By Barry Lee Musikant, DMD
Just reading the headlines of our ongoing economic crisis drives home the point — we cannot have it all; we must make choices.
Our politicians tell us that we cannot have ever-increasing debt, and cutting entitlements has become a necessity. In effect, this removes the social safety net that has added security for so many in this country. Of course, those who don’t need it — the wealthy — say rugged individualism and sacrifice is what is called for today. This means sacrifice for others, so the policies that have been put in place to make those who are wealthy will continue.
From a dental point of view, the financial environment impacts us in ways that we may not immediately recognize. For example, the cost of employing the most touted endodontic techniques cost dentists far more than they did in the past.
It is suggested that rotary NiTi instruments, which can cost anywhere from a few dollars to $23 per instrument, be used only once and then discarded, in contrast to instruments of a previous generation that cost less than $1 and were often used several times before replacement.
Marketers of these products rationalize the dramatically increased costs by stating the productivity of the practitioner will increase enough to compensate for the increased costs. They also tell dentists to pass on the costs of the instruments to patients. In the best of times, passing on costs may have a negative impact on “business.” Currently, common sense tells us this is not the time for such experimentation.
One of the goals of this ubiquitous marketing effort is to drown out any recognition that alternative methods, far less expensive initially than rotary NiTi, exist. These savings are then magnified by their ability to be used several times before being replaced. Yet, this is the case, and the consequences of this reality can have a major impact on a dentist’s practice.
Some of these consequences include a major reduction in the cost of endodontic instrumentation, savings that can then be directed into other areas of productive growth that may require an initial investment that is now available.
For example, if I were a general dentist, I would be very interested in learning about Invisalign from Align Technologies, a lab-assisted technique designed to allow general dentists to handle an array of orthodontic situations.
The savings accrued by eliminating the high cost of rotary NiTi could then be applied to this new venture, expanding one’s capabilities into areas that increase the array of services offered. The decision to make this tradeoff is beneficial on all fronts.
The rotary endodontic technique has been replaced by a far less costly and safer system that actually gives the dentist more confidence for tackling more complicated endodontic anatomy. This increases the services that can be rendered to patients before referring to a specialist.
The dentist has less procedural stress because these instruments are designed and used in a way that virtually precludes their breakage within a root. The dentist is now rendering an orthodontic service he or she may not have previously considered.
The more effective services a dentist can offer patients, the happier those patients will be. Of course, specialists will always be necessary for situations that are beyond the scope of the general dentist. But there is no reason why the dentist’s level of competence across a broad range of procedures cannot be increased.
A safe way to increase competence is for dentists to take intense workshop courses that force them, under supervision, to hone the skills being acquired. These courses are expensive and take time. Time, as the saying goes, is money.
In short, we are talking about resource allocation and cost benefit analysis. Are the dentist’s present expenses justified from this standpoint? Is the money being spent (resource allocation) providing the dentist with the best return on investment?
My contention is that rotary NiTi is an example of poor resource allocation, because other more productive and safer techniques are available at dramatically lower costs. By switching to these safer and more productive alternatives, monies are freed to invest in other areas of education. This will produce a still greater return from the expanded set of skills that the dentist can more easily afford to attain.
If not in orthodontics, knowledge may be gained in learning more about implants, or stocking up on inventory that is not inexpensive. One could learn more about the handling of soft tissues that aid in the maintenance of healthy gingiva, improving esthetics when placing maxillary anterior implants, becoming proficient in tissue grafting, the reduction of pocket depth, or the use of various osteogenic materials and how they are optimally placed.
Today you can play the stock market and become an active day trader in the hopes that you will find a way to outsmart the market. From everything I’ve read, this is a fool’s game. While the lucky few will win, it is not a formula for success for most of us.
The best place we can invest for success is in ourselves, and the best way to make those investments is to reconsider your present resource allocations and then determine whether or not redirecting some of those resources into other areas will be beneficial.
Those using rotary NiTi for several years can make their appraisal if their investment has paid off. Given the techniques they used prior to the adoption of rotary NiTi, they may conclude it was a wise investment.
I would add, however, that a comparison to K-files is a poor one. This keeps the dentist from realizing the cost benefits from switching from these expensive and vulnerable systems to those that are less costly, safer, and more productive.
While a transition to this alternative approach is its own reward, the dentist will also now have the resources to reinvest in the practice for his or her benefit and the benefit of patients.
Dr. Barry Lee Musikant’s lecture schedule has taken him to more than 250 international and domestic locations. He has coauthored more than 350 articles in major dental journals, domestic as well as international. Dr. Musikant holds 19 patents for co-inventing revolutionary endodontic obturation, instrumentation, and post and composite systems. As a partner in the largest endodontic practice in Manhattan, Dr. Musikant’s 35-plus years of clinical experience have made him one of the top authorities in endodontics. You may contact Dr. Musikant by email at [email protected].
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