Root canal or extraction and implant: which is better?

Root canal or extraction and implant? If a dentist has told you a tooth is infected, cracked or badly decayed, you have probably heard both options. Some people are told to “just take it out and have an implant”. Others are told every tooth should be saved at any cost. The truth sits in between. Both treatments have good results in the right case, and the deciding factor is the condition of the tooth itself. Here is how our dentists weigh it up.

What each option involves

Root canal treatment

Inside every tooth is a soft core of nerve and blood vessels, the pulp. When decay, a deep crack or a knock lets bacteria reach it, the pulp becomes inflamed or dies, and infection can spread into the bone at the root tip. A root canal treatment removes the infected pulp, cleans and shapes the narrow canals inside the root, and seals them with a filling material. The tooth is then rebuilt and, for back teeth, usually covered with a crown.

The NHS points out that an infected tooth left without root canal treatment may need to be taken out. The treatment is done under local anaesthetic, so you are awake but should not feel pain, and it usually takes two or more appointments. Afterwards the area may feel sore for a while, settling over a couple of weeks.

Extraction and implant

The tooth is removed. After healing, or sometimes at the same visit, a titanium implant is placed in the bone. Once it has fused with the bone, a crown is fitted on top. With us this means two trips to Antalya: the implant on the first, the crown on the second, usually 3–6 months apart. Our dental implants page covers the process step by step.

What the research says

Two well-known reviews are useful here.

A 2010 systematic review from the UCL Eastman Dental Institute pooled studies of tooth survival after root canal treatment. About 86–93% of root-treated teeth were still in the mouth at 2 to 10 years. Four things made survival more likely: having a crown placed afterwards, having teeth on both sides touching it, not using the tooth as an anchor for a bridge or denture, and the tooth not being a molar.

A 2007 review compared root-treated teeth with crowns against single-tooth implants. It found no significant difference in survival between the two. The authors concluded that the choice must be based on other factors, because both are excellent treatments for compromised teeth.

What decides: is the tooth worth saving?

These are the questions our dentists answer, usually with a 3D CBCT scan, before recommending either path.

1. How much healthy tooth is left?

A root canal saves the root, but the tooth still needs enough solid structure above the gum to hold a crown. If decay has gone down below the gum and bone level, there may be nothing for a crown to grip. Teeth like that can sometimes be saved with extra procedures, but the prognosis drops.

2. Is there a crack?

A crack running down into the root is one of the strongest reasons to extract. Cracked roots cannot be reliably sealed, and infection tends to return. A 3D scan, close examination and sometimes a look under magnification help find these.

3. What is the gum and bone support like?

A tooth with advanced gum disease and little bone around it may be loose regardless of the nerve. Root canal treatment fixes the inside of the tooth, not its support.

4. Can the canals be reached?

Some roots are very curved, blocked with calcium or contain broken instruments from earlier treatment. These cases are harder and the chance of success is lower.

5. Is this a first treatment or a redo?

A first root canal has a better chance than retreating a tooth that has already been root-filled and failed. Retreatment is often worth trying, but expectations should be realistic.

6. Your health and wishes

Some medical conditions and medicines make extractions and implant surgery riskier, which pushes towards saving the tooth. Others make long, complex dental treatment hard to manage. And some patients simply prefer to keep their own teeth wherever possible.

Comparing the two over time

One point people often miss: keeping your tooth does not close the door on an implant. If a root-treated tooth fails years later, an implant is still possible. Going straight to extraction is the step you cannot undo.

Cost over the years

In the short term, a root canal and crown is usually the cheaper and quicker option. An implant involves more steps: extraction, perhaps a bone graft, the implant, the abutment and the crown, plus two trips. Our published price for one implant with a zirconia crown is £450. For root canal treatment, we give a written price after seeing your X-ray, because the work varies a great deal from a simple front tooth to a curved molar with four canals.

Over a longer period, the sums depend on what happens next. A root-treated tooth that needs retreatment and then extraction can end up costing more than going straight to an implant. That is why the prognosis of the individual tooth matters more than headline prices. A tooth with a good outlook is worth saving. A tooth with a poor outlook may be more expensive to keep than to replace.

When we recommend saving the tooth

• Enough tooth above the gum for a well-fitting crown
• No crack running down the root
• Healthy gum and bone around the tooth
• Canals that can be reached and cleaned
• The tooth is important for your bite or for supporting a bridge you want to keep

When we recommend extraction and an implant

• A vertical crack into the root
• Decay too deep below the gum to restore
• Severe bone loss around the tooth from gum disease
• A failed retreatment with ongoing infection
• Repeated problems that make the tooth unreliable

If an extraction is needed, it is free with us as part of implant treatment. We would rather spend time explaining why a tooth can be kept than remove one that could be saved.

After a root canal: protecting the tooth

A root-filled tooth no longer feels pain from the inside, so decay can go unnoticed. It also becomes more brittle, especially at the back. Have a crown fitted promptly on back teeth, keep cleaning carefully around it, and attend regular check-ups so your dentist can X-ray it from time to time. Our root canal treatment page explains the appointments themselves, and the crowns page covers the crown that follows.

Get an honest opinion on your tooth

Send us your most recent X-ray of the tooth, ideally a close-up of the root, and a note of any symptoms. One of our dentists will tell you whether it looks worth saving and send a written plan for either path. Contact us through our contact page or on WhatsApp.

Common questions

Does a root canal last as long as an implant?

Studies comparing the two have found no significant difference in survival when each is done in a suitable case. A large review found about 87% of root-treated teeth still in the mouth 8–10 years after treatment, with better results when the tooth had a crown.

Is it cheaper to have the tooth out and an implant?

Often not. A root canal plus a crown usually costs less than extraction, implant and crown, and needs fewer visits. We give a written price for root canal treatment after seeing your X-ray. Implant prices are on our prices page.

Can a failed root canal be redone?

Often, yes. A retreatment cleans out the old filling and re-seals the canals. It has lower success than a first treatment, and sometimes an extraction is the better choice. Your dentist should tell you honestly which applies.

Does a root-filled tooth need a crown?

Back teeth almost always do, because they become more brittle and take heavy chewing forces. Research shows root-treated teeth with a crown survive much better. Front teeth with little damage can sometimes manage with a filling.

Is root canal treatment covered by your guarantee?

No. Root canal treatment is not covered by our written guarantee, because its outcome depends heavily on the tooth’s condition. The crown on top is covered under our crown terms. See our guarantee.

Sources

1. NHS: Root canal treatment
2. Oral Health Foundation: Root canal treatment
3. Ng, Mann, Gulabivala. Tooth survival following non-surgical root canal treatment. Int Endod J 2010
4. Iqbal, Kim. Outcomes of restored endodontically treated teeth compared to implant-supported restorations. Int J Oral Maxillofac Implants 2007

Checked October 2026. Where we give our own view as a clinic, we say so.