Hi. I'm Keisha Lewis. I'm a senior
dental assistant mentor with Heartland
Dental. Today we're going to cover tips
that will help dental assistants assist
doctors to do root canal therapy more efficiently.
The key is organization and
the ability to think ahead. Understanding
the primary steps of a root canal will
help you with not only your setup of the
procedure, but also in anticipation of
the next steps. Let's start with the
steps surrounding a procedure with WaveOne® Gold.
This is a popular instrument
system. We'll also talk about using a
carrier-based obturation method known as GuttaCore®.
In diagnosis our role as
assistants revolves around the
radiographs. The doctors and the patients
will be making treatment decisions and
plans based on the accuracy of our images,
so it is very important.
Having a correct x-ray means making sure there is
a periapical image and not just the
bitewing before the doctor starts.
This will get the procedure off to a smooth
start. Having quality x-rays means making
sure the doctor can see the entire tooth,
including the apex. Be sure the x-ray is
taken at the correct angle. In the
course of a busy practice day, the least
amount of holdups or redo's we can
have, the better. Let's talk about endodontic
access next. Before we start a
root canal, have you placed the rubber dam?
This is the standard of care expectation.
It allows the doctor greater tooth
isolation and visibility as well as a
huge measure of safety for the patient.
Placing the rubber dam for your doctor
will reduce time, allowing the clinician
to start right away. The recommended
clamps are the 12 A and the 13 A. These
clamps are universal meaning you can
isolate all four quads
just by using two clamps.
Another critical step is making sure all the
burs needed for the endo are included in your kit.
Here is a list of the most
frequently used burs that should always
be ready to go. After access be ready for
instrumentation. Have your RC prep or
ProLube® ready to use. It will be needed
frequently. As I mentioned earlier,
knowing the WaveOne Gold system will
help you determine which files your
doctor may need during this process.
You'll be more confident throughout the
procedure as you help keep things moving
making for efficient chair time and a
better patient experience. You'll always
start with the red primary file. From
there, your doctor will tell you if they
need other instruments based on the
anatomy. That said you don't want to open
the files until you're sure which ones
you are going to be called for. The WaveOne Gold
instruments are pre-sterilized
for one time use and are not
autoclavable. You don't want to waste any
files so be certain what direction the
doctor is going in. After the
instrumentation phase is complete it's
time to fill the canal space. The doctor
can generally reconfirm the working
length with the apex locator. The canal
should have some irrigating solution in
it when the GuttaCore size verifier is
handed over. Once the size is confirmed,
go ahead and set your stopper or the
corresponding obturator at working length.
Use the calibration rings for a more accurate measurement.
This is an example of anticipating
the procedure and working ahead.
The final irrigation of
the canal space is a critical part of
the procedure. This is when we are
washing away the bacteria and debris
that have been removed and preparing the
canal for a complete filling. Having
multiple pre-loaded syringes ready to
use minimizes the time. You don't want to
have to stop and reload your syringe.
Have your paper points open and cotton
pliers ready to hand to the doctor to
dry the canal. Again be prepared for this.
For obturating with a carrier-based
method like GuttaCore, have sealer
ready to go. With the GuttaCore obturator
sizing confirmed, you can put it in the
oven and start the heating cycle. Only do
this when you know the doctor will be
ready for it. The heating takes less than
a minute but can only be kept in the
oven for about a minute after the beep.
Restoration completes the case.
Usually the goal is to bring the tooth back to
function, but there will be occasions
when the restoration will be temporary
and the ultimate treatment plan calls
for a new crown. Have your preferred
composite build-up materials ready. Don't
forget your etch and bond cement and
power up your curing light. Is your
matrix system handy and ready to go? Just
in case? The doctor needs to be ready to
react and respond and that means they
will rely on us for that flexibility
when needed. There are a handful of other
ideas that can make the endo in your
office more efficient. Here is a picture
of a cart that is dedicated to endo.
It has all the items that are related to
the procedure which don't need to be sterilized.
You should also place rubber
dam clamps in your restorative kits.
A great time saver is to pre-load sponges
with your doctor's standard hand files.
And finally, make sure you have several
pre-loaded irrigation syringes stored in your cart.
Endo is a team game. Your work
as an assistant plays a critical part in
the success of the treatment.
Implementing these steps will help you
be more prepared, confident and help your
doctor be more efficient with these procedures.