In the world of restorative dentistry, one of the most important—and often complex—questions we face is: Should this tooth be saved? Determining a tooth’s restorability isn’t just about what we can do, but also what’s worth doing, ethically and predictably.
Here’s a breakdown of how clinicians can assess whether a tooth is salvageable and what factors make a real difference in treatment success.
🦷 The Pillars of Tooth Restorability Assessment
To make a sound clinical judgment, four major categories need to be carefully evaluated:
1. Structural Integrity
- Is there enough healthy tooth structure remaining?
- Is there sufficient ferrule effect to retain a post-core and crown?
- Would the case benefit from surgical crown lengthening or orthodontic extrusion?
2. Periodontal Health
- Assess probing depth, tooth mobility, bone support, and furcation involvement.
- Evaluate the crown-to-root ratio—a critical element for long-term prognosis.
3. Endodontic Considerations
- Can the tooth be treated or retreated successfully?
- Are there complicating factors like separated instruments, sclerosed canals, or root perforations?
4. Local and General Factors
- Consider tooth position, occlusion, function (e.g. abutment for prosthesis), and patient habits (e.g. parafunction).
- Evaluate the patient’s overall health – conditions like radiotherapy or bisphosphonate use may steer treatment decisions.
🧩 The Tooth Restorability Index (TRI)
Developed by McDonald and Setchell (2005), the Tooth Restorability Index (TRI) is a practical tool that scores each tooth based on six dentine wall segments (2 proximal, 2 buccal, 2 lingual):
- Score 0 = No dentine wall
- Score 1 = Thin wall (<1.5 mm)
- Score 2 = Questionable (>1.5 mm)
- Score 3 = Adequate height and thickness
🟢 TRI ≥ 12 → Acceptable
🟡 TRI 9–12 → Questionable
🔴 TRI < 9 → Unacceptable (consider advanced techniques or extraction)
🛠 What If There’s Insufficient Tooth Structure?
When the ferrule is compromised, all is not lost. Consider:
- Orthodontic extrusion to elevate the tooth structure coronally
- Surgical crown lengthening to gain biological width
- Reassessing via radiographs, furcation, and root morphology
Whether it’s an anterior incisor, premolar, or molar, the approach may differ—but the core principle remains: maximize structure, function, and longevity.
💡 Final Thoughts: Restorability is a Spectrum
“To save or not to save?” isn’t always a black-and-white question. A successful decision is based on clinical findings, evidence-based indices, and a patient-centered approach. Understanding and applying concepts like the Tooth Restorability Index helps clinicians plan restorations that last—not just survive.
So before you prepare that crown or reach for the forceps—pause, assess, and plan thoughtfully.
