Dentaltown June 2019 - 16

professional courtesy
column

Specialists Aren't Perfect
of the apex but he believed the canal was sealed well. I
Sometimes I joke that I moved across the country so
asked, "Did you already obturate the tooth? I thought
I wouldn't have to treat a long list of relatives back home.
But not long after relocating from upstate New York to
in re-treats with an apical lesion, it was common to
Arizona, we had a new list of "close family"-neighbors,
medicate first and then obturate." He said many
parents of our kids' friends, people at church, etc. It's a
studies suggest that a single-visit re-treat is acceptable
and if the patient had a problem, he would perform an
privilege to help someone I know personally, but there's
apicoectomy. I wasn't impressed.
always that underlying pressure to have everything go
My neighbor's version of the story had me feeling
well. Nothing's more embarrassing than listening to
your friend tell a story about a recent
even worse. He described the early part
dental procedure when you're together
of treatment when he felt the endodontist
at a party.
was being "too aggressive" and how he
My recent story started when my
felt the file separate, and described the
neighbor casually said, "I need to get in
great lengths the endodontist took in
to see you soon" as I left his home after
his attempts to retrieve the broken file.
a party. He was in the office a few days
His confidence in going back for an
later for a limited exam due to pain in his
apicoectomy was at rock-bottom. He
lower anterior teeth. We discovered that
then texted a screenshot of the final X-ray
#23 was sensitive to percussion and an
that he took with his phone (Fig. 2). I
was speechless.
X-ray revealed a periapical radiolucency
Fig.
1:
Diagnostic
appointment.
This case brought home that I can't
on this endodontically treated tooth.
He'd had root canal treatments on #23,
assume all specialists are experts at what
#24 and #25 approximately 30 years
they do, and when I work with new
ago; they didn't look great on X-ray
referrals, I need to do a better job of
(Fig. 1) but this was the first time he
communicating my expectations. I also
had a problem. He was eager to get
need to be more proactive in commutreatment, so I referred him to an
nicating my expectations to specialists
endodontist nearby who'd recently
to whom I send patients for treatment.
moved to the area.
Over the years, I've had surgeons who
The next day, I received a call on my
placed implants in poor position due to
Fig. 2: After treatment
cellphone from my neighbor. I texted with endodontist.
lack of planning and a surgical guide;
that I was at a doctor's appointment but
orthodontists who had lingual retainers
would call him back later; he replied that it was urgent
coming off on multiple patients; and periodontists who
and to please call as soon as possible. I told him to call
did crown-lengthening before I had a chance to prep and
my wife at the office so she could help him, and I'd be
temp the tooth. In the past, we'd send a referral slip with
in touch as soon as my appointment
our recommendation and discuss more complex cases
finished. I was already getting that
by phone. In the coming weeks, I'll reach out to my
sinking feeling in my stomach. His
specialists with more specific expectations.
next text said it all: "File broke during
I'd love to read your comments on the topic
root canal." It had to happen to my
of specialist relationships. What have you done to
neighbor!
establish your expectations? Is it something that you
developed over time or established at the beginning
When I called the endodontist, he
seemed very nonchalant: He explained
in a formal way? Share your comments under this
that he'd been using a gutta percha
article online at Dentaltown.com, where I will also
removing fi le that separated in the
post updates on the clinical outcome of this case,
canal; there had been a small bit out
which is currently TBD. ■

by Thomas Giacobbi, DDS, FAGD, editorial director, Dentaltown magazine

16

JUNE 2019 // dentaltown.com


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Dentaltown June 2019

Table of Contents for the Digital Edition of Dentaltown June 2019

Dentaltown June 2019 - Intro
Dentaltown June 2019 - Cover1
Dentaltown June 2019 - Cover2
Dentaltown June 2019 - 1
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