When a tooth is badly decayed, cracked or infected, you are usually offered a choice: treat it and keep it, or remove it and replace it. Both can be reasonable. Which one is right depends on the tooth in front of you, and a general rule applied to every case will be wrong for some of them.
Dr. Jin-Ho Cho at Shine Dental Newington — BDS (University of Sydney, 1987), more than 35 years in practice, over 9,000 implant fixtures placed — assesses both paths before recommending either. Here is how that decision is actually made.
What does each option involve?
Root canal treatment removes infected or dying tissue from inside the tooth, disinfects the canal system and seals it. The outer tooth stays. Because a root-treated tooth is usually weakened and often already heavily filled, it commonly needs a crown afterwards to protect it from fracture. The crown is part of the cost and part of the plan, not an optional extra.
Extraction and an implant removes the tooth entirely and places a titanium post in the bone, which later carries a crown. It is a longer overall process, usually spanning months, because the implant must fuse with bone before it can be loaded.
What actually decides between them?
Several factors carry more weight than patient preference alone.
How much sound tooth structure remains. This is often the deciding factor. A crown needs enough healthy tooth above the gum to grip. If decay or fracture has taken the tooth down to or below gum level, the long-term outlook for restoring it drops considerably, regardless of how well the root canal itself goes.
Whether the crack extends into the root. A crack confined to the crown portion may be restorable. One running into the root generally is not, and treating it can mean paying for root canal treatment and a crown only to lose the tooth later.
The state of the bone and gum around the tooth. A tooth with advanced gum disease and significant bone loss may be loose or heading that way. Saving the nerve does not address the support.
Which tooth it is. A front tooth sits in a visible, aesthetically demanding position where an implant needs careful gum management. A back molar carries heavy chewing loads. The considerations differ.
Whether the tooth has been root treated before. Retreatment is possible but has a lower success rate than first-time treatment.
Your general health and habits. Implant healing is affected by smoking and by poorly controlled diabetes. Where these apply, keeping a serviceable tooth may be the more predictable path.
Is one option more reliable than the other?
Neither is universally better, and claims in either direction should be treated carefully.
Root canal treatment on a suitable tooth has a good record over many years, particularly where enough tooth structure remains and the restoration is done well. Implants also have a good record in suitable patients. The failure modes differ: a root-treated tooth may fracture or reinfect; an implant may fail to integrate or, later, develop gum problems around it.
What matters is the specific case. A structurally sound tooth with a straightforward canal usually favours saving it. A tooth that has been repeatedly patched, has little structure left, and has a questionable crack usually favours replacement. Most cases sit somewhere along that line, which is why an assessment matters more than a general preference.
What about cost?
Comparing cost fairly means comparing the whole course, not one item.
Root canal treatment is usually quoted alongside the crown that follows it. Quoting the canal treatment alone understates what keeping the tooth actually costs.
Extraction and an implant includes the extraction, any grafting needed, the implant itself and the final crown. Our implant cost guide explains the components.
There is also the longer view. If a root-treated tooth is likely to fail within a few years, the eventual implant cost is added to what was already spent. Conversely, if the tooth has a good chance of serving for many years, saving it may be both cheaper and less invasive. Neither timeline can be known with certainty, which is why the clinical assessment of how much sound tooth remains carries so much weight.
At Shine Dental Newington you receive a written, itemised quote with item numbers for the option under discussion, so you can see the components and check them against your fund. HICAPS on-the-spot claiming is available, and the practice is a CBHS and NIB preferred provider.
What if I do nothing?
This is worth stating plainly. An infected tooth does not resolve on its own. Left alone, infection can spread into the surrounding bone and tissues, and pain that comes and goes tends to return worse. Leaving a gap after extraction has its own consequences — neighbouring teeth drift, the opposing tooth over-erupts, and bone in the gap shrinks over time, as covered in our article on missing teeth.
Doing nothing is sometimes a legitimate short-term position while you consider options or arrange finances. It is rarely a good long-term one.
Questions worth asking
- How much sound tooth structure is left above the gum?
- Is there a crack, and if so how far does it extend?
- If we root treat this tooth, what is the realistic outlook, and what would make it fail?
- What would the whole course cost for each option, including the crown?
- If the tooth is removed, what are the replacement options besides an implant?
A practice willing to answer the fourth and fifth questions candidly is giving you a plan rather than a product.
Arranging an assessment
Consultations run in English or Korean. Call (02) 9748 4822, mobile 0430 442 018, or send an enquiry.
The options described here depend on an individual clinical assessment. Outcomes vary between patients, and what suits one tooth may not suit another.