|
How I virtually eliminated positioning check
films
Here’s how upgrading from a traditional
apex locator to an “all-fluids” design slashed the time
required for endo. And, more important, my results have never been
better.
by Rodger Kurthy, DMD.
Mission Viejo, California
If your endo armamentarium doesn’t include a new-generation
“all-fluids” apex locator, such as the Root-ZX®
or Foramatron® D-10, you’re wasting time during
RCT. A lot of time. Unlike earlier locators, these devices pinpoint
the foramen though sodium hypochlorite, anesthetic solution or blood.
To me, however, the really important benefit is their improved accuracy.
When I first started using the Foramatron “All-Fluids”
D-10, I’d get an instrument readout and then ‘confirm’
it with a radiograph. If the film showed the file short of the apex,
I’d jump through hoops trying to decide who to believe.
Tedious …
Sometimes, I could ‘feel’ the constriction … and
when I could, it was always where the D-10 (NOT the radiograph!)
said it was. If I couldn’t feel the constriction, I’d
assume the film was right and file to radiographic apex. As a result,
I’d instrument through the foramen and get unstaunchable bleeding.
So I’d start reducing my working length little by little. After
lots of hard work and sweating bullets, the bleeding would finally
stop, but not until I was back to the point my apex locator had
originally identified.
No positioning film
The first time I skipped the positioning films, I really had no
alternative.
From the pre-op radiograph, I knew this upper molar was going to
be a problem. The roots converged and were inside the densest zygomatic
arch I’d ever seen. There was no way to visualize the three
apices in that situation.
As a result I flew entirely by the D-10 readings. And the results
were fine.
Next came a restorative case. When I began caries elimination I
discovered the tooth needed root canal therapy. The patient was
leaving for several months, so I had to perform the RCT at that
appointment! Now there’s nothing quite like surprise endo to
mess up a day’s schedule. And it got worse. The endo turned
out to be a real pain. By now I was running terribly behind. Based
on my growing confidence in the apex locator and my recent experience
flying by instrument with the molar, I decided to forgo the positioning
film.
When my assistant showed me the final film, it was perfect. And
again, no untoward post-op consequences.
After that, whenever I was rushed, I’d forgo the measurement
films. And the results were consistently excellent.
So one day I asked myself, “Why am I taking positioning radiographs
at all?” Either they confirm the apex locator. Or they don’t.
And when they don’t, it inevitably turns out that it’s
the apex locator (not the x-rays) that’s telling me the truth.
As a result whenever the pre-op radiograph indicated that the tooth
was appropriate for electronic apex location (no ankylosis, etc.),
I stopped taking radiographs as my normal routine. I didn’t
realize how time-consuming it is to stop the endo, have the film
taken, get a ‘quick-dip’ film, etc.
For the last 250 cases, I haven’t taken measurement or master
cone films at all — just initial and final films. And so far,
I’ve not been disappointed.
Here’s what it’s meant to my endo
Since using an all-fluid apex locator for my measurements, I have
much less trouble with bleeding canals. I like that. Also, I don’t
destroy apical constrictions here and there anymore. I like that
too. And just imagine doing two upper molars side-by-side, say #14
and #15. Think how much time I save by quickly determining the lengths
of all six or seven canals electronically. If you use radiographs,
or even ‘confirm’ length with radiographs, you’ve
got to deal with obscurity of those apices when they superimpose,
when they’re hidden under the zygomatic arch, when roots converge,
and when they have a foramen short of the radiographic apex.
Think of the reduced x-ray exposure!
“When I use my apex locator, where is the point for obturation?”
This is probably the most frequent question I’m asked by new
users of electronic apex locators. And the answer is very simple.
The point for obturation is exactly where it would be if you weren’t
using an apex locator.
Let me explain.
There are a number of different philosophies concerning the “best”
fill length. I’m a “0.5mm-short-of-the-foramen” guy.
But some dentists prefer to fill to the apex. Others like to see
a little “puff” of sealer out the apex. Which philosophy
you consider “correct” depends on which dental school
you went to, who your dental heroes are, and what your personal
endo experience has been.
An all-fluids apex locator like the Root-ZX or D-10 lets you identify
this goal faster, more accurately and with reduced x-ray exposure.
The device doesn’t force you to accept its philosophy of obturation.
All-fluid devices use several frequencies to determine the position
of the file tip. But the algorithms used to convert the electrical
signals to a readout vary from manufacturer to manufacturer.
So when first learning to use a new apex locator, I suggest you
do what I did. Use the locator as an adjunct to film ... not a replacement.
Start with some anteriors that are easy to read on a film. It won’t
be long before you recognize what a “good” readout looks
like. When I use the Foramatron D-10, it’s the yellow light
immediately preceding the apex signal. But you might prefer a different
signal. Once you have confidence in the device, start using it on
more difficult teeth.
At some point you’ll discover that you “know” what
your radiograph is going to look like even before you see it. Only
then should you start thinking about eliminating the check film.
Bottom Line
Now don’t misunderstand I’m not arguing that you should
get the same apex locator I have. I’ve talked to Root-ZX users
who are just as enamored with their device as I am with my Foramatron
D-10. I suspect the benefits I’ve experienced would be true
of any forth-generation all-fluids apex locator.
As a guy who was a fan of the earlier generation of electronic apex
locators, let me tell you that the newest generation is simply better.
- If you do any endo at all and have never tried an electronic
apex locator because you heard they were technique-sensitive,
try one now. This new generation of devices is so “non-fussy”
you can’t believe what it can do for your productivity.
- If you tried an earlier generation of apex locators, and gave
up because it seemed to be more work than it was worth, try this
new generation. They are unbelievably easy to use. No rinsing
and drying. No getting the canal precisely right for a reading.
- If you’re currently using an earlier generation of apex
locator, invest in a new one. It’s better. It’s faster.
And despite what Parkell may tell you, I’m positive it’s
more accurate. (Incidentally, prices have dropped dramatically.)
1 Custodio AF, et al. Comparative study
for working length determination due to digital radiography and
apex locator methods. Jour of Dent Res. 80:4, Abstr #32, p1002,
Apr 2001
2 Krupinski J, et al. The assessment of the agreement of root canal
measurement by the radiological and the electronic methods
For more information on Foramatron D10 click
here.
©2002 Parkell, Inc.
Notice
Marketing
handbook: Ways to attract only the BEST new patients! And LOTS of
them!!
Rodger 'Rod' Kurthy, DMD (DentalTown's on-line marketing maven and
frequent contributor to Parkell Today), proposes that great-looking,
expensive promotions often fail to attract the kind of quality patients
you're looking for.
Rod's new book, "THE 'NO-COUPON' MARKETABLE DENTIST" reveals
30 proven techniques Dr. Kurthy has used in his own practice to
generate a constant stream of good patients.
Marketed by New Patients, Inc. Read more about it, or order on their
website: www.newpatientsinc.com.
|
