Dr. Tariq Jagnarine
Family Medicine/ Endocrinology/Diabetes
Sometimes a tooth can become so severely damaged or infected that the dentist might discuss a couple of different kinds of treatment plans. The first is a root canal, and the other is a dental extraction followed by an implant, which is an artificial tooth designed to replace the damaged tooth.
It may be helpful to understand the differences between a root canal procedure and a dental extraction and implant. Both procedures aim to address the damage in the mouth, but they achieve it in different ways.
ROOT CANAL
Perhaps a more accurate name for this process is actually “root canal treatment”, or “root canal therapy.” First, the dentist will numb the area of the tooth with a local anesthetic injection. Next, they’ll make a small opening on the top of the tooth.
Using special tools, they will remove any soft tissue or pulp that’s become inflamed or infected down inside the pulp chamber and root canals of the tooth. This leaves some space, which the dentist will fill with a type of biocompatible material called gutta-percha. Then it’s time to seal off the opening at the top of the tooth, often with a temporary filling.
A week or two later, returning to the dentist’s office, the temporary filling can be removed, and a crown or other type of restoration can be put on top, if necessary. Sometimes the crown is created during the same appointment.
EXTRACTION AND IMPLANT
If the tooth is so diseased or damaged that it cannot be saved, even with a root canal procedure, it may be time for an extraction, coupled with an implant or other replacement option. A simple extraction usually involves the dentist administering local anesthesia and using a tool like forceps to remove the tooth. Or a surgical procedure which requires general anesthesia. With surgical extraction, the dentist will cut into the gum, and may remove some bone around the tooth as well as the tooth itself. However, a person might not be able to get a dental implant to permanently fill that gap in the smile for at least several months. The timing of the placement of the implant can vary, according to a 2019 study published in the Journal of Cranio-Maxillo-Facial Surgery.
Some people can get an implant, which resembles a screw, immediately after an extraction, but many people need to wait for proper bone healing before the implant. The wait is typically 1 to 4 months long, or longer.
Additionally, you may need to wait several months for the implant to become integrated into the bone before the replacement tooth or crown can be placed on top of the implant, according to the American Dental Association.
HOW TO DECIDE WHICH IS BEST?
Several factors must be considered, such as the storability of the tooth, the esthetic demands, and the cost-to-benefit ratio, according to an implant position statement from the American Association of Endodontics. But many experts believe that it’s better to save the damaged tooth, if possible.
* Prolonging the life of a tooth may delay or remove the need for an implant later.
Saving a damaged tooth with a root canal may prolong the life of the tooth. It could even eliminate the need to install an implant later.
A 2009 review of research on the differences between root canal therapy and implants found that nonsurgical endodontic treatment had very high success rates in terms of the affected tooth’s functionality several years later. For example, one large study found that more than 94 percent of the teeth studied were functional 3.5 years after the root canal treatment.
* A root canal may be less expensive. A root canal procedure may be significantly cheaper, as extraction and an implant may not be covered by the insurance. The estimated cost of a root canal with insurance coverage ranges from about Gy$40,000 to slightly over $50,000. The cost can vary, depending on the type of tooth that’s affected, the insurance plan, the location, and the type of dental professional performing the procedure. It can also cost significantly more if a crown cap is needed on top of the tooth that requires a root canal.
Meanwhile, the cost of a simple tooth extraction might not be that high. And the cost of a surgical extraction may be quite a bit higher. Add in the additional cost of just one implant, and you could be looking at a bill of at least $80,000 to $120,000, depending on the specific situation.
* The treatment is less invasive. Persons might not think of a root canal as noninvasive, but it is less invasive than a surgical dental extraction. With surgical extraction, there may be a need for intravenous anesthesia as well as local anesthesia, and the dentist must cut into the gum to remove the tooth — and possibly some bone around it.
It’s much quicker than going through the implant process. The extraction and implant process may take several months, or longer.
* The recovery period is shorter. It can take several months for the mouth to heal from an extraction — and that does not include the time it will take for the mouth to heal and regrow bone around the implanted tooth.
Meanwhile, the typical recovery period for a successful root canal is usually just a few days.
* Other factors may reduce the success of an implant.
Some other factors can reduce the likelihood of success of extraction and implantation.
For example, research published in 2009 suggests that smokers are more likely than nonsmokers to experience failure of an implant. And a 2005 clinical study suggested that both tobacco and alcohol use can hurt implant outcomes, causing bone loss.
* There are potential risks of opting for a root canal over extraction and implant.
Just as there are some benefits in opting for a root canal over extraction and implant, there are some risks to consider.
* A root canal might weaken the tooth. The dentist must drill down into the tooth to remove the diseased or inflamed pulp. If the tooth is already very fragile, this process could further weaken it. And if the root canal is done on one of the back teeth (whether the molar or premolar), it should have a crown placed to protect the tooth from the forces of biting down, and to support the remaining tooth structure.
* The tooth may fail anyway. If the tooth is weakened, or the damage is very extensive, choosing a root canal might not be enough to address the damage. The tooth may not survive, and an extraction may still be needed.
Are there any benefits to choosing extraction over a root canal?
Depending on the state of the tooth, persons may not have the option for a root canal and crown. The tooth might have sustained so much damage that the best way to stop the deterioration is extraction, and then replacement. There may be other possible procedures, depending on the situation.
As a 2021 study in the British Journal of Oral and Maxillofacial Surgery noted, some research is showing success with dental implants installed through impacted teeth or residual roots, rather than a complete extraction. However, the dentist needs to assess the tooth and discuss the specifics of the situation in detail with you.
Speak with a dentist about the short-term and long-term risks and benefits of both procedures, and explain what the goals and priorities are. Generally, when an existing tooth can be saved, it’s viewed as the more beneficial procedure.
