Is it better to preserve my own tooth or to place an implant?

As long as the tooth can be preserved with reasonable effort, preservation takes priority. Your own tooth retains the periodontal ligament as a shock absorber, keeps the bone stable and preserves the established bite position. An implant is a very good replacement, but not an equivalent one. Only when the tooth can no longer be sensibly saved does the implant become the better choice.

When is a root canal treatment no longer worthwhile?

When the root is fractured longitudinally, there is extensive resorption, or after preparation too little tooth substance remains for a stable crown. Root canal treatment is also pointless when the tooth has been lost through advanced periodontitis. In these cases we recommend extraction with a subsequent implant.

What is the success rate of a root canal treatment?

With primary treatments using a microscope, machine preparation and rubber dam it is above 90 percent over five years. With a second treatment (revision) it drops to 75 to 85 percent. A successful root canal treatment with a definitive crown lasts two to three decades with good care.

Is an implant cheaper than a root canal treatment?

Usually not. Root canal treatment with a crown is in direct comparison mostly the cheaper option, often at two thirds or less of the implant costs. Both restorations can last two to three decades with good care. We quote concrete amounts in a written cost estimate, on request for both options for comparison.

Does Resident recommend an implant because it generates more revenue?

No. We do not recommend an implant when the root canal treatment is medically sensible. If your own tooth can be saved with reasonable effort, we save it. Conversely, we also do not recommend a root canal treatment with minimal prospect of success just to postpone the implant. The measure is preservability, not revenue.

Root canal or implant. When preservation makes sense and when not.

A recurring question

When a tooth is severely damaged by deep caries, old restorations or trauma, the question arises: root canal treatment with crown or extraction with implant? The question is not trivial. Both options are clinically established, both have advantages and disadvantages, both have specific indications.

The dental rule of thumb is clear: as long as a tooth can be preserved with reasonable effort, preservation takes priority over extraction. There are, however, constellations in which an implant is the honestly better option. This article explains when what makes sense.

Why preserving your own tooth has priority

Three biological reasons speak for preservation:

Periodontal ligament structure. Between the natural tooth and the bone lies the periodontal ligament, a thin connective tissue with nerve fibers and blood vessels. It acts as shock absorber when chewing and sends fine sensory perceptions about the tooth’s loading to the brain. An implant is rigidly anchored in the bone and transfers chewing forces directly. The loss of the periodontal ligament is not replaceable.

Bone preservation. The periodontal ligament continuously stimulates the surrounding bone. The bone thereby remains stable. After an extraction the bone begins to shrink at this site because the biomechanical stimulus is lost. Within the first months after extraction the jawbone measurably loses height and width. A subsequent implant often requires bone augmentation, extending and increasing the cost of treatment.

Bite position and sensorics. A preserved tooth retains the individual bite position. The fine adjustments to tooth shape, contact points and movements are regulated over decades. An implant attempts to rebuild this bite position but only approximates the original function. Patients describe the difference differently; some do not notice it, others sense long-term that the implant tooth is not quite like an own tooth.

The dental consequence: preservation is in case of doubt the better option. The implant is a very good replacement but not an equivalent replacement for your own tooth.

When the root canal treatment makes sense

In the vast majority of cases in which the tooth is substantially present and the root is healthy. Specifically:

Pulp inflammation through caries or repeated restoration, root intact
Pulp necrosis after trauma, tooth externally intact or with small defect
Periapical granuloma, tooth substantially present
Unsuccessful first root canal treatment with clear cause (e.g. unreached lateral canal), revision possible

The success rate of modern endodontics with microscope, machine preparation and rubber dam is above 90 percent in primary treatments over five years. With revisions it drops to 75 to 85 percent. More on the clinical depth in the background article on root canal treatment.

A successful root canal treatment with definitive restoration lasts with good care two to three decades. During this time periodontal ligament, bone and bite position are preserved.

When an implant is the better option

There are clear constellations in which extraction and implant are honestly the better choice:

Longitudinal fracture or vertical root fracture. A tooth with a longitudinal fracture through the root cannot be preserved. The fracture line inevitably leads to chronic infection and bone loss. The diagnosis is clinical and sometimes only clear during surgery.

Extensive root resorption. With internal or external resorption the root is so substantially destroyed that the root canal treatment has no prospect of success.

Unsuccessful revision with persisting symptoms. When the second root canal treatment was unsuccessful and the symptomatology persists, apicoectomy or extraction with implant is the next option.

Very large substance loss without sufficient remaining crown. When after caries removal and preparation of the root canal so little tooth substance remains that a crown can no longer be stably anchored, extraction with implant is the statically safe option. A post build-up also has limits here.

Periodontal tooth loss. When the tooth has lost its hold not primarily through caries or pulp disease but through advanced periodontitis, root canal treatment is pointless. Only extraction with possibly subsequent implant after stabilization of periodontitis helps.

Economic disproportion. In very rare cases the root canal treatment on a tooth with minimal remaining substance and difficult anatomy is so elaborate that the prospect of success stands worse compared to the implant solution. Here it must be honestly weighed.

What the costs say

About the pure treatment sum:

Root canal treatment plus definitive restoration with crown: typically CHF 1,400 to 4,000 (range, details in the article on root canal cost)
Extraction plus implant plus crown: typically CHF 3,500 to 6,500 (details in the article on implant cost)
Extraction plus three-unit bridge: typically CHF 3,000 to 5,000

The root canal treatment is in direct comparison the significantly cheaper option, often at two thirds or less of the implant costs. Calculated over the lifespan the advantage usually persists because both restorations can last two to three decades with good care.

The economic analysis therefore almost always falls in favor of the root canal treatment when it is medically sensible. The exception is the constellation in which the root canal treatment will likely fail and in two or three years the extraction would follow anyway, then with more difficult conditions for the subsequent implant.

What insurance pays

Both options are fundamentally self-pay services. Supplementary insurance with dental care module can cover part of the costs. More on insurance logic in the article on health insurance at the dentist.

The insurance conditions are similar for both options. There is no systematic favoring of the root canal treatment over the implant or vice versa. You as patient decide freely as long as the medical indication permits.

How the decision is made in practice

The decision is medical, not primarily economic. In the initial consultation and after diagnostics (X-ray, possibly CBCT) we assess the following criteria:

Preservability of the remaining substance. Is the remaining tooth substance sufficient to anchor a stable crown after root canal treatment? If yes, preservation is priority.

Root status. Are the roots intact? Fracture, extensive resorption or massive periodontal bone loss speak against preservation.

Periapical findings. Is there an old inflammation at the root tip and if so, to what extent? Small granulomas heal with good root canal treatment, extensive findings speak for apicoectomy or extraction.

Number of root canals and anatomy. A difficult anatomy reduces the probability of success but does not exclude treatment.

Previous treatments. Is it a primary treatment or revision? At the third treatment the probability of success is significantly reduced.

General health. With certain pre-existing conditions (uncontrolled diabetes, bisphosphonate therapy, severe immunosuppression) implant placement is difficult. In these cases the root canal treatment is all the more important.

Patient preferences. Some patients want to preserve their own tooth at all costs, others prefer the implant solution because of higher lifespan reliability. We discuss the options openly and respect individual preference within the medically sensible.

The decision sequence at Resident

Findings and diagnostics. Clinical examination, X-ray, possibly CBCT.
Assessment of preservability. We honestly assess whether the tooth can be preserved with reasonable effort. If yes, we recommend root canal treatment.
Written treatment plan. When both options are valid, we prepare two separate cost estimates for comparison on request. More on the cost estimate in the article on the written cost estimate.
Decision. You decide based on the medical recommendation, the costs and your preference.
Treatment. With root canal treatment, two to three sessions over several weeks, then definitive restoration. With extraction and implant, four to six months from procedure to definitive crown.

What we do not do

We do not recommend an implant when the root canal treatment is medically sensible. That would be economically more attractive for the practice but not medically in the interest of the patient. Resident orients to preservability. If the own tooth can be saved with reasonable effort, we save it.

Conversely, we do not recommend a root canal treatment with minimal prospect of success just to postpone the implant step. If preservability is clearly not given, we recommend extraction with subsequent implant as the honestly better option.

When a second opinion makes sense

With clear constellation (clear indication for root canal treatment or clear indication for implant), a second opinion is rarely necessary. With borderline constellations, such as very severe substance weakening with uncertain crown anchoring, a second opinion can bring clarity. We share our diagnostic documents on request with other practices without objection.

Arrange an initial consultation at your location for an honest assessment. With acute pain come without prior appointment; in Winterthur and Rapperswil-Jona also on weekends.