Dentaltown June 2021 - 38

" Asking the right and specific questions and
possibly incorporating teledentistry could
help triage patients' dental issues and help
the office schedule accordingly. This could
mean reducing wasted appointment times
for non-endo-related issues. "
In such cases, they may not need to be
seen for a lengthy appointment that would
otherwise be set aside for possible treatment.
Not triaging these patients accurately
could result in waste of office time and
resources. On the flipside, a FaceTime
communication with such patients, or
an emailed photo taken by patients of
their problem (e.g., swelling) would help
tremendously.
So asking the right and specific questions
and possibly incorporating teledentistry
could help triage patients' dental issues and
help the office schedule accordingly. This
could mean reducing wasted appointment
times for non-endo-related issues.
Perfecting protocols
Making the most of every visit can also
be accomplished by having systems in place
and the necessary instruments to enable
fast and efficient root canal treatments. By
no means does it mean rushing or cutting
corners. It means working more efficiently
with up-to-date science and tools.
It's been shown that single-step root
canal treatments can be as successful as
two-appointment treatments.2
In fact, the
chance of post-treatment flare-ups might also
be equal between one- and two-appointment
treatments.3
This could mean fewer patient
follow-up visits.
Certainly, there are some key protocols
if one was to complete endo treatment in
one appointment, especially of necrotic
teeth. This includes, at least in part, the
following:
1. Locating all of the canals, including
calcified canals and MB2 canals in
maxillary molars.
2. Ensuring there are no internal
fractures that may lead to mechanical
failure of the tooth.
3. Instrumenting large enough apically
to mechanically remove as much of
the (necrotic) pulp tissues as possible,
and to enable intracanal medications
to reach the apical third of the canals.
4. Use of copious amounts of intracanal
medicaments (e.g., NaOCl).
5. Removal of the smear layer with
EDTA (e.g., QMix by Dentsply
Sirona) to enable penetration of a
medicament (e.g., QMix, which has
EDTA and chlorhexidine) into the
contaminated dentin tubules.
6.
Intracanal passive activation with
an endodontic ultrasonic or sonic
activator.4
Importance of instrumentation
The use of instruments that enable
faster treatment is paramount. This includes
enhanced magnification (e.g., loupes with
light, or a dental microscope) to help locate
canals, diagnose microfractures and enable
faster endo access preparations.
The incorporation of an accurate and
new generation apex locator is also crucial.
It helps reduce the treatment time by
requiring fewer (but not necessarily the
elimination of) midtreatment radiographs
for working lengths. It also helps improve
treatment quality, because instrumentation
and obturation lengths are obviously crucial
for success and patient comfort.
For instance, a short endodontic fill
may leave necrotic or inflamed pulp tissues
in the canal, while overinstrumentation or
overfill may reduce treatment success and
increase postoperative symptoms.
The third key instrument to consider
using is a NiTi file system that is efficient
in canal shaping and debriding, and may
require fewer files. Fewer files translate into
fewer steps required to fully instrument a
canal. Examples include reciprocating NiTi
files by Dentsply Sirona (WaveOne Gold)
or Brasseler (ESR).
Furthermore, while a patient is already
in the chair and rubber dam isolation is still
in place, one should consider permanently
restoring the endodontic access-at least with a
core. It's been shown that doing so increases the
treatment success of the endo-treated tooth.5
So, without compromising the quality of
More endo courses from Dr. Manor Haas online!
Head to dentaltown.com/ce and search " Haas " to find a variety of CE courses that
bring an endodontic expert right to your computer, tablet or smartphone. Dr. Manor
Haas has created half a dozen endo-related courses, ranging from a survey of endo
basics to the exploration of advanced techniques.
38 JUNE 2021 // dentaltown.com
care, it comes down to better diagnostics and
case selection and more efficient endodontic
treatments. This is what the pandemic has
shown us to be a best practice. So why
not invest in setting up systems with your
staff and clinical protocols permanently?
And why not invest in the necessary dental
instruments? The return on investment
could be significant for your practice and
patients as you look beyond the pandemic.
http://www.dentaltown.com/ce http://www.dentaltown.com

Dentaltown June 2021

Table of Contents for the Digital Edition of Dentaltown June 2021

Dentaltown June 2021 - Intro
Dentaltown June 2021 - Cover1
Dentaltown June 2021 - Cover2
Dentaltown June 2021 - 1
Dentaltown June 2021 - 2
Dentaltown June 2021 - 3
Dentaltown June 2021 - 4
Dentaltown June 2021 - 5
Dentaltown June 2021 - 6
Dentaltown June 2021 - 7
Dentaltown June 2021 - 8
Dentaltown June 2021 - 9
Dentaltown June 2021 - 10
Dentaltown June 2021 - 11
Dentaltown June 2021 - 12
Dentaltown June 2021 - 13
Dentaltown June 2021 - 14
Dentaltown June 2021 - 15
Dentaltown June 2021 - 16
Dentaltown June 2021 - 17
Dentaltown June 2021 - 18
Dentaltown June 2021 - 19
Dentaltown June 2021 - 20
Dentaltown June 2021 - 21
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Dentaltown June 2021 - Cover3
Dentaltown June 2021 - Cover4
Dentaltown June 2021 - Outsert_1
Dentaltown June 2021 - Outsert_2
Dentaltown June 2021 - Outsert_3
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