There is a plethora of studies reporting successful long-term retention of periodontally compromised teeth. However, such teeth are more likely to be extracted during active therapy than during supportive periodontal therapy. With the vastly growing dental implant market, the inclination to extract periodontally compromised teeth has become more pronounced. In this narrative review, relevant literature along with suggested guidelines for dental partitioners are presented, as well as four cases, in which teeth with compromised periodontal prognosis were successfully managed, with follow-ups of up to 36 years.
Conclusion: Preserving periodontally compromised teeth should be highly considered, especially because they tend to outlast dental practitioners’ expectations as well as the implant alternatives. The decision to replace periodontally compromised teeth with implants should be taken with caution as there is increased evidence that the success rates of implants in treated periodontal disease patients are lower than in patients without the history of periodontitis. Furthermore, there are significantly lower overall costs of treating and maintaining stage III and IV periodontitis–affected teeth with periodontal regeneration than placing and maintaining implants in the long term.