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.

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