Because implant-supported restorations have become very popular, there is a tendency to extract teeth and replace them with implants. However, the first goal of dentistry should always be the preservation of natural teeth, given the prerequisite that these can be maintained with the application of appropriate treatment modalities. Therefore, individual tooth risk assessment and prognosis are very important for the treatment planning process. Four important factors influencing the dentist's decision on whether to save or extract a compromised tooth have been identified, and an extensive search of the related English language literature has been performed. Additionally, a hand search in related journals was implemented, and classic textbooks were consulted. Identified articles on patient-related, periodontal, endodontic, and restorative factors were thoroughly analyzed, focusing on diagnosis and tooth prognosis. A total of 52 references were carefully selected and reviewed. Available information was used to develop a color-coded prognostic decision chart with four different factors and up to 14 crucial parameters. All factors and parameters were analyzed in an effort to help the restorative dentist make a prognostic decision. The proposed color-coded prognostic decision chart can be helpful when a treatment plan is made and predictable restorative care is planned. This comprehensive prognostic decision chart can aid dentists in providing clinical care of high quality and in establishing a consensus on available restorative options. It can additionally help to establish appropriate communication with patients and third-party individuals in the restorative care process, effectively manage risk factors, and provide a framework for quality assessment in restorative treatment.