This is an everyday question that can only be answered within certain guidelines as not all situations are the same. One of my mantras is to treat every mouth as if it was my own. So when faced with that question I typically put it on myself, as to what I would want.
In general I would try to save the tooth with a root canal if the Endodontist or general dentist performing the treatment anticipated a good chance of success with conventional root canal therapy and the tooth did not require additional periodontal treatment to complete the restoration, i.e. there is a substantial portion of the tooth still intact before and after the root canal procedure. An example of this might be tooth decay that has involved the nerve and blood supply to the tooth yet following the root canal therapy only a crown or other conservative restoration is needed to restore the tooth.
Here are some situations that I would opt to remove the tooth and do a dental implant:
- Periodontal crown lengthening is required in conjunction with the root canal or following the root canal to restore the tooth. This situation is typical following a fracture of the tooth that gets to or within a certain distance of the supporting bone of the tooth. In these situations bone and gum tissue is removed to provide adequate tooth length so that the dentist has enough tooth structure to make a crown that will be retentive and not encroach on the biologic attachment of the gum to the tooth. Some of the reasons to consider removing these teeth are as follows:
- The cost of the root canal therapy and periodontal crown lengthening can approach the cost of a dental implant and the implant is more predictable for the long term.
- The gingival architecture will change with the crown lengthening procedure. While there is also a risk of that during tooth removal or during healing, This risk can be minimized by using atraumatic tooth removal techniques.
- If the tooth already has a root canal but it is failing. If the original procedure was performed by a root canal specialist and there are still problems with the tooth. I would not try to save the tooth with additional endodontic surgery such as apical surgery. If the initial root canal was performed by a general dentist perhaps a root canal specialist can resolve the problem with re treatment. In general treatment at this juncture is not as predictable and spending additional money trying to salvage the tooth may not be as practical as just removing the tooth and replacing it with a dental implant.
In conclusion and as a general rule ideally you should try to save the tooth when:
- The tooth needs a root canal for the first time.
- The tooth will not require additional periodontal surgical procedures to facilitate the final restoration.
- The treating doctor feels the tooth is a good candidate for root canal therapy and will have a predictable outcome.
If the above criteria are not met, replacing the tooth with a dental implant should also be a consideration.