Dental implant vs. root canal, which makes the best choice? -

A comparison of success rates. / Additional factors that must be considered when deciding between the two.

Using dental implants as a way to replace missing teeth has gained widespread acceptance over the last decade. And dental patients who are aware of the success of this technique may wonder:

  • "If my tooth is so damaged that it needs root canal treatment, why not just have it extracted and get a dental implant placed instead?"

This is a very logical question to have. Here are some of the topics that must be considered when trying to make this decision.

  1. Success rates of implants vs. root canals. -

    - Success factors that you influence.

  2. Additional factors that may affect each type of treatment's outcome (both initially and long term).
  3. Which treatment approach is more cost-effective?


1) Dental implants vs. root canal treatment - Success rates.

Proving which of these two options is best is somewhat difficult. After all, if one treatment has been performed, it's impossible to know what the outcome of the other would have been.

However, when the success rate of each alternative is considered independently, it's easier to come up with an answer. And, in general, dental research has shown that both treatment approaches can make an excellent choice.

Root canal treatment compared to a dental implant.

Dental implant vs. root canal treatment.

A) What does dental research show?

Study 1 -

Title: "Endosseous implants versus non-surgical root canal therapy: A systematic review of the literature." (Blicher 2008) [page references]

This paper reviewed published research studies that either ...

  • Evaluated the survival rate of teeth that had received root canal treatment.
  • Or evaluated the success or failure of dental implant placement.

Its findings were ...

  • The success rate for root canal treatment ranged between 92 and 97% (over a time frame of four to eight years)
  • The success rate for dental implants ranged between 95 and 99% (over a time frame of two to sixteen years).

These results suggest that the overall success rate of either treatment approach is fairly similar, although slightly favoring dental implants.

Study 2 -

Title: "For teeth requiring endodontic treatment, what are the differences in outcomes of restored endodontically treated teeth compared to implant-supported restorations?" (Iqbal 2007)

This study, which was also a literature review, took into consideration 55 research papers evaluating dental implants and 13 root canal treatment. It came to the conclusion that no significant differences in survival rates existed between the two approaches.

It continued by stating that the decision for implant placement or root canal therapy (including the placement of an appropriate dental restoration afterward) needs to be based on factors other than just the statistical analysis of predicted treatment outcome. (See below for more details.)

In combination, the findings of both the Blicher and Iqbal literature reviews suggest that both treatment options can provide a successful outcome.

B) If the success rates are similar, what other factors need to be considered?

The fact that either root canal treatment or the placement of a dental implant can be expected to provide an excellent end result suggests that the decision between the two will need to hinge on other factors. These include:

C) Success-rate issues you have some control over.

Research suggests that the following factors can influence treatment outcome. And, to some extent, you have some amount of control over them.

  1. Who will perform your dental work?
  2. Will complete treatment to be performed?

1) The success of your treatment can be influenced by the dentist who performs your work.

Clearly, providing a tooth's treatment in some cases is more difficult than in others. And with difficult cases, the knowledge and abilities of the clinician can greatly affect the outcome of the work that's been performed.

a) Clinician success rates for root canal treatment.

A study by Alley (2004) found that 98% of routine cases treated by endodontists (root canal specialists) were successful vs. 90% for those treated by general dentists.

b) Clinician success rates for implants.

Unlike the field of endodontics (root canals) that's been around for decades, implantology is a much newer field. It's only been since the 1990's that it's been included in the curriculum of dental schools on a wide-spread basis.

Specialist vs. general dentist.

The earliest dental implant studies (those used to document implant survival rates over the longest time frame) typically involved treatment provided at a "specialists" level. In comparison, today many implants are placed by general practitioners.

It could be debated that collectively the work performed by general practitioners may not be at the same level as that of specialists, typically oral surgeons or periodontists. (A great deal of the education that many dentists have received in implantology has been via short multi-day training courses as opposed to rigorous academically-based coursework.)

A hint of this phenomenon might be apparent in the following data coming from Australia. There, the largest category of claims against dentists (24%) is founded on errors associated with inappropriate diagnosis and case selection (Cohn 2005). This is the type of error that might be more likely made by a less rigorously trained practitioner.

c) Be a consumer. Ask your dentist questions.

We're not trying to suggest that general practitioners can't provide quality implant and endodontic services because that statement would not be true.

But what we are suggesting is that before accepting a recommended treatment plan, be a consumer first. Quiz your dentist about their experience in providing the proposed treatment.

A tooth that has root canal treatment and a crown.

A tooth that has had root canal treatment and a crown placed.

2) With root canal, you must commit to complete treatment to reap the highest success rate.

Studies evaluating the success rates of teeth that had root canal treatment typically only evaluate those that also had an appropriate dental restoration placed on them after their treatment was completed.

That's because this combination is the one that typically provides the most predictable and lasting outcome.

Many endodontically treated teeth (especially molars) have been lost because they were not properly restored. Failing to commit to having a suitable restoration placed (possibly a dental crown) may compromise the long-term outcome of your treatment.


2) Additional factors that must be considered when choosing between root canal treatment and a dental implant.

A) Esthetics

Especially when a front tooth is the one being treated, factors involving the appearance of the procedure's final outcome will be a prime consideration.

1) Challenges with teeth that receive root canal treatment.

For the most part, improving the appearance of a tooth that has had root canal treatment is usually a fairly straightforward task. And in fact, even substantial improvements can be made if a dental crown is placed.

But in some cases original factors, like exceptionally poor tooth alignment, may make creating the ideal esthetic outcome virtually impossible. In comparison, tooth extraction and replacement with an implant may be able to make this type of alignment change quite readily.

2) Challenges with dental implants.

When placing a dental implant, a dentist must adhere to rules governed by the jawbone (its shape, bone quality, nearby anatomical structures). In some cases, having to adhere to these rules may interfere with being able to place it in a position that would be most ideal for cosmetic considerations.

Another issue involves the region where the implant's crown meets the gum line. In some cases, it can be difficult for the dentist to make this junction look totally natural. This consideration may make root canal treatment the better choice for people who display this area prominently when they smile (people who have a "skin grin").

c) Ask questions before your treatment begins.

You can expect that your dentist will be steps ahead of you when considering issues related to the final appearance of the work being planned for you. But what they consider a routine trade off may not be acceptable to you.

As a way of avoiding a disappointing surprise, if the issue of cosmetics is a major consideration ask questions about the expected esthetic outcome of your case before you decide upon a treatment approach.

B) Time required to complete treatment.

The time frame that is needed to complete a patient's treatment can play a role in their choice between these two options. Blicher (2008) cites a 2001 survey that reported that:

  • Performing root canal treatment and then placing a dental crown typically requires 4.5 hours of appointment time, broken up into six visits, over a time span of three months.
  • Restoring a tooth's space with a dental implant typically takes 5.5 hours of appointment time, divided among ten visits, over a time span of 9.5 months.

So while total treatment time is similar for both, the time span that it takes to complete treatment is roughly three times longer with implants.

C) Treatment costs.

Dental insurance is more likely to provide benefits for root canal treatment (and crown placement)
than for dental implants. Where both are covered, the level of benefits provided for each procedure may differ.

As a separate issue, we discuss the relative cost effectiveness of the two approaches here.

D) Procedural preferences.

Placing dental implants is a surgical procedure whereas having root canal treatment is not. Patients who have a fear of surgery may feel more comfortable with the latter option.

E) Bruxing.

A habit of tooth clenching or grinding may complicate the placement or longevity of dental implants. If this activity can't be controlled, root canal treatment may make the better choice.

F) Medical factors.

Health issues can affect the outcome of implant therapy. For example, root canal treatment may make the more predictable choice for patients who have uncontrolled (or poorly controlled) diabetes or are smokers. (More information.)

 

 
 

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