Clinical decision making regarding endodontics versus implants.

This article discusses the current considerations in treatment planning for retention of the natural tooth through endodontic therapy (including orthograde first-time treatment, retreatment, and endodontic surgery) versus extraction and placement of a dental implant. As a secondary goal, the article describes several specific cases in which the best option is either an implant or retention of the natural tooth. The issue of tooth retention versus implant therapy is also addressed with regard to the specific clinical diagnosis of resorption in all of its various forms. Emphasis has been placed on practical strategies for treatment of cases involving internal and external root resorption using a comprehensive evidence-based approach.

Discussion of a complex endodontic case: when to refer.

A clinical case has been presented which discusses the clinical pre- and post-op assessment of a challenging clinical case. Emphasis has been placed on risk assessment as well as prevention of iatrogenic events by achievement and maintenance of apical patency as well as attainment of an ideal master apical taper and diameter.

Slow is smooth, smooth is fast: safe driving, better endo.

Each stage in the process of evaluation and subsequent treatment should be performed both slowly and progressively. In this example, first to appreciate the challenges in fragment removal, then to remove the fragment (or refer), achieve patency, shape the canals, obturate, and place a coronal restoration. Much like a cave dive that is highly planned and rehearsed and carried out in successive and progressively building steps, to the greatest extent possible so should our endodontic procedures. Ideally, there should be no surprises. Once begun, performing every step in a sequential order allows the process (whether it's cave diving or endodontics), to be at first slow, then smooth, and ultimately fast.

Endodontic techniques for scouting the apical thirds of root canals.

It might be said that there are as many endodontic instrumentation techniques as there are operators, although no two clinicians perform the procedure in exactly the same manner. Despite differences, there are basic principles (correct diagnosis, adequate access, adequate irrigation, removal of the entire pulp, instrumentation to the minor constriction of the apical foramen, three-dimensional obturation, etc.) whose observance are consistent with long-term endodontic success. As a subset of these time-honored principles, there are guidelines and techniques for apical third "scouting" and instrumentation, which can also be considered universal, irrespective of the particular instruments or technique used for canal preparation. The purpose of this paper is to describe a scouting technique that is designed to optimize the apical part of root canal preparation. The author first heard the word "scouting" used in the context described by Dr. Clifford J. Ruddle.