In the 80’s, periodontics has distinguished itself by the advent of new procedures (surface treatment, guided tissue regeneration) and techniques (tunneling, root amputation, hemisection) to defer the maximum loss of Dental body. The origin of the development of these techniques was certainly the difficulties and risks of fixed or removable prosthesis on periodontium reduced. It was therefore necessary to maintain at all costs.
It was not counting on the development of implant techniques, which have led to the replacement of one-time dental body without risk to the adjacent teeth.
The inverted pendulum then why keep when we had a reliable solution to replace lost teeth?
Time and literature, however, have clearly indicated that the restoration implant-span were not free of complications, particularly in patients with periodontal disease.
Meanwhile knowledge about the disease and their treatment modalities have evolved offering new perspectives for the conservation of periodontal damage teeth.

The issue of conservation or extraction was therefore once again found at the center of the debate.

At the time of implant, mobile teeth, those with injuries or endo-periodontal attachment loss and bone loss are they immediately condemned? Should the contrary continue to fight to keep those teeth?

The question is essential and the answer bears heavy consequences. It implies a complex decision-making process that can not simply rest upon dogmatic positions but, on the contrary, requires that a number of criteria be taken into account, including the prognosis for the individual tooth, the nature of the periodontal disease, the patient ’s motivation, and the overall treatment plan set for this particular patient.
It is necessary in order to integrate the decision-making process into the treatment plan to determine at what moment the decision should be taken, and which precise parameters, in relation to the tooth and to the patient, should be considered to make the decision.
Except in specific situations (low Subgingival fracture, endodontic prognosis), the fundamental decisive parameters in relation to the tooth should be the degree of attachment loss and the degree of bone loss. These parameters however are not sufficient, as the decision to save the tooth must be weighed against the patient’s overall treatment plan, particularly if a prosthetic treatment is required.