Prefer to refer your endo cases?
General dental practitioners don’t always have to refer endodontic cases says Michael Davidson, who wants to inspire dentists to have the confidence to take on some simple cases.
Endodontics has come a long way in recent years thanks in the main to major advances in the file systems and materials that now provide the capability to navigate and shape even the most complex of canal morphologies. The progression from stainless steel hand files, through to the latest M-Wire nickel titanium technology, has improved the strength of files and steadily reduced the number required to complete successful endodontic treatment, making clinical outcomes faster and more predictable than ever before.
Endodontics is often perceived as one of the most complex of clinical procedures. A lack of confidence, fear of complications and the risk of file separation in particular, mean many GDPs have traditionally chosen to avoid root canal cases altogether, and refer patients for treatment by a specialist. However, in the majority of straightforward cases, endodontics is well within the scope of a GDP and there are a wide range of training opportunities that can help to hone a clinician’s skills, enabling them to offer this treatment and reducing the necessity to refer.
Specialist manufacturers have been driving the improvement of file systems, taking into account minimally invasive techniques for a number of years, as well as encouraging and giving confidence to those less-experienced dentists who want to offer more endodontic treatment within their own practice.
It is commonly accepted that one of the most widespread reasons why GDPs are reluctant to tackle root canal procedures is the risk of file separation. Although there are no guarantees that file separation will never happen. Understanding how it happens, and in what circumstances enables the clinician to take appropriate preventive measures. Using the latest file technology can go a long way to significantly reduce the risk.
Excessive torque and cyclic fatigue are the most common factors that can weaken a rotary file. However, the new generation of reciprocating files, led by Dentsply Sirona’s Waveone Gold, are manufactured using nickel titanium, a material that significantly improves strength and flexibility enabling it to negotiate a wider range of canal morphologies. Fatigue strength has been improved significantly when compared to most standard rotary systems, greatly enhancing patient safety. According to Dentsply Sirona’s in-house testing, the flexibility over its predecessor Waveone, has been improved by 80%, allowing an extended range of file sizes covering a greater range of canal structures.
Using the latest file systems, the majority of cases (around 80%) can be treated with a single file to start and complete the shaping of the canal, saving clinical time and eliminating the need to change instruments.
Single-use files are the gold standard in infection control. HTM 01-05 guidelines state that all endodontic files should be treated as single patient use, regardless of manufacturer’s instructions, to reduce the risk of prion transmission. The recommendation for single use has the added advantage of reducing instrument fatigue, an important consideration when a single file is performing the work traditionally performed by three or more rotary files. This also significantly reduces the risk of file separation and ensures that cutting efficiency is retained, resulting in shorter clinical treatment time and more successful outcomes.
Those GDPs who have embraced the latest file systems have become more confident about offering endodontics within their range of treatment options, recognising the benefits of keeping patients within their own local practice, rather than referring elsewhere. The majority of patients feel more comfortable about their treatment if it can be done within the familiar surroundings of their regular dental practice and with a dentist that they know and trust.
You can also access a range of education resources, video tutorials, courses and CPD webinars at dentsplysirona.com/ukeducation.
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