Dr. Garry Bey - Through the Keyhole

I am an endodontic specialist; my practice is limited to root canal therapy. Since limiting my practice to endodontics in 1982, I have completed more than 20,000 endodontic procedures.

What can you tell us about your background?

I was born and raised in Brooklyn, New York, where I attended Sheepshead Bay High School. In 1972, I entered Syracuse University where I majored in biology. I then moved to Manhattan where I attended the NYU College of Dentistry. After a year in general practice, I returned to NYU and completed my endodontic training in 1982. I then entered private endodontic practice in Rockland County, New York, where I continue to practice. I also, maintain a second office in nearby Woodcliff Lake, New Jersey.

When did you decide to become a specialist and why?

While at Syracuse I participated in a Community Internship Program.  I earned college credits while assisting at the General Dental Practice Residency program at Upstate Medical Center. It was in this program that I was first exposed to endodontics. Assisting the residents while they were being taught by the attending endodontists was when my love for endodontics was born. The rest, as they say, is history.

Is your practice solely Endodontics or do you practice other types of dentistry?

I am an endodontic specialist; my practice is limited to root canal therapy. Since limiting my practice to endodontics in 1982, I have completed more than 20,000 endodontic procedures.

Why did you decide to focus on endodontics?

Saving teeth is an extremely great service to provide for a patient, and that’s what attracted me to endodontics─the ability to save teeth and maintain oral health for my patients. I like the predictability of endodontics and the fact that our success rate can be so high. To be able to relieve pain and get patents comfortable is a gratification that words cannot describe. All of the above is part of what I do on a daily basis. That is why I decided to focus on endodontics.

Do your patients come from referrals?

A majority of our patients are referrals from our colleagues in the tri-state area. We also receive a large amount of referrals from former patients, a testament to the reputation we have built over nearly 30 years of successful endodontic practice in the same area.

How long have you been performing Endodontics and what systems do you use?

I have been performing endodontics since graduating NYUCD in 1979. Obviously, with this much experience I have seen many changes, not only in dentistry, but also in endodontics. In my practice, every patient is seen under a Zeiss surgical operating microscope (Carl Zeiss Inc.). I have always believed that if you can see, you can do. We incorporate KaVo (KaVo Dental) electronically driven handpieces in our practice, which run more quietly than air turbine driven handpieces and with minimal vibration. This allows us to access most porcelain-fused-to-metal crowns with little or no porcelain fracture. We use piezoelectric ultrasonics, the Satelec Piezo Ultrasonic P5 NewtronÔ (Acteon). This is useful for the removal of pulpal calcifications and the location of calcified canals. Also incorporated into our practice is hand-held fiber optic transillumination from Welch Allyn (welchallyn.com), useful in locating extremely calcified canals. I use the Diagnostic Elements Apex Locator (SybronEndo) for root canal measurement. We have been using Dexis digital radiography since 2001. We have found their sensors to be patient-friendly, and to have excellent image quality.

Although nickel-titanium rotary files came into vogue during the 1990s, I used hand files, with a step-back technique, until 1999. My reluctance to switch to rotary tapered files was two-fold. First was irretrievable instrument separation, which at that time was, in my opinion, occurring at an unacceptable rate. Second, was the loss of tactile sensation, an inherent disadvantage with the use of nickel-titanium tapered files. I waited until I found a nickel-titanium rotary file that made sense to me. Its non-tapered design allows me to instrument canals to their proper apical widths, while remaining centered in the canal. LightSpeedLSXÔ (Discus) allows me to achieve this without excessive dentin removal in the coronal and mid-root portion of the canal and with accurate tactile feedback. Since it cuts only at the tip, I can mechanically remove more bacteria and debris throughout the entire root canal system without sacrificing overall tooth structure.  In addition, LightSpeed files have a safety release feature that virtually eliminates irretrievable instrument separation.

After instrumentation, I use the EndoVac (Discus) irrigation system to safely irrigate every canal to full working length (WL).¹ EndoVac works on the principal of true apical negative pressure. A MicroCannula is placed to working length and aspirates irrigation solutions from the coronal portion of the root canal, down the canal,  and out through the lumen of the MicroCannula. I use full strength sodium hypochlorite and 17% EDTA in a precise sequence, which has been shown to provide significantly better debridement 1 mm from WL when compared with needle irrigation.²

Depending on canal anatomy, for obturation I use the HotTipÔ (Discus) for warm vertical compaction of gutta percha, or Simplifill Apical Plug obturators (Discus). To finish treatment when using either technique, I backfill with HotShot (Discus), a cordless backfill obturation device.  HotShot combines the clinical benefits of warm backfill with the freedom of a cordless design.

Can you tell us more about the training you have undertaken?

I received an excellent endodontic education in the NYU College of Dentistry Postdoctoral Endodontic Program. Dr. Harry Blechman, one of the original endodontic icons, was Chairman of the Endodontic Department at that time. His background was in microbiology; the program was evidence-based with a concentration on the goal of achieving root canal therapy that would provide as sterile an environment as possible. One of my early mentors, Dr. Paul Rosenberg, was the director of postgraduate literature review. I cannot tell you how much I learned from Dr. Rosenberg, who is now the present Chairman of the NYU Endodontic Department.

Who has inspired you?

In 1999, at an endodontic conference, I met Dr. E. Steve Senia, who at that time introduced me to LightSpeed instrumentation. It was this meeting that changed the way I practice endodontics. I finally found a nickel-titanium instrumentation system that made sense to me. A system that was not only superior to the hand filing I was doing at the time, but, in my opinion, superior to any of the tapered file systems available then or now. To me, this was a career changing event.

More recently, at the American Association of Endodontists (AAE) convention in 2007, I met Dr. John Schoeffel, and was introduced to the EndoVac system of irrigation. This was another epiphany and practice-changing revelation. After attending a 3-hour hands-on course and learning the fluid dynamics of traditional irrigation systems I realized that using true apical negative pressure was the wave of the future in endodontic irrigation. I use LightSpeed instrumentation and EndoVac irrigation on every canal that I treat.

What is the most satisfying aspect of your practice?

The most satisfying aspect of my practice is the ability to relieve patients in pain, save their teeth, and maintain their oral health, all in a pain-free and comfortable environment. I have surrounded myself with a wonderful staff, all of whom have this common goal. A visit to our website, painfreerootcanal.com, by our patients puts these expectations to the forefront before they ever walk into our office. We strive to exceed these expectations 100% of the time.

Professionally, what are you most proud of?

I am most proud of the practice and reputation I have built over three decades of practicing endodontics. The continued referrals we receive from past patients, general dentists, and other dental specialists are a testament to the trust and confidence we have built over the years. Words cannot express how gratifying this is.

What do you think is unique about your practice?

What is unique about our practice is the way our patients are treated before their first appointment. A patient interview is conducted during the initial phone call to our office where much important information is gathered. Any questions about treatment are discussed and their general dentist is called if more information is required. A brief medical history is taken over the phone so that if it is necessary to call any physician, he or she is contacted and medical clearance is obtained. Insurance matters are addressed, if applicable, and insurance companies are called by our staff so as to help our patients in any way we can. Although this is very time consuming, it is a service that is greatly appreciated. When a patient walks through our door, he or she is ready to be treated with no delay. It is one of the many ways we exceed their greatest expectations.

What is your biggest challenge?

My biggest challenge is balancing my family life with my professional life and my recreational interests. There don’t seem to be enough hours in the day to accomplish all that I set out to do. Add to that a lecture schedule that has sent me travelling both nationally and internationally, teaching dentists and endodontists the techniques that I feel allow me to practice endodontic therapy at its highest level.

What would you have been if you had not become a dentist?

I would have most likely become a research biologist. My love for biology and the science of living things runs deep in my soul.

What is the future of endodontics and dentistry?

It seems that through the years I have consistently heard about the elusive yet omnipresent “Golden Age of Dentistry.” Some talk about decades past with such great advances as dental radiographs, high speed handpieces, bonded composite restorations. By definition, wouldn’t the “Golden Age of Dentistry” be now? When has technology been further advanced? During which era could we treat our patients more comfortably and with greater safety? When could we provide more effective treatment with a greater choice of treatment modalities? The future of dentistry is bright and it’s getting brighter every day.

The future of endodontics is bright as well. The future of endodontics also has some challenges ahead. Similar to the broader scope of dentistry as a profession, the technological advances in endodontics are increasing by leaps and bounds. Endodontics, however, faces the philosophical quandary of when do we save a tooth and when do we extract a tooth and place an implant? Are we drifting to a point in time when even a simple carious exposure will be treated with an extraction and an implant rather than a root canal and a crown? I am of the belief that the best dental implant is a natural tooth. It is my hope that the dental profession moves in a direction that keeps that thought in mind.

What are your top tips for maintaining a successful specialty endodontic practice and what advice would you give to budding endodontists?

To maintain a successful specialty endodontic practice, the modern day endodontist has to ensure that all goes well in his office. Endodontic practices flourish when the patient, general dentist, endodontic staff, and endodontist remain content. For this to occur, the patient must be treated with the utmost attention from their first phone call until they leave the office with as positive an experience as possible. Good communication either verbally and/or in writing must be maintained with the referring dentist. Staff and doctor have to treat each patient with care and compassion, and have to treat each other with mutual respect. Success breeds success, and an upbeat office is a great place to start.

My advice to budding endodontists is to follow the above recipe. Treat patients the way you would want to be treated. Stay abreast of the literature, and stay current with the latest technologies. Practice evidence-based endodontics, and do the best you can for every patient.

What are your hobbies and what do you do in your spare time?

I enjoy spending time with my family and friends. My daughter Madison recently graduated from the University of Maryland and my son Alex just finished his freshman year at NYU. I am an avid golfer, enjoy running, and love to travel. I have lectured extensively for the last two and a half years, and this has become a passion of mine. It is very fulfilling to be able to share my clinical expertise with my colleagues and to give back to my chosen profession. I look forward to continuing to travel for both lecturing and recreation.

References

1. Desai P, Himel V (2009). Comparative safety of various intracanal irrigation systems. J Endod 35(4):545-549.

2. Nielsen BA, Craig Baumgartner J (2007). Comparison of the EndoVac system to needle irrigation of root canals. 33(5):611-615.