Before the era of dental implants, the only alternatives to restoring a heavily compromised natural tooth were either dentures or a bridge. Neither of these are without their drawbacks; dentures at best are not terribly pleasant, and bridges are destructive to neighbouring teeth.
Understandably, this has driven the dental profession to provide increasingly complex and, sometimes, heroic treatments in order to save teeth almost at any cost.
I would suggest that this reluctance to extract even heavily compromised teeth needs to be revised and revisited. With the advent of predictable dental implants, the ground rules need to change (Christenson, 2006). The alternatives to restoring teeth are no longer limited to removable denture or tooth-retained bridges and so the imperative for keeping heavily compromised teeth has all but disappeared. Despite this, there is still a lot of restorative dentistry being provided for no other reason than that it is possible.
As a profession we need to develop a collective shift in mindset. Rather than asking ‘can this tooth be saved?’, a more pertinent question would be ‘can this tooth be saved predictably?’ and consequently, ‘should this tooth be saved?’