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J Periodontol. 2009 Mar;80(3):476-91. doi: 10.1902/jop.2009.080454 .

A novel decision-making process for tooth retention or extraction.

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Graduate Periodontics, School of Dentistry, University of Michigan, Ann Arbor, MI 48109-1078, USA.



Implant-supported restorations have become the most popular therapeutic option for professionals and patients for the treatment of total and partial edentulism. When implants are placed in an ideal position, with adequate prosthetic loading and proper maintenance, they can have success rates >90% over 15 years of function. Implants may be considered a better therapeutic alternative than performing more extensive conservative procedures in an attempt to save or maintain a compromised tooth. Inadequate indication for tooth extraction has resulted in the sacrifice of many sound savable teeth. This article presents a chart that can assist clinicians in making the right decision when they are deciding which route to take.


Articles published in peer-reviewed English journals were selected using several scientific databases and subsequently reviewed. Book sources were also searched. Individual tooth- and patient-related features were thoroughly analyzed, particularly when determining if a tooth should be indicated for extraction.


A color-based decision-making chart with six different levels, including several factors, was developed based upon available scientific literature. The rationale for including these factors is provided, and its interpretation is justified with literature support.


The decision-making chart provided may serve as a reference guide for dentists when making the decision to save or extract a compromised tooth.

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