By Dennis Brave, DDS & Kenneth Koch, DMD
Incorporating modern endo-dontic technology into a general practice can often mean learning a new set of skills. This is not only for the doctor, but also for the staff and assistants. This also applies to endodontists who are converting to rotary instrumentation for the first time. Therefore, we think a good way to begin the New Year is to offer some Real World Tips for treatment room management.
Working with an assistant
We strongly recommend having two contra angles to use with your electric engine. A second contra angle facilitates the efficiency of rotary instrumentation. While the operator is working in the tooth, the assistant can place the next file in the second contra angle. In addition to placing the file, the assistant should also set the length. Dry gloves accomplish this task more easily. Have you ever tried to insert a rotary file into a contra angle with RC prep on your gloves? It's like a game show! Have the assistant insert and measure the files. Rotary files also need to be inspected visually after every use and should be wiped by the assistant with an alcohol gauze pad. When rotary files are over-stressed (excessive torque), they actually elongate and then unwind. When you notice the resulting shiny spot, trash the file. The additional contra angle also will keep the assistant much more involved in the procedure. Remember years ago when assistants used to fall asleep during root canals? This no longer is the case.
Rotary file sterilization
Prior to sterilization, place rotary instruments in an ultrasonic for a few minutes. Keep the nickel titanium files separate from the stainless steel instruments. Most people are unaware of this necessity. Keep the NiTi files in a glass beaker or something similar when they are in the ultrasonic.
Contact with stainless steel files or instruments can be deleterious to nickel titanium, and makes them more susceptible to separation. Gauze pads or autoclavable sponges can be used to hold the files for sterilization; mark them to keep track of usage. Do not use a bead/salt sterilizer for endodontic instruments. These units generate far too much heat and consequently fatigue the files. We personally favor the cartridge-type units for sterilization.
Clinicians can arrange their files for personal use in any number of ways. There are also just as many organizers. Dentsply Maillefer offers an extensive line of endo file organizers, as do other companies. Individual differences, sterilization routines, and operatory layout will dictate which method is most appropriate. Make certain that your set-up works not just for you, but also for your assistant. Also, it is quite common that as clinicians become more comfortable with endodontics, they find themselves dealing with multiple rheostats. If this becomes a problem, solve it by having a company incorporate the individual units into a cart with only one rheostat.
Develop an in-office system where the head assistant tracks equipment usage. It is important to set an inventory reorder level that is not too low to protect against backorders or increased patient demands.
The tips we have just offered are quite basic. However, implementing them into your practice will make your life as an endodontist much easier. We hope they work for you and, as usual, we will continue to give you, "Just the Facts, Nothing but the Facts."
Dr. Dennis Brave is a diplomate of the American Board of Endodontics and was the senior managing partner of a group specialty practice for 27 years. Dr. Kenneth Koch is the founder and past director of the new program in postdoctoral endodontics at the Harvard School of Dental Medicine. Drs. Koch and Brave together are Real World Endo, an endodontic education company. They can be reached at (866) RWE-ENDO, or visit their Web site at RealWorldEndo.com.