ROEN0210

06 I I special _ endo-implant algorithm Thelawsofnaturearebutthemathematicalthoughts ofGod. —Euclid of Alexandria _Four thousand years ago,anumberofBabylon- ian legal decisions were compiled in what came to be known as the Code of Hammurabi. The decision with reference to the construction of dwellings and the responsibility for their safety begins: If a builder engineers a house for a man and does not make it firm, and the structure collapses and causes the death of the owner, the builder shall be put to death. We are all builders or engineers of sorts; we calculate the path of our arms and legs with the computer of our brain and we catch baseballs and footballs with greater dependability than the most advanced weapons system intercepts missiles. In our profes- sional lives, however, in contradistinction to the par- adigm of evidence-based dentistry, our efforts as builders often rely solely upon personal experience, intuitive cognition and anecdotal accounts of suc- cessful strategies. Thechallengesposedbyimplant-driventreatment planning mandate vigilance of the interaction be- tween those involved in research and development, manufacturing and distribution and the leaders of ideologically diverse disciplines. Temporal shifts and trends in the service mix are part of the evolution of the art and science of dentistry; to some degree, the implant-driven vector has captured the hearts and minds of those who seek to nullify preservation of natural tooth structure in the oral ecosystem and deify ortho-biological replacement. The corporate entities from which we derive our tools too often fail to distinguish the point at which science ends and policy begins. By positioning advocates and acolytes at the vanguard of their marketing campaigns, they ef- fect change; however, their support for education is directed towards dissemination of product, not the fundamentals and rudiments of biological impera- tives. Prospective large cohort clinical trials with clearly defined criteria for survival, with and without intervention, quality of life information and eco- nomic outcomes are essential to comparing alter- native foundational treatments. These studies will requireexpertise,timeandfinancialsupportfromthe various stakeholders, professional and corporate alike.1 Theauthorityofthosewhoteachisoftenanobstacleto thosewhowanttolearn. —MarcusTulliusCicero roots2_2010 Back to the egg:An evidence- based endo-implant algorithm (Part II) Author_ Dr Kenneth Serota, USA Fig. 1 Size in mm Success in % 0 87.6 1–5 65.7 5 56.2 Fig. 1_The term tipping point refers to the moment of critical mass, the threshold, the boiling point. The colour sequence highlights the diagnostic steps to be followed in each tipping-point algorithm for the listed pathological states. Table I_As reported by Chugal et al., the most significant vector relevant to post-op healing is the presence and magnitude of pre-op apical periodontitis.17 Table I