During patient treatment, the clinician needs to consider the operator needs, the restoration needs, and the tooth needs. This article discusses molar access and failures of endodontically treated teeth that occur not because of chronic or acute apical lesions but because of structural compromises to the teeth that ultimately render them useless. The authors believe that the current models of endodontic treatment do not lead to long-term success, and that the traditional approach to endodontic access is fundamentally flawed. This article introduces a set of criteria that will guide the clinician in treatment decisions to maintain optimal functionality of the tooth and help in deciding whether the treatment prognosis is poor and alternatives should be considered.