Monday, February 19, 2018

7 Yr Recall on Intentional Replantation

It just so happens that in the last couple weeks I got the chance to do some long term recalls on a couple of intentional replantation cases.  I don't do a lot of these cases, but am surprised how many people are unfamiliar with this treatment option or have never seen one before.  Sometimes it makes me wonder if we should consider this treatment option more often when we have failure with traditional approaches.

This most recent case is a periodontist who came to our practice.  I originally did the root canal in 2005.  It had an odd lateral lucency - which might be suggestive of a root fracture.  We completed root canal without finding a fracture. 

Unfortunately, at the 2 year re-evaluation, the lateral lesion did not resolve. Since I'm working on a periodontist friend of mine, why not try a retreat again?  We tried it and again found no root fracture, or obvious reason for the failure to heal.

Four years later at another re-evaluation, the bone loss on the lateral is even worse. We are still puzzled at why this has not resolved, but not convinced there is a root fracture, so we decided to try intentional replantation.   So, here are some of the best photos I have to document the process.

The tooth is gently extracted. Here it is immediately after extraction.

The root is kept moist and quickly examined for fractures.  None found, so we did retro preparation using and ultrasonic instrument.

An MTA retrofit is placed.

The tooth is replanted into the socket within 10 minutes of extraction.  Firm pressure is placed for an extended period of time. No splinting

A seven year recall finds tooth #31 asymptomatic and fully functional.  While the mesial bone looks irregular, there is no periodontal pocket.  If you look at the initial photo of the extracted tooth, you can see the periodontal ligament, but there appears to be an area where the ligament had been lost.  There was not visible fracture on that area of the root at that time.  My assumption is that the pdl may not have ever reformed in that area - causing the current radiographic appearance. 
It is interesting how a perfectly good root canal and retreatment failed to give the desired results, but a last ditch effort with replantation has been successful up to this point.

Thursday, February 1, 2018

5 Yr Recall on Intentional Replantation

This patient came to SSE for RCT in 2010. It was a necrotic and RCT was completed.  The lesion failed to heal, so retreatment was completed in 2012.  Lesion still failed to heal, so intentional replantation was chosen as a last resort before extracting the tooth #14.
Tooth #14 was carefully extracted and all 3 canals were resected, retrofilled and reimplanted within minutes. 
5 Year recall shows great apical bone healing.  The tooth is functional, normal percussion, normal probing.  Intentional implantation should be considered as an opion in certain situations.

Monday, December 11, 2017

How to Manage a Negative Online Review

Step 1: Relax - A negative review is not the end of the world or the end of your practice. In fact, you can actually turn a negative review into a positive for your practice if you handle it correctly!

Step 2: Respond - After you have taken some time to consider the feedback and do some of your own research, respond to the review on the 3rd party website where it was posted.

Step 3: Thank Them for Their Feedback - First step in your response is a sincere thank-you for them taking the time to provide feedback.

Step 4: Don't Argue - Don't ever argue, make excuses, or blame someone else. Even if they are wrong or their complaints aren't fair, your response to a negative review will say more about your practice than what the negative review says. Other who read the negative review, will also be reading your response. They want to see that you are respectful, understanding and willing to do what's best for the patient.

Step 5: Remember HIPPA - Remember that patients can talk about your practice, but you can't share patient information online. But that doesn't matter because you are not going to argue with the patient but to show the patient and the world you are listening and they are your priority. You may need explain that you will need to discuss their concerns in private, but you can assure them that you will help them resolve their concern.

Step 6: Do The Right Thing - This might be apologize for falling short on customer service, give a refund, offer to re-evaluate a situation or simply express empathy. Only you can decide what the right thing to do is, but remember, this decision will speak volumes about your practice.

Use your response to educate patients about your values. Tell the world what your values/standards are and what you are striving for your practice. If you fell short of your regular standards, own it. People will respect that. Turn the response to a negative review into a promotion for your practice.

Step 7: Ask For A Revision - If you have properly taken care of your patient's concerns, it would be totally appropriate to ask if they would be willing to revise their review. If they don't, can't or won't revise the review, go back to Step 1: Relax.

You have shown the world you are listening to your patients, are responsive to their feedback and are trying to do the right thing. That is how you turn a negative review into a positive for your practice!

PS. There are those who say that if you don't have any negative reviews, then you look like a "fake". Patients who are reading reviews are smart. They can spot a reviewer who is unreasonable just like they can spot a practice who does the right thing for its patients.

Friday, September 29, 2017

How Competent Are You with Endodontics in Your Practice?

The American Association of Endodontists has just released a white paper on the topic of competency of endodontic care.  This paper defines the requisite skills required by all dentists who perform endodontic diagnosis and treatment regardless of whether the clinician is a generalist or specialist.

Topics covered include:

  • Proper pulpal and periapical diagnosis
  • Identifying odontogenic pain from non-odontogenic pain
  • Proper emergency treatment for traumatic dental injuries
  • Role of patient interview in endodontic diagnosis
  • Distinguishing features of irreversible pulpitis
  • The importance of multiple findings in determination of pulpal pathosis
  • Clinician's responsibility for accurate interpretation of radiographs
  • Proper use of 3D imaging
  • Difficult diagnostic cases such as resorption
  • Ability to evaluate case difficulty before treatment is started
  • Responsibility of the clinician to keep up with the latest and best practices in endodontics
  • Proper treatment planning including alternative treatments for patient's review
  • Careful consideration of restorability
  • Proper forecasting of prognosis
  • Proper interpretation of healing of endodontically treated teeth
  • Proper outcome assessment

In modern dentistry, with all it's advancements in technology, instrumentation and materials, we must remember that these are adjuncts to the clinician's skill and expertise. In fact, there are cases where investment in technology without proper skill, training and experience may actually hurt your practice of endodontics.  For example, the false sense of security of having a CBCT image showing the location of the MB#2 canal, without the microscope and skill to locate the canal may put the patient at greater risk of root perforation.  The patient's best interest must always be put first, even before our financial obligations for technology that we have chosen to invest in.

"Since endodontists set the standard of practice for conventional endodontics, if the endodontist’s standard cannot be met, such as the need for microscopy, regenerative procedures, complex traumatic injuries, 3-D imaging for complex anatomy or the need for apical surgery, the generalist should refer the patient to an endodontist. Planned endodontic cases should not be doomed to failure due to a lack of understanding of what is required to produce a certain level of quality treatment. Implants should never become an insurance policy for inadequate endodontic treatment." (AAE White Paper on Endodontic Competency)

The paper makes the important point that "Endodontic treatment on a hopeless tooth is just as unethical as extracting a restorable tooth and replacing it with an implant." while at the same time recognizing a shift in the philosophy of restoring endodontically treated teeth.  This shift has begun to recognize the importance of the periodontal tissues associated with the tooth (periodontal ligament, bundle bone, alveolar bone, gingival fibers creating the papilla) that cannot be replaced by a dental implant. These important tissues belong to the tooth.  They come with the tooth and go with the tooth.

At Superstition Springs Endodontics, we are pleased to partner with dentists who perform endodontic treatment and other specialists who are committed to multidisciplinary dentistry.  We are committed to helping and supporting the dentists in our community provide the highest quality of endodontic care available in their practices and the best care for their patients when they choose to refer a patient to SSE.

Wednesday, August 9, 2017

Success with Online Reviews at SSE

Over the last year, we have been using the ReviewWizards system to invite our patient to leave online reviews on third party websites.  We want our patients to leave their reviews on sites that matter to the search engines.  We have found great results in building our online reputation.  With ReviewWizard, our patient are sent a link to the phone that takes them to a customized webpage. inviting them to leave a review.  It then walks them through the process to leave a review at the review site of their choice from a selection of sites that are most important to us.

Here's an example of what we have accomplished using ReviewWizards.

Using the ReviewWizard system, we have increased our number of online reviews to 363!

Using the ReviewWizard system, we have gotten 39 new online reviews in the last 90 days.

In the last 30 days, we were able to get 70 people to visit our customized landing page,  46 to click through and  14 to complete the process of leaving our practice a review on a third party review site like Google, Yelp, HealthGrades, RateMDs etc.
To see where our patients are leaving reviews, click here.
If you have any interest in what your practice's online reputation looks like, sign up for a free reputation report at

Monday, April 24, 2017

Partners in Patient Care: Post and Core Buildup

The endodontists at Superstition Springs Endodontics are skilled in restorative procedures closely associated with endodontic treatment.  At your request, esthetic post and core buildups can be immediately placed following endodontic treatment.


Let the endodontists at Superstition Springs Endodontics be your partners in your patient's care.

Monday, February 20, 2017

Build Your Practice With Online Patient Reviews

In our practice at Superstition Springs Endodontics, we have found that patients of all ages are using online reviews in their selection of dental care providers.  Even many of our patients, referred by their general dentist, will go online, using our website or reading reviews to learn about us before coming to our practice.  We also find patients who self-refer to our practice after reading online reviews.  Patients routinely describe how they use online reviews in selecting their general dentist. This should come as no surprise. A recent survey indicates that 88% of people trust online reviews as much as a personal recommendation. The most effective and reliable online reviews are those left on 3rd party websites like Google, Yelp, Facebook, Healthgrades, RateMDs, etc. etc. These websites are more visible to search engines than your individual practice website.  The key to a successful online review strategy is to get patients talking about your practice online through social media and review websites. An effective online review strategy can be the least expensive and most effective SEO (search engine optimization) strategy you can find.

The key to a simple, effective online review strategy is:
1. Invite patients
2. Simplify the process

Invite: Without an a strategy for inviting patients to leave a review, you can expect to get the same amount of reviews that you are currently getting.  Success with online reviews requires leadership and accountability.  If you are not comfortable inviting patients to leave a review, assign someone in your office to make the invitation.  At SSE, we typically invite patients to leave a review as part of our post-operative instructions.

Simplify: Leaving a review takes time and people are busy.  The easier you can make the process for a patient, the more reviews you will get.  Let them choose a review site with which they are familiar with or already use, such as Google, Yelp, or Facebook.  Some of these sites require an account to leave a review.  Patients are not going to sign up for an account to leave you a review, but if you give them a choice of a place they already use, you have a much better chance of getting that review.  If you can direct them exactly to your profile on the third party review site to leave the review, you reduce the steps/clicks it takes your patient to leave a review.

The reality is that no one cares more about your online reputation than you do.  If you want to improve online reviews, it will require YOUR leadership.  It's a numbers game. You have to make enough invitations and understand that a fraction of them will leave a review.  In our practice, we take great pride in our service and clinical care.  We try to create an experience for every patient that exceeds their expectation making them want to share their experience with others.
In the calendar year of 2016, Superstition Springs Endodontics garnered 123 new online reviews.
 To see a full report of our 2016 results, click here.

Review Wizards is a product to help professionals build their online reputations.  With a platform specifically for dentists, called, it is a low cost, highly effective solution to help your practice build its online reputation by inviting patients to leave reviews on the websites that they like to use and that are most important to you.  With a over a year of successful testing in multiple practices, we are now prepared to share this solution with all of you!

A Review Wizard subscription does this by:
  1. Allowing you or your staff to send your happy patients a review invitation via text or email on their favorite device using the LinkWizard.
  2. Creating a customized and branded webpage for your practice.
  3. Filters unhappy patients and lets them provide direct feedback to your practice.
  4. Gives your patients choices of where they might leave an online review.
  5. Delivers them to the review site with instructions on how to leave a review.
  6. Notifies you of new reviews that have been published online.
  7. Allows you to stream the most current online reviews to your website.  (for example, click here)
Online patient reviews may be the least expensive, most effective marketing tool that you can use to build your online reputation and grow your practice.  We've had great results with this new product/system and invite you to check it out.  Click here.

Friday, January 6, 2017

Targeting Cancer Cells - One by One - The Nowzari Symposium

Everyone knows somebody affected by cancer.  The 2017 Nowzari Symposium will feature a novel approach to treating cancer on a molecular level.  This includes using nano-particle radio treatment, vaccine immunotherapy, isotope imaging and cell therapy.

Speakers will be presenting their groundbreaking findings in a simple, easy to understand language, for clinicians and patients alike.   All are welcome to attend.

Monday, November 21, 2016

Partners In Patient Care: Assisting in Treatment Planning - Cracked Teeth

The endodontists at Superstition Springs Endodontics are partners in your patient care.  One of the many ways we assist with the quality treatment of your patients in addition to endodontic diagnostics is in evaluation of restorability.  With the benefit of the dental operating microscope, we are able to excavate decay and evaluate cracks in your patient's tooth.  Every crack is unique and the extent, depth, discoloration, pulpal status, patient occlusion and parafunctional habits should all be considered in the treatment planning a tooth with a crack.

Cracks that go below the cemento-enamel junction and are not able to be completely removed when the buildup is placed or completely covered by the new crown will likely affect the long term prognosis of the tooth.  These types of cracks are best evaluated under the magnification of the microscope.  Additional tools such at staining and transilluination are also frequently used tools in the endodontist's evaluation of a crack.

Patients should be given the options and prognosis and helped to make the treatment decision that is in their best interests and meets their desires.

The following case demonstrates this process and usefulness of the microscope.

Pt is referred for endodontic evaluation/treatment.  Tooth is diagnosed with irreversible pulpitis, normal periapex and gross distal decay.  RCT recommended.

Distal decay is removed, mesial amalgam removed.  Crack identified on the mesial wall of the pulp chamber.

Further excavation reveals the extent of the mesial crack - going below the CEJ and starting to enter the root.  Patient is informed of the extent of the decay and the options: 1. Complete RCT, buildup and crown with guarded long term prognosis 2. Extraction and replacement with implant or bridge  Pt elects extraction in this case.

Tuesday, October 11, 2016

Is Your Endodontist A Partner in Patient Care?

What does it mean to be partners? On a recent episode of the The Profit, starring Marcus Lamonis, he was coaching two business partners on what it means to be partners.  Simply put, "partners need to help each other".  Partners recognize the strengths in each other and value those strengths.  Leaders in business have one goal in mind and that is to make the business successful and add value any way you can.

Is your endodontist a partner in your patient care? What kind of help does your endodontist provide to your practice?  At Superstition Springs Endodontics, our goal as your partner in your patient care is to make your patient's dental/endodontic treatment successful and add value to our relationship any way possible. This includes:

  • Providing the highest quality endodontic treatment
  • Seeing your patients when they need to be seen
  • Being available for consultation and emergency treatment
  • Assisting in treatment planning - especially determining restorability (diagnostic excavation) and evaluation of cracks/fractures - procedures which are often poorly reimbursed
  • Supporting your treatment plan and helping in patient education
  • Providing additional restorative work as requested (posts, cores, access fillings, minor crown lengthening)
  • Effective communication regarding patient care
  • Standing behind the work that we do
  • Providing high quality continuing education to help your practice
  • Searching for unique ways to build your practice (referrals, online reviews, marketing ideas, networking)
If this is the only time you find yourself needing to refer to
an endodontist, you are probably not working together
as true "partners in patient care".

As endodontists, the most fulfilling professional relationships we have with general dentists are those where we feel like partners in the treatment of your patients. These partners recognize our special skill set, specialized armamentarium and how that will benefit their patients saving them time, money and a providing a great experience.  These partners are comfortable enough to call or text us anytime with questions, concerns or feedback.  They are good at case assessment and rarely need to be "bailed out" of difficult cases.

In upcoming blog posts, we'll show some cases that demonstrate how we at Superstition Springs Endodontics work together with general dentists as partners in patient care.