ROEN0110

06 I I special _ endo-implant algorithm Studythepast,ifyouwoulddivinethefuture. —Confucius The endodontic implant algorithm provides high- lights in the assessment and identification of de- terminant factors leading to endodontic failures, in order to help in the decision-making process, whether it is adequate to implement a new en- dodontic approach versus extraction and replace- mentwithdentalimplants. —Confusion _Over the years, endodontics has diminished it- self by enabling the presumption that it is comprised ofanarrowlydefinedservicemix;root-canaltherapy purportedlybeginsattheapexandendsattheorifice. Nothing could be further from the truth. It is the catalyst and precursor of a multivariate continuum, potentiallythefoundationalpillarofallphasesofany rehabilitation (Figs. 1a–c). Early diagnosis of teeth requiring endodontic treatment,priortothedevelopmentofperi-radicular disease, is critical for a successful treatment out- come.1 Aesthetics, function, structure, biologics and morphologyarethevariablesintheequationofopti- mal oral health. Interventional or interceptive endo- dontics, restorative endodontics, the re-engineering of failing therapy, transitional endodontics and sur- gical endodontics encompass a vast scope of thera- peutic considerations prior to any decision/tipping point to replace a natural tooth. Everything we do as dentists is transitional, with the exception of extractions. No result is everlasting, none are permanent; thus our treatment plans must reflect this reality. Artifice versus a natural state is not a panacea for successful treatment outcomes (Figs. 2a–d). In 1992, funding from the Cochrane Collaboration wasobtainedfortheUKCochraneCentrebasedinOx- fordtofacilitatethepreparationofsystematicreviews of randomised trials of health care.2 The Cochrane Systematic Review is a process that involves locating, appraising, and synthesising evidence from scientific Figs. 1a & b_Previous endodontic therapy on tooth #14 had failed; the clinician chose to correct the problem with a microsurgical procedure on the mesio-buccal root. This procedure failed over time as well (sinus tract). Radiographic and clinical evidence indicate the developing apical lesion. The root-canal system was reaccessed, the untreated canal identified, the entire system debrided, disinfected and after interim calcium hydroxide therapy, obturated. One year later, the lesion had healed. While the retrograde amalgam re- mained in the root end, its presumed ability to seal a complex apical terminal configuration effectively was ill considered. Everything leaks in time; re-treatment is always the first choice for resolution of an unsuccess- ful endodontic procedure, where possible. roots1_2010 Untying the Gordian Knot: An evidence-based endo-implant algorithm (Part I) Author_ Dr Kenneth S. Serota, USA Fig. 1a Fig. 1b