Root canal vs extraction and implant: which one to choose

Sometimes a tooth can be so badly damaged or infected that your dentist can discuss different types of treatment plans with you. One is a root canal treatment, and the other is a tooth extraction followed by an implant, which is an artificial tooth designed to replace your damaged tooth.

When discussing with your dentist what to do next, you will need to consider the costs and the benefits.

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

It can be helpful to understand the differences between a root canal procedure and a tooth extraction and implant. Both procedures aim to treat the damage in your mouth, but they achieve this 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 near your tooth with an injection of local anesthetic. Then they will make a small opening in the top of your tooth.

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

A week or two later, you will return to your dentist’s office, so that he can remove the temporary filling and place a crown or other type of restoration over it, if necessary.

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

Extraction and implantation

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 pliers to remove the tooth. Or you may need to have surgery, which requires general anesthesia. With surgical extraction, your dentist will cut your gum tissue and may remove bone around your tooth, as well as the tooth itself.

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

Some people can get an implant, which looks like a screw, immediately after an extraction, but many people have to wait for good bone healing before the implant. The wait is usually 1-4 months or more. Additionally, you may have to wait several months for the implant to integrate into the bone before the replacement tooth or crown can be placed on the implant, according to the American Dental Association.

How to decide which is the best?

A number of factors must be taken into account, such as the restorability of the tooth, the aesthetic requirements and the cost-benefit ratio, according to a implant position statement of the American Endodontic Association. But many experts believe it is best to save the damaged tooth if possible.

Extending the life of a tooth can delay or eliminate the need for an implant later

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

A 2009 research report on the differences between root canal therapy and implants found that non-surgical endodontic treatment had very high success rates, in terms of functionality of the affected tooth many years later. For example, a large study found that over 94% of the teeth studied were functional 3.5 years after root canal treatment.

A root canal can be cheaper

A root canal procedure can be much cheaper, as the 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 around $250 to just over $1,600. The cost can vary depending on the type of affected tooth, your insurance plan, your location, and the type of dental professional performing the procedure. It can also cost a lot more if you also need a crown above the tooth that requires the root canal.

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

The treatment is less invasive

You may not think a root canal is non-invasive, but it is less invasive than a surgical tooth extraction. With surgical extraction, you may need intravenous anesthesia, as well as local anesthesia, and your dentist will need to cut into your gum tissue to remove the tooth – and possibly some bone around it. .

It’s much faster than going through the implantation process

When you have root canal treatment, you may need to return to your dentist about a week later to get a crown. But other than that, the process can usually be completed in just one office visit. On the other hand, the extraction and implantation process can take several months or more.

The recovery period is shorter

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

Other factors can reduce the success of an implant

Certain other factors can reduce the likelihood of successful extraction and implantation.

For example, to research published in 2009 suggests that smokers are more likely than non-smokers to experience implant failure. And one clinical study 2005 suggested that tobacco and alcohol consumption can have a negative effect on implant outcomes, leading to bone loss.

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

A root canal can weaken the tooth

Your dentist must dig 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 molar or premolar), a crown should be placed to protect the tooth from biting forces and to support the remaining tooth structure. .

The tooth can fail, anyway

If your tooth is weakened or the damage is very extensive, choosing a root canal may not be enough to remedy the damage. The tooth may not survive and you could have an extraction anyway.

Depending on the condition of your tooth, you may not have the option of a root canal and crown. Your tooth may have suffered so much damage that the best way to stop the deterioration is to extract it and then replace 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 shows the success of dental implants installed through impacted teeth or residual roots, rather than a full extraction. However, your dentist should assess your tooth and discuss the specifics of your situation in detail with you.

Talk to a dentist about the short- and long-term risks and benefits of both procedures and explain your goals and priorities. Generally, when an existing tooth can be saved, it is considered the most beneficial procedure.

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