There's No Hurry to Extract

Dentists are in the business of saving teeth. From preventive care to conservative restorations, our job is to prevent the loss of our patients' healthy tooth structure. However, when a tooth cannot be saved, our job becomes replacing it with a prosthesis to restore function and esthetics. The question, which is one that has been deliberated in the profession for decades and has only become more hotly debated as treatments improve, is "at what point is a tooth beyond saving?"

Inside Dentistry's May cover story explores some of the factors that affect the decision to save or replace, including clinical considerations, nonclinical patient concerns, and the clinician's education, experience, and preferences. Historically, the discomfort and poor esthetics associated with traditional dentures made saving teeth at all costs more of a no-brainer. But with more recent advances in implant therapy that have improved the predictability, long-term success, and esthetics of implant-supported restorations and research demonstrating survival rates that rival those of some endodontic treatments, many of today's clinicians are quicker to give up on a tooth and proceed with extraction and implant placement.

Personally, I try to do whatever I can to save teeth. Implants aren't 100%, and there have also been significant advances in endodontic therapy. That being said, there should be an evidence-based limit to these efforts. In situations involving failed endodontic treatment, I am more likely to preference implant placement over complex endodontic re-treatment. To best serve our patients, we cannot default to either extreme. Putting patients through endless endodontic procedures because we refuse to allow a tooth to die for ideological reasons is as much of a disservice as immediately yanking every compromised tooth and replacing it with an implant. We have to rely on our own skills and those of our specialists to determine what's most appropriate in each case. It's a collaborative effort that requires sound risk analysis by all parties. Many times, I've received referrals to extract in cases in which posterior restorations simply needed to be adjusted or anterior teeth were only loose due to occlusal problems that needed to be addressed. Don't be afraid to question and always use your own best judgement!

Robert C. Margeas, DDS
Editor-in-Chief, Inside Dentistry
Private Practice, Des Moines, Iowa
Adjunct Professor
Department of Operative Dentistry
University of Iowa, Iowa City, Iowa
rmargeas_eic@aegiscomm.com