Tips for GDPs looking to offer endodontic treatment – Mark Allen

  Posted by: Dental Design      27th February 2018

Every general dental practitioner has an understanding of the fundamental principles of root canal treatment. You clean out the canals to eradicate infection then fill and seal the space inside the root where the tissue had been – simple. Or at least it is on paper and when you’re practicing on phantom heads in a classroom. When you’re new to the game and your experience of providing endodontic treatment in the dental practice is limited, achieving successful results can be anything but simple.

Indeed, according to the British Endodontic Society the success rate of root canal treatment is 90% if carried out to good standard, yet problems can occur if the tooth develops decay or the restoration fails.[i] With the additional prospect of human error, dentists can never be too careful when providing endodontic therapy. If you’re a general dental practitioner (GDP) looking to branch out into endodontics, here are some points to consider.

First things first, you need to be confident in your diagnosis before proceeding with root canal treatment. There are a number of tell-tale signs to look out for, including lasting or severe hot and/or cold sensitivity, periapical lesions of endodontic origin (which can present with and without biting sensitivity), localised gingival swelling and tenderness, and foul odour. To diagnose correctly, a full history and full examination (both intraoral and extraoral) are always required. Particular attention should be paid to palpation, percussion and mobility. Radiography of the root and periapical region is also essential, while pulp testing, the use of an electric pulp tester, thermal pulp testing and sensibility testing are useful techniques, especially in complex cases.

The more information you have the better, as it will enable you to determine whether or not you are able to treat the patient yourself. Generally, the rule of thumb is that if all the canals of the tooth are clearly visible in the radiograph, then a GDP can attempt the root canal treatment. However, there are a number of exceptions where a GDP would not be qualified to carry out the treatment, in which case the patient would need to be referred to a specialist endodontist. Any instance where the canals are not visible is regarded as a complex case, as is any patient where the canal appears to start mid-way down the root. Other exceptions can include teeth that have had previous root canal therapy, long roots, severe root curvature and posterior teeth with difficult access.

With the cases that you are able to treat there are a few top tips you can follow to help achieve a successful outcome. When cleaning the canal to provide a canal shape that can be fully obturated, for instance, be sure to remove as little tooth structure as possible to ensure maximum strength during the procedure. The file that you use is also important because some rotary files can fracture in the canal if they aren’t strong enough to withstand the rotation. As such, you must take care when putting together your ‘toolbox’ to select tools with a proven track record of performance. The HyFlex EDM NiTi files by COLTENE, for example, which offer up to 700% higher fracture resistance, are well known for their flexibility and strength. This unique combination also makes it possible to reduce the number of files required for cleaning and shaping without having to compromise preservation of the root canal anatomy for maximum efficiency.

Once debridement and disinfection has taken place, care must be taken to get obturation just right – in other words ensuring that the canals are not under filled or over filled. Radiographs are helpful to a certain extent, but as they can only show you where the radiographic apex is and not the anatomic apex, it is always best to use this method alongside other tools and techniques. The use of an apex locator is one such solution that is renowned for achieving accurate results, as it determines the working length and calculates where to end the instrumentation and obturation. It can take a bit of getting used to so the more practice you can get in the better. Courses are a great way to learn and improve techniques, so it might be worth signing up to a one or two-day hands-on training course if you have the time.

Undoubtedly, endodontics can sometimes be challenging for new comers. However, if you take the time to research recommended practices, become more proficient through training and source the best materials and tools from leading manufacturers like COLTENE, then you can rest assured that you can provide safe and effective endodontic treatment to your patients.

To find out more visit www.coltene.com, email info.uk@coltene.com or call 01444 235486

[i] British Endodontic Society: Further Information. Accessed online 1^st December 2017 at https://www.britishendodonticsociety.org.uk/patients/further-information.html

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