Hwagok Dental Clinic: Preserving Natural Teeth vs. Implants—What Are the Treatment Decision Criteria?

Hwagok Dental Clinic: Preserving Natural Teeth vs. Implants,

What Are the Treatment Decision Criteria?

365 Seoul One Top Dental Clinic, Director Kim Geun-il

Hello.

I am Kim Geun-il, director of 365 Seoul One Top Dental Clinic.

When I meet patients in the treatment room,

there are occasionally people who visit our clinic feeling discouraged

after being told at another dental clinic:

“This tooth will be difficult to use any longer,

so it needs to be extracted and replaced with an implant.”

Whenever that happens, I look closely at the X-rays

and sometimes think with regret,

“It seems like we might be able to save it with just a little more effort…”

No matter how much implant technology advances and improves,

there is one belief I always hold as a dentist:

“I believe that no matter how outstanding an implant is,

it can never replace 100% of the delicacy

of the natural teeth we were born with.”

Then, what criteria do dentists use to say,

“Let’s do everything we can to save this tooth,”

and in what situations do they decide,

“It is time to extract it and proceed with an implant”?

Today, I would like to explain the treatment decision criteria

that I actually consider and apply in the treatment room.

Why Natural Teeth Are Important

The reason dentists insist on saving natural teeth first whenever possible

is simple.

Natural teeth have unique functions

that implants do not.

The Presence of the Periodontal Ligament

You may be familiar with the term “periodontal ligament,”

as I have mentioned it several times before.

Around the tooth root, or the root of the tooth,

there is a thin cushion-like tissue called the periodontal ligament.

The periodontal ligament absorbs the strong impact generated when chewing

and allows us to sense the texture of food delicately.

By contrast, implants are directly attached to the bone,

so the impact generated during chewing is not absorbed in the same way.

A Barrier Against Bacteria

Natural teeth are closely joined to the gums,

which effectively helps prevent bacterial invasion.

Implants have a relatively weaker protective barrier,

so without proper care they are much more vulnerable to gum disease

called peri-implantitis.

The Tooth’s Unique Sensory Sensors

Only natural teeth have delicate nerve sensors

that detect how hard food is

and whether it is hot or cold.

There is a nerve called the dental pulp inside a tooth,

but implants do not contain nerves.

Three Decision Criteria for Saving a Natural Tooth

Even when a tooth is severely damaged,

if it meets the following conditions,

I first try treatment to save the natural tooth instead of an implant

(such as root canal treatment, root canal retreatment, or periodontal treatment).

When the remaining jawbone supports at least half of the tooth root

Even if bone has been lost due to periodontitis (gum disease),

if the bone supporting the root remains at least above a certain level,

periodontal treatment may stabilize the tooth

and allow it to be used for longer.

When there is no crack in the root

Even if much of the crown has broken,

if the root is intact,

the tooth can be treated by rebuilding the crown

and covering it with a restoration.

When inflammation at the root tip can be treated with root canal retreatment or apical surgery

Even if a previous root canal treatment failed

and inflammation developed at the root tip,

there are cases that can still be treated.

Rather than extracting the tooth unconditionally,

the inflammation can be removed and the tooth restored,

depending on the situation, through root canal retreatment

or an apicoectomy, which involves removing only a small portion of the root tip.

Nevertheless, When We Recommend “An Implant After Extraction”

Then why would a dentist diagnose a tooth as needing extraction?

It is to prevent the situation from worsening

by trying too hard to save a natural tooth

until all the surrounding jawbone is destroyed,

making it impossible to place an implant later.

In the following situations,

we may recommend extraction decisively

for the patient’s long-term oral health.

When the tooth root is completely split lengthwise (vertical root fracture)

This is because bacteria continuously enter through the gap

and rapidly destroy the jawbone.

When the jawbone has been completely resorbed and the tooth is so loose it can be removed by hand

When too much jawbone has been resorbed,

the difficulty of implant treatment also increases.

During a subsequent implant procedure, a larger amount of bone grafting may be required,

and it may also take longer for the bone to stabilize.

When decay has progressed below the jawbone and restorative treatment is not possible

The key to the longevity of a restoration

is a precise fit at the margins.

If decay progresses deep below the jawbone,

it is impossible to completely block saliva, gingival crevicular fluid, and bleeding.

Because exposure to moisture significantly reduces the bonding strength of fillings or adhesives,

it creates an environment where recurrent decay can develop very easily.

Extraction is not simply “giving up on a tooth.”

It is a process of protecting the surrounding jawbone from further destruction

and safely preparing for the next treatment, such as an implant.

How Would I Decide If It Were My Family Member’s Tooth?

As a dentist, the two things I am most cautious about are

“hasty extraction” and “meaningless prolongation of a tooth’s lifespan.”

It is a problem to remove a tooth too easily when it can be saved,

but forcibly holding on to a tooth that has already reached the end of its lifespan

and is damaging the surrounding bone

can also cause the patient greater pain and financial burden.

As a dentist, I always ask myself,

“If this were a tooth belonging to my family, what choice would I make now?”

[Step 1]

If there is even a 1% possibility,

I first consider treatment to save the natural tooth.

[Step 2]

If I determine that saving it will be difficult,

I carefully explain to the patient why extraction is necessary

while reviewing the X-rays and intraoral photographs.

[Step 3]

If extraction is unavoidable,

I make a plan to place an artificial tooth

safely and with minimal discomfort.

If you are currently worried about tooth pain

or feel anxious after being told that extraction is necessary,

please do not worry alone.

Visit us comfortably and have the condition of your natural tooth

thoroughly evaluated once again.

I will always do my very best

to protect even one more of our patients’ precious teeth.

This was dentist Kim Geun-il.

Thank you.

📍 365 Seoul One Top Dental Clinic

179 Gangseo-ro, 4th Floor, Dongmyeong M Building,

Gangseo-gu, Seoul

Gangseo-gu Dental Clinic / Hwagok-dong Dental Clinic

A 1-minute walk from Exit 8 of Hwagok Station