Which provides the better solution, doing root canal treatment to save a tooth or extracting the tooth and replacing it with a dental implant?

As you have just learned, this question has been difficult for dental researchers to answer because, traditionally, it has lead to the need to make apples-to-oranges type comparisons. Having said that, when the success rate of each treatment modality is considered independently, a trend does appear.

Blicher (2008) reviewed dental studies that evaluated the survival rate of teeth that had received root canal treatment and also studies that evaluated the success or failure of dental implant placement. That review determined that the success rate for root canal treatment ranged between 92 and 97% (time frame of studies reviewed: four to eight years). It determined a success rate for dental implants ranging between 95 and 99% (time frame of studies reviewed: two to sixteen years). These findings suggest that the overall success rate of either treatment modality is fairly similar, although slightly favoring dental implants.

In another review of existing dental literature, Iqbal (2007) came to the conclusion that no statistical difference existed between the survival rates reported by studies that had evaluated root canal therapy and those studies that evaluated the survival of dental implants. In combination, the findings of both the Blicher and Iqbal studies suggest that both treatment choices can be excellent choices.

So, which to choose root canal treatment or a dental implant?

The fact that endodontic treatment (in conjunction with the subsequent placement of a proper dental restoration such as a crown) or the placement of a dental implant can both be expected to provide an excellent treatment end result suggests that the decision about which treatment modality is the best choice for a patient should depend upon factors other than just treatment outcome. That is to say, case selection (how closely the patient's pre-treatment situation conforms to the ideal) needs to play a key role in determining which approach is the better choice.

Of course this statement shouldn't come as much of a surprise to anyone. In fact, no doubt this is precisely what we think we are paying our dentist for. We expect them to provide us with an expert opinion. We expect them to have evaluated our situation and advise us as to what options constitute an appropriate remedy for it.

The deciding factors, when choosing between the two treatments, will probably hinge on issues influenced by the dental patient.

This means that issues such as the condition of the tooth in question and the value of the tooth in regards to the patient's present and future dental outlook, while being of utmost importance, are for the dentist to evaluate and pass judgement on. Then, if they have determined that either a root canal treatment or dental implant scenario provides a viable treatment option, then other issues, particularly those that the dental patient controls or influences, become the salient deciding factors. Our next page discusses these issues.