and contacts, but one question remains: do we want to leave the tooth un- covered? You must think about the patient; the particular case will deter- mine whether you use composite or amalgam, how badly broken down the tooth is, how much dentine re- mains, and importantly, what the patient’s occlusion looks like are all important considerations. I usually find it’s better to prepare the post base at the obturation stage, be- cause you’re more familiar then with the actual root canal system. For me personally fibre posts perform very well as opposed to metal posts and cores. They preserve the aesthetics of the tooth and provide a fast and ef- ficient sealing procedure. In practice I only use Radix fibre posts (Dentsply Sirona). I love their simplicity, the taper of the posts and the fact that they tend to fit the vast majority of root canals very well. To help ensure successful clinical outcomes and patient satisfaction I look for comprehensive restorative solutions, which is why I use Core X flow (Dentsply Sirona), consisting of a base and catalyst, which when mixed forms a dual-cured, highly filled composite resin core build- up and post cementation material, which is very easy to apply. Using ce- ramics on top I get a good, easily pol- ished aesthetic restoration. I could not practice without a sectional ma- trix system for placement of resto- rations in the posterior region and I also like to use SDR (Dentsply Sirona) bulk fill as a base in class I and II res- torations. What I love about modern endodon- tic systems is their simplicity and ease of use, making straightforward endodontic treatment a real option for the majority of general dentists. By knowing your limitations and only treating the cases you can do efficiently, you can adhere to biologi- cal principles and most importantly, you can get the best technical and healing outcomes for your patients.