Which is the more cost-effective,
root canal treatment or having a dental implant placed?

A dental patient may be faced with the following dilemma. Should they ...

Save their tooth via root canal treatment (including the placement of a post and crown)? Or have the tooth extracted and replaced with an implant (and crown)?

When pondering this question, one financial question might arise:

Which approach might be expected to be the most cost-effective solution?

In regards to answering this question, this page discusses the findings of a research paper titled "Evaluation of the cost-effectiveness of root canal treatment using conventional approaches versus replacement with a dental implant."

Related content:

• Dental implants vs root canal treatment. - Factors to consider.

A research study - Evaluating the cost-effectiveness of root canal treatment vs. dental implants.

British researchers (Pennington, et. al., 2009) developed an economic model that estimated the lifetime costs (treatment options and possible outcomes, both success and failure) associated with treating an upper front tooth that had a "nerve" infection.

[This model made the assumption that throughout their hypothetical person's lifetime (a male up to the age of 75) a tooth or replacement tooth would always be present (either a root canalled tooth with post and crown, a dental implant with crown, a fixed bridge or else a removable partial denture).]

What did the research show about the cost-effectiveness of root canal treatment as compared to dental implants?

In regards to lifetime costs, the researchers' reported the following:

• Root canal therapy, as a first treatment (including the placement of a dental crown and post), proved to be a more cost-effective strategy than dental implant placement (and "relatively low" cost even in comparison to extraction and replacement with a bridge or denture).
  
  
• In the case that the initial root canal treatment failed, conventional (non-surgical) re-treatment of the failed endodontic therapy made the most cost-effective choice, as opposed to going ahead and extracting the tooth and placing a dental implant.
  
  (The study did suggest, however, that tooth extraction and replacement with a bridge or denture at this point would be expected to have a slightly lower lifetime cost.)
  
  
• If the tooth's root canal treatment failed yet again, it would be likely that a dentist might suggest surgical re-treatment. With this scenario, the model suggested that tooth extraction and replacement with an implant, bridge or denture would be more cost-effective than surgical endodontic re-treatment.
  
  

What did this study use as expected success rates for root canal treatment and dental implants?

Per their own review of available dental literature, this study's model factored in the following survival rates for root canal treatment and dental implant placement.

• After 20 years, 25% of teeth receiving root canal treatment and a dental post and crown will be lost. This includes teeth that have been endontically re-treated.
• After 20 years, 10% of first implants will fail.

You might notice that the numbers above are slightly different than those research numbers we cite on other pages. In general, those studies typically report less of a difference in survival rates between an implant and root canal treatment approach. It would be our assumption that in the case where a fairly even success rate was factored into this study's model, the scales would be tipped even more so in favor of root canal treatment as being the more cost-effective choice.

There are some factors that should be kept in mind when evaluating this study's results.

1. Some people may consider some of the alternative treatments evaluated by the study unacceptable and therefore not an option at all. For example, some people may be opposed to wearing a removable partial denture. Others may find the surgical nature of implant placement a barrier to treatment.
2. The study involves treating a front tooth (an incisor). Root canal treatment costs vary by tooth type, incisors typically being the least expensive. The study did not address how their model's results might vary if a molar was involved instead. (Our expectation would be that the comparisons involving dental implants would remain similar. Comparisons with tooth extraction and replacement with a bridge or denture would become slightly more favorable for these treatments.)
3. The procedure fees used in this study's model are estimates of those prevalent in the United Kingdom in 2006. Dental costs in the USA are likely different. However, dental fees are typically based on factors such as the amount of time needed time to perform the treatment, office overhead, and materials and laboratory costs. On a comparative basis, within any one country, the relative cost hierarchy of dental procedures is likely to be similar.