international magazine of oral implantology

18 I implants1_2011 I special _ endo-implant algorithm Studythepast,ifyouwoulddivinethefuture. —Confucius Theendodonticimplantalgorithmprovideshighlights in the assessment and identification of determinant factors leading to endodontic failures, in order to help inthedecision-makingprocess,whetheritisadequate to implement a new endodontic approach versus ex- tractionandreplacementwithdentalimplants. —Confusion _Over the years,endodonticshasdiminisheditself by enabling the presumption that it is comprised of a narrowly defined service mix; root-canal therapy pur- portedly begins at the apex and ends at the orifice. Nothing could be further from the truth. It is the catalyst and precursor of a multivariate continuum, potentially the foundational pillar of all phases of any rehabilitation(Figs.1a–c). Earlydiagnosisofteethrequiringendodontictreat- ment, prior to the development of peri-radicular dis- ease, is critical for a successful treatment outcome.1 Aesthetics,function,structure,biologicsandmorphol- ogy are the variables in the equation of optimal oral health. Interventional or interceptive endodontics, restorative endodontics, the re-engineering of failing therapy, transitional endodontics and surgical en- dodonticsencompassavastscopeoftherapeuticcon- siderations prior to any decision/tipping point to re- placeanaturaltooth. Everythingwedoasdentistsistransitional,withthe exception of extractions. No result is everlasting, none are permanent; thus our treatment plans must reflect thisreality.Artificeversusanaturalstateisnotapanacea forsuccessfultreatmentoutcomes(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 studies in order to provide informative empirical answerstoscientificresearchquestions. 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. Untying the Gordian Knot: An evidence-based endo-implant algorithm (Part I) Author_ Dr Kenneth S. Serota, USA Fig. 1a Fig. 1b