New South Endodontics can: make you more money, increase your efficiency, increase the quality and durability of your dental work, reduce your liability, and reduce your stress.
First, the time that is required for you to set up your endo equipment, to thoroughly remove the decay, to perform the endo, to place a post and do the buildup, is time that you could have spent cutting a crown or bridge prep or some other [more comfortable] procedure that doesn’t interrupt the flow of your day.
Second, it is much easier for you and your laboratory to work with a tooth that has been made whole with an ideal buildup, as opposed to a tooth with missing structure.
Third, there are legitimate liability concerns with endodontics. If specialty procedures are performed without informing the patient of the availability of an advance-trained specialist, the referring dentist may be held liable if or when problems occur. If the quality of the endodontic procedure performed by a generalist is not equivalent to what is expected from an endodontist, the patient has a legal right to seek financial compensation.
Fourth, unless you are performing your endodontics with the use of a surgical operating microscope (SOM), you are simply visually incapable of matching the competency of the endodontist who uses the scope with every procedure. Dr. Elliott feels that an SOM should be used by all dentists, with all procedures. Unfortunately, the SOM is expensive and it takes lots of experience in order to be comfortable using it with every procedure.
Fifth, the magnification that Dr. Elliott utilizes allows him to thoroughly remove all decay from a tooth and easily and predictably perform durable build-ups that are often even with the bone level. What about the biological width and crown lengthening you ask? Prior to establishing proper biological width through crown lengthening, the endo and build up should be completed. If the endo cannot be done properly, there’s no sense in going any further. A common sense procedural sequence must not be forgotten.
When the crown lengthening procedure cannot be performed because of whatever reason, Dr. Elliott still supports the proper placement of build up material at the bone level. In this case, he feels that the crown margin should be placed at the gingival crest, thus leaving the build up material radiographically apparent under the crown. Dr. Elliott has encouraged this non-traditional technique for literally many thousands of cases with a very high degree of success. Traditionally, severely decayed teeth are simply extracted and the patient is burdened with edentulism. And doctor, please don’t forget that every tooth that is extracted, is one less tooth that could benefit from one of your beautiful crowns.
Sixth, cracks in teeth that extend into the chamber floor are commonly considered hopeless and are extracted. However, Dr. Elliott is able to repair most cracked teeth with a high degree of success. Even teeth with chronic J-shaped radiolucencies surrounding their roots are commonly treated with complete resolution.
In summary, retaining teeth benefits the patient as well as the dentist. Many teeth are needlessly extracted because of traditional pessimism and the lack of knowing the capabilities of modern endodontics. When endodontic retreatment is required, the outcome is much less predictable and the double-paying-for-the-same-procedure patient is never amused.
Years ago, we began a policy of taking a complimentary panoramic radiograph of each patient that we see. This includes our treatment patients as well as consultation patients.
There are several reasons for this service, the main reason being that being proactive in the battle against tooth disease is one of our fundamental responsibilities as dentists. Patients desire a healthy mouth and radiographs are our greatest tool to detect disease. Furthermore, detecting disease and it’s treatment is how we make a living. Simply put, the more disease we detect and treat, the more money we make. Both parties win. As an endodontist, I need to know what all is going on in a patient’s mouth, their overall treatment goals, and their ability to pay, before I initiate any treatment on any particular tooth. Often, it makes more sense to extract the tooth instead of performing endo.