22% are somewhat familiar with recent advances in regenerative endo therapies
94% would attend a CE course that included endodontics
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Developments
It helps that technologies such as electronic apex locators, digital radiography, rotary instruments and more have made life a lot easier on both dentists and their endo patients. It’s also critical to see well in such a small, often difficult-to-reach area, so practitioners who perform a lot of endo are more inclined to use magnification than those who don’t provide endo.
More than 7 in 10 of responding GPs use powered canal instrumentation (73%) and electronic apex locators, while 59% use loupes. Additionally, 55% use nickel titanium hand instruments, 49% use stainless steel hand instruments, and 48% use digital radiography.
Dr. Soileau believes rotary instrumentation, digital x-rays, apex locators, and nickel
titanium hand instruments all have had a major influence on improving endodontic care, and that all are musts for anyone performing any amount of root canal treatment.
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Digital x-rays are a big benefit while performing endodontics because of their timesavings.
Photo courtesy of Schick Technologies | | | | |
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“Two things that have been around awhile but nonetheless are huge are digital radiography and apex locators,” Dr. Soileau said. “With digital x-rays, you don’t have to wait to develop the x-rays. In other words, when that emergency comes in my assistant has the x-rays pulled big on the 19-inch monitors that are in the ops. Within 10 seconds she has the x-rays; and if she doesn’t get it perfect, I can adjust the image to see it; and if she misses the apex, she knows within 2 seconds and she just takes another one. It is a big cost, but it’s worth the money.”
As far as apex locators go, he says they’re more accurate than x-rays when you’re trying to find out exactly where the apex is located. “What we found out is that the apex of the canal is not always at the apex of the root, which means there are a lot of times that apex terminates about a millimeter, and sometimes up to 2 mm, above the apex of the root,” he said. “A lot of GPs think if you’re not taking films, you don’t know where that file is. But I’m telling you [in these instances], that radiograph is nowhere near as accurate as an apex locator.”
While rotary instrumentation has made performing root canals much easier, Dr. Soileau believes that some dentists incorrectly think they should work them at lower speeds so as not to break files. “Here’s the thing: Rotary files have changed everything,” he said. “Nickel titanium is so very flexible, but one of the issues is you can separate it because the file gets fatigued from using too much torque or actually not enough speed. Doctors make the mistake of trying to run the files very slow, thinking they won’t separate.”
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| Endo Aids | | | | | Which of the following do you use during non-surgical endo procedures?* | | | Powered canal instrumentation—rotary | 73% | | Electronic apex locator | 71% | | Telescopic loupes | 59% | | Nickel titanium hand instruments | 55% | | Stainless steel hand instruments | 49% | | Digital radiography | 48%
| | Heated gutta-percha | 41% | | Electronic pulp tester | 35% | | Powered canal instrumentation—reciprocal | 13% | | Resilon filling material | 9% | | Operating microscope | 2% | | *Multiple responses accepted. | | | Source: May 2008 DPR Endodontics Survey | |
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But Dr. Soileau warns that if doctors run these rotary instruments too slow, they don’t cut through the dentin in the canal, and that’s when they bind. “So when I teach endo, I teach students that you have to run these things at the maximum speed that the file can handle—usually, that’s twice the speed that you normally set your drill at,” he said. “You want to run it about 500 to 600 rpm, but most dentists run it between 200 and 300 rpm.”
Although nickel titanium rotary instruments have helped speed up the procedures, they have not solved the issue of file separation. Dr. Soileau, who lectures on behalf of SybronEndo, believes the company’s latest brand TwistIt Files (TF) will greatly reduce the risk of file breakage. These files were just launched at the American Academy of Endodontists annual session in April.
Dr. Soileau has worked with these files for some time and believes they have resolved the common problem of broken files. “Believe me, anybody who does root canals has separated a file. If you haven’t separated a file, you’re not doing root canals. It’s just part of the game. We all hate it and we hate to admit it, but it’s the reality.”
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