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Excerpt

Background: Teeth with deep intra-bony defects have long been considered a clinical challenge. Most authors have classified such teeth as having either a questionable or a hopeless prognosis: the complex interplay of reduced residual periodontal attachment, deep pocketing, functional demands, and often the resulting tooth hypermobility have been key factors in such opinions. The clinical decision to retain severely periodontally compromised teeth is based on complex considerations to forecast the prognosis. The overall oral prognosis largely depends on patient factors, obviously, while local factors affect individual teeth. Furthermore, as a prognosis cannot be based on a single observation, the clinical situation must be continuously reevaluated, since influencing factors can change over time. Retaining a tooth with a poor or “hopeless” prognosis is possible in a patient who submits to close monitoring. Moreover, hopeless teeth that have been retained do not seem to negatively affect the remaining dentition. In spite of periodontal therapy, a certain number of these teeth are lost over time. …