An objective review of clinical outcomes is fundamental to improving techniques. This is commonly done in graduate endodontic programs. While it is unsettling at first, additional feedback provides a great learning opportunity. The idea that your work will be projected onto a large screen and critiqued by a group that includes your peers and instructors is great preparation for private practice.
I still sit down and review my cases periodically. It assists me as a matter of Quality Assurance, and also allows me to review my clinical techniques. Sometimes I like what I see, sometimes I don’t. But I am always inspired to do better. Here are a couple of cases over the last few months that I learned something from.
Tooth #14
Pulpal Dx: Previously initiated therapy
Periapical Dx: Symptomatic apical periodontitis
Inadequate condensation in DB canal coronally. Although I always backfill canals incrementally and then condense, I was unable to achieve an ideal result here. In addition, a downpack radiograph was taken, but the angulation did not reveal the flaw until the final postop was taken. Idealizing the angulation of the downpack radiograph would likely have avoided this problem.
Tooth #5
Pulpal Dx: Previously initiated therapy
Periapical Dx: Asymptomatic apical periodontitis
Despite the successful removal of the separated instrument, the coronal restoration here is not what I like to see. There appears to be some gutta percha that has been left higher than the level of the orifice. By creating a neat and finished orifice, it allows for better adaptation or restorative material. Although it was seen on the progress radiograph, because no gutta percha was visible when looking into the chamber, I presumed it was an artifact of the angulation. While this is possible, I don’t think it is probable. However, in the interest of “do no harm”, I did not attempt to remove the core restoration to countersink the orifice. I would hate to reapply the rubber dam, only to damage the all porcelain restoration.
Relaxing during some down time and reviewing your clinical cases is a great way to learn. Continually challenging yourself benefits both patient and practitioner.
In doing so, remember this: “Nobody bats 1.000…”…but that doesn’t mean we stop trying.
