Preserve or replace
When a tooth nerve is inflamed or dead, there are two paths. The root canal treatment attempts to save your own tooth. Extraction removes the tooth completely and clears the way for an implant, a bridge or a gap without replacement.
The decision is often made under time pressure because an inflamed tooth hurts and patients want quick relief. Those who decide without a well-founded explanation sometimes regret the choice years later. This article shows the criteria by which a well-founded decision is possible.
What a root canal treatment achieves
A root canal treatment removes the inflamed or dead tissue from the root canal, disinfects the cavity and seals it tight. The tooth remains in its original position, anchored with its original roots in the bone. The separate article on root canal treatment describes the procedure in detail.
A modern root canal treatment with machine preparation, microscope support and thermoplastic root canal filling reaches in long-term studies success rates between 85 and 95 percent over ten years. Prerequisites are sufficient remaining tooth substance, reachable root canal anatomy and later stable restoration with build-up and crown.
After the root canal treatment the tooth is more brittle than before because it is no longer perfused. A crown protects against fractures and is practically obligatory in the posterior area.
What extraction means
Extraction removes the tooth including roots. The procedure itself is usually completed within one session, healing of the bone takes six to twelve weeks.
After the extraction a gap remains. This gap has consequences if it is not prosthetically closed. The neighboring teeth tip into the gap, the opposing tooth grows out of its socket, the bone shrinks. The article Implant or bridge provides a complete overview of options to close the gap.
The most common options after extraction:
- Immediate implant: placed in the same session if the anatomical prerequisites fit.
- Delayed implant: three to six months after extraction when the bone has healed.
- Bridge: neighboring teeth are crowned and carry the gap.
- Partial denture: cost-effective removable solution.
- Leave the gap open: only acceptable for wisdom teeth or in the very rear posterior area.
Comparison by criteria
Substance preservation
The root canal treatment preserves your own tooth with own root, own fiber apparatus and own bone bed. Biologically nothing is closer to a natural tooth. The implant is the next-best solution because it at least replaces the root function and stimulates the bone. The bridge requires grinding of two healthy neighboring teeth.
A tooth that can be preserved always has priority from a substance perspective over a replacement.
Lifespan
Root-treated and crowned teeth last in studies ten to twenty years and more if the treatment was technically correctly performed and the tooth has sufficient remaining substance.
Implants have in long-term studies survival rates above 95 percent after ten years. The bridge usually lasts ten to fifteen years. The most common reason for a bridge failure is caries on the abutment teeth.
In the lifespan balance the root canal treatment is approximately equivalent to the implant. Both solutions can last decades with good care and correct technique.
Treatment duration
Root canal treatment: one to three sessions over two to six weeks, then build-up and crown in two further sessions. In total four to eight weeks from start to finished crown.
Extraction plus immediate implant: one surgery, three to four months of healing, then crown. In total four to five months.
Extraction plus delayed implant: three to six months of bone healing, then implantation, three to four months of healing, then crown. In total eight to twelve months.
Extraction plus bridge: extraction, six to eight weeks of healing, then bridge fabrication in two to three sessions. In total two to three months.
Costs
We do not name concrete amounts because the Swiss dental tariff is standardized and the costs vary strongly by complexity. Bandwidths are in the articles on the cost of a root canal treatment and on the cost of an implant.
Rough order of investment:
- Root canal treatment with build-up and crown: middle range.
- Extraction with bridge: middle range, similar to root canal treatment with crown.
- Extraction with implant: highest initial effort.
Calculated over twenty years the costs are approximately equal because a bridge often has to be renewed after fifteen years, while implant and root-treated tooth last longer.
Pain and complication risk
The root canal treatment is performed under local anesthesia and is not painful during treatment. After treatment a few days of pressure sensitivity can occur, well manageable with painkillers.
The extraction is also pain-free during surgery under local anesthesia. The wound healing in the first days after extraction is often more uncomfortable than after a root canal treatment because an open wound in the bone must heal.
Complication risks:
- Root canal treatment: root fracture (often only recognizable months later), leaky root canal filling, persistent inflammation.
- Extraction: wound healing disorder, dry socket (alveolitis), injury to neighboring structures (maxillary sinus, nerve canal in the lower jaw).
- Implant afterward: peri-implantitis (see article on peri-implantitis), implant loss.
- Bridge afterward: caries on abutment teeth, loosening, bridge fracture.
When a root canal treatment makes sense
Sufficient remaining substance
The most important preservation factor is enough tooth substance after caries removal. If after removing all caries and old fillings enough stable tooth is still present that a crown can be placed on it, the root canal treatment is worthwhile. The rule of thumb: at least two intact walls of the tooth should be preserved.
Root canal reachable
Some root canals are calcified, curved or anatomically complex. An experienced endodontologist with microscope and machine instruments can also treat difficult anatomies, but with extreme constellations the success rate is lower.
Healthy bone apparatus
When the tooth sits firmly in the bone and the gum is healthy, the root canal treatment has good prospects. With advanced periodontitis with bone loss a root-treated tooth can lose anchoring despite technically correct treatment.
Strategic abutment tooth
When the affected tooth is the last stable abutment of a bridge or an important hold for a partial denture, its preservation is functionally decisive. An extraction would put the entire prosthetic restoration in question.
Young patients
With young patients with expected long lifespan, the preservation of one’s own teeth is particularly valuable. Implants last long but no one has a 60-year study on implant survival rates. The own tooth root is the only biologically proven solution over several decades.
When extraction makes sense
Tooth not worth preserving
When after caries removal less than two stable tooth walls remain, a stable crown is often not possible. A root canal treatment on a tooth that cannot be adequately restored is wasted time and wasted money.
Longitudinal fracture
A longitudinal fracture through the tooth root is not repairable. The tooth must be extracted. Longitudinal fractures are hard to detect on X-ray and are sometimes only discovered during an opened root canal treatment.
Root canal already failed
A revision (second root canal at an already treated tooth) has a lower success rate than the primary treatment, about 70 to 80 percent. If two root canal treatments have already failed, the third is rarely worthwhile.
Strongly loosened tooth
For teeth already clinically loosened by advanced periodontitis, there is hardly a prosthetic solution. The tooth would continue to lose hold even after root canal treatment.
Patient does not want multiple treatments
If someone does not want to invest four to eight weeks in root canal treatment and crown and perceives the implant as the better investment, that is a legitimate preference. We respect that.
When the decision is unclear
In borderline cases we recommend careful diagnostics before the decision:
- Clinical examination: probing, mobility degree, sensitivity test.
- X-ray: for assessing root anatomy, bone support and caries depth.
- 3D image (CBCT) if needed: for exact assessment of complex root canals or fractures.
- Findings discussion: we show you the images and discuss the options with pros and cons.
- Written cost estimate: on request for both options so you can compare. More on this in the article on the cost estimate.
A second opinion is always welcome. We share diagnostic documents on request with other practices so you can make a well-founded decision.
How Resident proceeds
We are fundamentally proponents of tooth preservation wherever it is medically sensible. A root canal treatment on a preservation-worthy tooth is the first choice. If preservation is promising and the remaining substance is sufficient, we treat endodontically with microscope and machine preparation, then protect the tooth with build-up and crown and check the course in annual recall sessions.
If the prospects are medically unfavorable or the remaining substance is insufficient, we say so openly. An honest assessment is long-term more valuable than a treatment that fails after three years. In such cases we discuss the extraction options and plan the gap restoration with the same standard of substance preservation of the neighboring teeth.
Arrange an appointment at your location for an assessment. With acute pain call us directly, we take emergencies daily.