21st century endodontics has been invaded by economics and the push for shorter procedures in less visits. Single visit endodontics is marketed everywhere and even some endodontists have fallen victim to the trend of giving every patient their best effort in one visit. This troubling trend is leading to poorer outcomes and decreased confidence in endodontic therapy.
Here in our office there are cases that we treat in a single visit routinely and there are other cases that we treat with an “n-step” protocol. N-step simply means that we don’t complete the treatment (obturate the canals) until the tooth is asymptomatic with signs of radiographic healing. It is a patient-centered approach to treatment rather than a procedure-based approach which is taught by dental reps and endo gurus all over the country. How many cases do you have in your office where the root canal treatment was completed (with gutta percha to the ends of the roots with little puffs) and the patient still can’t bite comfortably on the tooth?
By referring your patients to our office this becomes a non-issue. We don’t send patient’s back to you until they are asymptomatic. If a patient presents with biting pain, the canals will be opened and treated with an intracanal medicament (usually calcium hydroxide). If at the second appointment the tooth is still symptomatic, we will continue to treat the canals with medicaments until the tooth is asymptomatic.
Typically all it takes is two or three visits and everything gets better. On select cases where the success of the treatment is questionable, we will wait until there are radiographic signs of osseous healing to finish the treatment. By practicing this way, the predictability of endodontics increases, you can be sure that you are putting a crown on an asymptomatic tooth, and the patient knows they are restoring a tooth no longer hurts. A win-win-win.
Patient presents to the office with swelling and pain associated with #30. Root canal treatment had been initiated in the referring dentist’s office, but the symptoms (toothache, swelling, acute biting pain) never resolved over many visits. The patient came to us with the tooth “open”. At the first visit the canals were lightly instrumented, irrigated, and medicated with calcium hydroxide and the tooth was closed. At the second visit, two months later, the toothache and swelling had resolved but the tooth was still acutely tender to biting. The canals were again irrigated and medicated with calcium hydroxide. At the third visit (another two months), the tooth was feeling much better, but there was still some moderate biting pain. We opted to medicate again. At the fourth visit (6 months from the initial visit) the tooth was completely asymptomatic. Root canal treatment was completed and the access cavity was sealed up with a fiber reinforced composite core (FRCC). The patient was advised to have a crown placed as soon as possible.