Dr. Vigoren presents and lectures on the uses of magnification, photography, dis-assemblies, cleanouts and the salvaging, treating and restoring of hopeless teeth.
Endodontic background, experience;
Dr. Vigoren studied in the first dental class in the nation to obtain undergraduate endodontics at USC (68-72) under John Engle and Ed Beverage (authors of Engle’s Endodontics, still the standard text in endodontics).
Upon arrival in Japan at the USAF Hospital (72-74) he was made the base endodontist, in the largest dental-medical complex in the military (the Kanto Plains) servicing over ten thousand active-duty and ten thousand DOD personal, because of this endodontic training.
In the 80s to get restorative training under the use of a highly magnified surgical microscope the only courses available were from endodontists Cliff Ruddle, Gary Carr, Steve Buchanan and Dennis Shanalec a periodontist. Additional courses were taken from or studied under other endodontist including Richard Burns, Donald Arens, Noah Chivian, Shane White, Charley Cox and John West. He also practiced alongside with endodontist Bruce Harkins in his office for over three years.
In the last 46 years of practice he has treated conservatively over 6,000 teeth endodonticly. One third of his practice consists of endodontics, including over 4,000 dis-assemblies and endodontic re-treatments. Over 1,000 of those successful long-term treatments (over 20-30 years of success) were on consensus hopeless and non-restorable teeth that normally would have been extracted.
Opinions based on this experience:
The vast majority of endodontic treatments fail over time because of bacterial contamination. Almost all of existing root canal treatments that are dis-assembled are bacterially contaminated on dis-assembly based on a highly magnified visual examination or the smell test.Contaminated endodontic treatments are unhealthy and a risk factor for many other unhealthy conditions in the body through a direct vascular connection.
From a restorative perspective based on thousands of actual dis-assemblies, endodonticly treated teeth generally do not fail because of too large an access or from a fracture from too little remaining dentin. These endodonticly treated teeth fail from bacterial contamination. A larger access allows for better visual access, better cleaning, better shaping, better irrigation and better fills. This larger access also allows for finding and cleaning of extra anatomy, fins and those extra canals.
Is there a professional communication problem between the general dental community and endodontics that may need correction?
Many endodontists may be in a conflict with their referring doctors desires at the detriment of their patient’s best interest. This may be because of the general dentist not understanding enough about the difficulties or compromises that their demands place on the endodontist or endodontic outcomes.
For example: If the referring dentist is not doing a thorough diagnosis of the pupal health before doing restorative dentistry or not addressing other issues first, avoidable problems may occur. That pupal diagnosis includes a thorough occusal evaluation for contributing bite-overloading issues, caries removal and evaluation and/or a complete disassembly of a bacterial contaminated, leaking, cracked or carious tooth.
Or because the referring dentist is expecting immediate endodontic treatment to bale them out of subsequent sensitivity after treatment without giving the endodontist adequate time for proper diagnosis of these same issues.
Or because the referring dentist is asking the endodontist not to disassemble the tooth or remove the restoration that was just completed to evaluate properly for leakage around the restoration or the insult of bacterial contamination that may need to be or could be removed.
Or because the referring dentist is asking the endodontist to limit the size or the use of an adequate access necessary to improve success of treatment.
Or if on return of the patient to the referring dentist, they are not opening and cleaning out all of the temporary access materials or temporary filling materials before final restoring, or are not obtaining an adequate permanent seal to keep the endodontic treatment from being bacterial re-contaminated.