Romanticising the Last Tooth: Symbolism and Strategy in Prosthodontics

BACKGROUND: The final remaining tooth in an otherwise edentulous mouth embodies a unique intersection of biology, psychology, and identity. Beyond its limited functional role, it serves as a powerful symbol of continuity and selfhood, making its extraction an emotionally charged event for many patients. OBJECTIVE: This narrative review explores the concept of 'Romanticising the Last Tooth', emphasising its psychosocial and clinical significance within geriatric and prosthodontic practice. METHODS: The discussion integrates evidence on emotional attachment, bone preservation, proprioception, and overdenture strategies to illustrate how the final tooth can influence both treatment planning and patient adaptation. RESULTS: Ethical dilemmas surrounding tooth retention and patient autonomy are examined, highlighting the need for empathy driven, shared decision making to guide clinicians. Recent literature emphasises advances in implant-supported rehabilitation, digital workflows, and biomaterials in full-arch prosthetic management, which can influence decisions regarding the last tooth. CONCLUSIONS: The R.O.M.A.N.T.I.C. framework (Retain Or Move Ahead: Navigating the Tooth In Context) is introduced, offering structured parameters for deciding whether to preserve or extract the last tooth. This approach underscores a broader vision of prosthodontics one that harmonises technical precision with human understanding to restore not only function but dignity and confidence in the ageing patient.