Do you struggle to make endo profitable? When it comes to doing endo in your own practice, risk assessment is so valuable to making sure endo is profitable for you.  You never want to start something you can’t finish. That would be a waste of your valuable chair time!

That said, I think doing endo in your practice is a MUST! Let’s face it: Some of your patients don’t want to find another provider they can trust. They love you… and all they want is YOU. And, for those who live in a rural area, you will need to be doing as much endo as you can for your patients because the number of available specialists is limited. 


When to Refer Out

From an endodontist’s perspective, we are actually thankful for general dentists who do some endo, because we specialists couldn’t handle all of the root canals ourselves! Yes, we are here for you when you need it, but it’s best to determine your need to refer your patient out on the front end, not after you’ve already started a case. (If you’re wanting to make endo profitable, you’ll figure this out really quickly.)


Risk Assessment to Make Endo Profitable

 Risk assessment comes in many forms. If you’re deciding whether or not to refer a patient out, then you’ll need to consider the following:

  • The Patient’s Expectations — This may not happen a whole lot, but some people have high expectations and may intimidate you.  You may feel that you may not be able to make them happy no matter what you do, and this may warrant a referral to a specialist.
  • The Behavior of the Patient — Maybe the patient is too nervous.  I don’t know about you, but I think that can make any provider nervous.  If you think you’ll need added sedation, it may be time to refer them out. 
  • Not enough space to access — Perhaps the patient can’t open that wide — that never makes that #2 fun at all!  Again, if you want to make endo profitable, you may not want to take on this case… your energies will be better spent elsewhere, and we endodontists are very comfortable working in small spaces! LOL
  • Maybe it’s the tooth specifically —  Perhaps the tooth is super calcified, or maybe there’s a crown on the tooth and that makes you uncomfortable. When evaluating how to make your endo profitable, determine your criteria for deciding which cases you’ll handle in-house and which ones you’ll refer out. (And then make sure to stick to those boundaries!)


Radiographs to Help Risk Assessment

Radiographic assessment can be huge!  Again, if you take a little extra time on the front end, you will prevent things that waste your time on the back end. (Remember, wasted chair time does not make endo profitable for you.)

Let’s look at these two examples and see what we can do prior to treatment that make it a good situation for everyone. 

 Step 1: Take different angled radiographs (including a bitewing) to truly assess your internal anatomy. Let’s focus on tooth #3 here.  This patient’s canals are pretty wide open and the different angles show you just that.  

In fact, the bitewing shows that all of her teeth pretty much look like they have wide open canals. 

Step #2:  If you happen to have a CBCT, you can always use that to help you see if those canals are visible enough for your comfort level. 

Let’s zoom in a bit and see what I mean.  When we look at tooth #3 (or, for that matter, any tooth in that quadrant), those canals look wide open.  You might think that would be a case where you are comfortable doing the root canal yourself.  But remember, you want to make endo profitable for you. Don’t just assume you’ve got this… make sure you notice that there is a crown on the tooth as well. It’s just another factor to help you determine whether or not you want to do the root canal yourself. (And if you do, make sure you find that MB2!)

Let’s look at the opposite situation, when a tooth has some calcification.  In this case, all the maxillary teeth are pretty calcified, even the premolar.  But let’s look at tooth #15.  Remember, start with your different angled radiographs and also take that bitewing.  The only thing I can see is the palatal canal.

If you happen to have a CBCT, utilize it, because it may just help you in deciding how you handle this particular tooth.  If you ask me, this bad boy does not look easy and would likely need a microscope for proper visualization.   

Let’s zoom in and focus on the axial slice.  None of these teeth would be easy to root canal even if we needed to do an anterior tooth.  This is a case where, no matter what tooth needs to be treated, you may want to bounce this one to your specialist.  You don’t want to get started on it and then have to refer it out after hours of hard work. 

Making Endo Profitable

It’s crazy how a simple little radiographic assessment can save you from some wasted chair time. My advice to you is to only do treatments that you are 100% comfortable with.  No one is expecting you to treat a tooth if it is not in your comfort zone.  It’s always better to be smart about your chair time and not have to do a mid-treatment referral.  

Think about it: Your time would most likely be better spent doing crowns or bridges, rather than getting started on a complicated case that you end up having to refer out.  This will be different for everyone, so do what is going to feel best to you with the least amount of anxiety. After all, eliminating anxiety is one of the best ways to make endo profitable… there’s something to be said for having peace-of-mind in whatever you decide to do. 


Additional Help with Risk Assessment

I hope this has helped you evaluate your boundaries as you consider the endo cases that come up in your practice. It’s so important to take an honest look at each case and run it through your determining factors for whether it’s going to be worth your time and effort. 

If the business side of things is an area where you need to grow, I spend a lot of time covering how to reduce chair time and increase profits in my online continuing education course, E-School. I have a special version that includes coaching, where I meet with participants and talk through their specific business challenges. E-School with Coaching is only available certain times a year, so make sure you get on our waiting list to be one of the first to know when registration opens. 

Also, if you’d like quick tips and resources for everyday endo, you can connect with me on Facebook, Instagram, or Linked In. I will often post tooth stories and share helpful tidbits from the cases I see.