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In this era of increased dental implant use, there is a tendency to underestimate the long-term prognosis of a tooth with a compromised periodontium (treated or untreated). This can result in premature extraction of a tooth because of the rationalization that its retention can damage a future implant site, or its inclusion in prosthesis is too risky. Data in the literature was reviewed to ascertain if clinicians can assign an accurate prognosis to teeth based on currently used clinical periodontal parameters. Clinical trials were selected that addressed the ability of commonly used clinical periodontal parameters to predict disease progression leading to tooth loss. Currently, there is no single clinical parameter that can reliably forecast periodontal disease activity, tooth loss, or conversely, long-term tooth retention. Thus, combinations of parameters are evaluated in concert to guide the need for therapy and to assess treatment outcomes. The data indicate that the absence of clinical inflammation and a stable periodontium (eg, no increasing probing depths, no additional loss of bone, or clinical attachment) are advantageous for retaining teeth. With periodontal therapy, many teeth with an unfavorable periodontal forecast can be converted to teeth with a favorable long-term prognosis; therefore, caution should be taken when considering criteria for tooth removal. Presently, there is no precise way to delineate a quantifiable threshold for tooth removal based on periodontal status that is correct in every circumstance. The decision to extract a tooth will fluctuate depending on its clinical condition, and this action should be supported by the literature, clinical experience, and the patient’s declared goals.