Do periodontally compromised teeth deserve a second chance?

Working in the hospital system I see many patients who have slipped through the cracks or haven't contacted the hospital so haven't been seen for many years. So I have had the benefit of seeing sequential radiographs sometimes over 20 years. No doubt this is the same situation in long standing private practices. With the benefit of hindsight I can see things that have worked and things that haven't. Carious lesions that I would have gone straight to RCT have been treated with deep fillings and show no periapical lesions years later. Periodontally compromised teeth that the patient refused to extract or didn't return for treatment were still present sometimes decades later. It has allowed me to appreciate the role in occlusal forces in the rate of degeneration of periodontally affected teeth noting that patients with short faces and large masseters seem to have looser teeth at younger ages when combine with perio. Seeing these xrays and extracting many periodontally compromised teeth which are surprisingly solid has made me question the "hopeless" prognosis we give many of these teeth. I suspect that with regular maintenance (currently not feasible for many public patients), impeccable oral hygiene and addressing modifying factors, many "hopeless" teeth could be maintained for many years. Management of occlusal factors and splinting of teeth could prolong the life of such teeth even further.

I will continue to question what I do on a day to day basis and seek to improve my diagnostic skills.