How GPs Can Create a Full Root Canal Workflow

Across the country, GPs are finding success expanding their service offering to perform in-house root canal treatments. If this is a prospect for your practice, you'll need to identify the cases you can support in-house and refer the more complex cases to the local endodontist.

In dental school, you're required to complete the training necessary to perform root canal cases. So, you may be able to grow this expertise beyond a few root canal treatments a year to full scale - retaining more of your patients for in-house treatment.

Root canal therapies address infections and damage within the tooth's pulp, often saving a tooth that might otherwise be lost. Developing a structured workflow for this procedure not only enhances the quality of care but also improves patient experience and clinical outcomes.

Here’s a comprehensive guide for general dentists to create a streamlined root canal workflow.

1. Initial Assessment and Diagnosis

Patient History and Symptoms

Begin by gathering a thorough patient history, including symptoms such as pain, sensitivity, swelling, and any previous dental treatments. Ask about the duration, intensity, and triggers of the symptoms.

Clinical Examination

Perform a detailed clinical examination. Look for signs of decay, fractures, discoloration, or swelling. Percussion, palpation, and mobility tests can provide additional insights into the condition of the tooth.

Diagnostic Imaging

Take periapical and bitewing radiographs to assess the extent of the infection or damage. Digital imaging tools can offer enhanced detail and aid in accurate diagnosis.

Pulp Vitality Testing

Conduct pulp vitality tests, including thermal tests (cold and heat) and electric pulp testing, to determine the health of the pulp tissue.

2. Treatment Planning

Case Selection

Evaluate whether the case is within your skill level and comfort zone. Complex cases with severe curvature or multiple canals may be better referred to an endodontist.

Patient Communication

Discuss the diagnosis and treatment plan with the patient. Explain the procedure, potential risks, benefits, and alternatives. Ensure the patient provides informed consent before proceeding.

3. Preparing for the Procedure

Infection Control

Adhere to strict infection control protocols. Sterilize instruments and prepare the operatory to minimize the risk of cross-contamination.

Anesthesia

Administer local anesthesia to ensure patient comfort throughout the procedure. Test the area to confirm effective anesthesia before starting.

Isolation

Use a dental dam to isolate the tooth and maintain a clean and dry working field. This also protects the patient from swallowing or inhaling debris and irrigation solutions.

4. Access Opening and Canal Location

Access Cavity Preparation

Create an access cavity to reach the pulp chamber. Use high-speed burs and ensure you remove all overlying tooth structure without damaging the underlying pulp chamber.

Locating Canals

Use endodontic explorers and magnification tools, such as loupes or a dental microscope, to locate the canal orifices. Enhanced visualization can improve accuracy in locating all canals. Endodontists are trained specifically on dental microscopes for their higher powers of magnification and improved ergonomics. If you plan to scale your root canal service offering beyond several cases per year,  you may want to consider making the investment in your own comfort and visualization ability to a dental microscope.

For more on this topic, watch Dr. Michael Wenzel on his webinar "The Dental Microscope for the General Dentist".

5. Cleaning and Shaping

Working Length Determination

Determine the working length of each canal using electronic apex locators and confirm with radiographs. Accurate working length is crucial for thorough cleaning and shaping.

Canal Preparation

Use rotary or hand files to clean and shape the canals. Employ a step-back or crown-down technique to gradually enlarge the canals while maintaining their original shape. Irrigate frequently with sodium hypochlorite to remove debris and disinfect the canals.

Irrigation Protocol

Utilize an effective irrigation protocol, including the use of EDTA to remove the smear layer and ensure thorough disinfection. Consider using ultrasonic activation to enhance the efficacy of irrigation solutions.

6. Obturation

Canal Drying

Dry the canals thoroughly using paper points to ensure no moisture remains that could compromise the seal.

Obturation Technique

Select an appropriate obturation technique, such as lateral condensation, vertical compaction of warm gutta-percha, or thermoplasticized obturation. Ensure the canals are completely filled without voids.

Radiographic Verification

Take a post-obturation radiograph to verify the quality of the obturation. Check for complete filling of the canals to the apex and absence of voids.

7. Restoration

Temporary Restoration

Place a temporary filling to seal the access cavity if a permanent restoration cannot be completed immediately.

Permanent Restoration

Restore the tooth with a permanent filling or crown as soon as possible to prevent reinfection and ensure the tooth’s structural integrity.

8. Follow-Up and Aftercare

Post-Operative Instructions

Provide the patient with post-operative care instructions, including pain management and signs of potential complications. Schedule a follow-up appointment to monitor healing.

Follow-Up Evaluation

At the follow-up visit, assess the tooth for signs of healing and resolution of symptoms. Take a radiograph to confirm the absence of pathology and proper healing.

Questions? We Can Help!

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If you’re considering adding a microscope to your practice or you just want to learn more about utilizing a dental microscope, we are here to help! Please feel free to reach out at 800-861-3585 or by clicking the button below.