Root canal treatment, or extraction and an implant?

The question "can this tooth be saved, or should we extract it and place an implant?" does not have a single answer. The decision is made less on the tooth's condition today than on which option will hold up more soundly 10 years from now.

What is looked at when trying to save a tooth

• Remaining sound tooth structure: After root canal treatment, is there a wall left to bear the force that will come onto the tooth? In fractures that extend below the gum level, the prognosis worsens.
• Root and canal anatomy: Curved, calcified or previously treated canals change the difficulty of the treatment; most can still be treated.
• Periodontal support: If the bone that holds the tooth has been lost, the tooth continues to be mobile even if the root canal treatment is successful.
• Root fracture: A vertical root fracture is the main finding that removes the chance of saving the tooth.
• The tooth's role in the mouth: If it is to be a bridge abutment or a prosthesis support tooth, expectations are higher.

Situations that favour root canal treatment

Inflammation at the root tip is not an obstacle to treatment but the reason for it; once the canal has been cleaned, the bone often repairs itself. Earlier treatments that have proved inadequate can also be renewed (retreatment). Keeping your own tooth maintains the support of the neighbouring teeth and the natural stimulation of the jawbone.

Situations in which extraction is more appropriate

In the presence of a vertical root fracture, tissue loss to a degree that cannot be saved, advanced periodontal bone loss, and an infection that does not respond to repeated treatment, extraction followed by implant planning gives a more predictable result. In this case the timing of the extraction and the preservation of the site (socket preservation) are important for the later implant.

The decision is made together

The information given to the patient is the duration of both options, the number of sessions required, their possible complications and the long-term expectation. The plan for the restoration to be placed on the tooth after endodontic treatment (a filling or a crown) is part of this decision — because the most common cause of loss of teeth that have had root canal treatment is not infection but fracture.

Frequently asked questions

If the root canal treatment fails, does my chance of an implant decrease?

No; if the tooth is extracted after a failed treatment, implant planning can still be carried out. If a long-standing infection has led to bone loss, a graft may be needed.

How long does a tooth that has had root canal treatment last?

With an appropriate restoration it can be used for many years; what is decisive is the remaining tooth structure, the bite and regular check-ups.

I have no pain — is treatment still needed?

Yes; inflammation at the root tip often progresses without symptoms and is seen only on the X-ray.

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The information on this site is for general guidance only; diagnosis and treatment require an examination by a dentist.