On-the-go endodontics - profitable and mobile

For much of my dental career, the three words endo, profitable, and mobile were not uttered in the same sentence.

Gregory R. Hermsen, DDS

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For much of my dental career, the three words endo, profitable, and mobile were not uttered in the same sentence. Endodontic treatment took much too long, and the fee generated didn’t offset the time, material costs, and headaches that came with it. My staff also gave me trouble about it. They said, “It takes way too much time to set the operatory and all I do is sit there and suction occasionally, when I’m not falling asleep.”

I started looking for a better way to do endo. The scientific studies and peer reviewed journal articles got my attention, and I signed up for a Smart Endo hands-on course. After taking the course, I look at endo in a whole new way. I do not want to treat endo patients the same as I did before, and I don’t think I have much to lose.

Even after taking the course, I did not feel like I was cleaning the apical portion of the canal very well. To be sure I was making a change for the better, I prepared several extracted teeth with both the old and new technique.

The first thing I noticed was what a difference it made in both time and effort. To check the quality of each technique, I cross-sectioned and viewed each canal under a microscope — and I could not believe what I saw!

With my old system, I noticed that canals were either transported or under-instrumented (sometimes both), and that there was inevitably dark debris and bacteria left behind. With the new system, the results were much better, yielding very nice looking, clean, and perfectly round canals.

I realized that I was now capable of delivering high quality work on par with, if not better than, many of my dental colleagues with more experience. Now I could be proud of my endo treatment and be comfortable treating anyone, including my own family

The efficacy of this new system has been proven to me, but another fantastic benefit is that everything is cordless. This allows me to use two handpieces during a procedure. While I’m instrumenting with one handpiece, my assistant is loading the next instrument into the other handpiece.

My dental assistant has become an integral part of the process by greatly reducing the time and effort I must spend during the endodontic procedure. You can view a short YouTube video of my assistant and me working together at www.youtube.com/watch?v=bRMgMXHI_qE.

I was concerned about going to a rotary system because many times I have heard colleagues talk about breaking instruments. I do not share in their “separation anxiety” because I use LightSpeedLSX’s built-in safety release feature.

In my experience, when the instrument separates, it does so very high up, leaving a 20-mm fragment to easily grab hold of and remove from the canal. Coupled with the confidence of safely disinfecting the canal to full working length with the EndoVac irrigation system, I know I am doing the best endo for my patients.

For the last several years, I have taken my endo on the road and volunteered with Medical Teams International, an organization with a dental van that delivers free dental services for people in need in the Seattle area.

Again, the cordless Smart Endo system has made mobile endo very easy since it can all be transported to the van in a case the size of a tackle box. The mobile van outreach depends on volunteers.

A dental assistant from my office is not always available to help, but I have found that most dental assistants have no trouble learning the system quickly because it’s sequential and predictable. Once I teach them the sequence, they can change the instruments and set the rubber stop so that the next instrument is ready when I am. This greatly speeds up the process, and makes it fun for the assistant as well.

Cleaner canals through better instrumentation and irrigation, a faster more efficient procedure using two cordless handpieces, safe negative pressure irrigation, no-carrier-left-behind-obturation, cordless warm backfill, and an involved dental assistant who knows how to make the procedure go smoothly … what’s not to love!

Gregory R. Hermsen, DDS, is a participant in PRECEDENT (Practice-based Research Collaborative in Evidenced-based DENTistry). Dr. Hermsen practices in Seattle, Wash., in general practice with a focus on endodontics. In 1994, he started using the LightSpeed system, and in 1999 began teaching the technique. He can be reached at francis6505@gmail.

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