Extraction is recommended for most bottom-penetrated teeth because treatment of infection at the root parting may be troublesome and the prognosis is not ideal even with root canal treatment. If the patient’s tooth can be root canal treated and the inflammation at the root tip can be effectively controlled, the tooth can be root-split to separate the bottom-penetrated portion and turn the tooth into two small teeth with separate roots. After performing a perfect root canal treatment, the roots of the tooth are preserved as much as possible, but the treatment may not be ideal and many will have to be extracted at a later stage. It is only a conservative treatment to preserve as much of the tooth as possible, some bottom penetrated teeth can be considered, but probably most bottom penetrated teeth are recommended to be extracted directly.