Keep the tooth or replace it? Root canal treatment versus extraction and implant

“Just take it out” sounds simple. Sometimes it is right. More often the decision deserves a careful comparison, because what replaces the tooth is neither simple nor cheap.

What root canal treatment keeps

Your own root, held in bone by a ligament that senses pressure and protects you from overloading the tooth. Your own gum profile. Your neighbouring teeth, untouched. Treatment and crown are usually completed within weeks, without surgery.

What replacement involves

An implant means extraction, healing, a surgical placement into bone, further healing and a crown — commonly four to nine months, sometimes with bone grafting first. A bridge is quicker but requires the neighbouring teeth to be cut down and carries risk to their nerves. Both can be excellent; neither is a like-for-like substitute.

Longevity

Properly treated and promptly crowned, root-treated teeth survive for many years, frequently for life. Implants have good long-term survival too, but they are not immune to problems: the gum and bone around them can become inflamed, and repair is complex.

Cost over time

Root canal treatment plus a crown generally costs considerably less than extraction, an implant and an implant crown — before counting grafts, temporaries or future maintenance.

When replacement is the better choice

• the root is cracked lengthways;
• too little sound tooth remains to hold a crown;
• advanced gum disease has removed much of the bone support;
• a tooth has already failed after good treatment and retreatment.

How to decide

Ask whoever is advising you what makes the tooth unrestorable, what the success rate of treatment would be for this tooth and what the full timeline and cost of replacement are. An independent endodontic assessment answers the first two in writing; see keeping your natural tooth. If you are told the tooth cannot be saved, you will be told why.