Systematic review (2007)
Systematic review143 studies. Long-term survival of restored root-canal-treated teeth and implant single crowns was similar, and both exceeded fixed partial dentures.
Clinical Pathway
Root Canal (Save the Tooth) vs Extraction + Implant
When a tooth is damaged or infected, two common options are a root canal to keep the natural tooth or removing it and placing a single-tooth implant. For a restorable tooth, their long-term survival is broadly comparable, and the choice is individualized for the specific tooth and person.
Comparable long-term survivalSuccess differs from survivalIndividualized decision
Last updated: June 4, 2026
Save the tooth or replace it: what the choice means
A root canal treats the inside of a damaged or infected tooth and, once the tooth is properly rebuilt (for example with a crown), keeps the natural tooth in place. Extraction with a single-tooth implant removes the tooth and replaces it with an artificial root and crown. Both are established, widely used options, and each can be the reasonable choice depending on the tooth.
For a restorable tooth, the long-term survival of a root-canal-treated and properly restored tooth is broadly comparable to that of a single-tooth implant. Neither option is universally superior, and the two are judged by different criteria, so raw success-rate comparisons are not directly meaningful. The choice is individualized, guided by how restorable the tooth is, bone quality, esthetics, cost, systemic and personal factors, and patient preference. Saving a restorable natural tooth is a feasible option, while an implant is a reasonable alternative when the tooth's prognosis is poor or it cannot be predictably restored.
What the evidence shows
The evidence below comes from a large systematic review and two influential reviews. Taken together, they indicate that a restored root-canal-treated tooth and a single-tooth implant tend to survive over the long term at broadly comparable rates, and they caution against comparing the two on raw success figures.
Comparable long-term survival
- A systematic review of 143 studies reported that the long-term survival of implant-supported single crowns and of restored root-canal-treated teeth was similar, and that both were higher than for fixed partial dentures (conventional bridges) — Torabinejad et al. 2007.
- A review of treatment-planning factors concluded that the major studies show no difference in long-term prognosis between single-tooth implants and restored root-canal-treated teeth — Iqbal & Kim 2008.
- Because survival is broadly comparable, neither option is presented as universally preferable; the right choice depends on the individual tooth and patient.
Why 'success rate' and 'survival' are not the same
- Survival means the tooth or implant is still present and functioning. Success is a stricter measure judged against specific clinical and radiographic criteria — and those criteria are defined differently for teeth and for implants.
- Because success is defined so differently across treatments, directly comparing one option's success rate against the other's is not meaningful, and raw success numbers can be misleading if read side by side — Torabinejad et al. 2007; Setzer & Kim 2014.
- Advances in modern endodontics and endodontic microsurgery have improved the long-term prognosis of keeping the natural tooth — Setzer & Kim 2014.
Other options and important context
- Both a restored root-canal-treated tooth and a single-tooth implant showed higher long-term survival than fixed partial dentures (bridges) in the systematic-review data — Torabinejad et al. 2007.
- Limited data suggested that extraction without replacing the tooth was associated with poorer function and psychosocial outcomes, so simply removing a tooth and leaving the space is generally not treated as an equivalent option — Torabinejad et al. 2007.
- A root canal aims to retain the patient's own tooth, while an implant is a separate procedure with its own prerequisites such as adequate bone, healing time, and suitable systemic conditions.
Treatment-planning review (2008)
ReviewNo difference in long-term prognosis between single-tooth implants and restored root-canal-treated teeth; the decision rests on individualized factors.
Survival comparison (2014)
ReviewDistinguishes success from survival and notes that modern endodontics and microsurgery have improved the prognosis of keeping the natural tooth.
Where each option may fit
The points below describe situations where each option is typically considered and the considerations a clinician weighs with the patient. They are not a self-selection tool and do not imply that one option is preferable in general.
01Save the tooth (root canal)The tooth is restorable with enough sound structure and an adequate ferrule, and periodontal and bone support are reasonable; often when keeping the natural tooth is preferred.
01Save the tooth (root canal)The tooth is restorable with enough sound structure and an adequate ferrule, and periodontal and bone support are reasonable; often when keeping the natural tooth is preferred.
Typically considered when
The tooth is restorable with enough sound structure and an adequate ferrule, and periodontal and bone support are reasonable; often when keeping the natural tooth is preferred.
Key considerations
Long-term survival of a properly restored root-canal-treated tooth is broadly comparable to an implant. Usually needs a definitive restoration (often a crown) to protect the tooth. Retains the natural tooth and its attachment.
02Extraction + implantThe tooth is not predictably restorable (for example severe structural loss or an unfavorable fracture), the endodontic or periodontal prognosis is poor, or there are strategic reasons, with adequate bone for an implant.
02Extraction + implantThe tooth is not predictably restorable (for example severe structural loss or an unfavorable fracture), the endodontic or periodontal prognosis is poor, or there are strategic reasons, with adequate bone for an implant.
Typically considered when
The tooth is not predictably restorable (for example severe structural loss or an unfavorable fracture), the endodontic or periodontal prognosis is poor, or there are strategic reasons, with adequate bone for an implant.
Key considerations
A reasonable alternative when the tooth cannot be predictably saved, with long-term survival broadly comparable to a restored tooth. It is a separate surgical procedure with prerequisites such as adequate bone, healing time, and suitable systemic conditions.
03Extraction alone (no replacement)Sometimes chosen for specific reasons, but limited data link leaving the space unreplaced with poorer function and esthetics.
03Extraction alone (no replacement)Sometimes chosen for specific reasons, but limited data link leaving the space unreplaced with poorer function and esthetics.
Typically considered when
Sometimes chosen for specific reasons, but limited data link leaving the space unreplaced with poorer function and esthetics.
Key considerations
Generally not treated as equivalent to the options that retain or replace the tooth; any decision to leave a gap is discussed individually with the clinician.
| Option | Typically considered when | Key considerations |
|---|---|---|
| Save the tooth (root canal) | The tooth is restorable with enough sound structure and an adequate ferrule, and periodontal and bone support are reasonable; often when keeping the natural tooth is preferred. | Long-term survival of a properly restored root-canal-treated tooth is broadly comparable to an implant. Usually needs a definitive restoration (often a crown) to protect the tooth. Retains the natural tooth and its attachment. |
| Extraction + implant | The tooth is not predictably restorable (for example severe structural loss or an unfavorable fracture), the endodontic or periodontal prognosis is poor, or there are strategic reasons, with adequate bone for an implant. | A reasonable alternative when the tooth cannot be predictably saved, with long-term survival broadly comparable to a restored tooth. It is a separate surgical procedure with prerequisites such as adequate bone, healing time, and suitable systemic conditions. |
| Extraction alone (no replacement) | Sometimes chosen for specific reasons, but limited data link leaving the space unreplaced with poorer function and esthetics. | Generally not treated as equivalent to the options that retain or replace the tooth; any decision to leave a gap is discussed individually with the clinician. |
How the decision is generally made
Because long-term survival is broadly comparable, the choice between saving the tooth and replacing it is an individualized clinical decision for the specific tooth rather than a fixed rule or a patient self-diagnosis. A clinician and patient typically weigh several factors together.
Factors weighed together
- Restorability: how much sound tooth structure remains and whether an adequate ferrule for a crown is achievable.
- Periodontal and bone support, including whether there is adequate bone for an implant if extraction is considered.
- Esthetic demands, especially for front teeth and the surrounding gum and bone.
- Cost and the cost-benefit balance over time for each option.
- Systemic and personal factors, including general health, healing capacity, and habits.
- Patient preference, including the wish to keep the natural tooth and tolerance for surgery.
There is no single answer that fits every tooth. The plan is made by the treating clinician with the patient for the specific tooth, weighing these factors rather than relying on a general claim that one option is preferable.
Frequently asked questions
01Is it better to get a root canal or an implant?
01
Is it better to get a root canal or an implant?
Short answer
Neither option is universally preferable.
- 01For a restorable tooth, the long-term survival of a properly restored root-canal-treated tooth is broadly comparable to a single-tooth implant.
- 02The right choice is individualized and depends on how restorable the tooth is, bone and gum support, esthetics, cost, your general health, and your preference.
02Do implants last longer than root canals?
02
Do implants last longer than root canals?
Short answer
The available evidence does not show that one outlasts the other.
- 01Studies report broadly comparable long-term survival for a restored root-canal-treated tooth and a single-tooth implant.
- 02How long either lasts in a particular case depends on the specific tooth, the restoration, and ongoing care.
03Is a root canal or an implant cheaper?
03
Is a root canal or an implant cheaper?
Short answer
Cost varies widely by case, region, and what each plan involves (for example a crown for a root-canal-treated tooth, or surgery plus a crown for an implant), so a general price comparison is not reliable.
- 01Cost and its balance against the expected benefit are part of the discussion, and a clinician can give an estimate for your situation.
04When is extraction and an implant chosen over saving the tooth?
04
When is extraction and an implant chosen over saving the tooth?
Short answer
An implant is generally considered when the tooth cannot be predictably restored or saved, for example with severe structural loss, an unfavorable fracture, or a poor endodontic or periodontal prognosis, and when there is adequate bone for an implant.
- 01In those situations replacing the tooth can be a reasonable alternative to keeping it.
05What does 'success rate' mean for each option?
05
What does 'success rate' mean for each option?
Short answer
Success is a strict measure judged against specific clinical and radiographic criteria, and those criteria are defined differently for teeth and for implants.
- 01Survival simply means the tooth or implant is still present and functioning.
- 02Because success is defined so differently, comparing raw success rates side by side can be misleading; survival is the more directly comparable measure, and it is broadly similar.
06Can any tooth be saved with a root canal?
06
Can any tooth be saved with a root canal?
Short answer
Not every tooth can be predictably saved.
- 01A root canal generally requires enough sound tooth structure to rebuild and support a restoration, along with reasonable bone and gum support.
- 02When a tooth is not predictably restorable, extraction with replacement such as an implant may be considered instead.
- 03A clinician assesses this for the specific tooth.
Continue reading
Related EndoGuide pages
References
- Torabinejad M, Anderson P, Bader J, et al. Outcomes of root canal treatment and restoration, implant-supported single crowns, fixed partial dentures, and extraction without replacement: a systematic review. J Prosthet Dent. 2007;98(4):285-311.
- Iqbal MK, Kim S. A review of factors influencing treatment planning decisions of single-tooth implants versus preserving natural teeth with nonsurgical endodontic therapy. J Endod. 2008;34(5):519-29.
- Setzer FC, Kim S. Comparison of long-term survival of implants and endodontically treated teeth. J Dent Res. 2014;93(1):19-26.
Disclaimer
This information is for educational purposes only and is not a diagnosis or a treatment plan. Whether a tooth can be saved or is more suitably replaced is a clinical decision made by the treating dentist or endodontist together with the patient, based on the specific tooth. Seek prompt dental evaluation for worsening pain, swelling, fever, or difficulty swallowing or breathing.
LY
Reviewed by
Dr. Levent Yuksel
DDS · Endodontist
Independently authored and clinically reviewed.