A clinician evaluates a tooth for its quality of health. Once accomplished an estimate of longevity and survival is estimated. With current knowledge about the survival and success of implants a decision is made as to whether to extract or to treat and maintain the tooth. Questions and doubts abound in the decision making process in regards to the prognosis of an individual tooth. Unfortunately in dentistry, as in all biologic sciences, there are no straightforward answers to questions. This article will attempt to review the literature in this area to aid the practitioner in the decision making process with regards to the compromised tooth. The article will focus on the single tooth or implant restoration. Other factors such as the strategic value of a tooth and financial limitations in relation to long-term prognosis will also be discussed.