Choosing between a dental implant and root canal treatment - Important patient-specific considerations.

Since dental research suggests that dental implants and root canal treatment both share similar success rates, the decision between the two is typically based on other, more patient-specific, factors.

Patient-specific factors that influence the decision between root canal treatment or a dental implant.

A) Esthetic concerns:

Dental implants and root canal treatment each possess unique characteristics that can have an affect on the cosmetic end result of a patient's treatment. And especially in the case where a front tooth is being treated, these factors may become a very important consideration.

A root canal approach can present challenges.

For example, rebuilding a tooth via root canal treatment and the placement of a dental crown is typically a straightforward task of putting the tooth back together the way it was. However, it's possible that original factors, such as poor tooth alignment, may (or quite possibly may not) make creating a esthetic improvement for the tooth a challenge.

A dental implant approach can present challenges.

Along these same lines, when placing a dental implant a dentist must adhere to rules dictated by the jaw bone (shape, bone quality, anatomical considerations). Having to adhere to these rules may make creating a superior result relatively more difficult. Additionally, making the juncture where an implant's crown approximates the gum tissue look perfectly natural can sometimes be difficult to manage.

You'll need to ask your dentist questions about 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 be asking questions about the expected esthetic outcome of your case before you decide upon a treatment plan.

B) 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.

[ Related content: Which is the more cost-effective choice, root canal treatment or a dental implant? ]

C) 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 two options.

Blicher (2008) cites a 2001 survey that reported that:

• Performing root canal treatment 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.
• Restoring a tooth's 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.

D) 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 (such as a fear of even minor surgery), it may necessitate that the other alternative is chosen.

E) Oral home care proficiency:

For those patients who have a history of experiencing continued problems with tooth decay, salvaging a tooth via the use of root canal treatment may not be the best long-term choice. (Neither root canal treatment nor the placement of a dental crown will reduce the potential for tooth decay formation on exposed natural tooth surfaces where dental plaque is allowed to accumulate and persist.)

In general, people who have lax oral hygiene habits may not reap the long-term success rates typically associated with the dental treatment they have received.

• Teeth that have received root canal treatment remain at risk for gum disease (periodontal disease) just like any tooth does.
• With dental implants, poor oral hygiene can lead to the formation of peri-implantitis.

F) Para-functional habits - Tooth grinding:

The bone-to-implant interface is different than that which exists between bone tissue and a natural tooth. And because of this 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 way of either altering their bruxing habits or wearing a mouth guard appliance that can help to mitigate its effects, an implant may make a poor choice.

G) 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.