Fat-free endodontics, part II

by Dennis Brave, DDS Kenneth Koch, DDS

We want to build on the foundation we created with last month's column with more ways endodontics can contribute to your bottom line.

Rotary instrumentation with an electric engine should be part of every practice that performs significant root canal therapy. The ultimate goal is success with speed. The key is creating consistent shapes. The predictability of shaping with rotaries has not only influenced instrumentation but obturation results as well.

More than 80 percent of endodontists use some type of rotary technique. Nickel titanium rotary instruments were introduced in the early 1990s and quickly became very popular. For dentists still using hand instruments, the shift to a rotary technique will be significant. A rotary technique is far less fatiguing. More importantly, it produces more predictable shaping results than hand instrumentation.

Another benefit of this new technology has been a dramatic decrease in post-operative sensitivity. This is a result of a combination of file design and utilizing a crown-down procedure. (see our related article, "How to profit from endodontics" on page 52 of this issue.)

We realize that rotary instrumentation is not a panacea. We have found that hybrid techniques that combine different systems or combine rotaries with hand instrumentation can successfully address most challenges. But the key to successful rotary instrumentation begins with the material used to create files — nickel titanium.

Nickel titanium is an alloy that can change its molecular structure when stressed. Because of this property, it is absolutely crucial to run nickel titanium files at a consistent RPM. Some air-turbine motors can achieve this; however, there has been a noticeable shift to electric engines. Electric engines offer a more consistent RPM, are smoother than air turbines, and are quieter. The perception to the patient undergoing a root canal with an electric engine, as compared to an air turbine, is dramatic. Patients can and do readily discern the differences between techniques.

Electric engines have continued to evolve. We now have the ability to run our files with torque-control electric engines. The advantage of a torque control engine is that when a file is stressed beyond a certain pre-set limit, it will automatically reverse rather than exceeding the torque limit. This safety factor is very helpful for the practitioner who performs a limited number of procedures. Torque-control engines are a tremendous help in minimizing breakage.

Preventing file separation is still about proper technique, but torque control serves as a safety cushion. Most rotary file manufacturers have electric engines associated with their systems. Some torque-control engines are battery-charged and therefore portable; however, they do need to be recharged. Great endodontics require a good apex locator and an equally good electric engine.

Rotary instrumentation has made single-visit endo more possible than ever before. As Dr. Pat Wahl says, "Would you like to have your by-pass surgery done in multiple visits to justify the fee?" Make single-visit endo an essential part of your practice. It is better treatment, more profitable, and patients love it!

General dentists perform approximately 80 percent of all root canal procedures. However, case selection is crucial. Dentists must know when a case is beyond their expertise. The American Association of Endodontists has addressed this problem through the publication of a difficulty assessment form. Using a numbering system based on the difficulty of the case, the dentist is given a "heads up" about the difficulty of a case. This is a very helpful document, and we recommend that every dentist who performs root canals get a copy and understand its contents. You can obtain this document by contacting the AAE at (800) 872-3636, or by visiting their Web site, www.aae.org.

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.

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