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EBC Fusion Endo By: Scott Perkins

More by this author (6)
EBC is short for Endo, Build-up and Crown. Combining both the crown and endo procedures within the same appointment is a tremendous benefit to your patients. Sometimes it’s hard to see things from a patient’s perspective until you become a patient yourself. I remember the last time I had dental treatment performed. I had to take a half-day off from my busy dental practice. When I am fortunate enough to schedule time away from my practice, I’d rather spend the time as vacation rather than dental treatment time. I’m sure your patients probably feel the same way.

I traveled across town to one of Houston’s best dentists, Dr. Fred Simmons. Besides being technically excellent, Fred is caring and gentle with injections. Even so, I always break a little bit into a sweat when I’m getting a mandibular block. Fred performed an onlay and a crown preparation that day on two adjacent teeth. Would I have preferred these procedures being performed individually? Absolutely not. That would have meant a tremendous time cost to me, not to mention an additional mandibular block. Yikes!

Our patients are no different. Their time is precious and injecting them multiple times on multiple visits is not the kindest way to treat them. Not when a simple, combined procedure can easily be performed. Minimizing time in the dental chair and the number of dental visits is highly valued by patients.

For the same reasons it’s good for the patient to have two adjacent crowns done in one visit, it’s good for a patient to have a crown performed in the same visit with a root canal.

Another consideration is the sad situation of a patient who presents with an endodontically treated tooth, which is now irreparably split because it wasn’t protected by a crown in time. Can you imagine how incredibly demoralizing it must be to a patient to have spent time and money and apprehension having a root canal performed only to find that their investment is down the drain and to make matters worse, the appropriate solution to restore the missing tooth will be approximately three times the expense and even more time?Unfortunately, some patients are so overwhelmed psychologically and financially that they select the path towards eventual edentulism.

Rather than put your patients at this type of risk, perform the crown with the endo procedure! Not only will your patients be better off, the benefits to your dental practice are stunning as well. From the front desk, to the clinical area, time is captured. Check in time, chart pulling time, clinical set-up time, seat time, anesthesia time, dismissal time, collection time, checkout time, insurance submission time are all performed once instead of twice. Even your high- and low-speed handpieces win, they get autoclaved once instead of twice.

If you want to make the leap from stunning clinical efficiency to mind boggling clinical efficiency, try the EBC Fusion technique. Using this technique, you will be able to perform an endo/build-up/crown on a molar tooth in less than an hour. Paradoxically, this technique requires less effort than the traditional approach and it improves quality at the same time. How is this possible? What is the explanation to this paradox?
15-MCP Gun Rack
This 15-MCP GunRack™ is locked and loaded and ready
to perform a crown procedure on demand. The cartridges
are color coded with generic names which match the color
on the handle of each dispensing gun which in turn matches
the color of the tab on the 15-MCP GunRack so that
everything is in the proper order.

The “fusion” aspect of the procedure stems from resequencing a critical step, which makes EBC Fusion remarkably efficient, compared to simply performing an endo and then a crown. Before accessing the pulp chamber, I remove the occlusal enamel with an SSWhite, Piranha, round wheel diamond—my personal favorite.

When files are placed to take a working length, the rubber stops rest on a flat plane instead of on a cusp tip, marginal ridge or inclined plane. Not only is this method much more reliable and accurate, it is unnecessary to record reference points, saving more valuable time.

But wait, there’s more! The chances of at least two canals being identical in length is greater which saves all kinds of time by reducing the many repetitive motions required by re-measuring files. Add all these advantages up and then toss in the increased visual access and it’s easy to see how flattening the top of the tooth before starting endo really saves time and decreases effort.
Compromise in quality?
Some have openly suggested that I must be compromising quality by shortening procedure times so drastically. Feel free to check with my lab techs as listed below. Quality-minded dentists quickly recognize these men.

• Matt Roberts, CMR, Idaho Falls, Idaho
  800-210-3401
• Phil Watkins, Functional Aesthetics, Lewisville,
  Texas 800-229-8650
• Peter Vereby, Dental Keramiks, Stockholm,
  Sweden 011-468-702-9925

Be sure to take a VPS quad impression before you flatten so that you will have captured the original tooth dimensions for fabrication of a temporary crown later on.

Now it’s a simple matter of performing the 15-Minute Molar Endo and 15-Minute Crown Procedure that have been published in the January 2001 and August 2001, issues of DentalTown Magazine respectively. In review, the 15-Minute Molar Endo procedure takes advantage of the fact that the majority of endo time is wasted in measuring, cleaning, wiping and switching NiTi files in and out of a single handpiece and the 15-Minute Crown Procedure understands that a crown procedure is largely a procedure of mixing things up and waiting for them to set.

Both procedures are preceded by administering rapid, predictable, profound anesthesia.
Speedpaks™ for Crowns go beyond just speeding things up.
They allow anyone on the staff to set up for a procedure.
Speedpaks allow a dentist to get through a procedure
even with staff turnover. All items necessary to perform a procedure
are always present. Hospitals have been using this concept for years.

Flattening the top of a tooth with an SSWhite
# round wheel diamond results in easier access
with files. It also eliminates the need for recording
reference points and decreases the number
of re-measurements of files.

It sounds simple enough but the ramifications for efficiency are very significant. The first efficiency gain is in easier, more accurate access. Use of the round wheel diamond results in a tooth, which now resembles a cut tree trunk. You basically have a flat table of dentin surrounded by a ring of enamel. It’s very easy to visualize where the pulp chamber lies beneath the dentin and access through the dentin with a GW#2 bur is rapid and effortless.

Because there is now less inter-tooth distance between the target tooth and it’s opposing tooth, physical access is enhanced. In addition, a shallower angle of attack of the tooth into the canal orifice is possible enhancing physical access even more.

Setting up for these procedures at a moment’s notice is very important. What difference does it make if you are super efficient, but it takes forever to set up for the procedure? Ordinarily, your assistant has to open drawers, open cabinets, pull out tubs and trays and “assemble” all the necessary items for performing a procedure. Not to mention, after going through all that, the assistant invariably forgets something that you don’t notice until right during the middle of your procedure. The procedure is interrupted while your assistant gets up and runs around looking for the missing item.

Now it is possible to set up instantly by using Speedpaks™ for Crowns from SimpleDental (800-454-5161). These Speedpaks solve a lot of problems. They contain everything you need to perform a procedure. Not only do Speedpaks contain everything you need so that nothing is ever missing, anyone in the office can set up for a procedure. No experience necessary. If you’ve ever gone through the brain damage of losing your assistant you know what I’m talking about. All you have to do is grab a Speedpak, pop it open, throw it down and you’re ready to rock and roll. Another time saving feature of Speedpaks is they save the assistant time in ordering since the items needed for performing a crown or a root canal are all purchased at once. Time is saved in stocking and handling. Even the bookkeeper has less work to do.

Achieving extreme efficiencies allows a clinician to work in treatment that would have ordinarily run into the lunch hour or into the end of the day. Worse yet, delaying treatment would mean lost production for the day that could never be made up or result in the patient never making it back onto the book. All bad for business. Now it’s possible to capture this production and still go to lunch or go home on time. In this scenario everybody wins: patients, staff and doctor.

So, how does quality increase while treatment times are slashed in half? Actually treatment times are slashed into a third or a fourth of the usual time. The time savings is a result of savings in set times and non-value added movements and NOT in quality sensitive steps. Therefore, the clinician can devote some of the massive time savings he or she achieves by performing these extremely efficient procedures into concentrating on the quality sensitive steps such as machining the tooth to just the right shape. So the clinician actually has more time for perfecting their work. The net result is still cutting the usual treatment time in half.

Consider trying the EBC Fusion technique. It’s very easy to perform and your patients will love having everything done in one appointment.  DT
Overview/Extreme Clinical Efficiency
An organizational rack is permanently in place on the counter so that all dispensing guns are arranged in perfect order.

Everything is color-coded. The cartridges are color coded to the dispensing guns which are in turn color coded to the dispensing 15-MCP GunRack™. Everything is in its proper place. Even a beginning dental assistant can easily use the system.

All materials are auto-mixed. Base/Catalyst ratios are consistent. Mixing is rapid. Clean- up time is decreased. Fewer supplies are required.

Everything is pre-packaged. Set-up time is rapid. No special knowledge of supply location is needed because Speedpaks™ are clearly labeled by procedure. It is impossible to leave an item out so that there are no time consuming interruptions during the procedure.

Using rapid anesthesia techniques the doctor never leaves the operatory once he or she sits down. This means no interruptions during treatment. The patient feels “special” because the doctor has devoted uninterrupted time. Completion time is very rapid. No glove changing.

Scott Perkins, DDS is a solo, private care clinician who practices in downtown Houston, Texas. He has authored several articles on achieving extreme efficiencies in clinical dentistry.

For access to previous articles on clinical efficiency, visit Scott Perkins’ website scottperkinsdds.com

To order Dr. Perkins’ 15-Minute Crown Procedure video tape and/or the 15-Minute Molar Endo videotape call 713-658-1708 or order on the Internet at scottperkinsdds.com.
Dentaltown Magazine
September 2025
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