Providing the ultimate in referral care

Dr Nicolai Orsteen, Specialist in Endodontics at the Root Canal Referral Centre, Richmond, talks about his passion for making root canal treatment accessible and affordable for all.

As a registered specialist in endodontics both here in the UK and my home country, Norway, I firmly believe that as dental care professionals we should always try to save endodontically diseased teeth. There are, of course, exceptions, such as teeth with deep fractures or severe marginal periodontitis, but a properly endodontically treated tooth, in my view, has a far better prognosis than extraction or an implant.

Many GDPs are wary of taking on root canal treatment for a variety of reasons and that is why referral to a specialist in endodontics is important and they should be regarded as an integral part of the GDP team. Specialists have the experience and equipment to judge when a tooth is worth saving and provide the best possible prognosis for the tooth, which can exceed 95% depending on the diagnosis. In straightforward cases, GDPs can achieve good results with sufficient time, skills and equipment, but ultimately it is up to the GDP and the patient to discuss when to refer and it’s important for patients to know that they can be seen by an experienced specialist who can give them the best possible outcome for saving their tooth.

Referral to a specialist in endodontics means the GDP can rest assured that their patient will receive the best possible treatment and the specialist’s experience in treating thousands of cases gives them the ability to choose the best treatment option. Once treated the tooth will have the best possible prognosis and the patient can be returned to their own dental practice for placement of the final restoration and continue with any further ongoing treatment. Specialist placement of a permanent core saves on treatment time for both the patient and referring dentist and helps to prevent possible infection when exposing the root filling materials when placing the core.

My vision, my practice

I had been working as an associate endodontic specialist for almost eight years when I finally took the decision to set up my own dental practice limited solely to root canal treatments. I wanted the security of being my own boss and the fulfilment of building up a practice that matched my vision of what an ideal specialist referral practice should be.

Setting up a practice from scratch is hard work and the building was just a shell when I first took over the premises in Richmond, south-west London. My advice to anyone in the same position is to have a clear plan before starting any building work, know exactly what you want in terms of the best equipment and work with leading dental manufacturers who can help you to achieve your dream.

I choose to use premium NSK handpieces – a Ti-Max Z900L, the world’s most powerful turbine*, Ti-Max Z95L speed increasing (1:5) contra-angle and Ti-Max Z25L (1:1) contra-angle. These handpieces are very lightweight, which reduces the daily strain on my hands and wrists, yet they are extremely durable and come with a three-year warranty, which gives me valuable peace of mind. The Ti-Max Z95L is perfect as the design offers improved visibility through the reduction of head and neck size, and runs with almost no vibration. All of my handpieces are configured to the dental unit and instrument functions according to my personal preferences which gives me the best possible treatment set up.

Along with NSK’s range of endodontic handpieces, micromotors and apex locator I routinely use the NSK Endo-Mate TC2 motor that is easy to use even during the most delicate endodontic procedures, reducing the risk of instrument damage and fracture as it reacts when the load on the file reaches the preset level of torque in one of three predetermined ways – auto-reverse on, auto-stop, auto-reverse off. The unit is specifically designed for use with Ni-Ti endodontic files from all major suppliers as it offers five pre-set programmes for differing file systems, additionally the last programme settings can be memorised.

Increased productivity

It is essential that decontamination and infection control is at the heart of every dental practice and I wanted to ensure that my new practice would have a state-of-the-art decontamination room. When it comes to autoclaves I have chosen to use the NSK iClave plus as it is quick, reliable and cost-effective. The iClave plus incorporates a copper chamber and differentiated heating, making cycles faster without the need for a steam generator and so increasing the iClave plus’s reliability. It has an increased chamber volume that is 20% higher than comparable systems, and combined with fast cycles of less than 20 minutes makes a considerable difference to our practice efficiency whilst saving time and money.

Combining a compact and elegant design with quick cycles and low power consumption, the iClave plus is very easy to use. Equipped with a powerful vacuum pump enabling total air expulsion, the iClave plus makes it possible to reliably sterilise any kind of material, including the internal surfaces of handpieces. Moreover, the pump generates forced ventilation and perfect drying. The iClave plus delivers hospital standard sterilisation and can perform the Bowie & Dick and Helix tests as specified in HTM 01-05, ensuring compliance.

Access for everyone

As an endodontist, my aim is to save as much of the natural tooth as possible. There are three main questions which for me determines if a tooth can be saved:

• Are there no deep fractures?
• Is the tooth able to be restored?
• Is the periodontal status reasonably sound?

If the answer is ‘yes’ to all three then it is definitely best to save the tooth with root canal treatment, rather than extraction or replacing the tooth with an implant. If the tooth cannot be endodontically treated I will of course pass the patient back to the referring dentist and they can decide the next best option for that particular patient. As my practice is solely limited to endodontics I will only carry out the root canal treatment the patient has been referred for.

Appointments can be made at our practice either by self-referral or via a referring dentist. I have a good working relationship with my referring colleagues and they can reach me at any time by phone or email. I aim to reply to any queries on the same day, but probably the most efficient way of getting in touch is via my online secure portal which can be accessed via my website. I want my referring dentists to regard me as an integral part of their team and I am here to help them and their patients to the best of my ability.

At the Root Canal Dental Referral Centre, we will contact referred patients within 24 hours, keep the referring dentists updated throughout the treatment process and send a full treatment report within 48 hours of completing treatment.

I always try to give my patients the best possible treatment and for me it is important to treat every patient with the same high level of integrity, friendliness, transparency and honesty. Even with a state-of-the-art surgery and equipment, we believe our prices are very reasonable as our ethos is that specialist endodontic treatment should be an affordable option to as many people as possible.

For more information on the NSK product range, contact NSK on 0800 634 1909 or visit www.nsk-uk.com.

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*Only Z900L. Power output measured by NSK internal research department.

Dr Nicolai Orsteen

DDS Oslo 2002, Specialist in Endodontics, GDC No. 175404

Nicolai graduated from the dental school at the University of Oslo in 2002 and then continued full time study for a further three years to gain specialist qualifications in endodontics. During his time at university, Nicolai worked as both a clinician and an educator of dental students.

Since qualifying, Nicolai has worked in private clinics in both Oslo and London and particularly enjoys the challenge of complex root canal cases. He is a member of the British Endodontic Society and a specialist member of the American Association of Endodontists.

Nicolai hosts study events at his practice to help GDPs understand more about endodontics. For more information about upcoming events email info@rootcanalcentre.co.uk.

Referrals

GDPs can refer a case to Nicolai via a secure online referral form by visiting www.rootcanalcentre.co.uk, telephone 020 8050 0351, email info@rootcanalcentre.co.uk or by post: Root Canal Dental Referral Centre, 351 Richmond Road, Twickenham TW1 2ER.