Transcendent endodontics: the seven key attributes

Great endodontic clinicians produce consistent results. How do they do this? What characteristics do they have in common? Listed in no particular order are seven attributes (among many potential choices) that I believe most personify top endodontic clinicians:

1. The best clinicians learn from their mistakes so each setback improves future results. Seeing a potential problem early, as a result of past experience, and taking evasive action is far preferable to repairing iatrogenic problems later. Continuing education is a priority.

2. Top clinicians are compassionate. They keep their emotions in check. These individuals don’t internalize the stress and negativity that can come from routinely treating people in pain. Rather than burn out from the technical and personal challenges of endodontic practice, the astute clinician sees the opportunity to both help people and improve technically. Inherent in this skill is the ability to communicate well at a personal level with both patients and referring doctors. In essence, to arrive excited, refreshed, and more experienced every day at the office.

3. Pain control is essential in modern endodontics. Being proficient with intraosseous systems like the Anesto (W&H) or the X-tip^® (Dentsply), as well as periodontal ligament (PDL) injection/anesthesia delivery systems such as the The Wand^® STA^™ (Aseptico), can be a lifesaver.

4. Receptiveness to new technology challenges one’s comfort level and raises the standard of care. An endodontist without nitrous oxide (among other anxiolytic techniques) or without cone beam computed tomography (CBCT) is handicapped, in my opinion, by not offering patients all they deserve. When you need these tools, you need them, not platitudes about how expensive and unnecessary they are.

An example of new and emerging technology is Sonendo^® (Sonendo.com), a future game changer in the endodontic space. Be prepared to see existing treatment concepts, protocols, and armamentaria cast aside like honeymoon pajamas. A growing body of double-blind university-based literature is in line for submission and publication that will show canals and dentinal tubules cleared of tissue, bacteria, and biofilm. Stay tuned.

The best clinicians learn from their mistakes so each setback improves future results. Seeing a potential problem early, as a result of past experience, and taking evasive action is far preferable to repairing iatrogenic problems later.

5. Masterful clinicians appreciate canal anatomy through tactile sensation with stainless steel hand files before using rotary instruments. Creating patency, especially in blocked and transported canals, is an art that requires skill, passion, and time. There are no shortcuts to the apex.

6. Patience, skepticism, and attention to detail are all virtues. Savvy clinicians do not make assumptions or skip steps in the interest of saving time. While there may be many areas where improvisation and innovation “on the fly” are essential, the endodontic procedure is a series of many small steps that cumulatively add up to what we call a root canal. Get all the small steps right, and the final result is assured.

7. Flexible treatment strategies and preparation for the unexpected should be the norm, not the exception. Stuff happens. The clinician should anticipate any number of potential scenarios at any given moment, some more probable, some extremely unlikely. Based on the circumstances, the clinician must be prepared to shift gears quickly and be aware that the correct forward path may not be absolutely clear. For example, if the perforating needle of an X-tip (mentioned above) were to break, does the clinician immediately lay a flap to remove the fragment? Does her/she refer to an oral surgeon? Should the removal be done by the endodontist later? Is it essential to remove the fragment? Can it be left? Said differently, there is no place for tunnel vision at the highest level, only focus on both the problem as well as the range of given solutions at that moment.

Seven key attributes of top endodontic clinicians have been discussed. Emphasis has been placed on a high level of communication, focus, and dedication to continuous learning and investigation of new technology and techniques. I welcome your feedback.