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Searching for a better way
12th Aug 2009
Mike Walsh BDS is principal dentist at his well-established practice, MGW Dental Care, in Bedford. While he has a particular interest in cosmetic dentistry and endodontics, it is his penchant for searching out safer and more effective methods of treatment that command attention. He has the distinction of being the first dentist in general practice to use the now world-renowned Sterilox system for disinfection of dental unit waterlines, and now it seems his exclusive use of Smartseal for endo treatments puts him in the innovative category once more.
What's wrong with being satisfied?
Mike had been successfully treating patients with Gutta Flow and GP points for many years. The product had been more than adequate and Mike and his nurse, Kerrie, were familiar and comfortable with the process. There were no problems and customers seemed satisfied. But Mike was dissatisfied. He wanted a product that was biocompatible, that wouldn't affect people with a latex allergy. He wanted a material that provided a better seal than GP – ideally something that actually bonded. There's nothing wrong with being happy with what you have if it is
working well, but that's no reason to stop searching for something better.
Mike knew what he wanted and when he read about the launch of Smartseal, his interest was piqued. It certainly filled his criteria: a biocompatible, non-rubber-based, bonding material. It was 2007 and the BDTA Showcase was approaching, so Mike visited the Smartseal stand to find out more. He purchased the product, returned to his practice full of enthusiasm... and put it in his cupboard.
Like so many dentists, once back at the practice Mike returned to his usual routine and didn't have the time to try something new. Kerrie was unfamiliar with the new product and so wasn't keen to try it either. Despite knowing that on paper Smartseal ticked all the boxes, and the fact that he had invested money in its purchase, Smartseal remained in Mike's cupboard until a specific event forced him to try it.
The case for Smartseal
Mike's case notes read: ‘The patient presented in February 2008 with symptoms at UR6 requiring root canal treatment. The symptoms settled following the first stage of RCT, and the treatment was completed in March 2008 with GP, using the Race system, with our usual protocol of irrigation with hypochlorite, EDTA, and 2% chlorhexidene. ‘The patient returned two weeks later complaining of discomfort and tenderness on touching the side of the tooth. I could detect no cause, did a minor adjustment to the occlusion, and booked in for review a few weeks later. He
re-attended as an emergency appointment five days later, complaining of sharp, shooting sensations and increased sensitivity. Suspecting a missed canal, I re-opened, and being unable to detect any extra canals, I refilled the tooth.
‘He returned again in May 2008 complaining of an ache from the same tooth and tenderness to palpation. I removed the GP, reviewed canal lengths (MB 21mm, DB 20mm, P 20mm), irrigated ultrasonically with 2% chlorhexidene, and dressed with calcium hydroxide. The symptoms settled within a few days, and on return two weeks later, I refilled the canals with GP. The patient returned a month later, reporting that the discomfort settled within a few days of the root filling being placed, but then returned describing it as being “like a nail being driven into the gum”.
That subsided, but now had become tender on touching the side of the tooth with a general ache all of the time, no temperature sensitivity, and not waking the patient.
‘I decided to keep it under review, but in October, as there was no improvement I again removed the GP, and this time I placed Smartseal, which had been languishing in my cupboard since I'd purchased it. Being unused to it, I felt that my handling of the new material was not as accomplished as we had become with Race and greater taper GP, but the symptoms settled almost immediately and the tooth has been problem-free since October 2008.'
Seminar solution
Smartseal succeeded where all else failed, which was no surprise to Mike and Kerrie. Their only issue was how fiddly it seemed to use. Mike had always used tweezers to place points, and so naturally he emulated the process when using Smartseal. The points were difficult to grasp with tweezers and he embarrassingly had to contend with several flying across the room. And so, despite the fantastic result, Mike and Kerrie returned to their quick, efficient and well-practised GP-based approach until Mike decided there must be a solution and booked them both onto a Smartseal seminar.
Mike said: ‘I really wanted to use Smartseal so we attended a local seminar one evening to find out how we could overcome the drawbacks we had identified. I am very glad we did because the solution was so simple I can't believe I didn't think of it myself. Smartpoints are much more rigid than traditional points, so tweezers are unnecessary – you can just use your fingers. It's that simple. With that one problem solved we now use Smartseal exclusively and why wouldn't we? It is biocompatible, it seals better and it is much easier to use. Both Kerrie and I love it.'
Beneficial to patients
Mike acknowledges that because of its radio-opacity, Smartseal radiographs don't look as clear as GP. However, he also has experience of X-rays that show perfectly sound root canals
treated with GP that later turn out to be unsuccessful. He says: ‘If you know, as I do, that Smartseal is in there and working better at a microscopic level, then that's what counts. Once you understand and acknowledge that the material you are using is superior, how it looks on an X-ray is less important.
‘Patients appreciate both my explanation and the fact that I am using what I consider to be a superior product. Let's put it this way: if I were having a root canal, I would want Smartseal, and
you can't get a better recommendation from your dentist than that.'
Author
Jerry Watson
Jerry Watson is a general dental practitioner based in Stamford. He is a well-respected trainer and has worked with many companies and organisations to deliver training for dental teams; he is particularly interested in facilitating customer care and teamwork training events. He has been involved with Smartseal since the late 1990s and has experienced the journey from concept to research and development, to finally bringing the product to market.
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