Molar root canals can be fun and profitable
What's your favorite excuse for NOT doing molar root canals?
Clarence R. Feller Jr., DDS, MAGD, FAAID
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What’s your favorite excuse for NOT doing molar root canals? Does it take too long? Is it too much work? Do you fear the instruments will break? Do you have post-op pain nightmares? Are you not pleased with the results? Do you get any enjoyment from it? Do you not have a good assistant? Would you rather do anything but endo?
Like so many of my colleagues, I had the same dilemma about 10 years ago. Should I keep molar endodontics, or forgo the revenue and headaches and refer to a specialist? Keeping it in my practice would have to be based on the idea that it was comfortable for the patient, and predictable, enjoyable, and profitable for me...period!
Good fortune and my willingness to change created an opportunity for me to copy genius instead of settling for mediocrity. My mentors, E. Steve Senia, DDS, and Bill Wildey, DDS, showed me a system that took away all my issues. Now endo is the most enjoyable and profitable part of my general practice.
The Discus Smart Endodontics line combines an excellent system for instrumentation called LightSpeedLSX, which has an incredible irrigation system called EndoVac. Together they far surpass anything I have seen or used previously.
The goal of any root canal treatment should be to remove as much of the bacteria and biofilm as possible. LightSpeedLSX does this best in the apical part of the canal system and has done more to simplify my root canal preparations than any other system. Its nontapered shaft provides extraordinary flexibility. These instruments stay centered, even in curved canals.
The one thing I like most about the LightSpeedLSX is its safety-release feature. This means that when the instrument encounters too much twisting force, rather than breaking at the tip like other rotary instruments, it breaks up high near the handle. This leaves a 20mm segment of the file to grab hold of, making retrieval simple and quick. This has taken away my fear of instrument separation. It is also good from an economical standpoint as I can use these instruments in four molars before replacing them.
These nontapered instruments do an excellent job of mechanically preparing canals, and facilitate a large enough apical preparation to irrigate effectively with EndoVac, which is unparalleled when it comes to chemically cleaning the canal. This apical negative pressure irrigation system uses suction at the apex to draw the irrigant apically from the chamber rather than forcing it into the canal through a traditional needle (positive pressure). A vortex of irrigant evacuates debris, kills bacteria, and removes the smear layer from the canal wall.
There is an incredible amount of published peer-reviewed research on this system, which all points to the fact that it can safely deliver unparalleled bacterial kill levels, and result in reduced postoperative pain for patients.
This ingenious system gives you the ability to use copious amounts of sodium hypochlorite to full working length, which is then safely taken away from the apical area through a microcannula needle. If you were to use a standard side port needle at working length with positive pressure, you would run the big risk of causing a hypochlorite accident.
I’ve gotten into the good habit of calling my endo patients personally at the end of my workday. I can say without doubt that since I have used the Smart Endodontics system, my patients have shown much less postoperative pain. I attribute this solely to the fact that cleaner canals lead to better results.
Cleaner canals not only yield better results, but they also make canals easier to fill. I use SimpliFill Apical Plugs, made to precisely match the size and taper of the LSX prepared canal. Although I find these customized plugs a great way to quickly and easily fill the canal, it’s important to note that any suitable obturation system can be used.
The combination of these products in a molar case typically costs less than $50, a small amount compared to the revenue I generate from a single-visit treatment that lasts between one and two hours. When my schedule permits, I prep the crown immediately after root canal therapy.
These are just a few of the many advantages that I enjoy with the Smart Endo system. I now look forward to the next time I get to do a root canal treatment. If you have any questions, please email me at firstname.lastname@example.org.
Clarence R. Feller Jr., DDS, MAGD, FAAID, is a Fellow of the American Academy of Implant Dentistry and a member of the American Association for Functional Orthodontics. He maintains a general practice in San Antonio, and can be reached by email at CFellerendo@aol.com.