What one strategy has gotten me to where I am today in my practice? Investing in endodontic technology. This is the key to constant growth and staying at the top of your dentistry game. 

I’ve always been an early adopter of technological advances in endodontics and dentistry. Back in residency, I trained on the dental operating microscope, and when the CBCT hit the market I made a point to jump on it as soon as I had enough cash! Then the GentleWave made its way on the scene, and I implemented it in my practice as soon as I realized how much it could benefit my patients. 

Now, I’m not saying you have to spend tons of money on endodontic technology to have a successful dental practice. However, it is important to have an awareness of how your patients can benefit if you refer them to an endodontist who uses GentleWave and other top-of-the-line tech. It is a complete game changer, and it will have an incredible impact on your referrals and their treatment plans. 

I want to tell you a tooth story that illustrates exactly what I mean here. Keep reading, and you’ll understand why I always say that you don’t have to do the root canal yourself to be doing endo in a case like this!

A Tale of Two Teeth

This patient has an extensive treatment plan that’s still currently in progress. I performed a root canal retreatment on tooth #30, which was failing at the time and which is still failing now. When I see that a tooth isn’t responding to an orthograde root canal therapy and re-treatment, I consider it time to treat the tooth surgically and to prepare the tooth for an apicoectomy

This first radiograph is of the patient as he presented to my office a few years ago. He had never experienced any pain, and he had normal probings, palpation, and percussion. Since the tooth had already been treated with a root canal, he obviously didn’t have any response to cold. His diagnosis was Previously Treated and Asymptomatic Apical Periodontitis #30. You can see that #31 was extracted due to some mesial resorption.

Since I don’t know what the previous disinfection protocol was, I decided to re-treat the tooth. I know it doesn’t look like my root canal made much difference, but I hoped that refreshing the insides would do the trick and start to heal the tooth.

Since I don’t know what the previous disinfection protocol was, I decided to re-treat the tooth. I know it doesn’t look like my root canal made much difference, but I hoped that refreshing the insides would do the trick and start to heal the tooth.

You can see it more clearly on the CBCT.

Evidently, it was time for me to pivot and treat the tooth surgically, so we decided on an apicoectomy. However, that part of his treatment wasn’t the priority, since he was symptomatic on the other side of his mouth. 

So let’s shift our focus to tooth #19. You’ll be able to see how the treatment for this tooth (and the endodontic technology I used) impacted treatment for tooth #30!

What the Radiographs Revealed 

The patient had a root canal performed on tooth #19 a few years ago (by another provider), and it was tender to percussion. I made no other significant findings, and all his probings were within normal limits. The diagnosis for tooth #19 was simple: Previously Treated and Symptomatic Apical Periodontitis. Look closely… you’ll see a small periapical radiolucency around the mesial root.

This is where things get interesting. The straight angle shows the gutta percha length is right on the money, but the off-angle radiograph shows that the two canals are 1mm away from the radiographic terminus. Your radiograph’s angle can really impact your working length. I’m not sure if this case achieved true patency.

After I finished cleaning and shaping, I took a conefit to discover I was a bit long on one of my mesial canals. Since it was a mesial angle, I knew from the SLOB rule that I needed to trim both my mesiolingual cone and my distal cone, since they were both long. 

Everything in my obturation seemed straightforward until the next radiograph. 

Holy moly! There was a middle mesial canal starting in the middle third of the canal. I didn’t see it or even get a file into it previously. However, I was using my GentleWave (as I do in all retreatment cases), and the machine’s fluid dynamics got the disinfection solution into this tiny canal to clean the area. There’s no way any rotary file could do that. 

What the Future Holds

So what does this mean for tooth #30? Well, I know that most things are bilateral in nature, and so based on my treatment of tooth #19, I’m guessing that there’s a middle mesial canal in tooth #30 as well. 

I’ve decided to re-treat tooth #30 again to see if using the GentleWave will improve its prognosis. The patient understands that an apicoectomy is still on the table, but he also knows that I want to avoid surgery or extraction at all costs.

The Importance of Endodontic Technology  

As is so often the case, there was more to this patient’s tooth story than it seemed. Anatomy like this is exactly why some treatments fail, and why so many people think that certain teeth are cracked when they’re really not. I want dentists and endodontists to all be aware that when it comes to root canals, anything is possible!

This story also highlights the importance of using all the endodontic technology available to you. If I hadn’t had my GentleWave, I wouldn’t have been able to tell what was really going on with not just one, but possibly two of this patient’s teeth. Investing in the best technological advancements in endodontics allows me to successfully treat so many patients and to save even more teeth!

I’m curious what endodontic technology you are saving up for! Let me know in the comments.

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