Address endodontic failure, to encourage acceptance
Featured Products Promotional FeaturesPosted by: Dental Design 6th July 2021
Endodontics has a high success rate and patients report how they now enjoy improved health and comfort as a result of their decision to say “yes” to it. Failure can and does occur though, and for individuals who are reluctant, the job is to keep them focussed on the positives.
Modern, empowered patients will do their own research before embarking on any kind of treatment. Although some information will come from the dental team – treatment coordinators are particularly valuable at managing the acceptance aspect of a patient’s journey – the practice does not have full jurisdiction over the knowledge-gathering process. One of their first stops will almost certainly be the internet, where they can read about the good, bad and downright ugly of root canal therapy. But they won’t only be looking online; they may know someone who has experienced unsuccessful endodontics, and who plants the seed that root canal therapy doesn’t work.
It is important to never be dismissive when a patient tells you, “Yes, but what about X, Y or Z?” when you are proposing a treatment plan. Quality dental care requires them to spend their money and time at your practice. Since the pandemic, you’ll see people more motivated than ever to maintain good oral health and willing to invest in it, but many others who will have pushed it further down their priorities list for all sorts of reasons, including financial.
Practices that engage in effective communication, to not only avoid disinformation but to build relationships, will find they have better treatment acceptance. Your goal should be clarity and transparency, rather than one-sided conversations based only on your professional point of view. Offer your diagnosis, show them how you reached your clinical conclusion, but be prepared to address treatment failure, to explore their reasons for doubt and talk about any horror stories they might have heard. When communication is open, honest and equal, you can work together to achieve a successful and enduring outcome.
What may complicate matters further, is if they have already had endodontic treatment that failed. These patients may have come to you as a referral; quality dentistry means knowing when to refer, and also having the ability to make a strong case for referral to a specialist, who may be based in a different practice. Teamwork between referring and specialist practices has always been crucial, now more than ever a joined-up effort will see more patients returned to health.
There are a number of common factors why treatment does not remain stable, from the persistence of bacteria to leakage (improper coronal seal), a broken crown, also the presence of untreated canals that may have been missed the first time around.[i] Root canal systems are intricate and failure to treat an additional canal is one of the main reasons cited for endodontic retreatments.[ii] It is also why referral to a specialist supports success for all endodontic cases, as they can employ all their experience and knowledge to identify then treat even canals that are tricky to locate and negotiate, because they’re hidden deep in the mesial root. A canal might be heavily calcified and narrow, or curved – good, careful preparation, shaping using flexible, yet robust instruments can also mitigate the risk of failure.
Acceptance of retreatment can be encouraged by a clear explanation of the steps that you will take to achieve your goal. Once again, communication is your most effective weapon, so a patient has all the information they need and knows that they can get in touch if another question occurs to them, no matter how minor they think it might be.
Retreatment means the pulp chamber will need to be re-accessed, and the existing obturation materials cleaned away before proceeding. For non-surgical retreatments, COLTENE’s HyFlex™ REMOVER file will remove all the gutta-percha mechanically, without the use of solvent. As solvent can be toxic for patients, this is another “selling point” for your endodontic retreatments and once you’ve completed this stage using this specially designed file, you can move on to reshaping the canal. This is an example of quality, efficient and high-value endodontics: using the right techniques and tools for a predicable, stable result.
The factors for endodontic failure may or may not be avoidable, but they must be addressed. With endodontics, as with all dental treatment, there is a fine line between dismissing patients’ independent research and correcting misinformation in order that they have are confident in their decision to go ahead. Referral to a specialist is key, as are instruments that can guarantee your success. When endodontic patients are returned to their dentist, pain free and healthy – whether this is a primary or retreatment – they are the best adverts for root canal therapy, to avoid a dental extraction, and achieve better oral and all-round health.
For more on COLTENE, visit www.coltene.com,
email info.uk@coltene.com or call 0800 254 5115.
Author: Mark Allen, General Manager at COLTENE
[i] Tabassum S, Khan FR. Failure of endodontic treatment: the usual suspects. Eur J Dent. 2016 Jan-Mar;10 (1):144-147. doi: 10.4103/1305-7456.175682. PMID: 27011754; PMCID: PMC4784145.
[ii] Witherspoon DE, Small JC, Regan JD. Missed canal systems are the most likely basis for endodontic retreatment of molars. Tex Dent J. 2013 Feb; 130(2):127-39. PMID: 23930451.
