The definition of a hopeless tooth is, I dare say, somewhat elusive and ethereal. In fact, in the 2 decades of my career, the definition has been challenged numerous times. Traditionally, the prognosis of a hopeless tooth is granted to the one that got involved by the disease to the point that it is considered unbeneficial and/or even detrimental to leave it in place. As an example: a vertical fracture is often a clear indication for extraction.

In periodontology a dramatic vertical bone resorption, deep pockets associated with intrabony defects, degree III furcation, especially in the maxilla, endo-perio lesion, apex involvement, mobility degree III with attachment loss etc. have often been quoted as decisive factors in the prognosis of the tooth.