How fast should I be?

[Whatthefut]

Hi everyone, I will be graduating from dental school soon and I am worried about private practice life. Particularly in terms of the time it takes me to complete treatments. I still take a long time to finish procedures relative to private practice. I need about an hour for an average sized 3-surface restoration, that's if it's not difficult access. I need two 2.5 hour appointments to finish a single canal RCT. I am afraid of the impact this will have on my work, and of course on my income. Did anyone else feel this way as they graduated? How long does it take to develop speed and efficiency? And did it come naturally with experience, or is it something that you actively worked on to enhance? How fast should I be generally? In other words, how long should it take me to finish an average sized resto, or an anterior or posterior RCT?

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[TanMan]

Hi everyone, I will be graduating from dental school soon and I am worried about private practice life. Particularly in terms of the time it takes me to complete treatments. I still take a long time to finish procedures relative to private practice. I need about an hour for an average sized 3-surface restoration, that's if it's not difficult access. I need two 2.5 hour appointments to finish a single canal RCT. I am afraid of the impact this will have on my work, and of course on my income. Did anyone else feel this way as they graduated? How long does it take to develop speed and efficiency? And did it come naturally with experience, or is it something that you actively worked on to enhance? How fast should I be generally? In other words, how long should it take me to finish an average sized resto, or an anterior or posterior RCT?

As long as you realize that you are slow and that you need to speed up, you've hit the first step of becoming a fast/profitable clinician. Your speed will definitely affect your relationship with patients and your income. Patients don't want a slow dentist nor do they want one that's mean or hurts them.

It will take several months to get faster, but you will get better and/or faster as time progresses. It's called a dental practice for a reason, in that you are always evolving in terms of quality and/or speed.

An average standalone MOD should take you 7-15 minutes. An average anterior RCT: 12-17 minutes, molar RCT 17-40 minutes. Of course, there are always outliers, but you should strive for those numbers. You could go faster on the MOD if you were using tofflemeier instead of sectional matrices, but I prefer broad tight contacts rather than point contacts. With RCT, it's highly dependent on what you find in the root canal system, the numbers I quote you are average ranges.

Edit: RCT's are mostly single appointments. These times include buildup, crown prep, any necessary length and post-op PA's.

You will get faster with more experience as long as you are striving to become faster and better with every procedure. You have to figure out what you're doing in each step and how you can make that step more efficient. I have some guide out here somewhere in the forums.

2nd Edit: Fun last case of the day, took 28 minutes to finish this case. Dx: PN/CPA/CPP, severely symptomatic to pressure w/ intraoral palatal and buccal swelling, cold negative, 2+ mobility, endo/perio lesion, no STTP. The longest part was ensuring that all purulent exudate was gone and canals were bone dry. Case was done through the crown.

 

[allDAT]

You’ll be fast soon enough.

 

[setdoc7]

Fast is easy. Fast and good is harder. Fast and good and painless is where you want to get to.

 

[P7898]

As long as you realize that you are slow and that you need to speed up, you've hit the first step of becoming a fast/profitable clinician. Your speed will definitely affect your relationship with patients and your income. Patients don't want a slow dentist nor do they want one that's mean or hurts them.

It will take several months to get faster, but you will get better and/or faster as time progresses. It's called a dental practice for a reason, in that you are always evolving in terms of quality and/or speed.

An average standalone MOD should take you 7-15 minutes. An average anterior RCT: 12-17 minutes, molar RCT 17-40 minutes. Of course, there are always outliers, but you should strive for those numbers. You could go faster on the MOD if you were using tofflemeier instead of sectional matrices, but I prefer broad tight contacts rather than point contacts. With RCT, it's highly dependent on what you find in the root canal system, the numbers I quote you are average ranges.

Edit: RCT's are mostly single appointments. These times include buildup, crown prep, any necessary length and post-op PA's.

You will get faster with more experience as long as you are striving to become faster and better with every procedure. You have to figure out what you're doing in each step and how you can make that step more efficient. I have some guide out here somewhere in the forums.

2nd Edit: Fun last case of the day, took 28 minutes to finish this case. Dx: PN/CPA/CPP, severely symptomatic to pressure w/ intraoral palatal and buccal swelling, cold negative, 2+ mobility, endo/perio lesion, no STTP. The longest part was ensuring that all purulent exudate was gone and canals were bone dry. Case was done through the crown.

View attachment 288653View attachment 288654

Agreed 100%. Although I am a dental student like yourself. Speed is something to keep track of. Look up profitable docs like TanMan and see what they do as a reference for time. My fiancé is a GP and has a guy at her office who does 1hr - 45min molar endo. Like TanMan said - the first step is recognizing you are an alcoholic.... I mean "slow" .

Playfulness aside life is humbling so the more you critique yourself and are honest with yourself it will be for the better. Although it is definitely not fun to know you are slow or lacking in something however it takes a lot of courage to "man up" or "woman up" and just become better. Kuddos to you OP - you'd be surprised that a lot of people actually don't take the time to criticize themselves.

 

[Whatthefut]

Agreed 100%. Although I am a dental student like yourself. Speed is something to keep track of. Look up profitable docs like TanMan and see what they do as a reference for time. My fiancé is a GP and has a guy at her office who does 1hr - 45min molar endo. Like TanMan said - the first step is recognizing you are an alcoholic.... I mean "slow" .

Playfulness aside life is humbling so the more you critique yourself and are honest with yourself it will be for the better. Although it is definitely not fun to know you are slow or lacking in something however it takes a lot of courage to "man up" or "woman up" and just become better. Kuddos to you OP - you'd be surprised that a lot of people actually don't take the time to criticize themselves.

Well as of now I can only dream of finishing a molar Endo in 1hr 45mins . The bar is pretty high but I hope to get there soon enough. I just don’t want whoever I end up working for to hate me and give me crap for taking forever on procedures in my first few months of work.

we also don’t see many patients in school to be able to develop any speed at all. In my dental school, we see a patient from 8am to 11am. And another patient from 1 to 4pm on most days of the week. Some days we only see one patient a day. There is no pressure to develop the speed that we will need to become productive GPs. And I get it. The school’s job is to teach us how to be good dentists, not how to be fast/profitable dentists. But I also think that a major part of patient care is being able to reduce the chair time for the patient as much as possible. I scream internally when I see myself seating an old patient with their mouth wide open for 2.5 hours straight.

Also for Endo, I am extremely slow and I attribute that to the fact that we barely complete any RCT’s in my school. We need to complete 7 canals to graduate which is absurd. How can someone possibly be proficient enough to go out there and do endos daily/weekly when all they were trained in dental school were on 3 or 4 teeth??

 

[P7898]

Well as of now I can only dream of finishing a molar Endo in 1hr 45mins . The bar is pretty high but I hope to get there soon enough. I just don’t want whoever I end up working for to hate me and give me crap for taking forever on procedures in my first few months of work.

we also don’t see many patients in school to be able to develop any speed at all. In my dental school, we see a patient from 8am to 11am. And another patient from 1 to 4pm on most days of the week. Some days we only see one patient a day. There is no pressure to develop the speed that we will need to become productive GPs. And I get it. The school’s job is to teach us how to be good dentists, not how to be fast/profitable dentists. But I also think that a major part of patient care is being able to reduce the chair time for the patient as much as possible. I scream internally when I see myself seating an old patient with their mouth wide open for 2.5 hours straight.

Also for Endo, I am extremely slow and I attribute that to the fact that we barely complete any RCT’s in my school. We need to complete 7 canals to graduate which is absurd. How can someone possibly be proficient enough to go out there and do endos daily/weekly when all they were trained in dental school were on 3 or 4 teeth??

Speed should never be priority over quality. It is a healthy balance. Sometimes trying to get something perfect has demising returns clinically right so it should be a health balance of speed and quality. Once speed starts taking away from quality then slow down.

Everyone has their own medium. Use productive guys as a standard to achieve but also try and stay in your lane. Harder said then done.

 

[P7898]

Well as of now I can only dream of finishing a molar Endo in 1hr 45mins . The bar is pretty high but I hope to get there soon enough. I just don’t want whoever I end up working for to hate me and give me crap for taking forever on procedures in my first few months of work.

we also don’t see many patients in school to be able to develop any speed at all. In my dental school, we see a patient from 8am to 11am. And another patient from 1 to 4pm on most days of the week. Some days we only see one patient a day. There is no pressure to develop the speed that we will need to become productive GPs. And I get it. The school’s job is to teach us how to be good dentists, not how to be fast/profitable dentists. But I also think that a major part of patient care is being able to reduce the chair time for the patient as much as possible. I scream internally when I see myself seating an old patient with their mouth wide open for 2.5 hours straight.

Also for Endo, I am extremely slow and I attribute that to the fact that we barely complete any RCT’s in my school. We need to complete 7 canals to graduate which is absurd. How can someone possibly be proficient enough to go out there and do endos daily/weekly when all they were trained in dental school were on 3 or 4 teeth??

For the endo question - repetition and CE afterwards. This guy loves all aspects of dentistry and he wanted to get good at it for the right reasons - not the money. But to provide all his friends (patients) with comprehensive care. So it is easy to always learn something at things you love to do and sustain it.

 

[145bluz]

I am a 59 y.o. GP. I have been practicing for 30+ yrs. Most everyone is slow when they graduate. Some are slower than others. I was quite slow. I did a gpr which helped and I would recommend it. I would say that it took me 8 years to feel pretty confident about most procedures. Even now, I am learning how to do things better and more efficiently. It takes a long time to be a really good dentist. Concentrate on doing your best and with time you will get faster. Best of Luck!

 

[P7898]

I am a 59 y.o. GP. I have been practicing for 30+ yrs. Most everyone is slow when they graduate. Some are slower than others. I was quite slow. I did a gpr which helped and I would recommend it. I would say that it took me 8 years to feel pretty confident about most procedures. Even now, I am learning how to do things better and more efficiently. It takes a long time to be a really good dentist. Concentrate on doing your best and with time you will get faster. Best of Luck!

Well said.

 

[TanMan]

Well as of now I can only dream of finishing a molar Endo in 1hr 45mins . The bar is pretty high but I hope to get there soon enough. I just don’t want whoever I end up working for to hate me and give me crap for taking forever on procedures in my first few months of work.

we also don’t see many patients in school to be able to develop any speed at all. In my dental school, we see a patient from 8am to 11am. And another patient from 1 to 4pm on most days of the week. Some days we only see one patient a day. There is no pressure to develop the speed that we will need to become productive GPs. And I get it. The school’s job is to teach us how to be good dentists, not how to be fast/profitable dentists. But I also think that a major part of patient care is being able to reduce the chair time for the patient as much as possible. I scream internally when I see myself seating an old patient with their mouth wide open for 2.5 hours straight.

Also for Endo, I am extremely slow and I attribute that to the fact that we barely complete any RCT’s in my school. We need to complete 7 canals to graduate which is absurd. How can someone possibly be proficient enough to go out there and do endos daily/weekly when all they were trained in dental school were on 3 or 4 teeth??

Go mount some extracted teeth on a typodont, mount it on a simulated head and start practicing rubber dam, access, and the whole process. You may not be able to simulate the patient process completely, but you can simulate the clinical parts of the procedure to become faster. The good thing is you can take the tooth out afterwards and study your technique.... ask yourself the questions, how long did I take on this step, how is my access, did I locate all orifices, how's my instrumentation, length control, and obturation, and so on... No excuse on endos, because you should have a bunch of extracted teeth. Also, most of my school decided to specialize, and I found one of the best opportunities to get endo experience is to offer your classmates to do their endo (except for the obturation. If you can get it to the step where all they have to do is drop a master cone and sear, then your classmates who don't care about endo will end up giving their case to you so that they can have an easier time.

Second, having a 3 hour appointment should not be an excuse as to why you're so slow. If you have a 3 hour appt, cut it in half. Only give yourself 1.5 hours or even an hour to finish. If you can, stack 2 1.5 hour appts in that 3 hour block, or 3 1 hour appts in that 3 hour block. That's how you can get faster, if given the option. IF you don't have the option, then you need to aim in finishing those appts in 1 to 1.5 hours.

Also, work with the right faculty. Work with the easy, practical faculty (usually part timers with their own practice) and aren't stuck in "university/academic" mode.

 

[Faux]

As long as you realize that you are slow and that you need to speed up, you've hit the first step of becoming a fast/profitable clinician. Your speed will definitely affect your relationship with patients and your income. Patients don't want a slow dentist nor do they want one that's mean or hurts them.

It will take several months to get faster, but you will get better and/or faster as time progresses. It's called a dental practice for a reason, in that you are always evolving in terms of quality and/or speed.

An average standalone MOD should take you 7-15 minutes. An average anterior RCT: 12-17 minutes, molar RCT 17-40 minutes. Of course, there are always outliers, but you should strive for those numbers. You could go faster on the MOD if you were using tofflemeier instead of sectional matrices, but I prefer broad tight contacts rather than point contacts. With RCT, it's highly dependent on what you find in the root canal system, the numbers I quote you are average ranges.

Edit: RCT's are mostly single appointments. These times include buildup, crown prep, any necessary length and post-op PA's.

You will get faster with more experience as long as you are striving to become faster and better with every procedure. You have to figure out what you're doing in each step and how you can make that step more efficient. I have some guide out here somewhere in the forums.

2nd Edit: Fun last case of the day, took 28 minutes to finish this case. Dx: PN/CPA/CPP, severely symptomatic to pressure w/ intraoral palatal and buccal swelling, cold negative, 2+ mobility, endo/perio lesion, no STTP. The longest part was ensuring that all purulent exudate was gone and canals were bone dry. Case was done through the crown.

View attachment 288653View attachment 288654

How can you do a molar RCT In 40 minutes that include access, c&s/ build up and crown prep?

 

[2TH MVR]

Let's not forget that you also need exceptional front and back office staff to coordinate the flow of your patients. Hard to be fast when you're waiting on a slow asst.

 

[yappy]

Another thing to consider when you graduate is how good you and your assistant work together.. I work with some assistants that allow me to work surprisingly fast and it's all so easy. There are other assistants that the procedure takes 1.5-2x longer than when I'm with a good assistant.

 

[Awarara]

17 min molar endo lmao. i think the difference is that an endodontist uses a microscope and they take their time. they probably don't use just one file and don't just slam a single cone/guttacore or whatever it is dentists use these days. had a molar rct done on myself by an endodontist and him and his assistant were efficient and methodical. they didnt even take intraop radiographs and it took them like an hour.

 

[Torshammer]

17 min molar endo lmao. i think the difference is that an endodontist uses a microscope and they take their time. they probably don't use just one file and don't just slam a single cone/guttacore or whatever it is dentists use these days. had a molar rct done on myself by an endodontist and him and his assistant were efficient and methodical. they didnt even take intraop radiographs and it took them like an hour.

GPs have the luxury of selecting which cases to send out as well

 

[TanMan]

Let's not forget that you also need exceptional front and back office staff to coordinate the flow of your patients. Hard to be fast when you're waiting on a slow asst.

Definitely important on the assistant part. I have strong and weak assistants (relatively speaking). If I need to switch out a weak assistant, I'll switch them out midprocedure.

I know endodontists that have done 10s of thousands of cases and still do only 5-6 per day in practice. And they are scheduled out.

So what’s the difference between them and you tanman? Obviously I’d rather be slinging gp down 4 canals in 17min.

That's their comfort zone. I'm sure if they trained to go faster, they could. My comfort zone is to complete the procedure as fast, efficient, and predictable as possible. I've outlined my techniques here somewhere on the forums. One of my biggest time savers is simultaneous irrigation while rotary instrumentation and having the assistant suction at the same time. My irrigant is flushing all the debris generated, cleaning the flutes of my files, lubricating the files, and disinfecting it all at the same time. Unlike other techniques, where they instrument in a pool of stagnant hypo, replace hypo after every file, then repeat over and over until final shaping is complete. Also, hot full strength hypo helps significantly with tissue dissolution along with 12mL syringes of hypo. Other thing that I don't think i explicitly mentioned is using new files for every case.

Edit: I'm going out on a limb and saying that I don't know that exact pharmacokinetics of Time/Concentration/Temperature Dependent disinfection rate of a root canal system, but looking at it from a conceptual perspective, I assume that hypochlorite is rapidly deactivated by anything and everything in the canal, from inorganic debris, dentinal debris/wall contact, tissue, etc, if I kept the concentration fairly high by continual replenishment with fresh solution (combined with active removal of debris that could inactivate the effects of hypochlorite, then I would assume that my disinfection is better than if it were only periodically replenished. Second would be temperature, rate of reaction(s) typically increase as temperature increases. In that effect, I also assume that the reactivity of hypochlorite increases, bacteriocidal rate/effects increase, BUT rate of inactivation of hypochlorite also increases more rapidly therefore requiring a constant replenishment. Third part is smear layers, aberrant anatomy, and microscopic accessibility to dentinal tubules and this is where solution activation plays a role (surfactants too, but I haven't messed with surfactants yet). Anyway, this is how I think of it, I don't have any randomized double blind controls or any studies to back it up, it just works for me clinically. Through temp, concentration, sheer volume/rate of replenishment, and irrigant activation, I believe I can achieve the objectives of root canal therapy faster.

17 min molar endo lmao. i think the difference is that an endodontist uses a microscope and they take their time. they probably don't use just one file and don't just slam a single cone/guttacore or whatever it is dentists use these days. had a molar rct done on myself by an endodontist and him and his assistant were efficient and methodical. they didnt even take intraop radiographs and it took them like an hour.

Go watch Scott Perkins and his 15 minute molar endo on Youtube. The principles behind it are important, not the speed itself. Although I cannot do it in 15 minutes in most instances, the longest part for me is the cycling of irrigant w/ the Er:Yag laser to ensure nothing else floats up and no reactivity of the hypochlorite. Not taking a WL shot seems kinda lazy, but sometimes doable if they had a really good feel for the apical constriction and consistent EAL readings. The big question is, within that hour, was your endodontist in the room the whole time or only for certain parts of it.

 

[2TH MVR]

This speed issue with different procedures can apply to all aspects of dentistry. I personally like to spend a little extra time detailing stainless steel archwires for finishing as compared to the many orthos that rely on speedier large Niti archwires to do their work. No right or wrong. All personal choice.

At the end of the day ... the TRUE test of your abilities regarding speed is the longevity, stability and success of your procedure. Just because your patient walks out the door happy does not completely mean your restoration, procedure was a success.

Speed means NOTHING unless your procedure is successful longterm.

 

[OMSDoc]

Go mount some extracted teeth on a typodont, mount it on a simulated head and start practicing rubber dam, access, and the whole process. You may not be able to simulate the patient process completely, but you can simulate the clinical parts of the procedure to become faster. The good thing is you can take the tooth out afterwards and study your technique.... ask yourself the questions, how long did I take on this step, how is my access, did I locate all orifices, how's my instrumentation, length control, and obturation, and so on... No excuse on endos, because you should have a bunch of extracted teeth. Also, most of my school decided to specialize, and I found one of the best opportunities to get endo experience is to offer your classmates to do their endo (except for the obturation. If you can get it to the step where all they have to do is drop a master cone and sear, then your classmates who don't care about endo will end up giving their case to you so that they can have an easier time.

Second, having a 3 hour appointment should not be an excuse as to why you're so slow. If you have a 3 hour appt, cut it in half. Only give yourself 1.5 hours or even an hour to finish. If you can, stack 2 1.5 hour appts in that 3 hour block, or 3 1 hour appts in that 3 hour block. That's how you can get faster, if given the option. IF you don't have the option, then you need to aim in finishing those appts in 1 to 1.5 hours.

Also, work with the right faculty. Work with the easy, practical faculty (usually part timers with their own practice) and aren't stuck in "university/academic" mode.

Great advice all the way around.

A classmate and I mounted teeth to practice the “90 second crown prep”...cut them at breakneck speed It didn’t look any different than ones we worked on for an hour.

The same classmate had me assist him in oral surgery.

Parkinson’s Law: The amount of time it takes you to do something fills up the time you have allotted for it.

My roommate had cast a 3-unit all gold bridge and there was a defect on the margin. The part-time instructor said he could not cement it, but she took it to the lab and talked them into soldering on a new margin. My roommate then cemented it and made a million production points and got an A++!!

 

[wannagiveup]

As long as you realize that you are slow and that you need to speed up, you've hit the first step of becoming a fast/profitable clinician. Your speed will definitely affect your relationship with patients and your income. Patients don't want a slow dentist nor do they want one that's mean or hurts them.

It will take several months to get faster, but you will get better and/or faster as time progresses. It's called a dental practice for a reason, in that you are always evolving in terms of quality and/or speed.

An average standalone MOD should take you 7-15 minutes. An average anterior RCT: 12-17 minutes, molar RCT 17-40 minutes. Of course, there are always outliers, but you should strive for those numbers. You could go faster on the MOD if you were using tofflemeier instead of sectional matrices, but I prefer broad tight contacts rather than point contacts. With RCT, it's highly dependent on what you find in the root canal system, the numbers I quote you are average ranges.

Edit: RCT's are mostly single appointments. These times include buildup, crown prep, any necessary length and post-op PA's.

You will get faster with more experience as long as you are striving to become faster and better with every procedure. You have to figure out what you're doing in each step and how you can make that step more efficient. I have some guide out here somewhere in the forums.

2nd Edit: Fun last case of the day, took 28 minutes to finish this case. Dx: PN/CPA/CPP, severely symptomatic to pressure w/ intraoral palatal and buccal swelling, cold negative, 2+ mobility, endo/perio lesion, no STTP. The longest part was ensuring that all purulent exudate was gone and canals were bone dry. Case was done through the crown.

View attachment 288653View attachment 288654

Are those numbers from the moment you sit down to occlusion check?

 

[TanMan]

Are those numbers from the moment you sit down to occlusion check?

Those numbers are from when you start to when you're saying goodbye to the patient.

 

[wannagiveup]

Those numbers are from when you start to when you're saying goodbye to the patient.

Incredible. Do you keep track of your RCT success rate through a recall program (1yr 5yr etc)?

 

[Utdarsenal]

My biggest shock entering private practice from University was the quickness of things. The "ideal" work we were taught to do in school is thrown out of the window in private practice. In private practice, it mostly turns into accomplishing "acceptable" work rather than ideal.

There is a very, very thin line between working faster and quality of work dropping. You have to be really careful about this when you enter private practice.
I worked with a doctor who did fillings extremely quick (30 minutes for 3 adjacent MOD fillings), but she'd grind the hell out of her fillings and leave them very out of occlusion to not spend time "checking the bite", for example. There'd be more post-op sensitivity on the fills as well, not sure why, had to re-do a couple of those fillings a few months following. I prefer to work slower but prefer doing things right the first time to not have to see the patient a second time.

What I'm trying to get at is, you'll eventually develop a limit where you'll notice that if you go any faster than that-your quality will drop. Watch out for this. With more patients, you'll get quicker. You'll need a lot of patience at the beginning.

Most endodontists I know finish molar root canals in about 30-40 minutes. These are specialists who do molar root canals ALL DAY everyday. A nearby clinic has an in-house root-canal guy who also only does molar root canals--he gets 1 hour booked per molar RCT.

Every case is different and 2 patients are not similar. One patient can have limited opening already causing you to take longer.. one MOD can be tricker compared to another MOD.. it varies.

 

[TanMan]

Incredible. Do you keep track of your RCT success rate through a recall program (1yr 5yr etc)?

I'm a GP, so I see these patients every 3-6 months. I know if they are failing or not at the radiograph intervals or if they come in as a post-op followup for any issues. I'll tell you that my 2013 root canals are worse than my 2015 root canals. My endodontic experience has evolved over time to become more efficient, less postop issues, and improved long term success rates.

What I'm working on right now is the 30 min RCTBUCrn and I find that there needs to be a specific set of circumstances to allow this to happen. I'll give more details once I've perfected it more and and consistently perform it at that time.

My biggest shock entering private practice from University was the quickness of things. The "ideal" work we were taught to do in school is thrown out of the window in private practice. In private practice, it mostly turns into accomplishing "acceptable" work rather than ideal.

There is a very, very thin line between working faster and quality of work dropping. You have to be really careful about this when you enter private practice.
I worked with a doctor who did fillings extremely quick (30 minutes for 3 adjacent MOD fillings), but she'd grind the hell out of her fillings and leave them very out of occlusion to not spend time "checking the bite", for example. There'd be more post-op sensitivity on the fills as well, not sure why, had to re-do a couple of those fillings a few months following. I prefer to work slower but prefer doing things right the first time to not have to see the patient a second time.

What I'm trying to get at is, you'll eventually develop a limit where you'll notice that if you go any faster than that-your quality will drop. Watch out for this. With more patients, you'll get quicker. You'll need a lot of patience at the beginning.

Most endodontists I know finish molar root canals in about 30-40 minutes. These are specialists who do molar root canals ALL DAY everyday. A nearby clinic has an in-house root-canal guy who also only does molar root canals--he gets 1 hour booked per molar RCT.

Every case is different and 2 patients are not similar. One patient can have limited opening already causing you to take longer.. one MOD can be tricker compared to another MOD.. it varies.

While it's true that there is a limit that quality will drop after a certain limit, I believe that dental practice and the procedures we perform are not static and we always have to strive to become more efficient. Whether it comes from trying different techniques or different dental materials, I think it's important not to fall into the trap of complacency. We always have to keep up with new materials and think of ways on how we can become faster and more efficient.

Funny you mention limited opening, I had patient for an endo today that could open the width of my middle finger. I got lucky in that I was able to stick a rubber dam in and I ended up accessing through the MB cusp/buccal groove of the 1st man molar and bending my 21mm rotary files close to 90 degrees. I believe if you give people an hour on a procedure, they'll take the whole hour. If you schedule more efficiently and give 30 mins for a procedure such a molar rct, you'll be pressed to be more efficient.

 

[Molar Whisperer]

My biggest shock entering private practice from University was the quickness of things. The "ideal" work we were taught to do in school is thrown out of the window in private practice. In private practice, it mostly turns into accomplishing "acceptable" work rather than ideal.

There is a very, very thin line between working faster and quality of work dropping. You have to be really careful about this when you enter private practice.
I worked with a doctor who did fillings extremely quick (30 minutes for 3 adjacent MOD fillings), but she'd grind the hell out of her fillings and leave them very out of occlusion to not spend time "checking the bite", for example. There'd be more post-op sensitivity on the fills as well, not sure why, had to re-do a couple of those fillings a few months following. I prefer to work slower but prefer doing things right the first time to not have to see the patient a second time.

What I'm trying to get at is, you'll eventually develop a limit where you'll notice that if you go any faster than that-your quality will drop. Watch out for this. With more patients, you'll get quicker. You'll need a lot of patience at the beginning.

Most endodontists I know finish molar root canals in about 30-40 minutes. These are specialists who do molar root canals ALL DAY everyday. A nearby clinic has an in-house root-canal guy who also only does molar root canals--he gets 1 hour booked per molar RCT.

Every case is different and 2 patients are not similar. One patient can have limited opening already causing you to take longer.. one MOD can be tricker compared to another MOD.. it varies.

Private practice should equate efficiency and quality. It should never be rushed and I disagree with the doctor restoring out of occlusion. Employers don't expect recent grads to produce like crazy. Rushing can lead to iatrogenic events. TanMan will disagree with me, but he is like a Ferarri which is too fast, too beautiful, and unattainable. I've been practicing for almost 23 years. I'm still learning and I'm proud to be a lifetime dental student.

My easy molar RCTs & BUs take me 40 min (not 17 min like TanMan). For harder RCTs, it will take about 50 to 60 min. I was struggling with a RCT on a bridge abutment and the temp DA said it was the smoothest RCT she had ever witnessed! I take 3, 15-25 min complete denture appts before final delivery, 15-20 min crown preps, and 5-15 min surgical extractions. I use Fuji Equia (approved for final composite restorations) for posterior composites due to their low PO sensitivity, predictable bonding, and super easy placement . I follow the KISS principal with a twist....Keep IT Simple & Stress-free. Don't worry about speed. Work on efficiency & quality. With more practice, you will see the patterns and tendencies of particular cases. There are a lot of You Tube videos on technique, and new ways of doing things. Attend more hands on workshops. How you know you made it is if other dentists want you to work on them and their families.

 

[wannagiveup]

Private practice should equate efficiency and quality. It should never be rushed and I disagree with the doctor restoring out of occlusion. Employers don't expect recent grads to produce like crazy. Rushing can lead to iatrogenic events. TanMan will disagree with me, but he is like a Ferarri which is too fast, too beautiful, and unattainable. I've been practicing for over almost 23 years. I'm still learning and I'm proud to be a lifetime dental student.

My easy molar RCTs & BUs take me 40 min (not 17 min like TanMan). For harder RCTs, it will take about 50 to 60 min. I was struggling with a RCT on a bridge abutment and the temp DA said it was the smoothest RCT she had ever witnessed! I take 3, 15-25 min complete denture appts before final delivery, 15-20 min crown preps, and 5-15 min surgical extractions. I use Fuji Equia (approved for final composite restorations) for posterior composites due to their low PO sensitivity, predictable bonding, and super easy placement . I follow the KISS principal with a twist....Keep IT Simple & Stress-free. Don't worry about speed. Work on efficiency & quality. With more practice, you will see the patterns and tendencies of particular cases. There are a lot of You Tube videos on technique, and new ways of doing things. Attend more hands on workshops. How you know you made it is if other dentists want you to work on them and their families.

What's your time on upper second molar crown prep and impression?

 

[Molar Whisperer]

What's your time on upper second molar crown prep and impression?

If the patient has gagging, aggressive tongue, distally angled, extremely dental phobia, upper 2nd molar would take me about 25 min to prep. Depending on how bad his gagging, maybe 5 to 10 min to impr. I've had to anesth the soft palate less than a handfull of times to control the gagging. I'm not the fasted guy. TanMan would be ashamed of me for being so slow with that case.

 

[2TH MVR]

TanMan will disagree with me, but he is like a Ferarri

No proper Texas man will be caught driving a Ferrari. I see @TanMan driving a big ole diesel Ford Duelly 4X4 Truck.

 

[wannagiveup]

I'm a GP, so I see these patients every 3-6 months. I know if they are failing or not at the radiograph intervals or if they come in as a post-op followup for any issues. I'll tell you that my 2013 root canals are worse than my 2015 root canals. My endodontic experience has evolved over time to become more efficient, less postop issues, and improved long term success rates.

Do you have some sort of referral guidelines for endo? What kind of cases do you refer to an endodontist? Second molars with crowns on geriatric pts?

 

[TanMan]

No proper Texas man will be caught driving a Ferrari. I see @TanMan driving a big ole diesel Ford Duelly 4X4 Truck.

Hahaha, I need a bigger house first and I'm not a fan of Ferraris too much. The Porsche SUV is enough for me, the gf wants a matching Porsche though. If a good deal comes up, probably end up getting one.

Do you have some sort of referral guidelines for endo? What kind of cases do you refer to an endodontist? Second molars with crowns on geriatric pts?

I refer patients that need sedation (Kids and anxious patients). Most everything else, I can do. I enjoy molars more than I do incisors.

 

[Cold Front]

The Porsche SUV is enough for me

I drive a Macan Turbo. Solid car all round, but set me back a pretty penny after upgrades. I would get it again in a hear beat. It’s my first auto transmission car with a triptronic. I always drove a stick/manual transmission, my previous car was Audi S5, which was perfect for a single life, but not practical.


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[schmoob]

No proper Texas man will be caught driving a Ferrari. I see @TanMan driving a big ole diesel Ford Duelly 4X4 Truck.

Nah, he’s an i8 guy. He was made to prove it too.

 

[P7898]

fast.

 

[TanMan]

I drive a Macan Turbo. Solid car all round, but set me back a pretty penny after upgrades. I would get it again in a hear beat. It’s my first auto transmission car with a triptronic. I always drove a stick/manual transmission, my previous car was Audi S5, which was perfect for a single life, but not practical.


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I was looking at the Macan Turbo, but I'm torn between getting another Cayenne Turbo S or a Macan Turbo. What are your thoughts as a Macan Turbo owner?

 

[Molar Whisperer]

Hahaha, I need a bigger house first and I'm not a fan of Ferraris too much. The Porsche SUV is enough for me, the gf wants a matching Porsche though. If a good deal comes up, probably end up getting one.

I drive a Macan Turbo. Solid car all round, but set me back a pretty penny after upgrades. I would get it again in a hear beat. It’s my first auto transmission car with a triptronic. I always drove a stick/manual transmission, my previous car was Audi S5, which was perfect for a single life, but not practical.

Do you guys want to trade SUVs? My SUV (Slightly Used Vehicle) is a 10 y/o Subaru with a couple of dings and a little oil seepage but runs really smooth. I don't want to trade my house though. It is very hard to find a 4.5 car garage, 5.5 scale earthquake resistant house with a nice view of the Pacific NW valley and snowcapped mtns that I could afford with my measly DMO salary. If the wife don't mind, maybe I'll look good for the ladies driving your vehicles.

 

[Cold Front]

I was looking at the Macan Turbo, but I'm torn between getting another Cayenne Turbo S or a Macan Turbo. What are your thoughts as a Macan Turbo owner?

The Macan Turbo is far popular than the Cayenne Turbo, it’s the company’s best selling car. I didn’t buy mine from the dealership lot, it was a customer order, and I had to wait 4 months for it to ship from Stuttgart, Germany. I had the option to fly and pick up the car from the assembly plant, then drive it on the Autobahn to the shipping docks. I was too damn busy at the office to do all that, it would have been a great experience. I went with all black exterior, red leather interior, with some alcantara interior finishes. I ordered a vanity plate from the local BMV to go with the car as soon as it was delivered.

The car is my daily car, with a daily driving of about 10-15 miles for work. 10 of those miles are on the highway against the morning traffic. I just hit my 60k miles on the car last week, and it still drives new. I set off from every red light quickly and smoothly, and it’s very quiet at high speeds. I often have to keep my eyes on the speedometer to make sure that I’m not 20+ miles over the speed limit. It’s very responsive to turns, and I think that’s where it will stand out more against the Cayenne Turbo S - because it’s a smaller car. It’s the closest car to the 911 series, while still having all the benefits and practicality of a SUV.

I test drove the Taycan Turbo last March (before the Covid lockdown). That car is hands down better than any Tesla car I have ever driven (except the P100 models with the ludicrous mode that I’m yet to test drive). It was dangerously fast, I kept holding my breath the whole time during the test drive. I zoomed past other cars on the freeway like I had a mushroom on Mario Kart. There is a 2 yrs waiting period for any Taycan at my dealership.


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[Molar Whisperer]

The Macan Turbo is far popular than the Cayenne Turbo, it’s the company’s best selling car. I didn’t buy mine from the dealership lot, it was a customer order, and I had to wait 4 months for it to ship from Stuttgart, Germany. I had the option to fly and pick up the car from the assembly plant, then drive it on the Autobahn to the shipping docks. I was too damn busy at the office to do all that, it would have been a great experience. I went with all black exterior, red leather interior, with some alcantara interior finishes. I ordered a vanity plate from the local BMV to go with the car as soon as it was delivered.

The car is my daily car, with a daily driving of about 10-15 miles for work. 10 of those miles are on the highway against the morning traffic. I just hit my 60k miles on the car last week, and it still drives new. I set off from every red light quickly and smoothly, and it’s very quiet at high speeds. I often have to keep my eyes on the speedometer to make sure that I’m not 20+ miles over the speed limit. It’s very responsive to turns, and I think that’s where it will stand out more against the Cayenne Turbo S - because it’s a smaller car. It’s the closest car to the 911 series, while still having all the benefits and practicality of a SUV.

I test drove the Taycan Turbo last March (before the Covid lockdown). That car is hands down better than any Tesla car I have ever driven (except the P100 models with the ludicrous mode that I’m yet to test drive). It was dangerously fast, I kept holding my breath the whole time during the test drive. I zoomed past other cars on the freeway like I had a mushroom on Mario Kart. There is a 2 yrs waiting period for any Taycan at my dealership.


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You have a beautiful life to drive beautiful cars.

 

[2TH MVR]

The Macan Turbo is far popular than the Cayenne Turbo, it’s the company’s best selling car. I didn’t buy mine from the dealership lot, it was a customer order, and I had to wait 4 months for it to ship from Stuttgart, Germany. I had the option to fly and pick up the car from the assembly plant, then drive it on the Autobahn to the shipping docks. I was too damn busy at the office to do all that, it would have been a great experience. I went with all black exterior, red leather interior, with some alcantara interior finishes. I ordered a vanity plate from the local BMV to go with the car as soon as it was delivered.

The car is my daily car, with a daily driving of about 10-15 miles for work. 10 of those miles are on the highway against the morning traffic. I just hit my 60k miles on the car last week, and it still drives new. I set off from every red light quickly and smoothly, and it’s very quiet at high speeds. I often have to keep my eyes on the speedometer to make sure that I’m not 20+ miles over the speed limit. It’s very responsive to turns, and I think that’s where it will stand out more against the Cayenne Turbo S - because it’s a smaller car. It’s the closest car to the 911 series, while still having all the benefits and practicality of a SUV.

I test drove the Taycan Turbo last March (before the Covid lockdown). That car is hands down better than any Tesla car I have ever driven (except the P100 models with the ludicrous mode that I’m yet to test drive). It was dangerously fast, I kept holding my breath the whole time during the test drive. I zoomed past other cars on the freeway like I had a mushroom on Mario Kart. There is a 2 yrs waiting period for any Taycan at my dealership.


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Having owned 3 911s (2 Twin Turbos and a cab) .... I love P cars, buttttttt ...... I still come from a time where a P car SUV was unheard of. I get it. Economically SUVs make up the bulk of the sales. P cars are great. They do everything well. Excellent dealership network. Precision performance. Awesome daily driver.

Buttttttt. Most P-cars lack passion. The GT3, GT3RS and the Carrera GT are the exceptions imho. These are exciting cars.

Italians do passion. They make cars that are FUN to drive. If I was looking for a fun performance SUV daily driver. Consider the Alfa Romeo Stelvio Quadrifolglio. Engine has Ferrari dna. I would take this SUV in a heartbeat over all the others. This car feels special. Of course everything is a trade-off. Alfa Romeo dealerships are a mess. Not many around. Possible reliability issues, but they are getting better.

As for all electric sportcars. I'll pass for now. Speed is just one variable of sportscars. The new Corvette C8 is quicker than a Ferrari 458 (few tenths to 60 mph) but I would take the Ferrari every day.

 

[Molar Whisperer]

Having owned 3 911s (2 Twin Turbos and a cab) .... I love P cars, buttttttt ...... I still come from a time where a P car SUV was unheard of. I get it. Economically SUVs make up the bulk of the sales. P cars are great. They do everything well. Excellent dealership network. Precision performance. Awesome daily driver.

Buttttttt. Most P-cars lack passion. The GT3, GT3RS and the Carrera GT are the exceptions imho. These are exciting cars.

Italians do passion. They make cars that are FUN to drive. If I was looking for a fun performance SUV daily driver. Consider the Alfa Romeo Stelvio Quadrifolglio. Engine has Ferrari dna. I would take this SUV in a heartbeat over all the others. This car feels special. Of course everything is a trade-off. Alfa Romeo dealerships are a mess. Not many around. Possible reliability issues, but they are getting better.

As for all electric sportcars. I'll pass for now. Speed is just one variable of sportscars. The new Corvette C8 is quicker than a Ferrari 458 (few tenths to 60 mph) but I would take the Ferrari every day.

Since I can't afford one, I can ask. What are high performance cars' maintenance and repairs like? Do they have dry sump oil and tires lasting less than 2k miles? BTW, how's your golf game?

 

[2TH MVR]

Since I can't afford one, I can ask. What are high performance cars' maintenance and repairs like? Do they have dry sump oil and tires lasting less than 2k miles? BTW, how's your golf game?

I leased all three P cars through my offices when I practiced privately. I wrote off a majority of the leases. Maintenance costs again written off. I had 3 yr leases .... so repairs were rare. If I bought a car outright .... I usually only kept the car through it's warranty period. Yes. Most of these cars have dry sumps. Never replaced any tires since I changed the car out every three years. If I did have a tire issue ..... again ... I just wrote it off in the practice.

 

[ToothJockey]

As for all electric sportcars. I'll pass for now. Speed is just one variable of sportscars. The new Corvette C8 is quicker than a Ferrari 458 (few tenths to 60 mph) but I would take the Ferrari every day.

Also personally, there's no fun in driving without being able to hear that loud V10 engine with those crackle pops. That's why I hope sports/supercars never go fully electric or find some way to keep their sound.

I don't think I'll ever be able to take a silent supercar seriously. The concept itself is oxymoronic.

 

[2TH MVR]

Also personally, there's no fun in driving without being able to hear that loud V10 engine with those crackle pops. That's why I hope sports/supercars never go fully electric or find some way to keep their sound.

I don't think I'll ever be able to take a silent supercar seriously. The concept itself is oxymoronic.

There's hope for you.