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HOW UNDERSTANDING YOUR

LIMITS CAN MAKE ENDO MORE PROFITABLE

By Lauren Krzyzostaniak

Introduction Let’s say you want to add endodontic procedures to your repertoire, or you want to find out how to make your current endo procedures more profitable. There are several things to consider: knowing what procedures you can and should do and which ones you should refer to a specialist, understanding the time endodontics will require, and understanding the imaging systems that help you perform better dentistry.

Know Your LimitsThe most important thing to keep in mind when implementing endodontic

procedures into your repertoire is your ability and confidence to do them. While it’s smart to try to find ways to make your practice more profitable, it is not smart to cut corners and stress yourself out in the process. If you, as a general dentist, are not comfortable performing endodontic procedures, then by all means refer them to a specialist. The money is not worth the stress, nor is it worth the potential complications that could arise from faulty procedures that resulted from a lack of your confidence or know-how.

If you are comfortable with performing endodontic procedures, know your limits. Perhaps you’re confident in performing a more complicated procedure: that doesn’t mean you should do it. Pick the procedures that can be done in one visit (and lower your risk for postoperative complications) and perform only the ones that aren’t high risk. The American Association of Endodontists has a guideline on how to choose endodontic procedures. In summary, choose ideal patients (those with no medical issues and a good disposition), ideal diagnostic factors (symptoms consistent with conditions, clear X-rays, normal crown morphology), and no history of endodontic treatment or periodontal disease. (For the full list of considerations, download AAE Endodontic Case Difficulty Assessment Form and Guidelines from the AAE website.)

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If you start a procedure but soon find out that you’re in over your head, don’t be afraid to cut your losses. It’s better to refer your patient out early than wait for complications to inevitably arise. Your specialist will be grateful that you did.

Time Your Process and Know Your ValueTake a few weeks to time how long it takes you to do certain procedures. With

this information, you can determine if the profit was worth your time and effort.

In addition, recognize that performing endodontic procedures means you get to charge what endodontists charge. Make sure your fees are consistent with those of a specialist, and if you established fees years ago and haven’t since raised them, consider comparing your procedure cost today and raising them to be consistent with your operating costs.

Establish a Positive Relationship with a SpecialistIf you haven’t done so already, find an endodontists to whom you can refer your

more complicated cases. Work on establishing a positive working relationship with them, giving you the opportunity to use them as a resource when you have questions about endodontics. Even better: perhaps they’ll start referring their patients back to you for those simpler cases or general needs.

Invest in Better ImagingBecause it allows endodontists to better diagnose, evaluate, treat, and care for

patients, having cone beam CT 3-D imaging in the operatory is the new standard. Not only does it allow dentists to provide comprehensive oral health care to patients, it also allows dentists to provide guidance to peers in the industry.

There’s no one-size-fits-all 3-D imaging machine. Instead, there are a plethora of options on the market that are suitable for a wide range of practices. Dentists should do research before committing to one, understanding the machine’s abilities within pre-screening treatments, pain diagnosis, and implant treatment for special needs patients.

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Because of the variety of multi-modality machines (MMM) available for imaging, here is a short overview of the generalities of MMM and how they improve the practices of endodontists.

Ideal MMM CapabilitiesMulti-modality endodontics (MME) describes the use of multi-modality imaging

machines for endodontic procedures. These machines provide images that complement each other, giving dentists a more comprehensive look and enabling them to be better providers. They allow 2-D and 3-D imaging, panorex, periapical imaging, and super bitewings.

According to Brian Trava, DMD, multi-modality machines should be able to take an extraoral bitewing, capturing apexes and separating the contacts with no overlap. They should also have an adjustable rate panorex, a segmented panorex, and an interproximal panorex.

A great MMM will allow you to take large and small volume images in 3-D, in addition to bilateral images. With MMMs, you should be able to view every aspect of the oral-maxillary complex, including the TMJ and sinus. The software of an MMM should have an implant library and the capability to place implants.

Cutting CostsBeing able to take complementary 2-D and 3-D images allows you to issue

better treatment plans, streamlining pre-treatment planning. In doing so, dentists reduce costs with minimized sedation times and make the process safer all around.

CBCT and PreventionCone beam CT scans provide several benefits to practitioners: they allow

dentists to treat current endodontic teeth more effectively, illuminate root morphology for future endodontic treatment, and diagnose developing issues. Seeing the root morphology for all teeth clearly allows you to identify all possible issues in the patient’s mouth, paving the way for increased case acceptance.

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CBCT is also a good option for patients undergoing radiation treatment or needing an organ transplant, as the radiation emanated from one large scan is less than that emanated from several smaller scans.

Pre-Screening and Treatment PlanningMMMs are also effective at providing pre-screenings for medical procedures.

They can highlight any major dental issues, saving dentists money in the long run and ensuring more accurate treatment plans in the short term.

ConclusionThere is a reason that specialists spend more time in school learning their trade

than general dentists. If, as a general dentist, you are not comfortable performing any or all endodontic procedures, don’t do it. The profitability isn’t worth the stress and the risk if you’re not confident. It’s important to know your limits: learning more about what goes into this type of procedures and establishing relationships with the people who do them all day long will help you to determine them. When in doubt, refer out.

How Understanding Your Limits Can Make Endo More Profitable

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