Madeline Kenworthy

02/23/2022
Visiting Dr. Xia

This week I was fortunate enough to observe Dr. Xia while he performed three

root canal procedures. While each procedure was similar, there were also unique

aspects as well. For each patient a consult was provided prior to moving forward with

the procedure. For two of the patients the consult had occurred on a previous day, but

for one patient the consult happened directly before beginning treatment. The assistant

explained to me that the doctor always diagnoses the need for a root canal before

placing one, despite referral from a general dentist. Dr. Xia used a probe, a cotton

swab, radiographs and endo-ice to diagnose pulpitis.

I was under the impression that Endodontists only placed root canals that were

too tricky for general dentists to place, but that’s not the case. The assistant informed

me that some general dentists just don’t do root canals and that overall when the

procedure is done by an endodontist the results are much more reliable because it’s a

procedure that they perfected in school and practice often. Endodontists also have

specialty equipment to make their technique perfect. Dr. Xia used a microscope during

each procedure, as well as a rubber dam. He also utilized a high speed handpiece, a

slow speed handpiece, as well as a handpiece that he referred to as a rotary. He said at

its fastest it only went about 300 rpm. He began each procedure by administering a full

cartridge of Lidocaine in an inferior alveolar (I.A.) injection, he then added about half of

a cartridge of septocaine to the I.A., administered a supraperiostial injection on the tooth

of interest, and then used the slow speed handpiece to create a port for an intraosseous

injection. He would add the remaining septocaine to the port and without changing the
position of the needle, the assistant would help him remove the cartridge and replace it

with another cartridge, which he administered into the intraosseous port. It was

incredible to watch the doctor and the assistant work together to complete this process,

however I never observed a single aspiration attempt.

After the rubber dam was placed Dr. Xia would drill into the tooth using either a

#2 or #4 round burr to gain access to the pulp chamber. Once he accessed the pulp

chamber he used an explorer to feel if each root had one or two canals. I learned that

usually on mandibular molars the mesial root has 2 canals and the distal root usually

has 1 but may have 2. After he determined how many canals were present he removed

all existing pulp with endodontic files. After the canals were cleared out he would irrigate

them with bleach and then EDTA. Then, he would measure the depth of each canal

using a machine called a “Root ZX” which made different beeps when he was at the

apex of the root. He measured the depth over and over and over again before placing

gutta percha. The gutta percha was pink (which I didn’t expect) and before he placed it

he dipped it in a “glue” made from grossman sealer and clove which the assistant mixed

before treatment. Once he was satisfied with the placement the assistant would remove

the rubber dam partially and place an X-ray sensor which the patient held in place

during exposure.

If Dr. Xia was satisfied with the radiograph he would cut the excess gutta percha

off and then use a machine called “Obtura” which he explained acted similarly to a hot

glue gun. He told me it heated up the gutta percha and allowed it to seep into small

spaces. Then he would use a condenser again to pack it all down. After the canal was

filled he added a small piece of green foam into the void of the crown and sealed the
crown off with “cavit” temporary filling material. At this point the assistant would take one

last radiograph of the final product and give the patient post op instructions.

Post op instructions included taking 800mg of ibuprofen immediately, and

sticking to a strict 8 hour regimine for the next 48 hours, she said after 48 hours the

patient could decide if they wanted to keep taking pain relief medication. She advised

each patient to avoid chewing on the side with the new root canal and to stick to a soft

food diet for the next two days. She sent them home with a sheet of suggested soft

foods and always made the joke that “If you want a milkshake for breakfast, you can

have a milkshake for breakfast.”. The instructions included for the patient to see their

general dentist within 1-4 weeks for the general dentist to place the permanent filling or

crown if needed. She mentioned that post op sensitivity is normal and will subside within

a few days to a few weeks but that the work was covered for a year and to return for a

free consultation if pain persisted. The post op sheet also states that if a patient is

taking antibiotics, to continue until the sequence is finished.

In addition to root canal therapy Dr. Xia also specializes in apicoectomy

procedures. He employs 4 assistants and 1 sterilization technician. The assistants are

responsible for all instrument recirculation, seating the patient, updating the medical

history, taking radiographs, and setting up the rooms for patient treatment including

preparing all instruments and accessories for easy access during treatment, as well as

flipping them between each patient. The assistants also checked in with the patients

throughout treatment to ensure that they were comfortable and awake, as well as

provided post op instructions. Dr. Xia does not employ any hygienists although one of

his assistants is an RDH.

 Dr. Xia uses Daisy software for the client records and treatment procedures, the

assistant informed me that through Daisy an office can create their own templates which

is really helpful for specialty treatments. The sterilization procedures were similar to

LCC’s, they used an ultrasonic for biofilm removal and a Midmark Autoclave to sterilize

cassettes and other instruments. I liked that the doctor and assistant chair backs had

barriers on them, and would like to see that implemented at LCC.

Overall I was blown away by the speed and efficiency of Dr. Xia and his

assistants. They worked like a well oiled machine, completing one of the root canal

procedures in about 37 minutes from the time the patient was seated to the time that he

was dismissed. I was slightly shocked by the volume of anesthetic that was regularly

administered to patients but I understand that nobody wants to be able to feel nerve

pain associated with root canal procedures. I also learned that initial root canals are

about 95% effective after 1 year, and roughly 80% effective after 10 years.