For Dentists | Canberra City Endodontics

Referring your patients to CCE
How referring benefits you and your patients
Strengthening your practice
Helpful links

Welcome and thank you for your interest in Canberra City Endodontics. We value our relationship with you as we partner to deliver the best quality treatment to our mutual patients. Our mission is to provide outstanding endodontic treatment to patients referred to our practice and to serve as a resource to help you continually improve the quality of endodontic treatment you personally provide. You are vital to our success in achieving these goals and we value your feedback as we work together for the benefit of our patients.

This section of our website is dedicated to you and focuses on our interaction with you and the patients that you refer to us for endodontic treatment as well as key information to help your practice thrive, including helpful tips and reviews on current science and techniques involved in providing excellent endodontic care.

We value comments and feedback from referring doctors and staff to help us continually improve our service.

Referring your patients to CCE

Thank you for referring to us. If you need our business cards or referral pads, contact our practice on +61 (02) 6162 1676.

To download our referral form, click here.
To download our referral envelope for printing, click here.

How referring benefits you and your patients

Referring patients to an endodontist for root canal treatment benefits your patients and your practice. Key findings from several nationwide surveys conducted between 2008 and 2011 indicate the following:

Happy patients are more loyal to their dentist as evidenced by more repeat visits and stronger patterns of referring family and friends.
80% of American adults fear the dentist.
Root canal treatment is the most feared dental procedure.
When a dentist refers a patient to an endodontist, 90% of those patients end up satisfied.
Endodontic treatment is significantly more successful when performed by an endodontist.
87% of dentists reported the work performed by endodontists was worth the cost.
The average dentist refers about 50% of patients who need endodontic treatment to an endodontist.
One out of four dentists refer more than 90% of patients who need endodontic treatment to an endodontist.

We value your role as the treatment manager for your patients. By referring patients to our office, you show personal concern that your patients receivethe highest quality endodontic care and an outstanding treatment experience. Your referral provides us an opportunity to reassure patients regarding your diagnosis and treatment plan and to make positive comments regarding the quality of your work. Patient confidence in you increases as they hear another dental professional confirm your recommendations. Patients appreciate knowing you have partners who specialize in more complex procedures and they are comforted by knowing they are getting the best possible care for their particular dental situation. When we complete treatment, we contact your office to schedule your patient’s visit for their restorative treatment. We send reports of treatment by email or mail the business day following treatment and we invite your interaction anytime by phone or personal visits at your convenience.

We want to help your practice thrive. Knowing that satisfied patients are the key to your continued success, we want to create situations where your patients are most likely to be happy with you as their dentist. Often when patients need endodontic treatment they are fearful and in pain. This can significantly decrease their pain threshold and make it more likely they will have an unpleasant treatment experience. When patients are referred to our office, the overwhelming majority report being pleasantly surprised and satisfied with their treatment experience. For those few patients who may not be satisfied, your referral to our office often preserves their good feelings toward you since an unpleasant experience did not occur in your office. Keeping your patients satisfied is extremely likely when you make the choice to refer.

Referring your patient to us for endodontic treatment can save your patients and you time and money. We can complete most endodontic treatment in one visit to help your patients avoid additional expenses from travel and missed work. The high success rate of endodontic treatment provided by an endodontist gives you a solid foundation on which to build your restorative work, thereby reducing the likelihood of future complications and costs. We refer patients back to your office for needed restorative treatment as quickly as your schedule allows. By referring your patient to our office quickly, you can avoid the costs associated with starting treatment that you later decide to refer, which often results in patient frustration in addition to the costs of rendering that treatment without billing for a completed procedure.

Strengthening your practice

We want to help your practice thrive. Knowing that satisfied patients are the key to your continued success, we want to help you create situations where your patients are most likely to be happy with you as their dentist. For us, this means creating successful endodontic treatment experiences. Often when patients need endodontic treatment they are fearful and in pain. This can significantly decrease their pain threshold and make it more likely they will have an unpleasant treatment experience. When patients are referred to our office, the overwhelming majority report being pleasantly surprised and satisfied with their treatment experience. For those few patients who may not be satisfied, your referral to our office often preserves their good feelings toward you since an unpleasant experience did not occur in your office. Keeping your patients satisfied is extremely likely when you make the choice to refer. Please see referring your patients to CCE if you would like to refer your patient for endodontic treatment.

There will likely be times when you would prefer to perform endodontic treatment yourself. While each dentist’s level of comfort and skill with endodontic treatment varies, there are a few situations that are very likely to be extremely challenging for any practitioner and where a referral to an endodontist will likely benefit you and your patient. Recognizing the following situations early and referring to an endodontist before errors are created will likely provide the best result and greatest satisfaction to you and your patient.

First and foremost, if you treat any maxillary molar and do not find and completely instrument at least four root canal systems, refer the patient to an endodontist. In most cases, the MB2 canal cannot be adequately negotiated, cleaned, and shaped until you have removed several millimeters of dentin, usually to a level apical to the pulpal floor. Without additional specialty training, an operating microscope, additional instrumentation, and extensive experience in managing this area, the risk of inadequately instrumenting or creating a perforation is great. When treating maxillary molars, experienced endodontists usually spend at least 30 minutes just to create the endodontic access and initially negotiate all root canal systems. Although treating the MB, DB, and P canals may resolve immediate pain and infection for patients, leaving the MB2 (or any other canal) untreated often results in lack of healing months or years later. Make your patient’s health and healing your highest priority and refer to an endodontist if you cannot adequately instrument at least four canal systems in upper molars.
Calcifications: When evaluating radiographs, note the size of the pulp chamber and root canal systems. Constricted pulp spaces indicate tertiary dentin has been formed thereby reducing the size of the root canal systems. The risk of perforation and separated instruments increases with decreasing root canal size. Be very cautious, use high magnification, and instrument only what you can see while using light brush-like strokes of the bur to remove small amounts of dentin at a time.
Uncovering the entire pulpal floor: Particularly in multi-rooted teeth, the pulpal floor often becomes covered with tertiary dentin that traps remnants of pulp tissue. When a tooth becomes necrotic, these areas are very difficult to identify (no bleeding tissue can be seen so you must distinguish between tertiary and normal physiologic dentin which can be very difficult, even with an operating microscope), but leaving them untreated provides a nutrient source for bacteria and increases the risk that long-term healing will not occur. Tertiary dentin over pulpal floors often covers additional canals and/or grooves between canals where bacteria flourish. When treating multi-rooted teeth, if you cannot completely uncover the pulpal floor (this has a grey-brown color), refer to an endodontist. Be extremely cautious to remove tertiary dentin rather than physiologic dentin to avoid creating a perforation.
Significant root curvatures: Instrument separation and other complications become more common as root curvatures increase. Consider referring in these situations. Suggestions for instrumenting curves: coronally flare to the level of the curvature, use small hand files to create a glide path, use rotary files of a small taper (.04 usually, .06 at the most) and consider using files will small changes in tip size (e.g., ProFile Series 29).
Blocked canals: The easiest was to manage a blocked canal is to never create one! Learn to refer difficult cases long before you create a ledge. The result is so much better for your patient in terms of time required for treatment and the healing result. In situations where canals are blocked by instrumentation errors, fractured instruments, or restorative posts, refer to an endodontist. To prevent formation of blocked canals, constantly maintain a sea of irrigant in the pulp chamber. Coronally flare each canal and create a glide path with small hand files before using any rotary instrument. Never push rotary or hand files. If a file will not go to the length you desire, it is probably catching on a calcification or sharp bend in the canal. Bend the tip of your hand file then gently work it in a twiddling (watch-winding) motion with occasional slight up-down motion until the file becomes loose in the canal before using the next larger size. Use hand files up to at least a size 25 before introducing a rotary file.
Apical surgery: When healing does not occur following adequate root canal treatment and retreatment is not advisable, refer to an endodontist for apical surgery. Traditional techniques for apical surgery are successful only about 60% of the time whereas microsurgical techniques are successful more than 90% of the time. Given this drastic difference in success rates, apical surgery that is not performed using microsurgical techniques does not meet the standard of care.

Helpful links

The Dental Trauma Guide (http://www.dentaltraumaguide.org/): An excellent website produced by Dr. Jens Andreasen (renowned oral surgeon known for his extensive work with traumatic dental injuries) in part by a grant from The American Association of Endodontists. Click on the Trauma Pathfinder to guide you through diagnosing and treating dental injuries. Pictures provide an excellent patient/parent education module.
Website of the American Association of Endodontists: http://www.aae.org/. Access current information related to endodontic treatment, obtain full-length articles from the Journal of Endodontics, and review copies of productions designed to help you with endodontic treatment (e.g., Colleagues for Excellence Newsletters).