[A tooth or an implant--literature based decision making]

The common use of dental implants in the daily practice led to a profound change in the available treatment strategies. The option of replacing a diagnosed doubtful tooth with an implant has become widely accepted and often used. The prognosis systems in use today are based on the three major disciplines: endodontics, periodontics and prosthodontics. Combining these three may impair and bias the decision making process and increase the tendency to base it on subjective clinical experience and personal preference. Reading and reviewing the relevant literature gives no clear tool for use. Root canal treatment is considered a highly predictable treatment procedure and a treated tooth is affected mainly by the quality and type of the fabricated restoration and the risk of caries. Periodontal treatment followed by a suitable maintenance regimen will likely allow long term tooth survival. When comparing the success rates of natural teeth rehabilitation versus implant supported restorations, it appears that with implants an additional treatment is demanded along the years. This coincides with the fact that to date there is no consensus regarding the extent of perimplantitis and perimucositis that is to be expected around a restored implant. In addition, a peri implant tissue problem or a failure of a dental implant may prove to be more challenging than a failure of a tooth. It is important to remember that a dental implant is made to substitute a missing tooth and it is a treatment modality with known and clear indications for rehabilitation of an edentulous space. The aim of this paper is to review and discuss the various aspects of whether to maintain a compromised or a doubtful tooth or to prefer a treatment modality using dental implants. In conclusion it is advised here, to incorporate the discussed issues in the decision making process towards the most suitable treatment plan.