When Preserving the Tooth Comes at the Cost of Losing Bone

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A patient had presented with two anterior central incisors; short roots, probably affected by orthodontically induced resorption, and a history of having the crowns replaced several times because of patient dissatisfaction. The previous crowns had been removed because of gingival inflammation. After removing the crowns, because the inflammation persisted, crown lengthening surgery had been performed to preserve the teeth. The patient recounted that before treatment she had asked: «Isn't an implant a better option?» and the answer had been: «Nothing is better than the patient's own tooth, and the tooth must be preserved.»

‍️Today, however, the patient is still dissatisfied with the current situation; two long crowns, with abnormal proportions and a disharmonious appearance in the most sensitive esthetic zone.

Sometimes in dentistry we focus so much on "tooth preservation" that we forget that in the anterior region, especially in the presence of short roots, the bone and the soft-tissue architecture are the most valuable assets of the treatment. Preserving the tooth is not always equivalent to treatment success. Sometimes the tooth may be preserved, but the final result — in terms of esthetics, biomechanics, and patient satisfaction — is a failure.

‍️Perhaps in some cases the main question is not: «Can the tooth be kept?» but rather: «Is preserving this tooth worth the price paid in the bone and architecture of the region?» Many say: «Nothing is more important than the tooth.» But perhaps in some cases, especially in the anterior, nothing is more important than the bone.

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