The economic truths of endodontics

Dec. 1, 2008
Endodontically speaking, dentists are all looking for more effective and safer techniques.

by Barry Musikant, DMD

For more on this topic, go to www.dentaleconomics.com and search using the following key words: rotary NiTi, endodontics, reciprocating handpiece, Dr. Barry Musikant.

Endodontically speaking, dentists are all looking for more effective and safer techniques. Perusal of any trade magazine reveals many rotary NiTi competitors vying for a share of the market, each touting some design feature or metallurgic innovation that will produce either safer and/or more effective results.

All these products have far more in common than they have features that differentiate them. That includes an individual cost that ranges from $8 to $20 an instrument. More aggravating, perhaps, is that despite these high costs, manufacturers recommend them for single usage. This can easily produce instrument costs for the dentist that exceed $75 per tooth. This might not matter if a private fee is well in excess of $1,500 per tooth, but the insurance fees of most dental programs do not come close to this level of compensation. Nevertheless, a case could be made for these expensive instruments if there were no adequate alternatives to the results produced by them.

The fact is that there are extraordinarily well–designed systems that not only produce effective endodontic shaping, but do so with far more safety and at a dramatically reduced cost. This safety and reduced cost is brought about by a series of relieved reamers that are used both manually and in a reciprocating handpiece.

The reciprocating motion is limited to a 30° arc of motion, 1/12 of a full rotation, which is five minutes on the face of a clock. This limited motion virtually eliminates torsional stress and cyclic fatigue, which are the most significant factors in the separation of rotary NiTi instruments. By substituting reciprocation for rotation, we now have a system that is far less likely to break during canal shaping. Consequently, these instruments are used at approximately 3,000 cycles/minute, a speed that makes shaping at least as easy as rotation, but without the anxiety of instrument fracture.

The reason rotary NiTi instruments are replaced after one use is to reduce the incidence of separation. Because reciprocation minimizes the causes of separation, the relieved reamers constituting the alternative system can be used at least six to seven times. Dullness, not breakage, is the determining factor for when they should be replaced.

With a starting cost of about one–third that of rotary NiTi, and their subsequent six to seven uses, the cost per instrument compared to rotary NiTi is roughly 90–95% less expensive. From a practical point of view, if you spend $5,000 on rotary NiTi per year (and that is a conservative figure for many dentists), you would reduce that cost to between $250 and $500 per year.

This cost reduction is so glaring that it would take minimal cynicism to conclude that there must be something missing in this discussion. In fact, what is missing is awareness on the part of dentists that — with the introduction of rotary NiTi around 1990 — the cost of these new endodontic instruments shot up about 10 times. Through the years, the manufacturers' recommended number of uses for these instruments kept falling — to the point where it is now limited to single usage. Obviously, this increases the cost per use of each instrument dramatically.

These rotary NiTi systems are so expensive that they have distorted what we think should be a proper price. Relieved reamers in a reciprocating handpiece have done far more to maintain a traditional price structure than rotary NiTi, and most importantly have not compromised the results that dentists can expect to gain with these far safer, less expensive systems.

The results of these reamers would be difficult for a rotary system to duplicate without great concern for separation.

In light of the heavy marketing that the rotary NiTi companies use to maintain their sales, please realize that the best way for dentists to evaluate what we are discussing is through the opportunity to try the systems. In that regard, we offer free two–to–three–hour, one–on–one workshops in our endodontic office in New York City. We supply all the teeth. Anyone interested in this opportunity should contact me at (212) 582–8161. I generally give the courses from about 7 to 9:30 p.m. after I am finished with patients.

In addition to these courses, a variety of tuition–based programs are available on this and other topics. One such program is an intensive two–day workshop in which the participants in this 17–hour CE course get a minimum of 11 hours of hands–on training working on numerous teeth, mostly molars, and often under a microscope. All the participant needs are loupes and their skills, which will dramatically improve rapidly. For those interested in these extended courses, please call (888) 542–6376.

Dr. Barry Lee Musikant, one of the nation's leading endodontic authorities with 35–plus years of clinical experience, is a partner in the largest endodontic practice in Manhattan. You may reach him at [email protected]. To view examples of complex anatomy shaped in a nondistorted manner, safely and effectively, with the SafeSiders instruments used in the EndoExpress reciprocating handpiece, visit www.edsdental.com/xrays.

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