Which is the more cost-effective, root canal or an implant?

A dental patient may be faced with the following dilemma.

Should they ...

Related: Implants vs. Root Canal
  1. Save their tooth via root canal treatment.
  2. Have the tooth extracted and replaced with a dental implant.

Our previous page explained how both of these treatment options can be expected to have a similar success rate.

This page evaluates this choice from the standpoint of which approach might be expected to be the most cost-effective solution.

There's actually a research study that looked into this issue.

Title: "Evaluation of the cost-effectiveness of root canal treatment using conventional approaches versus replacement with a dental implant."

British researchers (Pennington, et. al., 2009) developed an economic model that estimated the lifetime costs associated with treating an upper front tooth that had a "nerve" infection.

The treatment options evaluated were: 1) Root canal with post and crown. 2) Dental implant with crown. 3) Fixed bridge. 4) Removable partial denture.

What did the study determine?

In regards to expected lifetime costs (to age 75), the researchers came to the following conclusions.

Choosing between root canal treatment and a dental implant.
  • Root canal therapy as a first treatment (including the placement of a dental crown and post), was determined to be a more cost-effective approach than placing a dental implant.

    This approach, estimated at a lifetime cost of about 5 to 8 pounds per year (about $8 to $13), was also found to be relatively low-cost even in comparison to extraction and replacement with a bridge or partial denture.

  • In the case that a tooth's initial root canal treatment had failed, conventional (non-surgical) re-treatment of the tooth made the more cost-effective choice, as opposed to going ahead and extracting the tooth and placing a dental implant.

    This study did suggest that at an estimated lifetime cost of 12 to 15 pounds per year ($20 to $25) that a re-treatment approach could be expected to be more costly than tooth extraction and replacement with a bridge or denture.

  • If the tooth's root canal treatment failed yet again, it would be likely that surgical re-treatment would be required. 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).

In plain terms...

If your dentist thinks that conventional root canal treatment provides a suitable solution for your tooth, from a standpoint of cost effectiveness, research suggests that it should make a good choice.

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

Per their own review of available dental literature, the authors of this study determined the following.

  • 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 endodontically re-treated.
  • After 20 years, 10% of first implants will fail.

Note: These rates differ from the findings of other research studies that have shown a similar success rate for both treatment approaches.

It would be our assumption that if an even success rate (like that determined by other studies) was factored into this model, the scales would be tipped even more so in favor of root canal treatment as being the more cost-effective choice.

Other issues that should be considered when choosing between root canal treatment and a dental implant.

A) Esthetics

Especially when a front tooth is being treated, the appearance of the procedure's final outcome may be a major consideration.

1) Difficulties 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 (especially if a dental crown is placed).

It's possible, however, that original factors, such as 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) Difficulties with dental implants.

When placing a dental implant, a dentist must adhere to rules governed by the jaw bone (its shape, bone quality, nearby anatomical structures). In some cases, having to adhere to these rules may interfere with ideal implant positioning.

Additionally, the junction where an implant's crown meets the gum line can sometimes be difficult to get to look perfectly natural. This may make root canal treatment the better choice for people who display this region prominently when they smile ("skin grins").

You'll need to ask your dentist questions about your expected results.

All and all, with either root canal treatment or dental implant placement, there's no need to be overly concerned. But if the issue of cosmetics is a major consideration for you, you need to 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.

C) Treatment costs:

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

D) Patient treatment perceptions:

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) Tooth grinding:

Uncontrolled tooth clenching or grinding may complicate the placement or longevity of dental implants. If a person can't control this habit, root canal treatment may make the better choice.

F) Medical concerns:

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

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