Conservative dentistry: how we decide whether a tooth can be kept
Conservative dentistry means trying to keep the patient's teeth first and removing a tooth only when it can no longer be treated. At D'Institute in Cluj-Napoca, each tooth is assessed separately, on the X-ray and in the chair, before any extraction.
Most people who reach this page have recently been advised to have a tooth out, or have a tooth that has started to move, and they have one question: can anything still be done? Sometimes the answer is yes, sometimes it is no. On this page you will find the criteria the dentist uses to decide, the treatments that help keep teeth, and the situations where extraction is still the answer.
Why your natural tooth matters
A natural tooth is held in the bone by a thin ligament, the periodontal ligament. The ligament has nerve endings that sense pressure, so you know how hard you are biting, you can feel a seed in your bread or a bit that is too hard, and you adjust your bite without thinking about it.
Teeth sense pressure through the periodontal ligament. Implants reproduce this sensation only in part. Studies that have measured it show that sensitivity to pressure is lower with implants than with natural teeth, and better than with removable dentures.
That does not make an implant a bad treatment. Implants are a recognised treatment, and we place them too when a tooth can no longer be kept. It is simply that when your own tooth can stay, it is worth keeping.
Sources:
- Higaki et al., meta-analysis of the differences in sensitivity between implants and natural teeth, Clinical Oral Implants Research, 2014
- González-Gil et al., review of osseoperception and tactile sensitivity with different types of dental work, Medicina, 2022
How the dentist decides whether a tooth can be kept
The dentist looks at five things: how much bone there is around the tooth, the quality of the root, how much the tooth moves, how much of it is healthy and how well it can be cleaned. The first of these show up on the X-ray; the rest only at the examination in the chair.
| What is checked | How it is checked | What it means for the tooth |
|---|---|---|
| The bone around the root | Panoramic X-ray, CBCT | With enough bone, the tooth has something to stand on. With a lot of bone lost, the chances drop. |
| The root | X-ray, clinical examination | An infection at the tip of the root can be treated with root canal treatment. A vertical crack through the root usually cannot. |
| Mobility | Clinical examination | Mobility comes in grades. Teeth that move a little can be stabilised. |
| How much of the tooth is healthy | Clinical examination, X-ray | If enough of the tooth is left, it is restored with a crown or an endocrown. |
| Hygiene | Clinical examination, the patient's history | A tooth that is kept needs looking after. The dentist shows you how. |
No single criterion decides on its own. The dentist puts them together and explains, on your X-ray, why a tooth stays or goes.
Treatments that help keep your teeth
Root canal treatment under the microscope
When infection has reached the inside of the tooth, root canal treatment cleans and seals the root canals, and the tooth stays in place. Under the microscope, the dentist can see extra canals and cracks that the naked eye misses. At D'Institute it is done by Dr. Adriana Morar, an endodontics specialist.
Splinting loose teeth
Loose teeth can be joined together with a glass fibre strip bonded to the back, so they stay stable while the gums heal.
Crowns and endocrowns
A tooth that has had root canal treatment or is partly broken can be restored with a crown, which covers and protects it. On molars, an endocrown can be used: a crown that is also anchored inside the tooth, so more of the tooth is kept.
A fixed restoration on your own teeth: D'Original
When many teeth on an arch are affected but enough of them can be kept, a fixed full-arch restoration is placed over them. The teeth are joined together in a titanium framework, with zirconia crowns.
Can a loose tooth be saved?
Yes, often. A loose tooth is not automatically lost: what matters is the grade of mobility and how much bone is left around it.
| Grade | What it means | What can be done |
|---|---|---|
| 1 | The tooth moves slightly more than normal, from side to side | The cause is treated (usually gum disease); the tooth can be stabilised |
| 2 | The tooth moves visibly from side to side | Gum treatment, splinting or a restoration that joins the teeth together; the tooth can be stabilised |
| 3 | The tooth also moves up and down and can be pressed into the bone | Usually extracted |
Dr. Dimir explains why grades 1 and 2 can be recovered: a loose tooth held in a framework together with its neighbours no longer takes the load on its own, and the gums and bone around it can recover after treatment.
The grade of each tooth can only be seen at the examination in the chair. At a consultation, the dentist tells you what grade each tooth is and what can be kept.
When extraction is still the answer
Not every tooth can be kept, and it is only fair to say so. Extraction is still the answer when:
- the root has a vertical crack, running from the crown towards the tip; a crack like this does not close;
- the tooth is very loose and moves up and down too, because almost all the bone around it has been lost;
- the bone can no longer support the tooth, even after gum treatment;
- the tooth is broken down below the gum line and there is nothing left for a crown to sit on;
- keeping the tooth would put the neighbouring teeth at risk, or a larger restoration.
The dentist then explains what goes in its place: an implant, a restoration on your remaining teeth and a few implants (D'Original Plus) or, less often, a denture. What matters is that the decision is made after the assessment, not before.
Before an extraction, ask for a second opinion
An extraction cannot be undone. If you have been advised to have one or more teeth taken out, you can ask another dentist for their view before you decide. At D'Institute, a second opinion is a consultation: the dentist looks at the X-ray, examines you and tells you what can be kept.
Cases: teeth kept at D'Institute
[FROM THE CLINIC: the cases, with consent]
Results vary from one patient to another.
Frequently asked questions
What does conservative dentistry mean?
It means the dentist first tries to keep the patient's teeth and removes a tooth only when it can no longer be treated. The treatments used include root canal treatment, gum treatment, crowns and fixed restorations supported by your own teeth.
Can a tooth I was told needs extracting be saved?
Sometimes, yes. It depends on the bone, the root and how much the tooth moves, so only an assessment can answer that: an X-ray and an examination in the chair. That is why a second opinion before an extraction is worth getting.
Can a loose tooth be saved?
Often, yes, when the mobility is grade 1 or 2 and there is bone left around the root. The cause is treated, usually gum disease, and the tooth is stabilised with splinting or with a restoration that joins it to its neighbours.
When does a tooth need to be extracted?
A tooth is extracted when it has a vertical crack in the root, when it is very loose because it has lost almost all its bone, or when it is broken down below the gum and can no longer be restored. The dentist shows you the reason on the X-ray.
Is it better to keep the tooth or have an implant?
It depends on the state of the tooth. A tooth that can be treated and has enough bone keeps the natural feel of your bite. A tooth that can no longer be treated can be replaced well with an implant. The dentist tells you which applies in your case.
Can I have an implant if I have gum disease?
Yes, once the gum disease has been treated and is kept under control. Your gums need to be healthy before the implant, and sometimes bone augmentation is needed as well.
How long does a root-canal-treated tooth last?
A tooth that has had proper root canal treatment and been restored with a crown can last many years. It depends on how much of the tooth is left, how well the canal was sealed and how well you look after it.
Written by the D'Institute team and reviewed by Dr. Cătălin Dimir, dentistUpdated October 2026