Save or Extract

Try to save the tooth, or extract it and have an implant?

Which findings decide it, and what waiting changes

Saying a tooth 'can be saved' is not the same as saying it is 'worth saving'. On this page we explain the criteria that decide it, and how your options narrow the longer the decision is put off. If you send us your X-ray, we will write to you within 24 hours with our initial assessment of which side you are on; the final decision is made after an examination and a CBCT scan.

Short answer

The decision is not made on a single finding. Six things are looked at together: how much sound tissue is left in the tooth, whether the root is intact, how much of the bone around it is still there, whether the tooth is actually doing any work in your mouth, how many times it has been treated and failed again, and how many years an attempt to save it would buy you. A tooth can be technically savable and still not be worth saving. The real decision is made between those two statements.

What decides it: Whether the root is intact, and the bone support
What the decision needs: An examination and a 3D CBCT scan
Initial assessment: From your X-ray, within 24 hours
Our field: Many missing teeth

Medically reviewed by Bilge Ilgın, Dentist · ImplantologyLast reviewed 2026-08-31

Savable and worth saving are not the same thing

These two phrases sound alike, but they answer different questions. 'Can it be saved?' is a technical question: can this tooth be brought back into working order today with the methods available? 'Is it worth saving?' asks something else: how many years would saving it buy you, how many more times would it need treatment in that time, and what would be left if it failed? A tooth that answers 'yes' to the first question and 'not really' to the second is something we come across often.

Six criteria decide it. The first is how much sound tissue is left above the gum line; if there is no wall for a new crown to hold on to, the restoration will not last long. The second is the integrity of the root: if there is a crack along the length of the root, a pathway opens up for bacteria that cannot be sealed, and no treatment will seal it. The third is the bone support, that is, how much of the bone holding the root is still in place.

The fourth is often skipped: what job the tooth does in your mouth. A molar with no opposing tooth left to chew against carries almost no load; going through difficult surgery to keep it in place gives you little in return. If the same tooth supports a bridge or is at the front of the mouth, the calculation changes. The fifth is the treatment history: in a tooth that has been opened up and closed again many times, a new attempt does not have the same chance of success as the first. The sixth is the time dimension of cost: a procedure that looks cheap today can, once it is combined two years later with an extraction and replacing the bone that has been lost, bring the total above what the right decision would have cost at the start.

Thinking about one tooth in isolation from the rest of the mouth also leads to wrong decisions. If there is only one problem tooth, the calculation is simple. But if five or six teeth are in doubtful condition, trying to save each of them in turn can draw you into a chain of repairs that stretches over years; with every link, a little more bone and a little more time are lost. In a situation like this, the question is not 'will this tooth survive?' but 'what is the plan for this mouth over the next ten years?'

Which finding points which way

The breakdown below becomes clear after an examination and a CBCT scan. Seeing yourself in the second list does not mean the tooth will be taken out straight away; it only shows that less can be expected from an attempt to save it.

The tooth can be saved

A sound wall is left above the gumIf there is sound tissue for a new filling or crown to hold on to, the restoration will carry on taking the load of chewing. The wall that is left is one of the most concrete criteria for the decision.
The root is intactIf there is no crack along the length of the root, the load-bearing body of the tooth is sound. If the bone support and the remaining wall are also adequate, a new restoration can be built on an intact root.
Most of the bone support is still thereIf the bone surrounding the root is in place, the tooth is not expected to become loose and can stay in place for years. This makes an attempt to save it a step that can be reversed.
The tooth does real work in your mouthIf it has an opposing tooth to chew against, supports a bridge or is at the front of the mouth, it is worth making more effort to keep it in place. A tooth that has a function is also harder to replace.

Saving it is unlikely to hold

A vertical crack in the rootThe crack opens up a pathway for bacteria that cannot be sealed; no filling, root canal treatment or crown will seal it. What needs discussing here is not saving the tooth but when it will be replaced.
The fracture is below the gum lineIf there is no sound wall left for a crown to hold on to, the restoration will not last long. You do not want to be back at the same point two years later, and with less bone.
Most of the bone has resorbedIf the bone holding the root has been lost to an advanced degree, the tooth will carry on being loose and also puts the bone of the neighbouring teeth at risk. The real question is not about the tooth but about how to preserve the remaining bone.
The same tooth has been treated many timesThe more times a tooth has been opened up and closed again, the less sound tissue is left. The chances of a new attempt succeeding are low, and the time spent comes back to you as bone loss.

How we reach the decision

This sequence is for diagnosis, not treatment. At the end, you will know which route is realistic for your mouth and why; we do not make the decision for you, we set out the information.

1
Send us your X-ray
If you have a panoramic X-ray or a CBCT scan, send it through the form. The image is read by the dentist who would carry out the treatment, and we write to you within 24 hours about which options are on the table. You do not need to come in for this step.
2
Examination and the tooth's history
We assess the remaining sound walls, how loose the tooth is and how deep the gum pocket is. At the same time, we talk about how many times this tooth has been treated: a problem that keeps coming back is read differently from pain that has appeared for the first time.
3
Three-dimensional imaging
A cone beam CT (CBCT) scan shows root cracks and the extent of bone loss much better than a standard X-ray; even so, fine cracks may not always show up on the image. The decision usually becomes clear at this point. If the findings are not clear from a standard X-ray, a decision to save or extract made without seeing a CBCT scan is based on incomplete information.
4
We look at your whole mouth, not a single tooth
We read the problem tooth's neighbours, the teeth opposite it and any old bridges you have, all together. A decision made without seeing how saving one tooth affects the plan for the others often has to be reopened two years later.
5
We talk through the options openly
We explain what each route solves, how many visits it needs, what is left if it fails and the total burden over time. If your situation is not suitable for our protocol, we tell you that too.

The routes on the table

None of these routes is better than the others in absolute terms; which is better depends on the condition of your mouth. The right order starts with the least invasive, because when that step fails, the others are still on the table.

Keeping the tooth

Root canal retreatment, apicoectomy (root-end surgery), gum treatment or a new crown. If the root is intact, this is the first thing we try. If it fails, the implant option is still there; the reverse is not true. For teeth whose root is not cracked and that have a sound wall left above it.

Putting off the decision in a planned way

If the tooth is not causing pain and there are no signs of infection, we can put off the decision and monitor it. But this only works if the postponement has a set date and is monitored with check-up X-rays; a postponement that gets forgotten is the most expensive option we see. For teeth where bone loss is not progressing.

Extraction and a single-tooth implant

If only one tooth is missing, a conventional implant or a bridge is the option for that gap. This is not our main field, and we say so plainly to anyone who comes to us with a single-tooth problem: going to a clinic in your own city for this may mean less travel and less expense.

Extraction and a full-mouth fixed solution

If many teeth are missing, you can leave with final fixed teeth on implants after three clinical days. The strategic implants we use lock mechanically into the hard outer layer of the jaw, the cortical bone; conventional implants anchor in the softer, spongy bone inside, and you have to wait for them to fuse. That is where the difference comes from: in most suitable cases, a bone graft and months of waiting do not come into it. It can also be used in people with diabetes if their blood sugar is under control.

What you need to know when deciding

We write these down not to frighten you but so that you can ask the right questions whichever dentist you see. If a dentist does not tell you these things of their own accord, ask.

Putting it off narrows your options

As long as infection around the root or gum disease continues, the bone keeps resorbing. An area where the tooth could be extracted today and an implant placed within the same plan may, months later, need bone to be added first and then a wait. Putting it off does not make the decision go away; it hands it back to you in a harder form.

The order cannot be reversed

If an attempt to save the tooth fails, extraction is still possible; but a tooth that has been extracted cannot be put back. That is why, as long as the root is intact, we almost always try to save it first. Skipping a reasonable attempt and going straight to extraction is also a mistake.

A saved tooth does not last for ever

A tooth that has been saved with difficulty does not promise the same lifespan as a healthy tooth. Ask for an answer to the question 'how many more years will this tooth last?'; 'there's no way of knowing' is also an answer, and you need to build your plan around it.

Our method is not the answer to every question

The field of the protocol we use is the full mouth or many missing teeth. For a mouth with one problem tooth and the rest healthy, this method is not the right tool, and we will tell you so. If there is a gum infection that has not been brought under control, that also needs to be resolved before surgery.

What to expect afterwards

The two routes do not heal in the same way. With treatments that keep the tooth, recovery usually takes a few days. The course below applies when extraction and a full-mouth fixed solution are chosen.

Three clinical days
Day 1: planning, any extractions needed and placing the implants; day 2: try-ins; day 3: fitting your final fixed teeth. You do not spend this time without teeth; we plan a temporary solution for the two days between the extractions and the fitting of your final fixed teeth.
The first week
Some swelling and tenderness are normal; they usually go down after the third day. A cold compress and the medicines we give you are enough. During this period we ask you to eat soft food and to clean the area gently.
The first three months
Tissue healing is completed during this period. Because your fixed teeth are in place from the start, your daily life carries on; we only ask you to be careful with hard and sticky foods. We can also carry out the interim check-ups remotely.
The long term
Care is not very different from natural teeth: regular brushing, interdental cleaning and a yearly check-up. Smoking and uncontrolled blood sugar have a negative effect on healing; we talk about both at the start.

Message us right away if

Swelling increases after the third day. Swelling is expected to go down as you heal; if it is increasing, it needs to be assessed.
You have a fever. A fever can be a sign of infection. Message us without waiting.
Numbness does not wear off. Tell us without delay about numbness that persists in your lip or chin.

What determines the cost

We do not give figures on this page, because the right figure can only be given once a CBCT scan has been seen, and the costs of the two routes are very different. Send us your X-ray and we will share the scope and the figure in writing. These are the items that determine the price:

The route chosen: Keeping one tooth and a full-mouth fixed solution are not work of the same scope. But putting the two side by side is also misleading: one deals with a single tooth, the other with the plan for the whole mouth.
How many teeth are involved: A problem with a single tooth and several teeth about to be lost at the same time mean different plans. Dealing with them together often means fewer visits and a lower total cost.
Whether additional surgery is needed: If bone grafting or a sinus lift (sinus floor elevation) is needed, the scope widens. With implants that lock into cortical bone, this item does not come into it in most suitable cases; there are cases where it does, and we tell you at the start.
The total over time: The price of today's procedure is only half the story. Going back to the same tooth several times, ending up with an extraction anyway and replacing the bone lost in the meantime all push the total up. Ask for the calculation over the years ahead, not for a single procedure.

Frequently asked questions

One dentist said 'let's save it', another said 'let's take it out'. Which one is right?

Both may be right, given the information each of them looked at. The most common reason is that one of the dentists has not seen a CBCT scan: a root crack and the true extent of bone loss are often not visible on a standard X-ray. When you get a second opinion, take your images with you so that the discussion is based on the same information. If you send us your X-ray, we give you a second opinion in writing.

My tooth is loose but it doesn't hurt. Is it urgent?

No pain does not mean the problem is not progressing. A loose tooth often shows that some of the bone holding the root has been lost, and this process can progress silently. Whether you need to act quickly depends on how much of the bone is left, and an X-ray shows that. If you have swelling, a fever or a bad taste in your mouth, do not wait.

If I try to save it and it doesn't work, will I lose my chance of an implant?

Usually not, but it does not come free either. When an attempt fails, the implant option is still on the table; the real loss is the bone that resorbs in the time that passes. That is why, before you start an attempt, get an answer to the question 'how long before we see the result?' at the outset. A plan that leaves the result uncertain for a year can cost more than the attempt itself.

I have several doubtful teeth in my mouth. Should I try to save them one by one?

This is one of the sticking points we see most often. Dealing with the teeth in turn can create a chain of repairs that puts off the next problem each time. In a situation like this, you need to talk not about the teeth one by one but about a ten-year plan for your mouth. Within that plan, some teeth stay and some do not.

It's just one tooth, and it's in bad shape. Are implants in 72 hours right for me?

Probably not, and we say so plainly. The field of the protocol we use is the full mouth or many missing teeth. For a single gap in a mouth where the rest is healthy, a conventional implant or a bridge is more suitable; having this done in your own city may mean less travel and less expense for you. Send us your X-ray anyway; if it is not suitable, we will write and tell you so.

I have diabetes. Are extraction and implants risky for me?

Diabetes on its own is not an obstacle; what matters is whether your blood sugar is under control. We use the protocol in patients whose diabetes is controlled. If your blood sugar has been fluctuating for a long time, getting it under control comes before surgery, for the sake of your healing; in that case, we plan a preparation period together with the doctor who looks after your diabetes.

Why don't you put prices on the page?

Because the costs of the routes on this page are very different from one another, and we cannot tell which one applies to you without seeing a CBCT scan. Any figure we wrote would either frighten you unnecessarily or change at the clinic. Send us your X-ray and we will share the scope in writing, item by item.

Sources

Send your X-ray and we will tell you which option is realistic for your tooth.

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Next step

Send your X-ray and we will talk through the options.

Share your CBCT or panoramic X-ray. We will write back within 24 hours on which option is realistic for your tooth.

Get an assessment