One of the difficult decisions confronting clinicians in daily practice is whether to treat or extract a tooth, particularly those with moderate or advanced disease processes or where trauma has inflicted substantial damage. Studies have shown that the clinician's decision is based on the length of clinical experience and the complexity of the treatment. The high survival rate of endosseous implants has also had a significant impact on the way clinicians think about the best treatment for teeth requiring endodontic therapy. Several factors should be considered when making a decision to either treat or extract a tooth. This report provides evidence-based information about the various factors and related treatment outcomes as well as clinical perceptions from a prosthodontic perspective. Keywords: extraction, implant, outcomes, retention, root canal therapy