The prime objective of dental care is maintaining a natural functional dentition for life. It is expected that a growing group of adults will keep their dentition into old age. Although routine prosthodontic care will still be important in the future the treatment strategy for older adults and elderly people with a reduced dentition does require a different approach. The traditional approach in prosthetic therapy was guided primarily by morphological criteria aimed at preservation of complete dental arches, which resulted in emphasis on quantity in dental care. Nowadays requirements such as aesthetics and functional comfort are considered more important and more easily achieved. In the presented principles for treatment planning the importance of a thorough preliminary treatment is stressed. Furthermore, needs for tooth replacement are discussed and guidelines are given for a preventive prosthodontic treatment approach in severely broken-down dentitions and edentulous patients.