The greatest challenge in treatment planning is to assign an accurate prognosis and develop a predictable protocol. In the era of evidence-based dentistry, outcome studies have forced us to reexamine our treatment approaches and decide if superior treatment options should be pursued. As endosseous dental implants gain greater acceptance because of high success rates, the critical question is whether a tooth with a questionable prognosis should be managed conservatively in a traditional fashion or be strategically extracted in preparation for a dental implant. The outcomes of traditional periodontal, endodontic, and prosthodontic treatment approaches are compared to the option of strategic extraction. J Periodontol 2008;79:971–977.