Which is best, saving a tooth with root canal treatment or having a tooth extracted and then replaced with a dental implant?
Using dental implants to replace missing teeth has gained widespread acceptance in the dental community over the last decade or so. Those dental patients that are aware of the success that can be achieved with this technique might be inclined to ask: "If I have a tooth that is so damaged that it needs root canal treatment and a crown, why not just have it extracted and have a dental implant placed?"
This is a very logical question for a patient to have. It is also one that every treating dentist must consider when developing a treatment plan for their patient.
Which is the best approach, having an implant placed or going with root canal treatment?
While making a reasonable title for a paragraph, a question regarding which is a better solution, having a tooth "root canalled" or else having it extracted and a dental implant placed, really isn't so easily answered. Researchers have found that when cross referencing studies that might be used as sources to answer this query, the available studies typically have too many conflicting terms and conditions. Here are some of the types of difficulties that are encountered.
» What constitutes treatment success?
Should an endodontically treated tooth that has been lost because of the patient's lax home care and subsequent development of tooth decay really be considered to be a failed "root canalled" tooth? Should it be considered a success or failure if a tooth's root canal therapy does need retreatment but by doing so the tooth is saved from extraction?
» Who will perform the dental work?
Have the implants been placed by specialists and the root canal treatment performed by general practitioners, or vice versa? Specialty training can influence treatment outcome. As an example,
Alley (2004) found a success rate of 98% for routine (non-surgical) root canal treatment when it was performed by endodontists. This number fell to 90% for cases treated by general practitioners.
» What standard of care was practiced?
For a comparison with a dental implant, it seems likely that only teeth that have had root canal treatment and then had a dental crown placed should be considered. This is because this treatment 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 afforded the strengthening and sealing effect created by the placement of a dental crown.
These are all questions that dental researchers must deal with, both when reviewing and comparing existing dental literature or designing their own studies. Clearly the "Which is best, having root canal treatment or a dental implant placed" question is one that has not been as straight forward a question to answer as one might expect.
