Who hates endo> I do I do

[c132]

So I finally finished up with endo , with our last few teeth being rotary endo, which btw makes endo a lot easier. I had a headache every monday from that sh!+. Now with the rotary though, I see a very large decline in the need to refer to an endodontist, except in extreme molar cases. Am I alone in this? I mean even the people who didn't "get" it in my class did it well with the GT system.

Those Nickel-titanium files seemed to reem around any bend that the tooth had, and I had some pretty bad ones...

Anyone care to share some endo horror stories?

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[sxr71]

This is the funniest thread title I have read in a while. I picture someone with theirs hands up saying "I do I do." Hillarious actually.

 

[gpg]

Hey people

I don't hate Endo....I love it...but I do agree that rotary makes it much easier....a small suggestion...in case you are using the profile after the entire radicular prep is done,use the largest protaper only for the coronal third......gives a great shape to the preparation.

Also Essential Dental sells a bi-directional spiral....the amazing thing is that the coronal half has spirals shaped such that it pushes the sealer apically.....while the ones in the apical half push it coronally....ensures two things.....

1)The sealer is not pushed beyond the apex.

2)At the point where the spirals with opposite directions meet the sealer is pushed laterally,so the accesory canals are also filled.

Try both the things.....they work.....

P.s.I am a private practioner.....hence know all this.

 

[c132]

Quick ? If you use the largest taper for the top 1/3 then the preforemed cones that match the files wouldn't seal the whole tooth would it? I thought that was the whole "DEAL" with the files that the cone it the exact shape as the file. Let me know about this, for I am getting ready to take an advance endo course!!!

 

[gpg]

Ya I agree that the point is supposed to be that the point and the rotary instruments are made to order....but I feel it helps to have a wider coronal prep so as to pack in a few more points.....what we do at the clinic is a week after obturation,we call the patient for crown prep....where in we romove the coronal half of the GP placce a passive post and build up either with miracle mix or plain GIC.....and then prepare the tooth for a prosthesis....so a wider coronal prep helps in that there is more space for the post....we use a peezo reamer to remove the GP.....try it out......if the RC is done fine...the patient will not bother u for at least 7-8 years.....

 

[KAJALKIRAN]

ok i have this doubt...someone above pointed that rotary endo instruments reduces the need to go to an endodontist; so, in future if more and more general practioners get trained in use of rotary instruments, would that bring down the lucrativeness and demand of specialization in endodontics?
I see that a similar thing has brought down the demand of pediatric dental specialists, where most general practioners do the job themselves to cut down costs..! any new opinions??

 

[no2thdk999]

I am by no means an expert on endodontics but there are several statements being made here that have bit me in the butt before. As soon as I feel like I've got some aspect of dentistry licked it usually comes back to haunt me. IMHO throwing out the endo's referral card is a bit premature.

For me actually shaping the canals with instruments whether rotary or hand is not the most demanding part of root canal therapy. Rotary files don't help at all with obtaining the correct diagnosis, finding all the canals, determining their morphology, getting the approrpriate working length, maintaining patency, etc.....

The AAE has a nice risk assesment form on it's website http://www.aae.org/riskassess.pdf

Not to disuage anyone from jumping into endo and honing your skills, but I'd start with easy cases and build up your skills before tackling every tooth that presents itself.


JMH-grumpy-old-man-O
Rob

 

[bcDDS]

I am by no means an expert on endodontics but there are several statements being made here that have bit me in the butt before. As soon as I feel like I've got some aspect of dentistry licked it usually comes back to haunt me. IMHO throwing out the endo's referral card is a bit premature.

For me actually shaping the canals with instruments whether rotary or hand is not the most demanding part of root canal therapy. Rotary files don't help at all with obtaining the correct diagnosis, finding all the canals, determining their morphology, getting the approrpriate working length, maintaining patency, etc.....

The AAE has a nice risk assesment form on it's website http://www.aae.org/riskassess.pdf

Not to disuage anyone from jumping into endo and honing your skills, but I'd start with easy cases and build up your skills before tackling every tooth that presents itself.


JMH-grumpy-old-man-O
Rob

I would have to agree with Rob. Endo isn't about shaping canals with rotary instruments. There are a lot of cases that are potential liabilities and should go straight to the endodontist before access is even attempted. But is takes years of experience to be able to predict these problems before RCT is initiated. We're talking about possible calcifications, apical canal trifurcations, abnormal morphology, diagnostic conflicts, refractory lesions, etc.. the list goes on. A lot of the cleaning and shaping has been simplified and is more efficient than ever, but that was never the most challenging part of endodontics to begin with. Talk to any endodontist or any endodontics program director, and you'll find that a major portion of the emphasis in endodontics lies in the biological aspects. There is so much more to Endo than meets the eye. So before everybody talks about how easy and monotonous endo is these days, it might be a good idea to go beyond that #9 single canal that you treated. Every case presents a different set of challenges and variation can easily be the norm. Do at least 50 cases (and lots of molars) and if you think Endo is still easy, maybe it's your calling to be an endodontist. Because maybe then you'll find a challenge in some of the crazy cases that are referred. Personally (and maybe I am biased) I think Endo is one of the hardest specialties to practice day in and day out. But it can be pretty rewarding to know that your expertise and skills allowed a tooth the be saved when it would have otherwise gotten extracted. Sure Endo is lucrative, but specialist level endodontics is by no means easy work. Just thought I'd get it out there for those that are sitting on the fence.

 

[c132]

So before everybody talks about how easy and monotonous endo is these days, it might be a good idea to go beyond that #9 single canal that you treated. Every case presents a different set of challenges and variation can easily be the norm. Do at least 50 cases (and lots of molars) and if you think Endo is still easy, maybe it's your calling to be an endodontist.

HUH? Who said anything about #9? I treated #2 with rotary. A RCT on #9 is like the easiest thing in dentistry. Read my post as it says "I see a very large decline in the need to refer to an endodontist, except in extreme molar cases" not how good am I that I did a mand. premolar or canine with one canal! Access is EVERYTHING in my book with rotary, if you have the hands to get good access and if the tooths morph is shaped WNL--- rotary is a cinch. NO step backs, gatesing, etc....... It speeds up endo by about 25 to 40%, makes obturation a cinch, virtually eliminates spreader marks, keeps supplies low in that you dont have 300 sizes gp points laying around, and in my opinion here makes a much better apical seal for the point is the same shape of the file and there is much less chance of microleakage, which will attribute to failure.

All I was saying is that if people will take the time and get trained on the rotary endo, then a whole lot of endo will not be referred out, and kept within office, for endo is the lowest overhead procedure that you can probably name in dentistry. Just the "extreme cases" that I feel will be referred out, will make a endodontists life much more painful and less productive.

Do you guys believe this? I considered going into endo until this was brought up to me by a gp. He said he used to refer 80% of his endo out, for he didn't like it. He was trained on rotary and now he referrs around 10% out. Thats a big decrease in what is coming to the endodontist!!!!!

 

[bcDDS]

HUH? Who said anything about #9? I treated #2 with rotary. A RCT on #9 is like the easiest thing in dentistry. Read my post as it says "I see a very large decline in the need to refer to an endodontist, except in extreme molar cases" not how good am I that I did a mand. premolar or canine with one canal! Access is EVERYTHING in my book with rotary, if you have the hands to get good access and if the tooths morph is shaped WNL--- rotary is a cinch. NO step backs, gatesing, etc....... It speeds up endo by about 25 to 40%, makes obturation a cinch, virtually eliminates spreader marks, keeps supplies low in that you dont have 300 sizes gp points laying around, and in my opinion here makes a much better apical seal for the point is the same shape of the file and there is much less chance of microleakage, which will attribute to failure.

All I was saying is that if people will take the time and get trained on the rotary endo, then a whole lot of endo will not be referred out, and kept within office, for endo is the lowest overhead procedure that you can probably name in dentistry. Just the "extreme cases" that I feel will be referred out, will make a endodontists life much more painful and less productive.

Do you guys believe this? I considered going into endo until this was brought up to me by a gp. He said he used to refer 80% of his endo out, for he didn't like it. He was trained on rotary and now he referrs around 10% out. Thats a big decrease in what is coming to the endodontist!!!!!

I wasn't directing my post specifically at you. True enough that general cleaning and shaping of the root canal system is much easier and mor predictable these days. But you can't be proficient at Endo without being good with the hand files. There are times where rotary just won't cut it. For example, if a canal is ledged, you need to ditch the rotary and use hand filing to bypass it. Also, rotary doesn't eliminate the value and importance of gates gliddens in directional coronal flaring and obtaining straight line access. But you're right, life as an endodontist will be more difficult than it used to be. But that's why there are endodontists out there in the first place. You're not going to suffer from a shortage of endodontic cases as a specialist. However, your 'average' case will be more difficult than it used to be, that's for certain. GP's do a lot more endo these days because of NiTi rotary and simple thermafil type obturation systems, but there are good and bad things to be said about that. More endo is done these days by those that fail to acknowledge the biological aspects of RCT because the simplified mechanics of it have made it too lucrative to refer. A lot of GPs do great endo, but a lot of them do horrible endo as well and it can be more easily masked b/c it may look nice on the radiograph. I tend to see more and more failed cases everyday that seem to look great. Retreatodontics will make up a pretty big portion of future endodontic practice.
So you are probably correct in a sense that some GPs will keep more and more of their endos in house. And I don't think endodontists mind too much from a holistic standpoint because without GPs doing the majority of the endo, endodontists would be overflowed and backed up with too much work. Emergency and non emergency patients wouldn't be seen in a timely fashion, and it would reflect poorly on the GP that referred the case. If you can do good endo as a GP, great. Refer the stuff that is too difficult. That's what the endodontists are trained for..I think that the more basic endo the GP can do, the better off we all are. I personally think the advances seen in endodontics are a win win situation for everybody.

 

[Athene]

Hey people

I don't hate Endo....I love it...but I do agree that rotary makes it much easier....a small suggestion...in case you are using the profile after the entire radicular prep is done,use the largest protaper only for the coronal third......gives a great shape to the preparation.

Also Essential Dental sells a bi-directional spiral....the amazing thing is that the coronal half has spirals shaped such that it pushes the sealer apically.....while the ones in the apical half push it coronally....ensures two things.....

1)The sealer is not pushed beyond the apex.

2)At the point where the spirals with opposite directions meet the sealer is pushed laterally,so the accesory canals are also filled.

Try both the things.....they work.....

P.s.I am a private practioner.....hence know all this.[/QUOTE
thanks.................i love endo...........................