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Endo tips    Better Endo    Endo abstracts    Endo discussions

Diagnosis & Documentation - Courtesy ROOTS

From: Carlos Murgel 
Sent: Wednesday, September 28, 2005 6:19 PM
Subject: [roots] Diagnosis & Documentation

Here is a case that I would like to share to the brave colleagues that still 
can't see the value of magnification and keep arguing saying that some elitists 
and arrogant ones are trying to push this thing to our profession.....
IMHO magnification in any form should be the standard to our profession 
(all the dental students should start with loupes from day one and the schools 
should provide some microscope training) in all specialties and General dentistry.  
If you can afford a microscope to me this is the most valuable instrument that 
one can buy, and before you guys start accusing me: yes I am one of the elitists 
and idealists that want a better standard for dentistry by the incorporation
of the microscope!

This case was sent to retreat this # 31 (new referral, first case sent): patient 
has no symptoms what so ever and the mesial canal is calcified.  Everything looks 
great (maybe the Rxs at the distal looks strange but I have seen worse ones).  
Doing the perio probing and everything was 2-3-2-3 and suddenly 14 mm at the 
Distal Lingual.  Well took a couple of pictures, methylene blue and another one 
for the implant family.  Patient and GP were surprised and I am happy that I have 
this dam perio & diagnosis page to force me to make a better diagnosis...and of 
course don't forget the documentation capability.
- Carlos Murgel

There is no question that microscopes are valuable and purposeful and the standard, but the elitism you refer to is not the issue nor is it's place as the standard of care at's the fact that ROOTS was built initially to raise the bar for those who think THERMAFIL is the standard of care in obturation and that is just the vertiable tip of the iceberg...........I have no argument with any of this stuff photography, documentation et al, it's marvellous, but it isn't where success in endodontics is most defined. I find the incessant harangue about documentation counterproductive for those on ROOTS for whom a rubber dam is a luxury. The point has been made, repeatedly, it's wonderful, I'm happy for y'all that ya can take pictures, we can all take pictures, but I'm not happy that the largest selling obturation system in the world is a carrier based obturation system, that single cone obturation is being marketed ad nauseum by some very aggressive and specious marketers < If you really believe in what you do, you just do it, you don't have to shove it down anyone's throat. - Kendo Dear Kendo, I had no intention to push any hot spot on you or any other Rooter. I was very quiet about this issue and still going to be because I promise to my self that I am not going to participate in any arguments of this nature. I just wanted to disclose my opinion about how I see this issue and to make a point about the usage of magnification and diagnosis. Don't let this small thing disturb your wonderful day and for sure we don't need arguments or personal attacks here. Roots is sharing and learning, that is where I learned a lot and that is where I want to share the little that I know - Carlos Murgel Hi, Good point dear Ken, regarding different regions in the world, different concepts and economic levels....BUT...I was always LOVING Carlos's emails because beside the extreme beautiful pictures he is capable of doing, he has showed always also really valuable hints of how do properly make a diagnosis and decide a treatment plan..... I know for sure that this case in the hands of other clinician (and I am referring now only to some from in my country, I don't want to be aggresive) would end up with root canal treatment...... You are so right that for some people rubber dam is a luxury ....I really feel is a luxury only because it's a mental barrier of changing to something new, not because of the price...In my country, after you buy the rubber dam intro kit, a rubber dam sheet costs about 0.30 USD, which is nothing compared to the very low fee of 10-20 usd/endo..... I am telling you all because I have literally start from zero when I was in the 4th year of dental school and begun my endo classes and I also joined ROOTS thanks to Rob Kaufmann.....Before placing the dam (that includes affording to buy it) everyone who is doing endo should properly place the diagnosis....and seeing Carlos&others emails and beeing with Terry those 3 months I really felt that in fact that's the START POINT for people from areas like mine.....We have to know to perform all the tests, to have the adequate time to archive them in a software or in a classical paper format, to place the diagnosis and to make a reasonable treatment plan and discuss it with the patient.... About's really sad their prices ar so high, and I am sure it's that because they are for medical/dental care...I don't know many economics but I think that when you produce something that is really selling very good, in millions , you can lower the sell price of each sold item because the profit comes from having millions of little profits....but when you sell only 100 items/year you cannot afford to lower even 2 cents because your total profit will be only 100 multiplied with the profit from each item....

Nevertheless, being so fortunate to be able to see through a microscope, and also workin on extracted teeth (I was also in Gary Carr's office) I really felt the huge wall that is separating the 2 worlds : the microscope users and the non-microscope users.....I use home my loupes with max 3.5 magnification, but that is really nothing compared to what you all could see with the aid of the microscope...And the pics with the scope are really wonderful and very helpful, but actually when you sit there, you could get also the 3D feeling of the access cavity/canals/etc.... I'll be home next week this time and I will post my impressions about the wonderful experience this summer...I wait to go home and start to apply the things I have learned here and also to share that with my friends and colleagues....And trying to impove things...

Regarding the advertising and marketing tools of some companies I have to tell you all this : It was not only once when some dentists sent me patient for doing endo, by saying : "Well Roberto , that's a tough case, I couldn't find the canals but you have Ni-Ti rotaries and it will be no problem".... AT that point I was shocked what are they thinking about the relationship Ni-Ti Rotaries/Calcified Canals.....Yesterday night I was downloading the catalogue of the biggest dental supply company from ROMANIA, trying to see the prices of some things I would like to buy when I'll be home....OOOPS, there was a very big and nice ADVERTISING of a COMPANY ( don't tell you the name, but it's really a HUGE COMPANY) : "NI-Ti ROATRIES FILES, WITH MULTIPLE AND PROGRESSIVE TAPER ARE THE LATEST INNOVATION IN THE TREATMENT OF THE MOST CALCIFIED AND CURVED CANALS " Then I realised that those dentists are big time influenced by that type of marketing.... And yes, oh yes, there are some that are buying the 35 USD /set rotaries but don't pay 30 cents for a rubber dam....I know them....ANd I could bet my life that I know some peolpe that when they will afford a microscope will use it without a rubber dam and without doing a correct diagnosis Sorry it was long and boring.....But I really felt your sadness Ken and I wanted to tell you that from people from areas like mine, Carlos's posts are of HUGE INTEREST AND HELP, he never made me feel inadequate that I don't have a scope..he always supported me and I really enjoyed his pics.... Roberto Roberto, Great and insightful post! I think itís important for people to understand that whether you live in Romania or Santa Barbara people are pretty much the same. You have people in both areas wanting to provide their best effort in their professional activities with a sincere desire to raise the bar for those around them; and then you have lazy thinking complacent mediocre schmucks who make fun of them. Commercial marketing and business interests target the mediocre schmucks because those with powerful creative independent thoughts like you reject the advertising lies and their marketing energy is foiled. Iíve learned as much from you as youíve learned from me. Professional ethics is a universal concern and itís wonderful to see that youíll be such a positive advocate and role model in your country - Terry Roberto: Thanks for this very deep thoughts and you are a person that can grasp the inner nature of things intuitively and then rationally. Talking to you was enlightening and inspirational. I for one feel privileged to have met you albeit only for one day. I know that Doug R. feels the same. I have Terry to thank for arranging your visit.

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