Project

Management
DMAIC
Client: Save Dent medical clinic

Emanuel Grozea,
MMA1

Emanuel Grozea,
MMA1

Process
:The
Endodontic
Treatment*

*the treatment of a root infection,

also known as a root canal surgery.

Emanuel Grozea,
MMA1

DMAIC
Defining the
Process

A - anesthesia - 5 min
B - cleaning the cavity - 10-20 min
C - reconstructing the missing walls -10-30 min

F - odontometry
G - canal treatment

90 min

H - canal obturation - 30
min

D - insuring the access to the canal/s - 2-10 min

E - pulpectomy (extracting the nerve) - 10-15
min

I - crown obturation - 10
min
S1-3 - the three stages

Emanuel Grozea,
MMA1

DMAIC
Defining the
Process
S1 - Prep
Work

S3 - Finishup
S2 - Root Canal
Surgery

S1 - Is performed one single time at the beginning of the

treatment, except for the anesthesia, that is performed for
each session.
Time: an average of 35 min (averaging also C)
S2 - Is performed individually for each of the canal along with the
anesthesia*.
Time: an average of 137.5 min (averaging also E)
S3 - Is performed at the end of each
session.
Time: an average of 10 min
Total time: 3-12
hrs

* A tooth can have 1 to 4 roots and

sometimes 5.

DMAIC
Defining the
Process

Emanuel Grozea,
MMA1

Goals:
To

reduce the Endodontic Treatment (root canal surgery) time

from up to 12 hours and 6 session to a max of 6 hours in two
sessions.

To

increase the treatment quality.

DMAIC
Measurin
g
F - Odontometry
(measuring the
canal/s)
Description

Emanuel Grozea,
MMA1

this process is needed so that the dentist would know how

deep is the canal and is done with the endo instrument (a
spiraled needle)

DMAIC
Measurin
g
F - Odontometry
(measuring the
canal/s)
Problems

Emanuel Grozea,
MMA1

low precision - could give inaccurate measurements due to

different root canal anatomies
high risk - an inaccurate measurement could result in an
apex rupture if the measurement is too high, or an insufficient
root filling and sealing if the reading is too low.

DMAIC
Measurin
g
G - Canal
treatment
Description
this is the manual cleaning and
widening of the root canal, and
its done with a series of endo
instruments of different sizes in
thickness

Emanuel Grozea,
MMA1

DMAIC
Measurin
g
G - Canal
treatment
Problems

Emanuel Grozea,
MMA1

high risk - the endo instruments can easily brake inside the root
canal. In such case the patient is in need of microscopic root canal
surgery.
high costs - a large number of endo instruments are needed,
some of one time use and others of some multiple use, resulting in
high costs. Also, even as this is not considered to be malpractice
and the clinic is not to be held accountable, in case of a endo
instrument fracture in a root canal, it is this clinics policy to cover
the microscopic root canal surgery.
high operation time - a classical procedure takes about 2
hrs/canal. Because of that, if one should work on a 4 canal tooth,
the operation would spread over 4-5 sessions.

DMAIC
Measurin
g
H - canal
obturation
Description
this is the process of filling and
sealing the root canal.
The filling is done by cold
condensation (fitting and
compressing) of
odontometrically measured
Gutta Percha cones.

Emanuel Grozea,
MMA1

DMAIC
Measurin
g
H - canal
obturation
Problems

Emanuel Grozea,
MMA1

low precision - due to the various canal ramifications,

widenings and/or narrowings, the cones may not go all the
way down, go further than its supposed, or incompletely fill
the canal.
high risk - an incomplete fill can result in sealing
(vulcanizing) failure. Reaching further than needed can
compress the apex and cause pain or even rupture it.

DMAIC
Measurin
g
J - A clean
environment
Description

Emanuel Grozea,
MMA1

when performing an endodontic treatment, a clean

environment is required, protecting the tooth from saliva, and
working chemicals

Problems
risk of infection - the primary factor of infection when
performing an endodontic treatment is the saliva, that is filled
with bacteria.

DMAIC
Analisy
s

Emanuel Grozea,
MMA1

Emanuel Grozea,
MMA1

DMAIC
Improv
e
Possible
solutions
Process

Odontom
etry

Improvement

Acti
on

Effect on
Time

Qualit
y

Effici
ency

Costs

Pain-testing

none

no

no

no

Radiography

none

no

no

no

Apex Locator

purc
hase

yes

yes

yes

1,20
0

C.
Treatment

One File Endo

purc
hase

yes

yes

yes

2,50
0

C.
Obturation

Warm GP
system

purc
hase

yes

yes

yes

1,50
0

Rubber dam

purc
hase

yes

yes

yes

220

Clean
Env.

5,42
0

DMAIC
Improv
e Odontometry Process can be best improved by purchasing
The

the Morita Apex Locator, a high-end device that electronically

measures the root canal length and always gives accurate readings,
minimizing all risks to zero and encasing the time and efficiency.
Time: 5 min
The Canal Treatment Process can be improved by purchasing the
VDW Silver Reciproc One File Endo device. This is an automated head
that cleans the root canal by using only one endo instrument chat
does not break, thus reducing all risk. The greatest up-side to this is
that it can reduce the time by up to 75%, thus cleaning the root canal
in under half an hour. This gives the dentist the chance to finish all up
in one session.
Time: 30 min
The Canal Obturation Process can be improved by purchasing the
E&Q +plus Warmed Gutta Percha Obturation System. As the
alternative to the cold condensation, this fills all gaps and creates a
complete 3D filling and can ensure a good vulcanization of the root
canal.
Time improvement: 70 min (fromTime: 15 min
120 to 50)
A clean environment can be obtained by
purchasing a rubber dam, a dental contraption
that wraps around teeth isolating it from the rest
of the mouth. This process is added to the
diagram.
Time: 2 min

Emanuel Grozea,
MMA1

Emanuel Grozea,
MMA1

DMAIC
Improv
e
Priority
Matrix
1. J - Clean
Environment

2. F - Odontometry
3. G - Canal Treatment
3. H - Canal Obturation

Diagra
m

from 2h to max 1h /
canal

Emanuel Grozea,
MMA1

DMAIC
Contr
ol

Time
improvement

Hour
s
Sesion
5

Sesion
4

Sesion
3

Sesion
2

Sesion
1

In the classical procedure the

time increases dramatically with
the number of tooth roots, from
about 31/2 hours to over 12
hours, whereas with the new
technology the time is brought
down to more than a half.

DMAIC
Contr
ol

Quality
improvement

Emanuel Grozea,
MMA1

There are two axis of control: a negative marker - the returning customers
with quality issues, and a positive marker - the encase in customers number
The positive marker for a RC surgery.
The positive marker
a decrease
an increase with up to 400%
from 18.51% (2 faults in 10.8
from an average of 3 per
clients)
month
to 0.96% after (1 fault in 96
to 12 RC in the last month
clients).

DMAIC
Contr
ol

Emanuel Grozea,
MMA1

Return Of
Investment

The total investment is of 5.420.

Out of a total number of 12 clients/day the firm currently performs 4
Root Canal Surgeries for 10 / canal. If we would to average 3 canals /
surgery, it would take 45 days to break-even.
The ROI in one year is 5.09 to every 1 invested.

Thank you
for your
time!