To Save (a tooth) or Not to Save?

By Dr Lawrence Spindel, Monday January 12, 2009

Dentist New York

Most of the time multiple treatment plans are possible for restoring ‘This Old Tooth’ and it is necessary to explore the available options with the patient, going over the pros and cons of each option. Sometimes one treatment plan seems clearly the best

If the tooth has plenty of tooth structure left and no problems with its supporting bone, but only needs a root canal core and a crown, it is an easy decision, the tooth should be saved if patient’s finances allow. Conversely, if a tooth is badly broken down and has a failing root canal and is missing over 50 percent of the bone support, it is clearly best to recommend its extraction. The problem is that most of the time a patients situation falls in between these two extremes and that makes our decisions more difficult.

When I am making a decision I try a pick what I call a predictable long term outcome… If I am going to counsel a patient to restore a tooth, I would hope that my restorations and the tooth holding them will still be intact 10 to fifteen years later. I can not guarantee this, but I think if the tooth does last that amount of time, it was worth saving. If I think my plan might only last 5 years I would try to come up with a different more predictable option. In some cases this would mean extracting a tooth an placing an implant restoration.

Studies have shown that Implant restorations when they work, tend to last more than 15 years (better than 90%) That is a pretty good success rate. An extraction and a single tooth implant and its restoration may be approximately 25% more than saving the tooth by performing a root canal core and crown, but if the tooth has a questionable prognosis after all is said and done, than an extraction and an implant and an implant restoration, is the best treatment plan for that patient.

In the end, every situation is different and has to be considered uniquely. After an evaluation is made by the dentist, the patient is owed and explanation for the proposed treatment plan and any other viable alternative treatment plans as well.