Michael A. Miyasaki, DDS

Building relationships in endodontics

What can you tell us about your background?

I was born and raised in Sacramento, California, and attended dental school at the University of Southern California where I graduated in 1987. During those 30 years, I have been very fortunate to have experienced many different aspects of the dental profession. For 27 of those years, I have been involved in education, mostly in live-patient treatment programs, which I consider the best way to learn. I have had the opportunity to travel and work with my dental colleagues internationally, and I always enjoy seeing that no matter where dentists practice, such as India, Russia, Lebanon, Albania, Mexico, or Australia, they are all very much alike. I have always been an active practitioner, but I returned to Sacramento 5 years ago to be closer to my family and then purchased a practice 3 years ago. I have also been an editor-in-chief of a dental magazine and have been involved at an executive level with many dental companies over the years. Dentistry has been much more and given much more to me than I would have ever thought. I must say, I have loved every day.

Is your practice limited to endodontics?

My practice is a general dental practice, and endodontics is one of the services we feel is of value for our patients when we can perform the service in our office. I respect what our endodontic specialist colleagues do and refer when it is in the best interest of our patients or ourselves.

Why did you decide to focus on endodontics?

When I graduated dental school, we used hand files and dipped our radiographs. This was an arduous process, and referring the endodontics was often our best option. A few years after I graduated, I took a live-demonstration course given by Dr. Stephen Buchanan. It gave me an appreciation of what I did not know, but he also gave us a system I could use that was much more efficient than what I had learned in school. Ever since then, I have tried to learn more to improve my endodontic treatment. We can save our patients so much time if we are preparing a tooth and find that the decay is more extensive than we had planned; and we have the option to provide their endodontic treatment at that time and restore the tooth in a single visit. We know that the success of endodontic procedures is best when the coronal portion of the tooth is sealed quickly. By being able to provide endodontic care, we respect our patients’ precious time and make the entire restorative service more predictable.

How long have you been practicing, and what systems do you use?

I have been in practice for 30 years, and over those years have used at least half a dozen systems. Ease of use, versatility, canal navigation, shaping with tooth preservation, retention of tooth structure/strength, cost, and success are some of the factors that I consider. Today I find that Ultradent’s Genius^® system satisfies the factors I consider important. I also find that magnification and cone beam computed tomography, which we use in the office, are great adjuncts to help us diagnose and perform much better endodontics.

What training have you undertaken?

Over the decades, I have taken many endodontic training courses from Dr. Ben Johnson, Dr. Stephen Buchanan, Dr. Cliff Ruddle, Dr. Richard Mounce, and Dr. Kit Weathers. All of them have been excellent educators stressing thorough cleaning and shaping while preserving the radicular tooth structure and then complete obturation. I have found that every course helps me better visualize the root canal systems and treat them.

Who has inspired you?

I have been very fortunate to have many dental mentors, and to each I am grateful. My family continues to provide me inspiration. My father is a dentist who practiced in the Navy and then for over 50 years in private practice and, over that time, developed deep relationships with his patients. He enjoyed the “work,” and I hope I can work as long. My wife was an assistant for almost 30 years and throughout supported my professional growth. My oldest son runs my office, and to see his growth in business and leadership has been rewarding. And I have a daughter who has just begun her dental education at Loma Linda Dental School, and I know she will push me to up my game. My family continues to inspire me, and I feel very fortunate.

What is the most satisfying aspect of your practice?

The relationships we have with our patients. Every day I go to work I am with patients who have been in our practice for over 3 to 5 decades. The next most satisfying aspect is the growth we see in our employees and the progressive nature of our practice to help our patients optimize their health and appearance for decades. The dental profession is very satisfying, but a  well-done root canal is always very rewarding.

Professionally, what are you most proud of?

Being able to improve other’s lives daily brings me great pride. I see this in the relationships we have developed with our patients, the growth I see in the team that I work with, and the change I see in my colleagues while providing education. I am fortunate to be able to receive so much fulfillment from our profession.

What do you think is unique about your practice?

We are focused on relationships, so after a comprehensive examination, we design treatment plans with the patients’ involvement after we explain the condition of their oral health and the options we have. My job is to show them their condition and the possibilities, and they help me determine what they value most, and we proceed in a way that is comfortable for all.

What has been your biggest challenge?

My personal challenge is setting fees that reflect the value of what we provide and yet that work in the world of dental insurance. I was insurance-free for a decade and then purchased a practice that accepted insurance, so we are in the process of transitioning out once again. We want to help our patients and control cost, but we also want time for personal attention and quality, so we can’t compromise. I was recently asked by someone selling a service if I wanted a lower cost product for our PPO patients, and I explained that we don’t treat patients by the fees they pay, but we provide the best we can for everyone. By managing our business carefully, we have been able to strengthen the financial fitness of our practice, allowing us to drop our participation in the last PPO plan I inherited with the practice. We have been educating our patients, so they can make the best insurance choices with this change. We have also been modernizing our office with some of the best technology available, such as digital radiography, cone beam computed tomography, bioelectric diagnostic systems for TMJ, CAD/CAM for digital impressions and milling, perioscopy, the Solea^® (Convergent Dental) and Gemini^® (Ultradent Products, Inc.) lasers, and the Genius endodontic system.

What would you have become if you had not become a dentist?

I would have considered a type of ministry. I enjoy serving others and helping others improve themselves. I see ministry as having a unique business model that provides a service but doesn’t require anything in return, and yet people throughout history will die for their beliefs.

What is the future of endodontics and dentistry?

Endodontics is so much more today than doing a root canal treatment. Just like when I graduated, a filling was most likely done with amalgam, and today there are many restorative options. With microscopes and reparative materials, we can perform microsurgery to repair and retreat teeth. And in the case of teeth that are not repairable, many endodontists today are assisting the patients to move into implants.

Dentistry overall is becoming more corporate-owned, which I think makes sense, although I think in my career, I would like to maintain ownership of my practice. Today it takes so much more energy and capital to run and grow a practice, and the clinical procedures we do are so much more involved and complex. Our new graduates with their education debt need opportunities to succeed. I am excited about the future, but we all have to be willing to adapt our vision of the dental business model, or I am afraid some will wake one day to find they don’t own much.

What are your top tips for maintaining a successful practice?

Keep improving and adapting. The dental profession is changing, but the opportunities are so exciting. Select the right team members focused on serving their patients and train them well to provide the best service possible and allow them to communicate the value of your services to your patients. Embrace change, and invest in education and equipment that will help you provide a better end result to your patients. We all have to grow personally and professionally to grow our business. Today consumers are doing their due diligence (which makes them much better healthcare consumers) about their treatment options and outcomes, so we must work hard to stay ahead of them.

What advice would you give to budding endodontists?

Find a mentor, and invest in education. Build strong relationships with your referring doctors, and provide them with the education that will make them better diagnosticians as this will make your time with their patients more efficient and productive, but in return you will stand out in the minds of your referring doctors. Again make those around you better. With a mentor, you will continue to grow and increase your value, which will in turn grow your practice; there are very few things that feel as good as that. I am not the same dentist I was 30 years ago for sure, but I don’t even think I am the same dentist I was a week ago with all the constant learning we are doing.

What are your hobbies, and what do you do in your spare time?

There isn’t a lot of spare time, but I have found it important to get some sort of physical exercise daily. Dentistry can take a toll on our bodies, and moving helps the comfort and longevity we will have in our profession. I grew up hunting, fishing, and skiing. Today I try to get out and go fishing with my father, and my youngest son, who is 11 years old, has taken up my hobby of flying small aircraft with me. I always enjoy traveling with family both domestically and internationally, so they have a greater appreciation for what they have. And on weekends, I love getting them all together to enjoy a fine wine, produced locally, with my wife’s food.

Top 10 favorites

1. My faith gives me both security and humility. It allows me to relax into life.
2. My family. Nothing else matters as much, and they make everything so much more enjoyable.
3. Sirona Galileos Comfort^PLUS cone beam computed tomography because it allows us to see so much more from endodontic pathology to implant planning, joint health, and airways.
4. A supportive work team. Like family, we carry each other through the challenges of the day, and we celebrate the successes. We encourage each other to do our best and keep improving. We have fun.
5. Fridays. Our workweek is busy, and a couple days of rest allow us to renew and reconnect to those around us.
6. Nothing. Ever been somewhere where there was nothing? No lights, no sounds, just your thoughts.
7. The Genius^® endodontic system, which makes my providing endodontic treatment a pleasant experience.
8. CAD/CAM technology for single-visit restorative patients.
9. Learning. I deliver hundreds of hours of education every year and take almost as much. I would be disappointed if I didn’t learn something new every day.
10. Our dogs. Always the first to greet me, and they love me unconditionally, or maybe it’s because I feed them. I like to think it’s love.