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Root Canal Academy

Endodontic Resources to Make You Better Tomorrow!

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BUT WHY CAN’T WE FINISH THIS TODAY?

March 7, 2018 by reid pullen Leave a Comment

(The story of my witch patient)

In a perfect world we would finish all of our root canals in one visit, prep the tooth, and cement the crown an hour later. It would be seamless and effortless and everything would succeed. Unfortunately, life is not ideal and endodontics is not perfect, patients can be a pain in the rear, and sometimes it takes two visits to finish root canal treatment.

So how do we manage patient expectations prior to the start of the root canal process? How do we communicate the reason why we are needing two visits to complete the endo? How do we make sure the patient comes back for completion and does not get lost in the sauce?

In the Army, I performed root canal treatment on a real live WITCH. She was a wife of an American soldier who happened to be a Wicca leader for the military in Germany. She came in one day on an emergency basis in a great deal of pain. I performed a pulpectomy (cleaned out the majority of the nerve to the apex at least up to a #25 hand file- ideal pulpectomy) and placed calcium hydroxide. I informed her that she needs to come back so we can complete the root canal treatment and restoration. I then promptly forgot about her except the witch part.

One year later she comes back to the clinic swollen and in pain. I look back in the records and see that she never came back for the completion of the root canal treatment or restoration and that we never called to re-appoint. Now I’m nervous because she’s a witch and what if she puts a spell on me (she told me she is a good witch and only practices white magic and doesn’t really place spells on people- Yes I asked her!)?

Again I perform a pulpectomy and place new calcium hydroxide and place her on antibiotics (I routinely give Amoxicillin 500mg, 1 g loading dose and then Tid for one week or for serious infections or an allergy to Penicillin, Clindamycin 300mg, 600mg loading dose, Tid for one week). This time she comes back in a week and I complete root canal treatment and the restoration and it was a success because I exited the Army 8 months later (geographic success!).

I have learned a lot since the early days and now I have communication procedures for everything I do in my practice. My goal is to manage patient expectations right out of the gate. Fist off, I tell my patients that, “This root canal will take an hour to an hour and a half and it may take 2 visits”. I have said this phrase ~8000 times and it works. If it takes two visits, I tell them, “We had to place an antibacterial medicine inside the tooth to help kill the infection.” If its vital (Irreversible pulpitis) then I say, “We had to place an antibacterial medicine inside the tooth to help kill the bacteria (because the tooth is not infected)”. I have said this ~3000 times and patients accept it for the most part because you are placing medicine to help kill the infection and in their mind prevent it from spreading.

The last step is to have good recall and re-appoint systems so that the patient does not get “lost in the sauce.” Make sure your front office appoints the patient for the completion appointment prior to them leaving and call and remind them of their next appointment.

I hope this helps. Please visit RootCanalAcademy.com for more patient one-liners.

Happy Endo My Friends,

Reid

 

 

Filed Under: Patient Communications, Patient Management Tagged With: Calcium Hydroxide, E3 Endodontics, Learning Root Canal Procedures, Root Canal Academy, Two-visits, Witch

You Are the Message (Patient Communications)

March 5, 2018 by reid pullen Leave a Comment

Dear Clinician,

Root Canal Academy is launching a new content series on ‘Patient Communications,’ which is a response to the numerous questions that I am getting about the topic directly, or questions that point to the effectiveness of patient communications. It is clear that the topic warrants a special series.

Managing patient expectations prior to starting the root canal treatment is vital to preventing miscommunication and possibly angry patients. Patient expectations are formed by HOW YOU SAY WHAT YOU SAY. When you link your treatment procedures with your communications, and state your recommendations confidently, patients are inclined to feel satisfied. Happy patients tend to be much more enjoyable and they also pay.

I hope you enjoy this first discussion about ‘how you communicate,’ and see how it can greatly influence the success of your treatment.

https://rootcanalacademy.com/wp-content/uploads/2018/03/PatientExpectationsPriortotheRCT.mp3

 

Please ask any questions or give me comments,

Reid

ReidPullen@RootCanalAcademy.com

Filed Under: Endodontic Education, Patient Communications, Root Canal Education, Root Canal Procedure Teaching, Uncategorized Tagged With: E3 Endodontics, Learning Root Canal Procedures, Root Canal Academy, Root Canal Procedure

Endodontic Education: Root Camp Boot Camp

January 19, 2018 by reid pullen Leave a Comment

Dear Clinicians,

I would like to introduce our 2 Day Root Camp Boot Camp where our goal is to make you better.  The 2 Day Root Camp Boot Camp has been going strong for 4 years and is proven to help you become an effective, efficient and excellent root canal clinician.  This course is designed for the general dentist and includes lecture, discussion, plenty of hands-on and a live patient molar demonstration performed on the Tru Vision Television monitor for easy viewing.  This is a fun informative course designed to get you back in the root canal game and achieving predictable results.  This Friday/Saturday January 26-27, 2018 course in Brea, CA includes all meals and a dinner at the amazing Brea Yardhouse.  To reserve your spot for this exclusive course please sign up quickly as this course is limited to twelve participants, and is first-come, first-serve. Contact the office of Reid Pullen at (949) 529-9029, or contact Dentsply Sirona Endodontics at (800) 662-1202, or visit the education section of www.Dentsply.com.  We look forward to seeing you and making you the best root canal clinician possible.

Sincerely,

Reid V. Pullen, D.D.S.

Diplomate of the American Board of Endodontics

Founder of Rootcanalacademy.com

 

Filed Under: Quarter 1, Quarter 2, Quarter 3, Root Canal Playbook, Uncategorized Tagged With: Access, Case Selection, Dentsply, Diagnosis, E3 Endodontics, Learning Root Canal Procedures, NiTi Shaping, Obturation, Reid Pullen

PROROOT ES — ROOT CANAL SEALER

July 22, 2016 by reid pullen Leave a Comment

ProRoot ES (Endodontic Sealer) from Dentsply Tulsa is a new sealer that came to market in May 2016. It comes in a box with 12 MTA like packets and 12 gel ampules. Each packet is intended to be a unidose and contains plenty of powder to predictably obturate any tooth in the mouth whether it has 1 or 6 canals. In this RCA product demonstration, I’ll describe Dentsply’s ProRoot ES, communicate its benefits, and in a patient video demonstration, provide insight to how to use ProRoot ES with patients.

 

Calcium Silicate Sealer

ProRoot ES represents a continuing paradigm shift in endodontic sealers toward calcium silicates or bioceramics. These new sealers are not just sealers but can also serve as an apical filler. Historically the gutta percha cone is buttered or lightly coated with a thin layer of Thermaseal Plus Ribbon Sealer (Dentsply Tulsa) or Pulp Canal Sealer EWT (Kerr Endodontics) and then placed in the canal to working length. The ultimate goal is to have a thin layer of sealer between the gutta percha, dentin and any portal of exit (foramen). The sealer serves as a sealer and in this technique it is better to have a tight fitting gutta percha cone that “fits and fills” the apex or the foramen with just a small layer of sealer in between. The Warm Vertical compaction technique serves to heat the apical end of the gutta percha so that it can be molded and plugged to intimately fill the foramen or apical exit thus obtaining an excellent seal between the ‘inside’ and ‘outside’ of the canal system.

ProRoot ES Description

 

 

ProRoot ES Packaging Micronized Gutta Percha

In reality, it is difficult to place a heated tip into the gutta percha within 4-5mm of the working length. Heat only travels 4-5mm down the gutta percha point so in order to heat the apical 1/3 and get a true apical seal the heated tip must reach that level. Often times this is not possible due to canal curvature, length, or smaller canal shapes (04 taper). So in essence the majority of dentists are performing a single cone obturation with Thermaseal Plus Ribbon Sealer or Pulp Canal Sealer EWT due to the fact that they are unable to get the heated tip within 4-5mm of the apical gutta percha.

It is my opinion that most dentists are performing a single cone obturation with the wrong sealer mainly because they feel warm vertical condensation is either too technique sensitive or takes too much time.

Why use calcium silicate sealers?

ProRoot ES represents a shift in sealer technology in that it not only seals the canal system but it also acts as a filler. Dentists can perform a double butter single cone hydraulic condensation with ProRoot ES and the new Dentsply Tulsa micronized gutta percha points (excellent fit due to greatly reduced error rate on size) and not worry as much if the apical end of the gutta percha cone fits perfectly into the foramen size. The ProRoot sealer will flow into the apical foramen filling any excess space and forming a tight seal.

ProRoot ES Patient Demonstration

 

What are some other benefits of ProRoot ES and calcium silicate sealers?

1- Massive reduction of post-operative sensitivity.
2- Osteogenic/Osteoconductive= can promote cementum growth
3- Antibacterial
4- Setting pH 11.6, Set pH 11.7
5- Bonds to the dentin and gutta percha
6- Hydrophilic= the sealer will set in moisture
7- Excellent Flowability
8- Excellent Coatability- the sealer coats the dentinal walls in a 360 degree fashion
9- Does not promote periradicular inflammation
10- 65 minute working time
11- Relatively quick set time of 12 hours (quick in the sealer world)
12- Re-treatable
13- Can seal apical perforations (in theory)

Here is what the packaging looks like:

ProRoot ES
ProRoot ES
WaveOne Packs
WaveOne Packs

 

 

 

 

 

 

Calcium silicate sealer, such as ProRoot, can certainly help us with our desired E3 goals of being more effective and efficient, yielding excellent results with patients.

–Reid Pullen

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Interested in being ‘Better Tomorrow?’  Become a Resident Member of Root Canal Academy. Or try us by joining our Join RCA’s Free Library.

RCA’s email list will keep you informed, as will our Twitter, Facebook, and LinkedIn feeds below. Thanks for visiting!

 

Filed Under: Product Demonstration, Root Canal Playbook Tagged With: Demonstration, E3 Endodontics, Learning Root Canal Procedures, Root Canal Academy, Sealer

Learn Excellence in Root Canal Technique

July 18, 2016 by reid pullen Leave a Comment

Benefits of Root Canal Academy’s Two-Day Root Camp Boot Camp Course

I have seen numerous dentists roll through my 2 Day Root Camp Boot Camp courses these last 3 years and I have received a ton of feedback on whether these courses really help the general practitioner to practice E3 Endodontics. E3 Endodontics means being Effective in technique, Efficient in its application, and thus achieving an Excellent result. E3 Endodontics is where it’s at. If you are not confident and effective during the root canal process than the efficiency is reduced. If the efficiency is reduced than it is more challenging to produce an excellent obturation and final post-op radiograph.

 

LIVE or ONLINE: 4 Qtrs of the Root Canal Game

My goal in teaching the 2 Day Root Camp Boot Camps (Standard RCT and Simple ReTx boot camps) is to help the general dentist “Be Better Today and Tomorrow” while performing root canals and simple Re-Tx’s in their practice. How do I achieve this grand goal?

#1 The 2 Day Root Camp Boot Camps will give you a root canal plan or prescription that works for every case. I call it the Root Canal Playbook. You will learn to follow the 4 Quarters of the Root Canal Game for each and every case.

#2 The 2 Day Root Camp Boot Camps will give you the confidence that you are performing better technique and using it in the correct application.

#3 The 2 Day Root Camp Boot Camps will increase your efficiency and reduce your total root canal treatment time. The live patient demonstration along with lecture, discussion and hands-on shows you how this can be done.

#4 The 2 Day Root Camp Boot Camp will help you boost your office endo production. You will learn to tackle simple to medium cases and complete them in 1/2 time you were before. Material overhead for each endo case averages $50-75 while your molar production can be anywhere from $700-1200 or higher. Not a bad overhead to production ratio!

#5 Lastly, The 2 Day Root Camp Boot Camp will make you better in endodontics forever as long as you consistently apply the 4 Quarters of the Root Canal Game principles.

 

Satisfied Customer

My friend found this online and sent me this unsolicited testimonial:

“Joseph, I recently attended a Dentsply endo weekend Boot Camp, given by Dr. Reid Pullen in Brea, CA. I think it’s the best course (besides cerecdocs, of course) I’ve ever taken. I wanted to feel more confident doing molar endos, finding and obturating MB2, getting around curves, etc. Pullen is an absolute master and excellent teacher. We spent 2 days in his office. Small group of 6. Now I went to feeling indifferent about endo to loving it. Attached is a recently done upper second molar.”    –Dr. E. Prouty

 

Dr. E. Prouty Tooth #15

EProuty Tooth 15

 

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See Reid Pullen’s teaching schedule on the Root Canal Academy ‘Learn’ page.

 


 

Keywords: 2 Day Root Camp Boot Camp, E3 Endodontics, Root Canal Playbook, 4 Quarters of the Root Canal Game, Learning Endodontics, Learning Root Canal Procedures

 

Filed Under: Root Canal Playbook, Uncategorized Tagged With: 2 Day, 2 Day Root Camp Boot Camp, 4 Quarters of the Root Canal Game, E3 Endodontics, Endo, Endodontics, Learning Endodontics, Learning Root Canal Procedures, Root Canal, Root Canal Academy, Root Canal Procedure, Root Canal Treatment

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