Research studies: What's the better solution,
root canal treatment or a dental implant?
Dental implants vs. root canal treatment - Which does dental research suggest is best?
In some ways, studying which is the best alternative, having root canal treatment or having a dental implant placed, is a difficult question for dental researchers to answer. After all, if one treatment modality has been performed, it's impossible to know the outcome of the other would have been.
However, when the success rates of each treatment 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.
Related content:
Root canal treatment and tooth implant success rates. - What does dental research report?
Study 1 - Title: "Endosseous implants versus nonsurgical root canal therapy: a systematic review of the literature."
This paper (Blicher 2008) involved the review of published dental research studies that either ...
- evaluated the survival rate of teeth that had received root canal treatment.
- or evaluated the success or failure of dental implant placement.
The findings of this literature review 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 ranging between 95 and 99% (over a time frame of two to sixteen years).
These findings suggest that the overall success rate of either treatment modality 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) was also a literature review (55 studies related to dental implants and 13 to root canal treatment). It came to the conclusion that no significant differences existed between the survival rates reported by studies that had evaluated root canal therapy and those studies that evaluated the survival of dental implants.
They continued by stating that the decision for implant placement or root canal therapy (with the subsequent placement of an appropriate dental restoration) needs to be based on factors other than just the statistical analysis of predicted treatment outcome.
In combination, the findings of both the Blicher and Iqbal literature reviews suggest that both treatment options can make excellent and predictable choices.
If the success rates are similar, what other factors need to be considered?
The fact that endodontic treatment (in conjunction with the subsequent placement of a proper dental restoration such as a crown) and 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 should depend upon factors other than just expected treatment outcome.
- 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. However, for the most part, you must rely on your dentist's knowledge and capabilities in regards to this matter.
- Other factors, such as those involving specific dental concerns or patient characteristics and habits can be critical factors in choosing the right treatment.
- Quite possibly treatment cost or expected cost-effectiveness will need to play a role in making the decision. This is an important factor because completing full treatment is a necessary part of helping to insure its expected success.
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 relatively 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. It provides a way of preserving, rather than replacing, natural dentition. And, as many dentists would likely express it, "the best implant is a natural tooth."
Additionally, root canal therapy very well may be the most cost effective approach of the two. In support of this statement, consider the following study.
Study - Title: "Evaluation of the cost-effectiveness of root canal treatment using conventional approaches versus replacement with an implant."
[ We've expanded our discussion of this topic here: Which is the more cost-effective approach, dental implants or root canal therapy? ]
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 re-treated 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 re-treatment 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.
