The goal of preserving the natural dentition has long provided the foundation for clinical decision making in prosthodontics. However, current trends in implant dentistry have weakened this paradigm and the rapidity of this shift of thought process has created some bias. Economics and Corporate influences have tipped the scales towards dental implants as the superior choice for fixed tooth replacement. It is now a well-accepted fact that implant restoration is the ideal treatment for tooth replacement in pristine dentition. Also the present era has brought to us improved science of dental materials and “ state of art” technology which has indeed refined our standards of oral health care. However, the key prognostic factors from a periodontal, endodontic, implant and prosthodontic point of view are crucial to decide whether to save and treat a questionable tooth OR to extract and replace with an implant. Preservation of enamel seems to be the anathema for tooth supported FPDs and the process of bone intervention for implant placement and future bone loss with implant failures have been underrepresented. Nevertheless it is realized that not only is the choice of treatment controversial but even the criteria for decision making add to the complexity of the treatment plan. To add to this mix affordability and patient choices have to be factored in. This scientific deliberation is an attempt to unravel the dilemma and simplify our treatment perspectives by judicious solutions, thus redefining success as well as survival.