Romanticising the Last Tooth: Symbolism and Strategy in Prosthodontics

The final remaining tooth in an otherwise edentulous mouth embodies a unique intersection of biology, psychology, and identity. Beyond its limited functional role, it serves as a powerful symbol of continuity and selfhood, making its extraction an emotionally charged event for many patients.

This narrative review explores the concept of 'Romanticising the Last Tooth', emphasising its psychosocial and clinical significance within geriatric and prosthodontic practice.

The discussion integrates evidence on emotional attachment, bone preservation, proprioception, and overdenture strategies to illustrate how the final tooth can influence both treatment planning and patient adaptation.

Ethical dilemmas surrounding tooth retention and patient autonomy are examined, highlighting the need for empathy driven, shared decision making to guide clinicians. Recent literature emphasises advances in implant-supported rehabilitation, digital workflows, and biomaterials in full-arch prosthetic management, which can influence decisions regarding the last tooth.

The R.O.M.A.N.T.I.C. framework (Retain Or Move Ahead: Navigating the Tooth In Context) is introduced, offering structured parameters for deciding whether to preserve or extract the last tooth. This approach underscores a broader vision of prosthodontics one that harmonises technical precision with human understanding to restore not only function but dignity and confidence in the ageing patient.