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tive outcomes for resurgery, the decision remains highly case specific. In spite of our best efforts, negative endodontic treatment outcomes occur and orthobiologic replacement of teeth and their surrounding an- choring structures is an integral part of contemporary founda- tional treatment planning. Engineering methods A recent article by Assuncao et al (44) describes engineering meth- ods used in dentistry to evaluate the biomechanical behaviour of osseo-integrated implants. Photo-elasticity is used for de- termining stress concentration factors in irregular geometries. The application of strain-gauge methodology on dental implants provides both in vitro and vivo measurement strains under static and dynamic loads. Finite element analysis can simulate stress using a computer-created model to calculate stress, strain, and displacement. An analysis of the impact of mechanical/ technical risk factors on implant- supported reconstructions is beyond the scope of this publica- tion; however, the replacement of lost teeth by implants should, without exemption, provide a feeling of restitutio ad inte- grum. The means by which the restoration of the original con- dition at the “crown/root” inter- face is idealised will be detailed. ‘The structure and composi- tion of teeth is perfectly adapt- ed to the functional demands of the mouth, and are superior in comparison to any artifi- cial material. So first of all, do no harm…’ Anonymous The final part of Kenneth Serota’s paper will be pub- lished in a future issue of Dental Tribune UK. DT Fig 7. The initial endodontic treatment procedure was in- adequate and failing. Reengineering (inclusive of interim calcium hydroxide therapy) ensured optimal eradication of microflora from the root canal space and the obtura- tion produced definitive closure of the apical termini. Surgery was performed to redress persistent symptoms. Fig 6. The image on the left is a flat field periapical radiograph; the one on the right, a small focal field cone beam volumetric tomograph (Kodak 90003D, Kodak Den- tal Systems, Woodbridge CT). The differential in visuali- zation of periapical pathology from a 3 dimensional to a 2 dimensional image is as much as 2:1 (Estrela et al, 2009). References 1. Torabinejad M, Anderson P, Bader J et al. Outcomes of root canal treatment and restoration, implant-supported single crowns, fixed partial dentures, and extraction without replacement: A systematic review. J Prosth Dent 2007;98(4):285-311 2. Ruskin JD, Morton D et al. Clinical controversies in Oral and Maxillofacial Surgery: Part One. Failed root canals: The case for extraction and immediate implant placement. J Oral Maxillofac Surg 2005;63:829-831 3. Moiseiwitsch J, Caplan D. A cost-benefit comparison between single tooth implants and endodontics. J Endod 2001;27:235 4. Jokstad A, Braegger U, Brunski JB et al. Quality of dental implants. Int Dent J 2003;53:409-443 5. Berglundh T, Persson L, Klinge B. A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years. J Clin Periodontol 2002;29 Suppl 3:197-212 6. Brånemark PI. On looking back with Per-Ingvar Branemark. Interview. Int J Prosthodont 2004;17:395-396 7. Christensen GJ. Implant therapy versus endodontic therapy. J Am Dent Assoc 2006;137:1440-3 8. Morris FM, Kirkpatrick TC et al. Comparison of nonsurgical root canal treatment and sin- gle tooth implants. J Endo Oct 2009;35(10):1325-1330 9. Torabinejad M, Kutsenko D et al. Levels of evidence for the outcome of nonsurgi- cal endodontic treatment. J Endod 2005;31:637-46 10. Torabinejad M, Bahjri K. Essential elements of evidenced-based endodontics: steps involved in conducting clinical research. J Endod 2005;31:563-9 11. Ricucci D, Grosso A. The compromised tooth: conservative treatment or extraction. Endo Topics 2006;13:108-122 12. Friedman S, Mor C. The success of endodontic therapy: healing and functionality. J Calif Dent Assoc 2004;32:493-503 13. Friedman S. Considerations and concepts of case selection in the management of post-treatment endodontic disease (treatment failure). Endod Topics 2002;1:54-78 14. Foster KH, Harrison E. Effect of presentation bias on selection of treatment option for failed endodontic therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:36-9 15. Tamse A, Fuss Z, Lustig J, Kaplavi J. An evaluation of endodontically treated vertically fractured teeth. J Endod 1999;25:506-8 16. Aquilinio SA, Caplan DJ. Relationship between crown placement and the survival of endodontically treated teeth. J Prosth Dent 2002;87(3):256-263 17. Zadik Y, DMD, Sandler V, Bechor R. Analysis of factors related to extraction of endodontically. 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Assunção WG, Barão VA, Tabata LF, Gomes EA, Delben JA, dos Santos PH. Biomechanics studies in dentistry: bioengineering applied in oral implantology. J Craniofac Surg. 2009 Jul;20(4):1173-7 About the author Kenneth S Serota, DDS, MMSc graduated from the University of Toronto, Faculty of Dentistry in 1973 and was awarded the George W Switzer Memorial Key for excellence in Prosthodontics. He received his Certificate in Endodontics and Master of Medical Sciences Degree from the Harvard-Forsyth Dental Center in Boston, MA. A recipient of the recipient of the American Association of Endodontics Memorial Research Award for his work in nuclear medicine screening procedures related to dental pathology, his passion is education and most recently e-learning and rich media. Ken provided an interactive endodontic program for the Ontario Dental Association from 1983 to 1997 and was awarded the ODA Award of Merit for his efforts in the provision of continuing educa- tion. He was selected for Fellowship in the Pierre Fauchard Academy and is a Fellow of the Academy of Dentistry International. The author of over sixty publications, he has lectured on Endodontics internationally. He is on the editorial board of Endodontic Practice, Endodontic Tribune and Implant Tribune. The founder of ROOTS – an online educational forum for dentists from around the world who wish to learn cutting edge endodontic therapy, he recently launched IMPLANTS (www.rximplants.com) and www.tdsonline.org in order to provide a clear understanding of the endodontic/implant algorithm in foundational dentistry. As well, he lectures on the empowerment digital technologies provide to the sophistication of the dental team and the propagation of comprehensive care. August 2-8, 201026 United Kingdom EditionClinical Flexibility is our Strength