implants - international magazine of oral implantology

I special _ endo-implant algorithm 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 The laws of nature are but the mathematical thoughtsofGod. —Euclid of Alexandria _Four thousand years ago, a number of Baby- lonian legal decisions were compiled in what came to be known as the Code of Hammurabi. The deci- sion with reference to the construction of dwellings and the responsibility for their safety be- gins: If a builder engineers a house for a man and does not make it firm, and the structure collapses and causes thedeath 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 base- balls and footballs with greater dependability than the most advanced weapons system intercepts missiles. In our professional lives, however, in con- tradistinction to the paradigm of evidence-based dentistry, our efforts as builders often rely solely upon personal experience, intuitive cognition and anecdotal accounts of successful strategies. The challenges posed by implant-driven treat- ment planning mandate vigilance of the interac- tionbetweenthoseinvolvedinresearchanddevel- opment, manufacturing and distribution and the leaders of ideologically diverse disciplines. Tempo- ral 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 cap- tured the hearts and minds of those who seek to nullify preservation of natural tooth structure in the oral ecosystem and deify ortho-biological re- placement. 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 im- peratives. Prospective large cohort clinical trials with clearly defined criteria for survival, with and without intervention, quality of life information andeconomicoutcomesareessentialtocomparing alternative foundational treatments. These studies will require expertise, time and financial support from the various stakeholders, professional and corporate alike.1 Theauthorityofthosewhoteachisoftenanobsta- cletothosewhowanttolearn. —Marcus Tullius Cicero Back to the egg: An evidence-based endo- implant algorithm (Part II) Author_ Dr Kenneth Serota, USA 06 I implants2_2011 Fig. 1 Size in mm Success in % 0 87.6 1–5 65.7 >5 56.2