When the nerve inside a tooth is infected or a tooth is broken down close to the gum, the decision usually comes down to two paths: root canal treatment and a crown, or extraction followed by an implant or bridge.
Neither is automatically right. Here is how the choice is made.
The case for saving the tooth (root canal + crown)
- Nothing replaces a natural tooth as well as the natural tooth. It keeps your natural bite, the bone around it, and the gum contour.
- It is usually faster and less invasive than removing the tooth and later placing an implant.
- Success rates are high for a well-done root canal finished with a crown — commonly quoted in the region of 85–95% over many years.
Root canal treatment makes most sense when:
- Enough sound tooth structure remains to build a crown on
- The root and surrounding bone are healthy
- The tooth is not cracked down into the root
The case for extraction
Extraction becomes the better option when:
- The tooth is cracked vertically into the root — these do not have a good long-term outlook
- There is too little tooth left above the gum to hold a restoration
- There is severe bone loss from gum disease around that tooth
- A previous root canal has failed twice and re-treatment is unlikely to succeed
- The tooth is a wisdom tooth or a non-functional tooth that does not need replacing at all
After extraction, the gap is usually restored with an implant (the closest thing to a natural tooth) or a bridge. Leaving a gap long-term can let neighbouring teeth drift and the opposing tooth over-erupt.
What a good consultation should give you
- A clear diagnosis with an X-ray
- An honest assessment of the tooth's long-term prognosis, not just whether it can be patched up today
- The cost and timeline of both paths — root canal + crown versus extraction + implant
- A recommendation, with the reasoning explained
The bottom line
For most restorable teeth, saving the tooth is the better long-term decision. But a tooth with a poor prognosis is not worth heavy investment — sometimes a planned extraction and a good implant is the more sensible use of your money. Ask your dentist to walk you through both options before you decide.
This article is general information, not a diagnosis. Book a consultation to discuss your specific tooth.