Office Visit: Dr. Adam Inaba by Kyle Patton

You come from a unique line of dentists, including Hawaii’s first endodontist—your grandfather, Dr. Carl Haga. Tell us about your grandfather, how the practice started and where it is today.

My grandfather was the first trained endodontist to graduate from Northwestern University in 1966. They actually had to create a curriculum just for him. His master’s thesis, “Microscopic Measurements of Root Canal Preparations Following Instrumentation,” showed that we do not physically instrument as much canal space as we think we do. The article led to many other studies regarding root canal preparation.

My grandfather started Endodontic Associates in 1966 with another dentist, Dr. Warren Wakai. Soon after, three other partners joined—Drs. Gary Kondo, William Stevens and Michael Tajima, who is Carl’s brother-in-law. Dr. Craig Haga, Carl’s son and my uncle, joined the practice in 1992 after graduating from the same school as my grandfather.

The practice remains a three-generation family practice with offices in Honolulu and Aiea, which are both on Oahu.

What solidified your decision to go into endodontics? Was there an “aha!” moment?

I always knew that I wanted to be in the health care profession, but I don’t think there ever was an “aha” moment. I had the opportunity in college to assist my uncle during the summer and realized how impactful endodontists could be with their abilities to heal and relieve people of their pain.

Even though the practice was the first endo office in Hawaii, competition remains tough. Hawaii has a surprisingly saturated market for endodontists. Why is this, and how does your office make sure it stays at the top of its game?

I’m not sure why Hawaii remains a saturated market for endodontics. Maybe it’s the beautiful beaches! Most of the current endodontists are not originally from Hawaii, but did general practice residencies here and decided to return after completing their endodontic training.

I think the one aspect that separates our practice from the competition is that it’s the only local three-generation endodontic practice in Hawaii. As such, we try to create a warm, family environment for our patients so that they feel as comfortable as possible. Our amazing team makes this achievable. Many of our team members have been working with our company for more than 20 years.

What’s the average day like at your practices? How does it compare to when you first started practicing?

I schedule six working patients a day, with consults and recalls scattered throughout. Keeping a schedule like this allows me to spend time talking to my patients and to work at a comfortable pace. We also make it a priority to see as many emergency patients as we can, which helps out referring doctors, too. My schedule gives me the ability to fit emergency patients throughout the day.

You’ve had some influence with bringing in cutting-edge technology into a practice that’s been doing endo since 1966. Which piece of clinical technology would you never practice without?

The microscope has definitely been a game changer for endodontics. Not only does it allow practitioners to see the root canal anatomy better under high magnification and better illumination, it also allows me to work while my body’s in an ideal ergonomic position.

What are the nuances or challenges of practicing in Hawaii?

The main challenge is that there is so much competition in a condensed area; in Honolulu alone there are about 15 to 20 endodontists. Competition can be viewed as a negative thing because it can affect your business, but it keeps us on top of our game so that we continue to strive for excellence.

Some would argue that endo is a specialty with a bleak future (more and more implants, etc). Have you noticed a downtick in patients?

About five years ago, implants were gaining a lot of popularity with the advancements in the field and there was a good push for implants over saving one’s dentition. But over the past couple of years, we’ve noticed that trend has flipped and more patients are becoming motivated to save their teeth. It seems that people are realizing that implants are not always guaranteed to work, they don’t quite feel like your natural teeth, and the process can be lengthy and expensive. We’ve seen a slight uptick in patients attempting re-treatments and apicoectomies, rather than extracting their teeth.

As a doctor who uses CBCT/3-D imaging, is it accurate to say that some of your cases would have been impossible, or at least immensely challenging, to do with traditional radiographs?

CBCT has improved our practice immensely. It helps us during all phases of treatment, from diagnosis to treating calcified canals and recalls. For me, it’s proved most beneficial during the diagnosis phase; countless times, conventional radiographs left us unsure of the diagnosis but a CBCT showed clear pathology that would require root canal treatment. Conversely, we’ve also had cases where we initially thought root canal treatment was the best treatment option, and the CBCT showed signs that the case had a poor prognosis. This has saved some patients time and money.

In one case, a patient presented with slight biting pain to tooth #14, which had previously received root-canal treatment already. Clinical testing and conventional radiographs showed the tooth had a failing root canal with a chronic apical abscess, so the treatment plan was to take a CBCT and plan for a re-treatment. To our surprise, the CBCT showed an obvious fracture and significant bone loss that had been clinically undetectable. This news completely changed our treatment plan, from a re-treatment to an extraction with an implant.

How many of your cases are GP referrals and how many are patients who find you on their own?

Most of our referrals come from general practitioners, but we do see a lot of returning patients who’d previously been treated by either my grandfather or my uncle. A lot of these patients enjoy that they get to see the evolution of endodontics through three generations. We’ve also noticed an increased number of self-referring patients. Most find us through social media or our website, so we try our best to maintain our website and have a strong social media presence.

What aspect of your work are you most proud of?

Customer service. Most times our patients are anxious when they come in to see us, so we make it our priority to make them feel as comfortable as possible. As a child I was afraid of going to the dentist, and even to this day I sometimes get anxious. I relate to my patients and help them get through the procedures. I get the most joy when patients tell me, “Wow, that wasn’t nearly as bad as I thought it would be!”

What do you think is the most challenging problem for endodontics today?

One of the problems that we face in endodontics is cracked or fractured teeth. It seems like I see at least one fractured tooth a day, and it feels like it’s becoming an epidemic. I am not sure why it’s becoming more of a problem—maybe people are more stressed out lately? Fractured teeth are a challenge because they can be difficult to diagnose, it’s hard to predict the long-term prognosis, and if the fracture is extreme, there’s nothing we as endodontists can do to fix it.

Some people believe that performing a root canal will weaken a tooth so much that it will eventually fracture. As an endodontist, I try to practice minimally invasive endodontics, which means removing minimal tooth structure in critical areas of the tooth during the root canal process. I do this by creating smaller access cavity preparations and keeping the coronal aspects of the root canal system as small as possible.

What do you want to see endodontics do differently in the next five to 10 years?

I’ve always been fascinated in technology. I think technology in dentistry has come a long way, and I am interested to see how it will continually evolve to improve all facets of endodontics. I wonder what the next game-changing piece of technology will be!

What’s something that remains a challenge for you?

One challenge I face is that I am a perfectionist, and endodontics feeds into my obsession because every millimeter counts. Whenever I used to make a mistake or my end result was not exactly the way I wanted it to be, I would dwell on it—sometimes it would take the joy out of doing endodontics. So now I’m trying to enjoy the process more and accept the fact that not everything can be perfect.

Give us a snapshot of your life outside of practicing.

I enjoy hanging out with my family and friends. I enjoy watching sports, playing golf and going to the beach every once in a while to relax. I also have a passion for playing fantasy sports.

What advice would you to give to dentists looking to go into endodontics?

Practice as much as you can and don’t be afraid to make mistakes. Endodontics is a very challenging specialty and you will inevitably make mistakes. But, if you can use those mistakes as learning tools, you’ll continue to improve and grow as an endodontist. I believe in lifelong learning, and as an active endodontist I try my best to learn something new every day, so I continue to perfect my craft.