Root Canal vs. Extraction

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At Omega, Dr. Pedram Bohluli and Dr. Parastou Terrany, endodontists, handle endodontics.

Root Canal vs. Extraction: The Decision in One Table

A root canal keeps your tooth, extraction removes it, and what you do about the gap afterward decides most of the cost.

There are really three paths, not two. You can save the tooth with a root canal and a crown. You can have it taken out and replaced with an implant. Or you can have it taken out and leave the space empty.

A root canal removes the infected or inflamed pulp, the soft tissue inside the tooth that holds its nerve and blood supply. Then the canals are cleaned and sealed so bacteria can't get back in, and the tooth stays in place with its root in the bone. An implant replaces the root instead: a titanium post placed in the jawbone, topped with an abutment, a small connector, and a crown.

The table uses a molar as the example, because back teeth need a crown after a root canal. A front tooth costs less to save, and it usually needs only a filling afterward.

If you're wondering about options other than these, such as capping the pulp in a young tooth, our guide to other alternatives covers them.

Fees assume a simple extraction; a surgical extraction is quoted from your X-ray. The bone graft is added only when the socket is damaged. Your fee is itemized in writing before you commit.

Not sure which path fits your tooth? Our endodontists can examine it, go over the scan with you, and give you the fee for each option in writing. Book a consultation  ·  (713) 322-7474

Cost Over Time: Saving a Molar vs. Replacing It

On the day, pulling a tooth costs less; once you replace it, saving the tooth usually costs less.

Here's the arithmetic for a molar at our office. Saving it means the root canal at $1,600 plus a crown from $1,200, so from $2,800. If the tooth needs rebuilding before the crown goes on, a post and core adds $438.

Replacing it means a simple extraction at $290 plus a single implant at $3,500, which covers the post, the abutment and the crown. That's $3,790. We add a bone graft, at $650, only when the socket is damaged, either by infection or because too little bone was left after the extraction, which brings the total to $4,440. A tooth that has broken off at the gum line usually needs a surgical extraction instead of a simple one, and that fee is quoted from your X-ray.

For a front tooth the gap is wider. The root canal is $1,200 and usually needs only a filling afterward, against the same $3,790 to take the tooth out and replace it. The American Association of Endodontists makes the same point in general terms: saving the natural tooth is generally less expensive than extracting and replacing it.

Extraction alone, at $290, is the least expensive option on the day. It's also the only one that leaves a gap, and the section on doing nothing explains what that tends to cost later. Our root canal cost guide breaks the fees down tooth by tooth, and single implant cost explains what goes into an implant fee.

If you have dental insurance, we check what your plan covers for each path before you decide. Monthly payments are available through Cherry, Affirm and Sunbit for qualifying applicants, subject to the lender's approval. Our membership plan, $199 a year, takes 15% off our published fees for crowns, implants and oral surgery. It doesn't cover root canals, so on the saving path it lowers the crown, not the root canal.

Every fee is itemized in writing before you commit: (713) 322-7474.

When Extraction Is the Right Call

We recommend taking the tooth out when there isn't enough of it left to restore, when the root has a vertical fracture, or when gum disease has left it loose.

• Not enough tooth left. A crown needs solid tooth to hold on to. When decay or a break reaches so far below the gum that there's nothing sound to build on, a root canal would clean out a tooth that can't be restored.

• A vertical root fracture. This is a crack running lengthwise down the root, often in a tooth that already had a root canal. No root canal can seal it.

• Severe bone loss. When gum disease has destroyed so much of the bone around the root that the tooth is loose, treating the inside of the tooth doesn't fix what's holding it in.

Outside those three, a tooth that can be restored is usually worth saving, and our endodontists will tell you plainly which side of the line yours is on. A root canal that starts to fail years later can often be retreated rather than pulled, so one failure isn't automatically the end of the tooth.

When a tooth does need to come out, our oral surgeons, Dr. Jonathan Rosenstein and Dr. Edmund Watkins, take care of it. If it's hurting now, we keep same-day slots on weekdays for a same-day extraction.

Root Canal vs. Implant

Both can last for many years; the real differences are surgery, time, upkeep, and the fact that a root canal keeps your own tooth.

Over the long term, both hold up well. A systematic review of the research found that bridges survived less well over the long term than either root-canal-treated teeth or single implants. Implants hold up well over time: a review of long-term studies found 96.4 percent still in place at 10 years. Results vary from person to person: smoking and gum health affect implants, and getting the crown on in time affects treated teeth.

Where they differ is in what you go through.

• Surgery. An implant is placed in the jawbone, in the same visit as the extraction when the bone allows. A root canal is done inside the tooth under local anesthetic, with no surgery on the bone.

• Time. A root canal is nearly always one visit, and the crown can go on right after. With an implant, the crown goes on about 3 to 4 months after the implant is placed, once it has bonded to the bone. If the socket needs a graft first, the implant waits until the graft has healed.

• Upkeep. A crowned tooth needs what your other teeth need: brushing, flossing and checkups. An implant can't get a cavity, but the gum and bone around it can still get infected, a problem called peri-implantitis, so cleanings matter just as much. Our guide to implant success rates covers what raises that risk.

At Omega, both happen in the same building. Our endodontists do the root canal, our surgeons place the implant, and our restorative dentists make the implant crown.

What Happens If You Do Nothing

An infected tooth doesn't heal by itself, and an empty gap doesn't stay the same, so waiting usually narrows your choices.

Once the pulp is infected, it can't heal on its own. The infection works down the canals toward the tip of the root and into the bone around it. The longer that goes on, the more likely it is that a tooth that could have been saved breaks down or loses the bone it needs, and extraction becomes the only option left.

If the tooth comes out and the space is left empty, three things tend to happen over the following years. The teeth on either side tilt into the gap. The tooth that used to bite against it, with nothing to meet, drifts up or down out of its socket. And the bone where the root was shrinks, most of it in the first months, which is why an implant placed years later can need a graft first. You can read more about how teeth drift into a gap.

The same review of the research found that pulling a tooth and not replacing it led to worse psychosocial outcomes, which is researchers' shorthand for how people feel about their teeth and themselves. A gap in the back isn't dangerous, but it does have consequences.

None of this is usually an emergency. Swelling is different, and the box below says when to call and when to go to the ER.

Why We Can Advise Either Way

Both treatments happen here, so our recommendation can follow your X-rays and scan instead of the one procedure an office happens to offer.

Our endodontists, Dr. Pedram Bohluli and Dr. Parastou Terrany, save teeth. Our oral surgeons take teeth out and place implants. When we look at your tooth, we're checking three things: whether there's enough of it left to restore, whether the root is cracked, and how much bone is holding it. Those answers decide it, and on most root canal cases a CBCT scan, a 3D X-ray, shows the root and the bone around it from every side.

If the tooth can be saved, we'll say so. If it can't, we'll say that too, and the extraction can often happen the same day. Either way, you get the fee for your path in writing before anything starts.

If another office told you a tooth has to come out, or that it needs a root canal, and you'd like another look first, you can book a second-opinion consultation.