The Decision to Restore a Tooth or Extract It and Replace It with a Single Implant

Every day, dentists are faced with situations where a decision must be made as to whether to treat and maintain a compromised tooth or extract it then replace it with a dental implant. This decision process must be made keeping in mind the various risk factors that come into play with different patient presentations. When faced with this question, retrieval of the most appropriate and available evidence from scientific research will assist the clinician and help compare treatment outcomes in order to determine which may have the higher chance of offering a predictable success in the long term. However, less objective factors pertaining to human variables such as patients’ preferences and expectations, motivation, access to care and financial ability can also influence the decision process. In certain situations, endosseous root form implants may offer advantages over the maintenance of the natural tooth as they are not subject to the same risk factors (e.g. risk of caries or risk of root canal re-infections). However, implants require specific oral conditions that may not always be easily attainable. They also hold disadvantages when compared to the natural tooth (e.g. they lack proprioception and offer no shock absorption; they behave like an ankylosed tooth). Understanding the irreversible nature of extraction and that implants act as imperfect root substitutes when the natural root cannot predictably and comfortably fulfil its functional and aesthetic role is crucial to the decision process. The objective of this chapter is to review the patient-related factors and conditions (medical, dental, psychological, social) that affect the decision process as related to the different dental diagnosis and treatment with teeth and implants.