Constant Improvement Keeps the Referrals Coming

"Our mission has always been to take the very best in endodontics and make it better," Zia says. "It is very centered around the Japanese concept of "kaizen," which means continuous improvement. We offer the highest level of service to a select group of restorative dentists with whom we have congruency regarding delivery of care. If one of them calls at 3:00 am, I am there."

Farshey, who had operated his own general dentistry practice for 6 years before shifting to endodontics, says his first impression of the practice was that it was very high-end in terms of services delivered, patient management, and even ambience.

"We are in the business of customer service, and we just happen to perform root canals at a high level," Farshey says. "I am so happy that, to this day, my impression of the practice has not changed."

Zia and Farshey embrace kaizen to the point that, without exception, they implement a new service or technology every year to radically improve their ability to provide a higher level of patient care. In 2008, they were one of the first practices in their area to acquire a cone-beam computed tomography (CBCT) scanner.

Last year, they added the GentleWave^® System from Sonendo, which utilizes multisonic technology to safely and effectively deliver a powerful vortex of procedural fluids and broad-spectrum acoustic energy for unprecedented cleaning.

"Root canal systems are complicated," Zia says. "It is now known that there is a type of bacterial formation called biofilm that plays a significant role in persistent endodontic infections. In order to clean the whole system and eliminate biofilm, you cannot simply wash out the canals. You need to physically disrupt biofilm to remove it. But how do you clean a very complicated system without weakening the tooth internally to a point where it is going to crack or break under the forces created during chewing? Before GentleWave, we did not have a good answer to this question. We had to choose between aggressively cleaning, which weakened the tooth, and not cleaning as well, which put the patient at an increased risk of infection. GentleWave allows us to "ultraclean" the inside of the root canal system in a way that leaves the tooth very intact and resistant to fracture."

Zia and Farshey have methodically and objectively tracked GentleWave cases in a spreadsheet, and Farshey describes the results as "awe-inspiring." They have managed to achieve successful outcomes for teeth that in many cases, they could not have previously, and patients are healing more quickly. Many of the treated teeth are 100% healed after 6 months, compared with a 12- to 18-month healing period for conventional processes.

Farshey recalls one case in which he believed the tooth was not worth trying to save, but the patient and the referring dentist insisted on trying. With the GentleWave System, not only was the tooth saved, but also it healed in only 6 months. "As an endodontist who makes my living trying to save teeth, I would have said that to the best of my abilities, that tooth was not worth the time and money to try to save, but we saved it in 6 months," Farshey says. "In another case, I conventionally retreated a tooth over two visits using calcium hydroxide, which is the standard of care. The tooth failed, and I was sure that it was fractured, so I decided to try GentleWave. In 8 months it was fully healed. These are cases for which I can honestly say that without GentleWave, we would not have been successful."

"Root canal therapy has suffered from the worst marketing campaign ever. In patients' minds, there is a Pavlovian response to those words," Zia says. "When they get the sense that their endodontist is taking steps to increase success rates while being gentler to the tooth structure, the concept of the root canal evolves in their minds."

Continuous improvement for their practice, of course, is the mission of both Zia and Farshey. "We are taking the best," Farshey says, "and making it better."