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18 I I special _ endo-implant algorithm _A risk-assessment algorithm If the biological parameters that mandate en- dodontic success are adhered to, in almost all cases, treatment outcomes will be successful. The endo- dontic implant algorithm processes the array of contributing factors leading to endodontic failure, in order to determine whether to implement a re-engi- neeredendodonticapproachortoextractandreplace the natural tooth with an osseo-integrated implant. Itfindsthegreatestcommondivisoramongstthede- greeofcoronalbreakdownoftheinvolvedoradjacent teeth, the quality and quantity of the bone support andtissuecondition,andtheengineeringdemandsto bebornbythetoothorteethinquestion,andassesses the occlusal scheme and the patient’s aesthetic and functional expectations of treatment. The reasons for tooth extraction may include, but are not limited to, crown-to-root ratio, remaining root length, periodontal attachment levels, furcation status, periodontal health of teeth adjacent to the proposed fixture site and non-restorable carious de- struction. In addition, the clinician must consider questionable teeth in need of endodontic treatment, teeth requiring root amputations, hemi-sections or advanced periodontal procedures with a question- able prognosis, and pulpless teeth fractured at the gingivalmarginwithrootsshorterthan13mm.These teeth will require endodontic treatment, crown lengthening, post/cores and crowns; however, their longevity is much in doubt with these parameters.60 Practitioners are ethically obligated to inform patients of all reasonable treatment options. It is the patient’sattitude,valuesandexpectationsthatarein- tegral to the risk assessment algorithm. Poor motiva- tiontoretainatoothmandatesextraction,notclinical intervention, whereas high motivation advocates non-surgical intervention or surgery. The process of planning, presentation and acceptance of dental treatment plans is always dominated by the duality of emotion and pragmatism associated with cost. Where it becomes specious is the side-by-side dollar comparisonofrestoringanaturaltoothorplacement of a fixed bridge etc. in contrast to ortho-biological replacement of a debilitated tooth. Far too often thecomparisonofpurportedtreatmentoutcomeper- centages are based upon corporate affiliation and/or fiduciarybias,oraresimplytoonarrowaparameterto suggest comparable alternatives. With the treatment options available to an experienced endodontist, only very few structurally sound teeth need be removed. Benjamin Disraeli said: “Expediency is a law of na- ture. The camel is a wonderful animal, but the desert made the camel”. The endodontic implant algorithm raises the question: Does science drive the market, or does the market drive science. “All truths are easy to understand once they are discovered; the point is to discoverthem,”Galileosaid.Timeandforbearancewill bearwitnesstothediscoveryofthesalientandrelevant truthsthatguidetheendodonticimplantalgorithm._ Editorial note: Part II of this article will be published in roots 2/2010. A complete list of references is available fromthepublisher. Fig. 16a_The ProTaper Universal System consists of two shaping files that address the planes of geometry of the coronal and middle thirds of the root-canal space. There are five finishing files that include tips sizes: 20, 25, 30, 40 and 50. Tapers range from 0.06 to 0.09 through the series. A thorough understanding of the metrics is essential for the preparation of the myriad variations in internal micro-morphology of the root-canal space and the assurance of minimal iatrogenic impact. Fig. 16b_Modification of taper in the last millimetre of the apical terminus exaggerates the constriction or minor apical diameter. Thermo-labile vertical condensation has been shown to enhance successful endodontic outcomes. The matrix effect of the apical control zone enhances the gravimetric density of the required hermetic apical seal and enables more material to flow into the region to occlude fins, cul-de-sacs, deltas and lateral arborisations. roots1_2010 Dr Kenneth S.Serota graduated from the University of Toronto in 1973 and was awarded the GeorgeW.Switzer Memorial Key for Excellence in Prosthodontics.He received his Certificate in Endodontics and Master of Medical Sciences degree from the Harvard-Forsyth Dental Center in Boston. A recipient of theAmericanAssociation of Endodontics Memorial ResearchAward for his work in nuclear medicine screening procedures related to dental pathology,his passion is education,and most recently e-learning,and rich media.Dr Serota provided an interactive endodontic programme for the Ontario DentalAssociation from 1983 to 1997 and was awarded the ODAAward of Merit for his efforts in the provision of continuing education. The author of more than 60 publications,Dr Serota is on the editorial board of Endodontic Practice,EndoTribune and ImplantTribune.He founded ROOTS,an online educational forum for dentists from around the world who wish to learn cutting-edge endodontic therapy,and recently launched IMPLANTS (www.rximplants.com) and www.tdsonline.org in order to provide dentists with a clear understanding of the endodontic–implant algorithm in foundational dentistry. _about the author roots Fig. 16a Fig. 16b