One of the most current topics of debate in dentistry concerns the retention of a compromised tooth versus the extraction of the tooth and replacement of said tooth with an implant.

When considering whether a tooth should be retained a number of factors should be considered. Cardinal among these factors from a restorative point of view is the “ferrule effect”. This concept applies to the presence of a “ring” of healthy natural dentine 1,5-2mm in height on the root surface over which a porcelain cap or crown will fit. This circumferential wall of dentine provides increased strength to the root to reduce the risk of root fracture as well as providing increased retention for the overlying crown.

Without this “ferrule effect” vertical root fracture can happen and this is associated with marked bone loss around the root. The bone loss often necessitates a bone graft to optimize implant placement.

Recurring periodontal disease which results in bone loss around a tooth could also be a reason to sacrifice the tooth in favour of an implant.