Choosing between a dental implant and root canal treatment: Patient considerations that may influence the decision about which is best.

After examining a patient's specific situation, a dentist may find that salvaging the tooth via the use of root canal treatment (and the subsequent placement of an appropriate dental restoration such as a crown) or else extracting it and placing a dental implant might both be expected to provide an equally suitable long-term end result. If so, then other issues, issues attributed to or influenced by the patient, will play a prominent role in determining which treatment modality will make the best choice. Some of these patient-related factors are:

» Esthetic concerns:

A dental implant and a "root canalled" tooth will both possess unique characteristics that can affect the cosmetic end result of a patient's treatment, both positively and negatively. If the location of the tooth in question is one where aesthetic considerations are of utmost importance to the patient, the patient must thoroughly discuss the cosmetic outcome that is expected with each treatment modality before a final decision between the two is made.

» Para-functional habits:

Related to the fact that the bone-to-implant interface is different than that which exists between bone tissue and a natural tooth, dental implants cannot withstand extreme forces such as those created by patient bruxing habits (tooth clenching and grinding). If a patient is not willing to address this issue either by altering their bruxing habits or wearing a mouth guard appliance that can help to mitigate its effects, an implant may make a poor choice.

» Health issues:

Patient-influenced health issues can affect the outcome of implant therapy. As examples, those patients who have uncontrolled (or poorly controlled) diabetes or are smokers will be at greater risk for dental implant complications. Those patients who are unwilling or incapable making the needed changes in their lifestyle to resolve these types of health issues may not be good candidates for the placement of a dental implant.

» Oral home care proficiency:

For those patients who have a history of experiencing continued problems with tooth decay or periodontal disease, salvaging a tooth via the use of root canal treatment may not be the best long-term choice. Dental implants (while not without concerns associated with the need for proper oral home care) may be the better option for those patients unwilling or unable to alter their dietary or oral home care habits.

» Patient treatment perceptions:

The majority of dental patients will complete either dental implant or endodontic treatment with a minimal amount of discomfort or complication. However, if a patient has, for whatever reason, a negative bias toward either treatment modality, it may necessitate that the other alternative is chosen.

» Treatment costs:

Treatment cost is typically a major consideration for patients. A paper published by Blicher (2008) cites a 2001 survey that reported that restoring a tooth with root canal treatment and a crown typically costs in the neighborhood of $2,200. In comparison, the treatment costs reported for placing a dental implant were on the order of $3,500. This price difference can be amplified if a patient's dental insurance does not provide coverage for both options. Traditionally, dental insurance policies have been more likely to provide benefits for root canal treatment (and crown placement) than for dental implants.

» Treatment time:

The time frame that is needed to complete a patient's treatment can play a role in their choice between two options. Blicher (2008) cites a 2001 survey that reported that treating a tooth endodontically and then placing a dental crown typically required 4.5 hours of appointment time, broken up into six visits, over a time span of three months. In comparison, restoring the space with a dental implant typically took 5.5 hours of appointment time, divided among ten visits, over a time span of 9.5 months.