There are so many misconceptions about root canals out there. Even for us dentists. I really think that our misconceptions come from a lack of understanding and belief in the extent of a root canal’s healing properties. The truth of the matter is that new endodontic technology has come a long way in the past few years, and it really does elevate the procedure and provide new capabilities for everyone involved—but this isn’t always being taught.

To be honest, I get it when dentists aren’t the biggest root canal evangelists.  A lot of the technology that I consider crucial in my practice has existed for less than a decade, and it still hasn’t gained widespread adoption. 

That means that you probably were trained with manual tools, no CBCT, low magnification, etc. Even if you graduated recently, your teachers might not be up-to-date on the latest and greatest in dental tech. So the old ways (which do work, it’s just harder) are still passed down to the newest generation of dentists.

Look, I can perform a root canal without all the fancy, new endodontic technology I’ll be talking about in this blog post. I did it for years. But when the new tech makes my patients’ lives easier, speeds up my production time, and helps me secure better outcomes… why would I practice without it?

I was recently invited to write an article for Dental Products Report titled “Deep Dive: The Benefits of Embracing Innovative Technology in Endodontics,” and I hope you’ll give it a read. This blog post is a companion to that article, going into even more depth.

What It Was Like before I Used my Favorite New Endodontic Technology

I’m not talking about the Dark Ages or anything! I just want to share what life was like in my practice only a few years ago. 

I was performing root canals daily, and I was getting really good outcomes for my patients. But they weren’t as kickass as the outcomes I’m getting now.

For example, I was having to retreat patients every few months from root canals I’d performed years in the past—and sometimes only months. That’s not a terrible failure rate, but it was obviously tough on the patients. Plus, it hurt my production, which isn’t great, because I like to protect every minute of my chair time. 

The types of complications my patients were experiencing were normal and expected, based on traditional instrumentation, irrigation, and obturation. When you’re using manual files, for example, you just can’t get into every tiny crevice and crack in a tooth’s root system.

After a little while, these retreatments started to be tough for me, too. Not only was I down on myself for having “failed” these patients and upset by seeing them back in pain (you know, the type of patient who says, “It hurts when I tap on my tooth.”), but it also started to impact my bottom line. Retreatments take up valuable clinical time for myself and my assistants, and they take up space in the schedule where I couldn’t treat a new patient. It hurt my production, which isn’t great, because I like to protect every minute of my chair time.

I really believe that dentists should offer to retreat failed root canals, unless they are truly stumped by the case. I encourage you to always do your risk assessment and know your limits. There’s absolutely nothing wrong with referring out to someone else if you worry that you’re in over your head. We’re here for our patients’ well-being, not our own egos. And also, balance that with honoring your promise to perform excellent work via retreatments, when possible. This shows your patient that you really care about them and their healing.

Everything Changed with the Trifecta of New Technology in Endodontics

In the last few years, several pieces of endodontic tech have really elevated my practice. My three favorites are:

Let’s dive into each!

GentleWave by Sonendo

I’ve written up some reviews of GentleWave before, so I encourage you to check out this post on why I’m a GentleWave provider

GentleWave ended the retreatment issue I was having in my practice almost immediately. My patients feel so much less post-op pain, needing only basic OTC Advil/Tylenol. I’m proud to be doing my part to help curtail our country’s opioid epidemic. Plus, my patients call the front office after their procedure with concerns way less than they were before, freeing up my staff’s time and energy. As another bonus, my referral rates from patients to their family and friends are higher every year, because they are happy to share their good

experience with their loved ones.

The clinical results are awesome, too. The fluid and sound dynamics of the procedure easily get into all those teeny tiny canals, cleaning out bacteria I never could have reached with manual techniques. Best of all, my practice is more profitable, because I have the space in my schedule to see new patients.

My retreatment count is down from 10-25 a year to only 1-2 a year. Some number of root canal failures are inevitable, since this is a biological process. My rate is as good as it gets.

Cone Beam Technology

Here’s what happens so often with CBCT: Dentists hear how freaking amazing it is, so they invest in the technology. A technician arrives to install it, and then they give the practice staff a training on how to use it. The training includes topics like: How to operate it and change the angles, how to position the patient, how to capture and download images. You’ll notice the training does not include how to actually effectively use the damn thing! You also need to learn how to manipulate the data and the software, so that you understand what you’re seeing and reading.

As a result, there are thousands of well-meaning dental practices all over this country and beyond, where no one in the practice feels confident or comfortable with their CBCT, and they don’t really know how to use it. Totally understandable, and I commend these practices for investing in the technology, but it’s SO powerful, that you’re leaving a lot of insight into your patients’ teeth on the table. Your CBCT shouldn’t be collecting dust; it should get used every day. And every single provider in the practice should be using it.

The twin problem that dentists often face is they aren’t adequately trained on how to read the images the CBCT produces. I saw some CBCT images recently for a patient I was doing a little consulting on, and while I commend the patient’s general dentist for investing in cone beam technology, none of the images really made sense. The angles were all wrong to get any useful information out of the imaging.

I use the shit out of my CBCT. I use it to find canals like MB2s that aren’t obvious in any other way (love me some coronal views). I use it to look at radiolucencies from all angles. I use it to preserve dentin since I can access it with precision. And so much more.

Cone beam technology is a gift, and it definitely takes clinical training, but it’s so worth it.

Fun fact: I teach an entire module on CBCT in E-School, my award-winning endodontic CE course.

Operating Microscope

When I am preparing dentists to attend my E-School LIVE program—which takes place with live patients at my practice in NC—I give them a packing list.

  • Comfy shoes
  • Extracted teeth to practice on before we move to real-life patients
  • Loupes with a magnification of at LEAST 5.0.

Those of y’all who practice with low-powered loupes, my hat’s off to you. I honestly have no idea how you do it. I rely SO much on magnification, because it allows me to see details I would otherwise never notice.

I know that general dentists almost never have operating microscopes, and I’m not expecting that to change any time soon. But at the very least, I highly suggest you invest in a pair of loupes that are 5.0x or higher.

And then practice with them! It’s going to shock you how different everything looks at first. It’s like peering through binoculars, and you’re disoriented, trying to find what you’re looking for. It’s like having Honey, I Shrunk the Kids vision—up close and personal! But also, oh, so powerful.

Enhanced magnification doesn’t just elevate your endodontic game, but your restorative game, too! Don’t think you’ll use your loupes just for endo; you’ll easily get your money’s worth out of them.

Why Dentists Don’t Invest in New Endodontic Technology

Please know that I am not here to blame or shame anyone. There are a lot of very good reasons why dentists choose not to invest in the latest, greatest tech. My goal in this post is to show you what is possible when you have the opportunity, and to empower you as you make decisions about the future of your practice.

Believe it or not, I have found through conversations with dentists that cost is not actually the biggest reason why they are reluctant to dive into a new piece of technology. The actual reason is that they’re worried it’s going to mess up their existing workflows and systems. In short, It’s not the way we’ve always done it.

I’m a huge believer in the power of repeatable processes and workflows, so I understand why this is scary. And it’s true, you do have to make changes when you introduce a new technology to your practice, which is a serious challenge. There are going to be days full of troubleshooting where you just want to chuck it across the room.

But if you can improve your success rate even by 1%, wouldn’t that be worth it? And if you could get access to the ever-growing support networks that many tech companies and CE programs like E-School provide, wouldn’t that make it easier? And if you could improve your confidence, production, patient happiness, and efficiency, wouldn’t that be amazing? Just envision it, my friend.

Sometimes, the things that scare us and that feel hard are still worth doing. In my experience, they’re the things most worth doing.

Our Teeth Are Precious. Technology Can Save Them.

Let’s wrap this up with a little metaphor. Have you ever played chess? When you’re a beginner, it’s easy to think that your pawns are dispensable. After all, you have eight of them! But the more you play, the more you realize that every single pawn serves an important purpose, and they’re just as important as any other piece on the board.

It’s the same with our teeth. Because we have 32 permanent teeth, it’s easy to think, “Hey, let’s just pull that tooth. I can extract and implant in-house, and the patient doesn’t even need to worry about a root canal.”

But if you take this path, it’s imprinting our own beliefs and goals onto the patient. Maybe that patient wants to worry about a root canal, because they are committed to saving their tooth. Maybe they don’t want to lose any more bone, or they know that the cost of extraction and implant will be higher than a root canal.

Yes, we’re the doctors, and we’re here to provide expertise and guidance for our patients. And also, it’s their bodies, so I really think it’s important to empower them to make informed decisions about their own care.

At the end of the day, you can have all of the modern endodontic technology in the world at your fingertips, but the most important technology to update is our own beliefs.

When we believe in our power as tooth savers, we can do miraculous things.

When I sign off my emails with the words, “empower yourself,” this is what I mean. Empower yourself, my friend, to upgrade your beliefs, step into a deeper understanding of what you’re capable of, and give teeth a chance.

I’d love to welcome you to my practice in North Carolina, where you’ll get a chance to try out all of my new endodontic technology before investing. E-School LIVE is my favorite course, because it’s in-person, in a small group, with live patients. You will get to do root canals, yourself, and play with all my tech. Apply today!

– Sonia