Root canal treatment or extraction and an implant?

What is the difference between root canal treatment and extraction?

When the nerve inside a tooth is irreversibly damaged or infected, the American Association of Endodontists (AAE) describes two main options. Both stop the infection spreading and the pain, in very different ways:

• Root canal treatment removes the diseased pulp, cleans and disinfects the inside of the tooth, then fills and seals it. The tooth stays and is then restored; see do you need a crown after root canal treatment?
• Extraction removes the whole tooth. The AAE says the gap needs filling to keep your bite aligned, as spaces left by extracted teeth can cause other teeth to shift. The usual replacements are an implant, a bridge or a partial denture.

So the real question is usually not which procedure is easier, but whether this tooth can be saved.

How is it decided whether a tooth can be saved?

The AAE’s 2015 treatment-planning bulletin for dentists says root canal treatment is indicated for restorable teeth with sound gum and bone support, and that diseased teeth should not be extracted without thoroughly assessing whether they can be restored. The dentist looks at:

1. How much sound tooth will remain once decay and old fillings are removed, including an adequate ferrule, a band of sound tooth for the crown to grip.
2. Gum and bone support, checked at the examination and on X-rays.
3. Cracks, root fractures or root resorption.
4. The tooth’s position and role: according to the bulletin, teeth with fewer than two neighbouring contacts, and teeth anchoring a bridge, may survive less well.

The bulletin adds that cone-beam CT (CBCT), a 3D scan, allows a more accurate diagnosis and better decisions.

When is extraction the better option?

According to the bulletin, root canal treatment is not appropriate for teeth that cannot be restored or have severe gum disease; options such as an implant should then be considered. The AAE’s patient information describes further cases:

• Vertical root fracture: a crack starting in the root and running towards the chewing surface. It often causes few symptoms and may go unnoticed for some time. Extraction may be needed, though endodontic surgery is sometimes possible if removing the fractured part saves the tooth.
• A crack below the gum line: the tooth is then no longer treatable and generally has to be extracted.
• A split tooth cannot be saved intact, though part of it sometimes can.

The AAE also names retreatment and endodontic surgery as ways of saving a tooth, and advises discussing every option for keeping it before choosing extraction. Delay matters too: an untreated cracked tooth progressively worsens, says the AAE, and according to the NHS an infected tooth without root canal treatment may need to be taken out.

What does research say about root-filled teeth and implants?

The AAE bulletin summarises two studies:

• Of more than 1.4 million root canal-treated teeth in an insurance database, 97% were still in place over an eight-year follow-up.
• At the University of Minnesota, 196 restored root-filled teeth were compared with 196 matched single implants. Both groups had a 94% survival rate, but the implants took longer on average to come into use and more often had complications needing further treatment.

A 2007 systematic review by Torabinejad and colleagues in the Journal of Prosthetic Dentistry found similar long-term survival for root-filled teeth and single implant crowns, both better than for bridges. The authors stress that direct comparisons were extremely rare and study quality limited. The AAE therefore recommends trying to save the natural tooth first, with an implant as the backup plan if healing does not occur. These are averages; your tooth’s outlook depends on its own condition.

Your dentist has suggested extraction and an implant: what can you send for a second opinion?

The NHS treatment abroad checklist calls a second opinion valuable, both on the options and on whether treatment is needed at all. A preliminary assessment is more useful when we can see what your dentist saw. You can send us on WhatsApp:

• X-rays: the small X-ray showing the whole root and surrounding bone, and any panoramic X-ray (OPG); digital copies are ideal.
• A CBCT scan, if one was taken, with its written report.
• Your dentist’s findings: which tooth, the diagnosis and why extraction was advised (for example a suspected crack or root fracture, too little tooth left, bone loss or a failed earlier root canal treatment), plus any notes on gum pockets or looseness.
• The tooth’s history: earlier root canal treatment, a post or crown, and when symptoms started.
• Your medical history and medicines: according to the AAE, diabetes, smoking and long-term use of bisphosphonate medicines can affect implant treatment.
• Clear photos of the tooth and gum.

The General Dental Council (GDC) recommends speaking to your own dentist before going abroad for treatment, partly so they know your plans if problems arise later.

A remote review has limits. The GDC says you should always be assessed by a qualified dentist before being given a treatment plan, and as the AAE notes, a vertical root fracture can go unnoticed for some time. A preliminary assessment helps you decide whether a trip is worthwhile; whether the tooth is kept or extracted is decided after the examination.

How many trips does each option take?

Keeping the tooth. The NHS says root canal treatment usually takes two or more appointments, with a temporary filling in between. A crown is made with CAD/CAM at the dental laboratory we work with, which takes some days, so it is fitted at a separate appointment. Whether both fit into one trip depends on the tooth and is planned at the examination. If you would fly home before the crown is fitted, see the section “What if you fly home before the crown is fitted?” in our crown guide.

Extraction and an implant. The AAE says an implant fuses with the jawbone over three to six months before the crown is attached; University Hospitals of North Midlands NHS Trust gives six months to over a year from placement to completion. Implants therefore usually need two trips, and as a general guide our dental implants page gives around five to seven days for each. If the socket must heal before the implant goes in, that can mean an extra trip, and the AAE notes that bone grafting or a sinus lift may be needed. Depending on your case, a temporary tooth can be fitted for the healing months. See how many days do I need to stay in Türkiye for dental implants?

A bridge or a denture can often be completed in one trip, but the AAE notes that both often require work on healthy neighbouring teeth.

How is the decision made at Rönesans?

We decide on an extraction only after the options for keeping the tooth have been assessed at the examination. Root canal treatment (endodontics), implants and prosthetics are among our clinic’s branches, so keeping and replacing the tooth can be discussed at the same examination. When an infection at the root tip or a possible root fracture needs clarifying, a CBCT scan can be taken at the clinic; if an implant is considered, the bone is assessed on the same scan. We carry out bone grafting and sinus lifts at our clinic.

Before treatment starts, you know which dentist will treat you and receive a written treatment and cost plan; the cost is confirmed after the examination. When you leave, you receive a copy of your treatment summary and copies of your X-rays for your dentist at home. Transfers and accommodation are described on planning your visit.

We are open Monday to Friday 10:00–22:00 and Saturday 10:00–19:00, Türkiye time. Send your X-rays, scans and findings on WhatsApp at +90 532 363 49 54, call +90 264 606 09 43 or use our contact page; during opening hours we reply in English and German within 15 minutes.