What Do I Do When I'm Told a Tooth Needs to Be Extracted?

In today’s implant era, patients hear a sentence more often than they should: this tooth needs to come out and be replaced with an implant. Sometimes that is exactly right. But we are very experienced with implant restoration in this practice, more than 3,900 implants placed and restored, and precisely because of that experience, Dr. Marlin will always try to save a tooth rather than extract it, when the patient wishes and the tooth allows.

That ordering matters. Here is why, and what to do when you have been told a tooth is finished.

Why a Savable Tooth Beats a Replacement

Natural teeth hold advantages no implant fully reproduces. A tooth connects to the jaw through a living ligament that provides sensation and shock absorption; an implant fuses rigidly to bone. A tooth preserves the gum and bone architecture around it as designed; a replacement approximates it. Implants are the best answer ever developed for a tooth that is truly gone, and we place them routinely. They are not an upgrade over a tooth that could have stayed.

So the first question is never “can an implant go here?” It is “does this tooth actually have to leave?”

A Case in Point: The Tooth That “Had” to Go

Our patient came to us simply wanting to replace crowns she found unattractive (Fig. 1). Beneath one of them, unknown to her, was extensive decay that had left very little tooth structure to work with (Fig. 2), the kind of finding that routinely triggers an extraction recommendation and an implant plan.

Fig. 1: Unsatisfactory Existing Crowns

Fig. 2: Extensive Decay Beneath Crown

Instead, we reconstructed the tooth abutments and fabricated two natural-looking custom crowns in our in-house laboratory. Her natural teeth stayed, the aesthetics she originally wanted were delivered, and the result has endured. Extraction was available the whole time. It simply was not necessary.

What to Do With an Extraction Recommendation

Treat it as a diagnosis to verify, not an appointment to schedule. Ask what specifically makes the tooth unsavable, whether a root canal, post, and crown could rebuild it, and what the long-term prognosis of saving it would be versus replacing it. Then, for any non-emergency extraction, get a second opinion from someone trained on both sides of the question.

A prosthodontist occupies exactly that position: specialty training in saving compromised teeth through reconstruction and in replacing lost ones with implants. When both tools sit in the same hands, the recommendation can follow the tooth instead of the toolbox. Dr. Marlin has written further on this in being told several teeth need extraction and implants, and the theme runs through cases like two front teeth saved with gold posts and zirconia crowns.

Extraction is sometimes necessary, and when it is, we say so plainly and plan the replacement properly. But it should be the last resort, not the first option. If you have been told a tooth needs to come out, invest one more visit before something irreversible happens. Call 202-244-2101 or schedule a consultation with Dr. Gerald Marlin at Elite Prosthetic Dentistry in Friendship Heights, Washington, DC.