We hear how Ammar Al Hourani delivers postgraduate education – and why he uses evidence-based and advanced materials to enhance the success of treatments.
Ammar Al Hourani has carved a niche for himself in endodontics. His journey from a student at Glasgow Dental School to a consultant/specialist in endodontics and clinical lecturer reflects his relentless enthusiasm for the specialty.
He developed a keen interest in endodontics early in his career, eventually pursuing a three-year full-time postgraduate DDSc endodontic training programme at Liverpool Dental School.
As a result, he earned his Membership in Endodontics specialism examination by the Royal College of Surgeons in Edinburgh (MEndo RCS Edin) and a Doctorate in Endodontology (DDSc).
‘I really enjoyed endodontics as an undergraduate student,’ he says. ‘I was privileged to be supervised by some inspiring clinicians who shared their passion. The more I understood the topic, the more intrigued I became to specialise in this field. I love gadgets, and endodontics is full of innovation and new materials, making the role even more exciting.’
Unpredictability
After working as a senior house officer and GDP, Ammar held roles as an honorary consultant and clinical lecturer at Peninsula Dental School, Plymouth. His expertise extended to supervising undergraduate endodontic teaching and instructing postgraduates in its Endodontic MSc programme.
Currently, Ammar practises across three dental practices – Alexandra Dental Practice in Hemel Hempstead, Hertfordshire, Treehouse Dental in Crouch End, north London and Appoline Dental Care in Grantham, Lincolnshire – taking referrals from across the UK.
But endodontics is an area of dentistry few GDPs enjoy. This is unsurprising, perhaps, because it presents many challenges.
According to the DDU: ‘Endodontic treatment can be a source of worry for dental professionals. This might partly be due to the easily explainable risks, such as file fracture, but also because of the unpredictability when treatment planning.’
Challenges and difficulties
Ammar says: ‘From my experience, a lack of diagnosis or misdiagnosis often leads to a breakdown in patient/dentist trust. Another pitfall is not having a reproducible set of protocols for mechanical and chemical shaping of the root canal system.
‘With so many file systems out there, knowing how to safely and reproducibly navigate and shape the root canal system without creating iatrogenic mishaps such as perforations, file fractures, blockages and ledges is key to success.’
In the paper, Challenges Assessment in Endodontics Among Undergraduate Students, its authors acknowledge that ‘even small errors can have significant consequences for patients in a clinical setting’. They also suggest that assessing students’ individual challenges and difficulties can aid in developing teaching strategies for preclinical and clinical instruction.
Dental education must, therefore, train future dentists in such a way that they become proficient in performing procedures independently and confidently.
Critical figure
Indeed, this aspiration for proficiency lies at the heart of Ammar’s approach to his teaching; his focus on delivering postgraduate education demonstrates an innate commitment to advancing the field.
He has been a critical figure in teaching several NHS courses in the Yorkshire, Merseyside and London deaneries. Through these efforts, he plays a crucial role in helping GDPs and DFTs overcome the day-to-day challenges in endodontics.
He is also the founder and course director of The Endo Guys, a project started during lockdown in 2020 that began as a short series of online lectures and grew. Ammar ensures delegates receive comprehensive and hands-on endodontic training, helping them avoid common pitfalls. These courses run in London, Manchester and Glasgow.
The evidence-based courses guide practitioners through every step of the treatment process, offering valuable insights, tips and tricks for predictable, reproducible and successful outcomes.
Strength to strength
Ammar is, it seems, a natural-born educator.
‘I have always enjoyed teaching and felt there was a gap in the market for basic endodontic courses for newly graduated GDPs. Since then, the courses have grown from strength to strength thanks to the delegates who trust our teaching methods,’ Ammar says.
‘The cornerstone of excellent care lies within the surgeries of GDPs who drive much of dentistry’s service provision and innovation. My job is tertiary, and I help my colleagues when they require specialist services. I believe that for GDPs to carry out RCT confidentially, they need to feel well-educated – to know which cases to take on and which ones to refer on based on their skill sets and the complexity of each case.’
He adds: ‘Diagnosis and treatment planning are the most important aspects of endodontic treatment. Confidently diagnosing the complexity will ease endodontic work and allow them to carry out tier 1 and possibly some tier 2 cases independently – hopefully, without complications.’
Restorative complications
‘They should be comfortable with the required procedural steps, using evidence-based knowledge, products and modern-day equipment. Knowing the cause of disease, how to treat it and how it fits into a larger treatment plan is key. Manual dexterity and magnification cannot be understated either, as endodontics is a technique-sensitive procedure.
‘And, of course, communication is key for being a good endodontist. You must bridge your thought process to your patients and the referring dentist so everyone is involved with the treatment going forward.’
The BES’s Guide to Good Endodontic Practice suggests that: ‘The most common reason for root-filled teeth to be extracted is because of restorative complications, which relate to structural failure. Survival studies have shown that the main factors influencing the survival of root-filled teeth are the quantity of sound residual tooth structure and the choice of restoration.’
Major factors
Whilst the outcome of endodontic treatment is influenced by several factors like the preoperative status of the root canal, the presence of a periapical lesion, previous root canal treatment (RCT), the root filling quality, and coronal restoration, microbial infection is one of the major factors associated with endodontic failure.
Clinical skills aside, Ammar also relies on evidence-based and advanced materials in his teaching and clinical care to enhance the quality and success of treatments.
One such material integral to Ammar’s practice is VOCO Ionoseal. This ready-to-use, one-component material has proven to be a time-saving solution, light-curing in seconds with quick and hygienic application.
With high compressive strength, fluoride release against secondary caries and excellent biocompatibility, Ionoseal has become a staple in Ammar’s procedures.
Successful outcome
‘Sealing the orifice after endodontic treatment is essential as part of a predictable coronal seal. We know the coronal seal is paramount for the successful outcome of any endodontic treatment. Personally, I’ve always felt a lining of Ionoseal orifice base and composite core gives me a good outcome.
‘It has been my go-to material since I was a GDP. Fast forward several years, and I now use it as an orifice closing material after my root canal treatments. The material is excellent value for money, and you get a lot of applications per syringe. It’s easy to apply and manipulate into position and is seen on my post-operative radiographs.
‘I am impressed by its handling properties and the customer service I receive. I have used several other materials but have always returned to Ionoseal as it works well in my hands and gives me the desired outcomes.’
But ever the teacher, he concludes: ‘Of course, it’s essential to modify our treatment based on current evidence to get the best long-term success and outcome.
‘So, constant reading of current high-impact journals is a must to ensure that our knowledge is updated and evolved. The aim is always to help patients with the best dentistry can offer them.’
For references email [email protected].
Follow Dentistry.co.uk on Instagram to keep up with all the latest dental news and trends.
