The goal of endodontics is to prevent and treat apical periodontitis. Inconsistent treatment outcomes have been reported for different endodontic procedures, especially in cases with persistent endodontic infection. Treatment decisions in such cases may often be a dilemma. Recommendations to the patients may vary from follow-up for longer periods, intervention through surgical or nonsurgical approaches, or even tooth extraction and selection of a potentially more successful treatment option such as dental implants. Clinicians must understand the prognostic factors that can influence the outcome of an endodontic treatment and the time required for endodontic lesions to heal. It is also essential to realize the long-term outcomes of implant dentistry in the hands of specialists and general dentists. All these factors must be well understood to select the optimal treatment decision for each case. Current endodontic procedures have undergone almost a complete change over the past decades. Teeth that were formerly considered to be hopeless now may be saved on a very high percentage basis using procedures and instruments recently introduced. The net result is that teeth that were extracted not long ago now have an outstanding chance for being retained. This presentation deals with many of these innovations and illustrates how they may be used for best results