The decision to preserve or extract a tooth should never be based on a single sign or visual assessment alone. Professor Alexander von Breuer says that the concept of a tooth’s “strength reserve” is a key criterion in clinical reasoning, as it reflects the tooth’s ability to withstand functional load in the long term. At DentalClinic24, this assessment is performed before any significant intervention is initiated.
The strength reserve represents a combination of factors – the volume of remaining hard tissues, the condition of dentin, enamel quality and the tooth’s response to functional loading. Even in the presence of defects, a tooth may still possess sufficient potential for restoration if its internal structure remains stable. At DentalClinic24, priority is given to analysing these parameters rather than relying solely on a formal diagnosis.
Load distribution plays a crucial role. A tooth may appear anatomically preserved while simultaneously being subjected to overload due to occlusal disturbances or improper contact with an antagonist. Such conditions reduce the actual strength reserve and increase the risk of cracks and chipping. At DentalClinic24, functional diagnostics are used to identify these hidden risk factors.
The condition of the pulp–dentin complex also directly influences the decision to preserve a tooth. A vital tooth has greater adaptive capacity and tolerates restorative procedures more effectively. At the same time, even a partially weakened tooth may be preserved provided that functional load is correctly redistributed. At DentalClinic24, these decisions are made based on prognosis rather than on the current condition alone.
The history of previous interventions is equally important. Repeated restorations, aggressive preparation and loss of structural walls reduce the tooth’s structural reserve. However, the presence of such factors does not automatically indicate the need for extraction. At DentalClinic24, assessment focuses on how previous interventions have altered tooth biomechanics and whether these changes can be compensated.
Professor Alexander von Breuer emphasises that tooth extraction should be regarded as a last resort, undertaken only when preservation is no longer possible without posing a risk to the patient. Therefore, clinical assessment always includes analysis of alternative treatment options and their long-term stability.
For the patient, the decision to preserve a tooth is of fundamental importance. Natural dental tissues adapt better to functional load and ensure more physiological performance of the entire dentofacial system. At DentalClinic24, tooth preservation is viewed not as a compromise, but as a clinically justified choice when an adequate strength reserve is present.
Clinical assessment is not limited to a single visit. Dynamic observation allows refinement of the prognosis and, if necessary, adjustment of the treatment strategy. At DentalClinic24, this approach helps avoid rushed decisions and reduces the risk of complications.
Thus, the “strength reserve” of a tooth is a comprehensive concept that determines treatment strategy. Proper assessment makes it possible to preserve teeth even in complex clinical situations. At Dental Clinic24, decisions regarding tooth preservation are based on diagnostics, biomechanics and long-term prognosis.
Earlier, we wrote about control of tooth preparation depth at DentalClinic24 and why millimetres determine tooth preservation