May 1, 2015
by Dr. Barry H. Korzen
Debate is healthy. It clarifies issues and it allows us to look at situations critically and with differing perspectives. In endodontics, as with the entire dental profession, debate has been present since its inception. Gutta percha vs. silver cones vs. paste fillers. Fill to the apex, ½ mm short, 1 mm short. V-shaped instrumentation vs. minimal dentin removal. Engine driven instruments vs. hand instruments. Rotary vs. reciprocation. And on and on.
But the debate is always about technique. As clinicians, we all develop preferences and loyalties. We have to be convinced to make a change. But as professionals, once we are presented with the evidence that we know will benefit our patients, we unhesitatingly move in that direction.
Where there is no debate is what is universally accepted as the most important step in treating our patients: accurate diagnosis. A proper diagnosis is essential to determine whether any treatment is necessary, and if so, what treatment options are available to the patient. As stated in the American Association of Endodontists position paper on diagnosis, “If an incorrect assessment is made, then improper management may result. This could include performing endodontic treatment when it is not needed or providing no treatment or some other therapy when root canal treatment is truly indicated.”
I firmly believe the operative word here is “assessment”. An astute clinician knows all the correct questions to ask, knows all the pertinent tests to run and all the proper radiographs to take. But that is not enough. We must hone our skills to ensure that we properly synthesize the information at our disposal to correctly diagnose the problem at hand. But sometimes the pieces of the puzzle just don’t seem to fit and the clinical tests and/or radiographic findings do not lead to a definitive diagnosis. That is when it is time to take advantage of one of our profession’s most redeeming qualities, collegial interaction with your fellow dentists. Whether it’s with a colleague in your office, a specialist with whom you have a working relationship or someone you may have taken a continuing education course with, I have never met anyone in our profession who will not try to help in solving a diagnostic perplexity. Discussing the case and verbalizing the facts may be just the spark necessary to transform the problem into a solution.OH
Dr. Barry H. Korzen is a graduate of the University of Toronto Faculty of Dentistry and the Harvard University graduate Endodontic program, Dr. Korzen is the Founder of The Endo Academy (www.TheEndoAcademy.com) and Zendo (www.Zendo-Online.com). He was an Associate Professor, Assistant Dean and former Head of the Discipline of Endodontics at the University of Toronto Faculty of Dentistry. Besides authoring numerous papers, Dr. Korzen has spoken to dental societies and organizations around the world and has delivered lectures at more than twenty universities. He has received fellowships from the American College of Stomatologic Surgeons, the International College of Dentists and the Pierre Fauchard Academy. Dr. Korzen is a Past-President of both the Canadian Academy of Endodontics and the Ontario Society of Endodontists and has been a long-standing member the American Association of Endodontists and the Alpha Omega International Dental Fraternity.