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 over the last decade. And those 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 have a dental implant placed?"
This is a very logical question have. Toward helping to provide an answer, offer three pages. One of them discusses dental implant and root canal treatment success rates. This page, which discusses factors your control that influence treatment success rates. And finially, our page - Which is more cost-effective, root canal treatment or an implant?
Dental implants vs root canal treatment - Success rates.
There are a number of different considerations that must come into play when making the decision between a dental implant or root canal treatment. And the anticipated success of the procedure is certainly one of them.
Research suggests that you, the dental patient, exert some amount of control over the following factors, which in turn can affect the success rate of your treatment.
A) The treatment outcome that you experience can be influenced by the dentist who performs your work.
Clearly, providing 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 is being performed.
For example, Alley (2004) found a success rate of 98% for routine (non-surgical) root canal treatment when it was performed by endodontists (root canal specialists). This number fell to 90% for cases treated by general practitioners.
Implantology is a relatively new field and a dentist's training in it will vary.
Unlike the field of endodontics (root canals) which has been included in the curriculum of dental schools for decades, implantology is a newer field. It has only been since the 1990's that it has been included in the curriculum of dental schools on a wide-spread basis.
The earliest dental implant studies (those used to document implant survival rates over the longest time period) typically involved treatment provided at a "specialists" level. In comparison, today many implants are placed by general practitioners.
It could be debated that this latter-mentioned work may not be able to duplicate the same success rates documented by previous studies. This is because a great deal of the education in implantology that dentists have received has been via "training course" (brief multi-day courses) as opposed to rigorous academically-based course work, such as that now provided by dental schools.
A hint of this phenomenon might be apparent in the following data coming from Australia. There, the largest category of claims against dentists (24%) are founded on errors associated with inappropriate diagnosis and case selection (Cohn 2005). This is the type of error that might be more likely with a less rigorously trained practitioner.
Be a consumer. Ask your dentist questions.
We are not trying to suggest that general practitioners cannot provide quality implant and endodontic services. That statement simply 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 experiences in providing the proposed treatment.
B) You must commit to complete treatment to reap the highest success rates.
Studies that have evaluated the success rates of teeth having had root canal treatment typically (and appropriately) only include in their data set teeth that have had root canal treatment and then a dental crown (and post if indicated) placed. 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. That is not to say, however, that all root canalled teeth require dental posts and crowns. It typically depends on:
- How intact the tooth is at that point when root canal treatment has been completed.
- What type of loads the tooth must function under.
But failing to have a dental crown placed when indicated can be expected to compromise the long-term success of choosing root canal treatment over having a dental implant placed.
