Implant + Perio Clinic

Every few weeks, I meet a patient who arrives expecting me to confirm that a tooth needs to be removed.

Sometimes they have already accepted it.

Sometimes they have spent months worrying about it.

Occasionally they sit down and say something along the lines of, “I know what you’re going to tell me. Just take it out.”

Our Goal

What often surprises them is that the conversation usually begins somewhere else.

Can we keep it?

Perhaps that sounds strange coming from an implant dentist. After all, a significant part of my work involves replacing missing teeth with dental implants. But that has never been the goal. The goal is to help patients keep a healthy, comfortable and functional mouth for as long as possible. Sometimes that means an implant. Sometimes it does not.

One of the misconceptions about implant dentistry is that implant dentists spend their days looking for teeth to replace. The reality is rather different.

Every tooth deserves careful consideration

Some of the most difficult decisions I make are not the implants I place. They are the teeth I try to save. Every tooth deserves careful consideration before it is removed. Not because every tooth can be saved. It can’t. There are situations where the damage is too extensive, the infection too severe, or the long-term outlook simply too uncertain. There are times when removing a tooth is unquestionably the right decision. Part of experience is recognising when that moment has arrived. But another part is recognising when it hasn’t.

In practice, many teeth exist in a grey area. A tooth may not be perfect, but it may still be comfortable and functional. A tooth may have lost bone support, but respond well to periodontal treatment and maintenance. A tooth may need further treatment, but still have years of service left in it. These situations rarely lend themselves to simple answers. They require judgement.

The reality is that no implant, however successful, is quite the same as a healthy natural tooth. Modern implant dentistry has transformed what we can offer patients, and I have seen implants restore confidence, comfort and quality of life for countless people over the years. But they remain replacements. Whenever possible, preserving what nature originally provided remains worth considering.

The cases I remember most

Looking back, many of the cases I remember most are not necessarily the most complex. They are often the quieter ones. The patient who thought they would lose a tooth and didn’t. The tooth that survived for another five years. Or ten. The patient who left relieved because they had options. Those moments rarely appear in photographs. They do not make dramatic before-and-after stories. Yet they remain some of the most rewarding parts of practice. Perhaps because they remind us that good dentistry is not about doing more treatment. It is about making thoughtful decisions.

Sometimes that means placing an implant. Sometimes it means waiting. And sometimes it means saving a tooth that others expected to lose. Those are often the teeth I remember most.

About the Author

This article was written by Dr Pedram Negahban, DDS, one of the implant dentists at Implant & Perio Clinic in Marylebone, London.

Much of his work involves replacing missing teeth with dental implants, but some of the decisions he values most are the ones that help patients keep their natural teeth for a little longer. He believes every tooth deserves careful consideration before it is removed and that successful dentistry begins with thoughtful treatment planning rather than treatment itself.

If you have been told a tooth may need to be removed and would like to understand your options, you can book a consultation with our team in Marylebone, Central London.

Implant & Perio Clinic is located on Portland Place, Marylebone, near Harley Street, London W1.

About the author