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I 07 special _ endo-implant algorithm I roots1_2010 studies in order to provide informative empirical answers to scientific research questions. In 1952, the enterprising son of an inventor named Ron Popeil created infomercials using 30- to 120-second television spots to sell his inexpensive arrayofusefulproducts,includingthePocketFisher- man and the Veg-O-Matic food slicer. The singular goal of an infomercial was to have the viewer phone immediately and place his or her order—no waiting weeks, months or even years for the lofty marketing goals of branding to pay off. Somewhere along the way, dentistry morphed the two concepts. Nowhere is this becoming more apparent than in the debate on the endodontic implant algorithm. “We have met the enemy ... and he is us.”(ThePogoPapers) Scientific doctrine is the cornerstone of endo- dontic therapeutics. However, of late, anecdotal testimony has become the default setting for new paradigms to justify endodontic treatment modali- tiesandanencomiumtotechnologicaladvances.The strengthofthearchofthisoranyspecialty’sintegrity andrelevancemustrelyonakeystoneofrandomised clinical trials and evidence-based treatment out- comes.Expertopinionsreflectedthroughthelooking glass of business models or global tours cannot replace stringently controlled clinical assessments distilled from exacting independent investigations. Science cannot be applied through a McLuhanistic rear-view mirror of technology. The two must symbi- oticallyoccupythesamespaceregardlessofwhether thatisantitheticaltothePauliExclusionPrinciple,one of the most accepted laws of physics: no two objects can simultaneously occupy the same space. In December 2004, Salehrabi and Rotstein3 pub- lished an epidemiological study on endodontic treat- ment outcomes in a large patient population. The outcomes of initial endodontic treatment by general practitioners and endodontists participating in the Delta Dental Insurance plan on 1,462,936 teeth of 1,126,288 patients from 50 states across the US were assessed in an eight-year timeline. Subsequent to non-surgical endodontic treatment over this period 97 % of teeth were retained in the oral cavity. The combined incidence of untoward events, such as re-treatments, apical surgeries and extractions, was 3 % and occurred primarily within three years from thecompletionoftreatment.Analysisoftheextracted teeth revealed 85 % had no full coronal coverage. A statisticallysignificantdifferencewasfoundbetween covered and uncovered teeth for all tooth groups tested, which is consistent with the findings of nu- merous investigations.4–6 The purpose of this publication is to evaluate cur- renttrendsandperceptionspertainingtothestandardof care in endodontics and provide an evidence-based consensus on their relevance and application. Part II will address the algorithm by which sacrifice of na- tural structures for ortho-biological replacements can be validated and the engineering principles and designs that best mimic clinical dictates. _Evolutionary paradigm shifts Three surveys have been conducted with the membership of the American Association of Endo- dontists since the late 1970s. The first reflected what is now an anachronistic view of emergency proce- dures and the standard of care defining non-surgical therapyduringthatperiod.7 Thesecond,donepriorto the technological advances of the last decade of the twentieth century, was hallmarked by a dramatic de- crease in leaving pulpless teeth open in emergency situations and a significant decline in the use of cul- turing prior to obturation.8 The report on the second survey indicated that theconceptofdebridementanddisinfectionversus cleaning and shaping was now the focus of the biological therapeutic imperative and the need for expansive microbial strategies was recognised as beingofparamountimportance(Fig.3).Theprimary patho-physiologic vectors of pulpal disease and themyriadcomplexityoftheroot-canalsystemhad always been understood; as the century closed, clinicians were provided with new tools and tech- nology to expand the boundaries and limitations of endodontic treatment procedures (Figs. 4a & b). Root-canal infections are polymicrobial, charac- terised predominantly by both facultative and obli- gate anaerobic bacteria.9 The necrotic pulp becomes a reservoir of pathogens; toxic consequences and their resultant infection are isolated from the pa- tient’s immune response. Eventually, the microflora and their by-products will produce a peri-radicular inflammatory response. With microbial invasion of the peri-radicular tissues, an abscess and cellulitis Fig. 1c_“Listening to both sides of a story will convince you that there is more to a story than both sides.” (Frank Tyger). The endodontic implant algorithm ensures that philosophy does not obscure pragmatism and expediency does not denigrate adaptive capacity. Fig. 1c