Dental implant or root canal, which makes the best choice?
Using dental implants 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 have a dental implant placed?"
This is a very logical question have. Here are some of the topics that must be considered when trying to make this decision.
- Success rates of implants vs. root canals. - ( Success-rate factors you influence. )
- Which treatment approach is more cost-effective?
- Additional factors to consider.
1) Dental implants vs. root canal treatment - Success rates.
Proving which of these two options is best is somewhat difficult to do. 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 of these treatments 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.
[If that's the cases, then other factors need to be evaluated and considered before making a decision.]
A) Dental research -
Study 1 -
Title: "Endosseous implants versus non-surgical root canal therapy: A systematic review of the literature."
This paper (Blicher 2008) reviewed published research studies that either ...
- Evaluated the survival rate of teeth that had received root canal treatment.
- 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 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?"
This study (Iqbal 2007), which was also a literature review (55 research papers evaluating dental implants and 13 root canal treatment), came to the conclusion that no significant differences in survival rates existed between the two approaches.
They 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.
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 about which treatment approach makes the best choice will need to hinge on other factors. These include:
- Case selection. (How closely the patient's pre-treatment situation conforms to the ideal.)
- Issues associated with specific patient characteristics, habits or concerns.
- Overall treatment cost or expected cost-effectiveness. This is an important factor because completing full treatment is a necessary part of insuring a procedure's expected success (especially root canal).
C) Success-rate factors you have some control over.
Research suggests that the following factors can influence treatment outcome. To some extent, you have some amount of control over them.
a) 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.
Clinician success rates for root canal treatment.
One literature review found that 98% of routine cases treated by endodontists (root canal specialists) were successful vs. 90% for those treated by general dentists.
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.
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 able to duplicate the same success rates documented by previous studies. (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 to be made by a less rigorously trained practitioner.
Be a consumer. Ask your dentist questions.
We are not trying to suggest that general practitioners can't provide quality implant and endodontic services. That statement simply would not be true.
b) With root canal, you must commit to complete treatment to reap the highest success rate.
Studies set up to determine the success rates of teeth that have had root canal treatment typically only evaluate those that have had an appropriate dental restoration placed after their treatment has been completed.
This is 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.