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.

Don't loose faith in the idea of retaining your tooth.

When given a choice between a dental implant and saving a tooth by way of having root canal treatment and crown placed, a patient may be biased by the opinion that one involves salvaging and then rebuilding a compromised tooth whereas the other, to some degree, offers a "fresh start." Don't be swayed by this type of thinking. Endodontic therapy (root canal treatment) has a long history of providing excellent clinical results. And using this approach very well may be the most cost effective of the two. In support of this statement, consider the following study.

British researchers (Pennington, 2009) created a model that estimated the "lifetime costs and the total longevity of tooth and implant supported crowns at the maxillary incisor site" (maxillary incisors are a person's upper center front teeth). They determined that choosing a root canal approach extended the life of a tooth at a cost of just 5 to 8 pounds per year (about $8 to $13). In those cases where a tooth's initial root canal treatment had failed but it could be retreated conventionally (no surgery involved), the endodontic treatment was estimated to extend the life of a tooth at a rate of 12 to 15 pounds per year ($20 to $25). In those cases were surgical endodontic retreatment was indicated the dental implant approach was estimated to be more cost effective.

So, if your dentist thinks that conventional root canal treatment provides a suitable clinical approach, based on research involving a determination of cost effectiveness, it seems likely that it should make a good choice.

Patient influenced factors and considerations.

In those cases where it is expected that either a dental implant or root canal treatment approach can be expected to provide a good clinical end result, the patient's decision will need to be based on factors that are unique and important to them. Our next page discusses these types of issues.