As you are working on your patient with rubber dam in place, accessing a second molar, it hits you: Should I really be doing this root canal? You wonder if this patient is receiving the best clinical care at this particular moment with this particular procedure. Chances are if you are in the middle of an endodontic treatment, hopefully you’re not having these pensive thoughts. But if this thought crosses your mind, then it begs another question: Should you bring on an endodontist to regularly treat root canals in your office?
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As dentistry has grown, so have the expansive skills of the private practitioner. Many dentists place their own implants, remove impacted wisdom teeth, do aligner-based orthodontic therapy, and treat pediatric patients. But what about when it comes to root canals? Advances in dental technology, both in radiography and material science have made endodontic accessibility and obturation more predictable and manageable. Despite technological progresses, there is still a higher failure rate among root canals when performed by a general dentist as opposed to an endodontist. According to Dr. Moein Darjani, an Orange County, California-based endodontist, “ A majority of the root canals I perform are retreatments of failed root canals.”
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Statistics are murky when determining the percentage of failed root canals performed by general dentists vs. endodontists. However, statistics show that root canals performed by endodontists tend to have a lower failure rate compared to those performed by GPs. An added two years of specialty training to become an endodontist equates to more experience with challenging cases that general practitioners usually pass on. In addition, the regular use of advanced imaging by endodontists helps with minimally invasive access and locating difficult-to-find accessory canals, which could otherwise be missed by the naked eye.
Depending on your location in the country, the option may exist to bring on an in-house endodontist, and not refer out root canals that you are uncomfortable performing. First, patients appreciate the convenience. There is the familiarity they have with your staff and office, where they already feel welcome and know the surroundings. In some instances, the final restoration can be performed the same day, saving patients another visit. Secondly, patients may have more peace of mind when the root canal is performed with you nearby. Your presence during the treatment can help ameliorate anxiety and any pending concerns patients may have. Most importantly, when the treatment is performed by an endodontist in your own office, there is a higher level of trust transference. Patients may take your word about the clinical prowess and painlessness of a specialist you are referring them to, but when your office has an in-house endodontist, they will be more trusting toward the treatment plan.
Bringing on an endodontist in your office also will generate more revenue for your practice. GPs can create a contract where they pay the endodontist a percentage of collection of each root canal that they perform, as opposed to referring out the entire amount. Keeping a percentage of each root canal that you diagnose can add up to thousands of dollars annually that otherwise would have been lost income. Bringing on an endodontist is one step toward building a more comprehensive private practice; except if you’re in a rural area, then finding one might be harder than locating an MB2 canal.
Author disclosure: Dr. Iman Sadri receives no compensation from the Carl Zeiss brand.
Iman Sadri, DDS, is a cosmetic dentist and writer. He is a 2008 graduate of the NYU College of Dentistry and maintains a private practice in Orange County, Calif. Contact him by email at [email protected].
