Sometimes a tooth snaps off at the gumline — or even deeper. In other cases a crown comes loose and you discover decay underneath. In any of these scenarios, your first stop should be a dentist. Don’t self-diagnose and don’t try to “fix” it at home; you can easily make things worse.
What a dentist will usually propose
After examining the tooth and taking the necessary images, your clinician will typically outline two paths:
- Attempt to restore the natural tooth, or
- Remove what’s left and place a dental implant.
Why saving the root often wins
Seasoned dentists generally favor preserving the natural root when it’s feasible. The root is anchored by the periodontal ligament, a specialized connective tissue that nourishes the area and suspends the tooth in bone. As long as your own tooth remains, the surrounding bone receives natural stimulation and is better maintained.
What changes with an implant
An implant is a titanium post that is mechanically inserted into bone. It lacks a periodontal ligament, so the biological “feedback loop” and micro-movement that help keep bone robust are absent. Over time, bone volume can gradually diminish around implants. In addition, because a dental implant is a foreign material, a subset of patients may experience failure to integrate or later complications, despite proper placement.
Even when integration is successful, long-term remodeling can lead to bone loss. That’s why many patients require bone grafting and, eventually, implant replacement somewhere around the 10-15 year mark, depending on individual factors and hygiene.
The time value of saving the tooth
Choosing to rescue the natural tooth – via endodontic therapy, post-and-core, crown lengthening, or other advanced techniques – can buy significant time. A well-restored tooth might serve for up to a decade or more. Only after that would you consider an implant (if needed). In practical terms, you might delay bone grafting and implant cycling by 20-30 years, which is a meaningful advantage.
When extraction and implant really are the better call
It isn’t always possible or prudent to keep a tooth. Reasons include:
- Unfavorable fracture patterns (vertical root fracture, cracks extending too deep below the gum).
- Insufficient remaining tooth structure to retain a crown, even with advanced retention techniques.
- Severe periodontal disease with poor support.
- Complex anatomy or recurrent infection that makes predictable endodontic retreatment unlikely.
- Clinician skill set and equipment — not every dentist performs complex restorative or microsurgical procedures.
A recommendation to extract the tooth isn’t necessarily profit-driven; it may reflect honest clinical judgment based on experience and the likelihood of a stable outcome.
A sensible decision process
- Get a thorough diagnosis: clinical exam, periapical radiographs, and often CBCT imaging.
- Ask explicitly about tooth-saving options: endodontics, crown lengthening, orthodontic extrusion, fiber posts, etc.
- Seek second (or third) opinions if you’re told the tooth can’t be saved. Different clinicians have different training and tools.
- Compare long-term horizons: longevity of a complex restoration vs. staged implant care and possible grafting later.
- Consider your personal risks: smoking, diabetes, parafunction (grinding), and oral hygiene all influence outcomes.
If a qualified dentist believes the tooth can be predictably saved, that route typically preserves bone physiology and may defer more invasive procedures for many years. If prognosis is poor, moving to extraction and implant can be the more reliable, cost-effective solution. Gather opinions, weigh the timelines and risks, and then choose the path that offers the best long-term stability for you.
