Although I am considered a dental implant specialist by a credentialing board and my peers let me first start by saying that saving your natural teeth is my FIRST priority.
Dental implants are fantastic, but they are a close “second” to your natural teeth. The question is more about “restorability” of your remaining tooth when deciding whether to have a root canal and keep your tooth, or to extract it have a dental implant replacement.
A root canal is a procedure to treat a dead or dying tooth. It is usually a result of a deep cavity touching the nerve or coming very close to the nerve. Some root canals are done to save a tooth that has suffered trauma like a hit to the mouth from a bike accident.
The inside of the tooth and roots are hallowed out and the nerves removed. This leaves the tooth weak, brittle and prone to fracture so a crown or onlay is made to “cap” over the tooth. A crown or onlay prevents your tooth with a root canal from breaking. So the crown is EQUALLY important as the root canal.
A crown or onlay’s longevity is mostly based on how much of your own tooth remains. So if your tooth had a huge cavity that went under the gumline and then a root canal, you have very little tooth structure left. A tooth post or build-up does NOT add strength to the tooth. It just gives the crown a bit more to grab onto.
Too often I see root canals done on near hopeless teeth. They have a crown made on a hopeless tooth, and it falls out or fails very prematurely.
That to me is just not right. You may have invested $2000 -$3000 for the root canal, crown, post and build up only to have it extracted in just a few years!
When your tooth is badly damaged, the cost of a dental implant makes a lot more sense than having a root canal and crown on your tooth that does not have a good long-term prognosis.
Can the really bad tooth in this picture be predictably saved?
It is better to extract it and place an implant which is far cheaper in the long-term than a root canal and crown. If the tooth is savable with a root canal for the long-term, that is what I would do in my own mouth or my family’s mouth.
A dental implant placed by me has a 99% success rate as opposed to a root canal on a very compromised tooth that may only have a 40-50% survival rate at 10 years!
If your tooth is restorable, by all means have the root canal. If not, the cost of a dental implant makes more sense in the long term. It does not cost that much more for something that will probably last your life.