Root Canal vs Extraction
Save the tooth or remove it?
Saving a natural tooth with root canal is usually preferable to extraction.
Verdict
Keep the natural tooth where possible.
The Default Is to Save the Tooth
Modern endodontics performs better than its reputation. Root-canal-treated teeth show roughly 97% survival and 93% success at ten years; when properly restored with a crown afterwards, ten-year survival is reported between 86% and 98%.
Nothing you can buy replaces a natural tooth root. An implant is an excellent replacement — it is not an upgrade. See root canal treatment.
What the Numbers Say Over Decades
Root-canal survival declines gradually with time: around 97% at ten years, 81% at twenty, 76% at thirty. Implants show comparable ten-year survival, above 95% in most studies.
The more revealing figure is complications: reported at roughly 18% for implants versus 4% for root-treated teeth. Implants survive well, but they need more intervention along the way — screw loosening, ceramic fracture, peri-implantitis.
When Extraction Is the Honest Answer
A tooth cannot be saved when the crown is fractured below the bone level, when the root is vertically fractured, when too little tooth remains to hold a restoration (no “ferrule”), when severe periodontal bone loss has already loosened it, or when repeated root canal treatment has failed and re-treatment or apicoectomy is not viable.
Extracting a savable tooth to sell an implant is over-treatment. Insisting on saving an unsavable tooth wastes money and bone.
The Sequence Matters
| Root canal + crown | Extraction + implant | |
|---|---|---|
| Keeps natural root | Yes | No |
| Bone preserved | Yes | Yes, if implant placed |
| 10-year survival | ~86–98% (crowned) | ~92–97% |
| Complication rate | ~4% | ~18% |
| Time | 1–2 visits | 3–6 months, two trips |
| Reversible | Extraction still possible later | Root is gone |
A root canal that fails can still be extracted and implanted. An extracted tooth cannot be put back. Where the prognosis is borderline, the conservative option preserves choice.
What to Ask
“Is there enough sound tooth above the bone to hold a crown?” “Is the root fractured?” “What is the prognosis with a crown, in percentages?” “If the root canal fails in five years, can I still have an implant?”
See also tooth extraction and implant vs bridge.
This page provides general information and does not replace professional dental advice. Always consult a qualified dentist about your individual case.
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