Clinical DENTAL TRIBUNE | April 201010A ADS A clinical case demonstrates the surprising importance of endodontists in dental implant treatment planning The endo-implant algorithm replacement with a dental implant is the correct treatment protocol. An endodontist is in the unique position to evaluate critical factors leading to endodontic failures in order to determine whether anoth- er endodontic procedure will lead to a predictable and successful outcome. Should the outcome not be favorable, then extraction and replacement with a dental implant would be the protocol to follow. In considering the ideal treat- ment plan, it is imperative to pro- vide the patient with all treatment options, as well as the financial cost and procedures associated with each treatment option. The patient is thus given the opportu- nity to make an educated decision as to the best treatment protocol for him or her. The information presented to the patient should include the endodontist’s opinion regarding which treatment option is more practical and predictable. For example, a patient with a non-contributory medical history was referred to my office for eval- uation of the maxillary left first molar. The patient was asymp- tomatic, and the tooth had been endodontically treated by a gen- eral dentist approximately seven months prior to the consultation and had never been restored. Clinically, it presented exten- sive decay, probing depths of 3 mm all around, exposure of the obturation material to the oral cavity and no temporary restora- tion. Radiographically, no peri- apical lesions were detected, and the bone levels around the tooth were adequate (Fig. 1). In order to determine the integ- rity of the tooth structure, some excavation was performed using 4.5x magnification and supple- mentary 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 By Jose M. Hoyo, DMD Fig. 1: Pre-op radiograph prior to extraction. There’s a new vision in dentistry that is gradually being recog- nized 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

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