Root canal or implant? The honest comparison

Implants are an excellent invention, and when a tooth genuinely cannot be saved they are often the best replacement. But "we could just take it out and do an implant" is not a neutral suggestion, and the comparison deserves to be made properly rather than in passing.

What each actually involves

Root canal treatment keeps your own tooth. The infected tissue inside is removed, the canals are cleaned and sealed, and your dentist fits a crown. Usually one or two visits of about ninety minutes, under local anaesthetic, with no surgery.

Extraction and an implant replaces the tooth. The tooth is removed, the socket heals for some months, a titanium post is placed surgically in the bone, that heals for several more months, and finally a crown is fitted to the post. Where bone has been lost, a graft may be needed first. The whole process commonly takes six months to a year.

Longevity

Both have good long-term records when done well, and neither is guaranteed. A properly root-treated and promptly crowned tooth routinely lasts for decades. Implants also last well, but they are not immune to problems: the gum and bone around an implant can become inflamed and infected in a way that is harder to treat than disease around a natural tooth. Claims that implants are "for life" and root-treated teeth are not do not stand up to the evidence.

What you keep, and what you lose

A natural tooth is anchored by a ligament that senses pressure, protects you from biting too hard and keeps the surrounding bone alive. An implant fuses directly to bone and has no ligament; it feels slightly different, and the bone around it behaves differently. For most people the difference is small, but it is real, and it is one reason endodontists prefer to keep a tooth that can predictably be kept.

Cost over time

Root canal treatment plus a crown is almost always less expensive than extraction, implant surgery and an implant crown — often by a large margin, and more so if a bone graft is involved. Both may need maintenance over the years, but the starting point differs substantially.

Timescale and recovery

Root canal treatment is finished in weeks and involves a few days of tenderness. An implant involves at least one surgical procedure, a longer recovery and months of waiting with a gap or a temporary tooth.

When an implant really is the better choice

When the tooth cannot predictably be restored: a root that is cracked or split, too little sound tooth left above the gum to hold a crown, or bone support so reduced by gum disease that the tooth is loose. In those cases keeping the tooth is not kindness, and the honest advice is to remove it and plan a replacement — which may well be an implant.

How to decide

Have the tooth assessed by someone whose job is to save teeth, and ask for the realistic chance of success in writing. If the tooth has a good outlook, keep it. If it does not, replace it with confidence. The page on alternatives to extraction describes what that assessment involves.