Figure 3Click here to enlarge imageThe net result of combining a true reamer design with a constant .06 taper is the most efficient instrument yet created in rotary endodontics. Endodontic practices that are using this file (in combination with laser-verified gutta percha) report an increase in production of one to two more cases completed per day per clinician. Talk about increased profitability!
The other topic is one that has remained off the radar screen. This is the single use of rotary files and its impact on office efficiency. While we certainly understand that rotary files are not cheap and that most clinicians would like to use them multiple times, the critical issue is cyclic fatigue.
Cyclic fatigue is one of the two reasons why rotary files separate (the other is excessive torque). This can happen regardless of the manufacturer. But the greater problem is this: Cyclic fatigue is insidious because you cannot see it like one can see excessive torque (unwinding). Consequently, the only way to control cyclic fatigue is to discard the files after use in a single case. The experience of having a file break simply because you used it too many times is something that can be and should be avoided. Nevertheless, there is another aspect to the single use of rotary files, and this is from the assistant’s perspective.
Since the introduction of the single-case-use of EndoSequence files in multiple offices, we have received numerous calls from assistants telling us how this has changed their office experience. We would like to relate some of their observations.
The first change they notice is the increase in productivity. Their doctors are completing cases more quickly (more single-visit endo), while the patients are expressing gratitude because they do not have to come back. The entire office from front desk to treatment room seems to be more cheerful (their word, not ours).
The second change is that the assistants find that they personally have less stress than they had previously when they had to be concerned about monitoring the number of times a file was used. This is especially true in those practices that have multiple doctors performing endodontic procedures. There can be a lot of stress on an assistant if a doctor breaks a file after it has been sterilized.
As a result of less stress, every assistant has said to us that they feel more effective working with the doctor and in the office. Also, single use results in a significant reduction in time spent with the ultrasonic baths and in the sterilization room. Most assistants state that their time is better spent with the patient in the treatment room.
Another positive aspect to single use (and one which escaped us) is that the assistants report that their doctors also seem to work with less stress. Every assistant we have spoken to stated that his or her doctor no longer has this overwhelming concern about “Is this file going to break?” or, “Have I used this file too many times?” We did not anticipate such a significant change in doctors’ behavior, but multiple assistants have repeated this point. Its importance is quite simple. The net result of a smoother, more efficient practice is increased profitability.
In this article, we have offered a few pointers that we feel can significantly increase your profitability in endodontics. We would like you to continue to prepare your canals with a constant .06 taper using the most efficient instrument available - the EndoSequence file - and please get in the habit of discarding them after a single difficult case (especially molars). If you take these tips to heart, we think you will be very pleased at the increase in your production as well as the increase in office morale. Certainly, we will continue to offer tips and suggestions 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 a member of the College of Diplomates. In endodontic practice for 27 years, he was the senior managing partner of a group specialty practice. Dr. Brave, formerly an associate clinical professor at the University of Pennsylvania, currently holds a staff position at The Johns Hopkins Hospital.
Dr. Kenneth Koch is the founder and past director of the program in postdoctoral endodontics at the Harvard School of Dental Medicine. In addition to having maintained a private practice limited to endodontics, he has written numerous articles on endodontics and maintains a faculty position at Harvard.
They can be reached at Real World Endo (866) 793-3636 or through www.realworldendo.com.