We just don't see anything in your narrative that suggests that the extraction procedure you require will be especially difficult or troublesome.

In regard to the process of having your tooth pulled, tooth #20 is a single rooted (lower left 2nd) premolar. It has a location that provides a dentist with great access and visibility, which should help the procedure to more smoothly and quickly.

In regard to pain and swelling, we would think you have more to be concerned about by leaving the tooth in place rather than having it out. (You state the filling is loose, if so, the root canal work is no longer protected by its seal, which is a common cause of root canal failure.)

With the exception that there's a medical issue involved, we're unclear why you anticipate problems with controlling bleeding after the extraction.

You mention you'd like an implant placed as a replacement tooth. It might be possible to place it during your extraction procedure, thus avoiding a separate surgical process.

Something you don't mention that you might consider is the use of sedation for your procedure. Doing so is frequently benefits both the patient and dentist.

As mentioned above, proceding with your treatment almost certainly holds more benefits for you than not. Doing so will allow you to make decisions, rather than conditions with your tooth dictating the course of events. Good luck.

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