Taking a closer look at Endodontics - a conversation with Dr. Gergely Hriczó-Koperdák Part 1
At the beginning of your career, you wanted to be a research doctor. How did you get into the specialty of endodontics? What attracted you?
HKG: Endodontics is one of the most special part of dentistry, you can use the most varied and versatile range of materials, tools, and instruments, it is an entire new world within dentistry. From diagnostics to prognosis assessment, rigorous treatment protocols are available which are in line with the professional guidelines and resolutions proposed by European (ESE) and American (AAE) associations, and endodontics professionals are expected to keep up to date their knowledge in these fields.
The journey has begun, after I’ve completed in 2018 my professional exam in conservative dentistry and prosthetics. I have performed an increasing number of root canals, which make up a significant proportion of tooth-retaining treatments. However, in many cases I did not find enough to use the usual free-eye control method over the interventions, so it would have been a mistake to leave the operating microscope already available in the office untapped.
The phrase "good is easy to get used to" is true, well, it's especially true for microscopic treatments, and its positives in ergonomics haven't even been discussed. At that time, I undertook to submit my application for the "Endodontics" specialization of the newly obtained examinations, supporting all my cases with complete documentation (initial status, X-ray and photo documentation on the steps of the treatment, and after the recovery).
Hearing the need for root canal freezes the blood in a person. Where can this perception come from? What does this treatment look like today?
HKG: Unfortunately, it is a common thing that most patients have negative experiences with root canal treatment. Perhaps the most common reason for this is that they visit the dentist only too late (in case of gingivitis, acute rheumatoid arthritis), when they may already have incurable pain, and although the former doctor did everything according to the rules to keep the tooth, the overall impression of the patients remains unchanged due to the predominance of prior discomfort.
However, in many cases, the objective approach to dispelling patients’ negative experiences remains insufficient, and it is therefore a real challenge to resolve a case not only from a purely professional perspective, but to gain real patient satisfaction and trust. Simply put, from a medical point of view, we start from a "disadvantage" in many cases. At the same time, the establishment of a doctor-patient relationship, communication and the exploration of facts, as well as empathy and humility, contribute greatly to counterbalancing this. Many patients visit the clinic as a last resort to save their teeth (because they have already given up elsewhere or simply have not taken up the case), so I think it is very important for the patient to feel that we are doing everything we can to feel comfortable and help in forgetting the previous negative experiences.
You were the first to use the microscope at Dentop Clinic, first only in complicated cases, then today it is part of the protocol and you only treat it with a microscope. What gives you more? Is the "workspace" really more visible?
HKG: That's right. As I mentioned earlier, at first I only used the magnification in situations where I found it relevant to use. Looking back, I am not saying that it was a mistake, but it is simply not possible to compare the image reproduced by the resolution of the human eye with the spectrum at 10x or 20x magnification. We are talking about small details that can be seen, explored, cleaned and sealed with complete confidence with the control of the free eye. It is no coincidence that the foreign literature mentions this field as "operative microsurgery" in many places; since we must notice formulas smaller than a millimeter (eg hairline cracks, fractures, undiscovered root canals) in the treated area which most of the times gives explanation on why the previously treated tooth not healing.
Why did you decide that even though using a microscope required a whole new attitude, you would still switch to it?
HKG: The reason is simple: you need to step out of our comfort zone, to expect progress in your professional development. Yes, the use of this tool requires a completely different attitude not only from the physician, but also from the assistant regarding lying treatment and four-handed treatment. Since the control of the work area during magnification rather limits the peripheral field of view for the physician, in many situations she can rely only on the active participation of the assistant, which requires great training, routine and confidence.
If the patient asks, Doctor, why would it be better for me to treat the tooth with a microscope, what would you answer?
HKG: To this question of my patients, I always tell them, that the nature of the treatment won’t change just because we use a microscope or not. I mean, in each case, after local anesthesia, the work area is isolated with the help of a cofferdam (saliva compartment), and then the subsequent work phases are carried out according to the cleaning-expansion protocol. Obviously, each case is unique, so during the preliminary planning I try to prepare for all the expected or unexpected. outcome, before the treatment I think it over what and how I will do it, it’s a kind of simulation. This may sound strange right now, but sometimes I feel like I have a "déjà vu" feeling, even though I treat that tooth there and for the first time, yet I follow it essentially along the lines of a pre-established pattern in my head. Of course, you have to improvise, but that’s why this profession is beautiful. I can't really argue against not doing a root canal under a microscope, for me there is no such thing as a "simple case, it can go without it" because, as I say, a blink of an eye seems to be the simplest case. It can become a multi-complicated situation, but vice versa, an intervention that promises to be complicated can be simple if it is preceded by sufficiently thorough and careful preparation and planning.
How long does a root canal typically take? How do your patients experience the treatment themselves? Is fear still the lord, or is it already the innervation of the past?
HKG: It depends on several things, but mainly on the type of tooth (pruning, grinding, grinding). This is precisely why I do not prefer to "box" the number of root canals according to the number of root canals, because the fact that a canal configuration occurs in a given root is more important in the timing of treatment than the fact that an upper grinder has 3 or 4 canals. .
The length of the treatments varies, but is generally around 75 and 90 minutes, which is an interval tolerated by patients for comfort during the first treatment. If a second or third session is required, they are practically shorter, usually 45-60 minutes. Interestingly, the doubts successfully dispelled by patients return absolutely positively already during the second treatment, and the same is true of fears instilled in the past, sitting in the chair much more calmly and in a balanced way than before.
In your experience, with a well-executed and controlled root canal treatment, how long can a given tooth last on average?
HKG: With root canal treatment, our goal is to keep the tooth, in other words to avoid tooth extraction. Unfortunately, in many cases the process still can’t considered complete after a properly executed root canal. In order to restore the tooth functionally, in the case of small and large grinders it is not enough to provide only one classic composite filling with a coronary part, as the risk of fracture is the highest along the junction of the tooth edge and the filling. Even for the most perfect root filling, if the coronal restoration is not suitable, unfortunately the whole tooth can be damaged - in the case of a longitudinal crack (so-called vertical fracture or fracture) our chances of saving the tooth later are unfortunately very limited. For this reason, we usually make an indirect restoration (eg an insert or a crown) for these teeth exposed to chewing, and we try to make the patient aware before the root canal treatment that the root canal treatment is intended to keep the tooth. Root canal filling is the goal, but we must not forget about the permanent coronal restoration of the tooth.
We usually book an appointment for this after the root filling, because if a tooth is clinically asymptomatic, we effectively "have no reason", the better the sooner the functional and (last but not least) aesthetic rehabilitation of the tooth takes place. If the question was focused on specific numbers, it can be the same as the life expectancy of natural teeth with proper oral hygiene, periodic checks, and a well-closing definitive restoration. Obviously, the more exposures a tooth has had in the past before a particular patient has accessed us (prolonged root canals, a re-treated tooth, a tooth with an inadequate corona restoration, etc.), the more likely the tooth will crack or break. Replacing a removed tooth with an implant, on the other hand, is unfortunately not always possible, so I used to say that "the best implant is your own tooth."
Thanks for the interview!
In block 2 of the endo interview, we also address other interesting and important issues.
On our microscopic root canal treatment page, we provide more details about the treatment and its benefits.
The profile of Dr. Gergely Hriczó-Koperdák can be viewed by clicking on the link below.