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24 I I case report _ endo-implant algorithm _There’s a new vision in dentistry that is gradu- ally being recognised and is referred to as the endo- implant algorithm. This new approach considers the role of the endodontist as critical in considering whether a tooth can be saved or whether extraction and replacement with a dental implant is the correct treatment protocol. An endodontist is in the unique position to evaluate critical factors leading to endo- donticfailuresinordertodeterminewhetheranother endodontic procedure will lead to a predictable and successful outcome. Should the outcome not be favourable, then extraction and replacement with a dental implant would be the protocol to follow. In considering the ideal treatment plan, it is im- perative to provide the patient with all treatment options, as well as the financial cost and procedures associatedwitheachtreatmentoption.Thepatientis thus given the opportunity to make an educated de- cisionastothebesttreatmentprotocolforhimorher. The information presented to the patient should include the endodontist’s opinion regarding which treatment option is more practical and predictable. _Case study Apatientwithanon-contributorymedicalhistory wasreferredtomyofficeforevaluationofthemaxil- lary left first molar. The patient was asymptomatic, and the tooth had been endodontically treated by a general dentist approximately seven months prior totheconsultationandhadneverbeenrestored.Clin- ically,itpresentedextensivedecay,probingdepthsof 3mmallaround,exposureoftheobturationmaterial to the oral cavity, and no temporary restoration. Ra- diographically, no peri-apical lesions were detected, and the bone levels around the tooth were adequate (Fig. 1). In order to determine the integrity of the tooth structure, some excavation was performed using 4.5 x magnification and supplementary illumination, provided by a fibre-optic headlight, with a dental rubber dam for isolation. After the removal of some decay, a bitewing X-ray was taken (Fig. 2) and the following was determined: a) the floor of the pulp chamber was too shallow; b) it was too close to perforation and c) theperi-radiculardentinewasinsufficientlystrong to support a permanent restoration. These critical factors, in my opinion, rendered the tooth non-restorable. A cotton pellet and Cavit were placed in the access cavity and a follow-up call with the referring dentist was conducted in order to update him on the condition of his patient and to determine what recommendations should be given regarding the tooth. It was recommended to the patient that the tooth be extracted and the socket preserved through a minor grafting procedure. This would allow for an ideal amount of bone to receive a dentalimplantapproximatelyfourtosixmonthslater. It was also recommended that he receive some orthodontic treatment prior to the placement of the Fig. 1_Pre-op radiograph prior to extraction. roots1_2010 Fig. 1 The importance of endodontics in implant treatment planning Author_ Dr Jose M. Hoyo, USA