May 26, 2022

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Root Canal vs. Extraction and Implant: Which to Choose

Sometimes, a tooth can become so severely damaged or infected that your dentist might discuss a couple of different kinds of treatment plans with you. The first is a root canal, and the other is a dental extraction followed by an implant, which is an artificial tooth designed to replace your damaged tooth.

As you speak with your dentist about how to proceed, you’ll need to consider the costs and the benefits.

For example, after an extraction, you might need an artificial tooth, or implant, or possibly a bridge or partial denture to fill that gap along your gumline. You’ll also need to keep in mind that extraction may create some risks and side effects down the line. But if the damage isn’t quite that severe, it may be possible to save the tooth with a procedure like a root canal and a crown.

It may be helpful to understand the differences between a root canal procedure and a dental extraction and implant. Both procedures aim to address the damage in your mouth, but they achieve it in different ways.

Root canal

Perhaps a more accurate name for this process is actually “root canal treatment” or “root canal therapy.”

First, your dentist will numb the area by your tooth with a local anesthetic injection. Next, they’ll make a small opening in the top of your tooth.

Using special tools, they will remove any soft tissue, or pulp, that’s become inflamed or infected down inside the pulp chamber and root canals of your tooth. This leaves some empty space, which your dentist will fill with a type of biocompatible material called gutta-percha. Then it’s time to seal off the opening at the top of your tooth, often with a temporary filling.

A week or two later, you’ll return to your dentist’s office, so they can remove the temporary filling and put a crown or other type of restoration on top, if necessary.

Sometimes, the crown is created during the same appointment, and you don’t have to worry about returning.

Extraction and implant

If your tooth is so diseased or damaged that it cannot be saved, even with a root canal procedure, it may be time for an extraction coupled with an implant or other replacement option.

A simple extraction usually involves your dentist administering local anesthesia and using a tool like forceps to remove the tooth. Or you may have to undergo a surgical procedure, which requires general anesthesia. With surgical extraction, your dentist will cut into your gum and may remove some bone around your tooth, as well as the tooth itself.

However, you might not be able to get a dental implant to permanently fill that gap in your smile for at least several months. The timing of the placement of the implant can vary, according to a 2019 study published in the Journal of Cranio-Maxillo-Facial Surgery.

Some people can get an implant, which resembles a screw, immediately after an extraction, but many people need to wait for proper bone healing before the implant. The wait is typically 1 to 4 months or longer. Additionally, you may need to wait several months for the implant to become integrated into the bone before the replacement tooth or crown can be placed on top of the implant, according to the American Dental Association.

How to decide which is best?

A number of factors must be taken into account, such as the restorability of the tooth, the esthetic demands, and the cost-to-benefit ratio, according to an implant position statement from the American Association of Endodontics. But many experts believe that it’s better to save the damaged tooth if possible.

Prolonging the life of a tooth may delay or remove the need for an implant later

If you can save a damaged tooth with a root canal, it may prolong the life of the tooth. It could even eliminate the need to install an implant later on.

A 2009 review of research on the differences between root canal therapy and implants found that nonsurgical endodontic treatment had very high success rates, in terms of the affected tooth’s functionality several years later. For example, one large study found that more than 94 percent of the teeth studied were functional 3.5 years after the root canal treatment.

A root canal may be less expensive

A root canal procedure may be significantly cheaper, as extraction and an implant may not be covered by your insurance.

According to CostHelper, the estimated cost of a root canal with insurance coverage ranges from about $250 to slightly over $1,600. The cost can vary depending on the type of tooth that’s affected, your insurance plan, your location, and the type of dental professional performing the procedure. It can also cost significantly more if you also need a crown on top of the tooth that requires the root canal.

Meanwhile, the cost of a simple tooth extraction might not be that high, but you may need a surgical extraction. And the cost of a surgical extraction may be quite a bit higher. Add in the additional cost of just one implant, and you could be looking at a bill of at least $4,000 to $10,500, depending on your specific situation.

The treatment is less invasive

You might not think of a root canal as noninvasive, but it is less invasive than a surgical dental extraction. With surgical extraction, you may need intravenous anesthesia, as well as local anesthesia, and your dentist has to cut into your gum to remove the tooth — and possibly some bone around it.

It’s much quicker than going through the implant process

When you get a root canal, you might have to go back to your dentist’s office a week or so later to get a crown. But other than that, the process can usually be completed in one office visit. By contrast, the extraction and implant process may take several months or longer.

The recovery period is shorter

It can take several months for your mouth to heal from an extraction­ — and that does not include the time it will take for your mouth to heal and regrow bone around the implanted tooth. Meanwhile, the typical recovery period for a successful root canal is usually just a few days.

Other factors may reduce the success of an implant

Some other factors can reduce the likelihood of success of extraction and implant.

For example, research published in 2009 suggests that smokers are more likely than nonsmokers to experience failure of an implant. And a 2005 clinical study suggested that both tobacco and alcohol use can have a negative effect on implant outcomes, causing bone loss.

Just as there are some benefits for opting for a root canal over extraction and implant, there are also some risks to consider.

A root canal might weaken the tooth

Your dentist has to drill down into your tooth to remove the diseased or inflamed pulp. If the tooth is already very fragile, this process could further weaken it. And if the root canal is done on one of the back teeth (whether the molar or premolar), it should have a crown placed to protect the tooth from the forces of biting down and to support the remaining tooth structure.

The tooth may fail, anyway

If your tooth is weakened, or the damage is very extensive, choosing a root canal might not be enough to address the damage. The tooth may not survive, and you may wind up getting an extraction anyway.

Depending on the state of your tooth, you may not have the option for a root canal and crown. Your tooth might have sustained so much damage that the best way to stop the deterioration is extraction and then replacing it.

There may be other possible procedures, depending on your situation.

As a 2021 study in the British Journal of Oral and Maxillofacial Surgery noted, some research is showing success with dental implants installed through impacted teeth or residual roots, rather than a complete extraction. However, your dentist needs to assess your tooth and discuss the specifics of your situation in detail with you.

Speak with a dentist about the short-term and long-term risks and benefits of both procedures and explain what your goals and priorities are. Generally, when an existing tooth can be saved, it’s viewed as the more beneficial procedure.

https://www.healthline.com/health/dental-and-oral-health/root-canal-vs-implant