When a tooth is badly damaged or infected, the decision between root canal treatment and dental implant placement is among the most consequential a patient faces. Both are well-established treatments with strong track records, but they serve different clinical situations and carry different implications for your remaining teeth, your jawbone, and your long-term costs. At Fitzroy Dental Practice in Fitzrovia, London, we help patients work through this decision with full information rather than a default recommendation in either direction.
What is the fundamental difference between root canal treatment and a dental implant?
Root canal treatment saves the natural tooth. The infected or damaged pulp is removed, the root canals are cleaned and sealed, and the tooth remains in the mouth, typically with a crown placed over it to protect the root and restored tooth structure. The original root stays in the jawbone, continuing to stimulate the surrounding bone as it always has.
A dental implant replaces a tooth that has already been removed or that your dentist advises extracting. A titanium post is placed surgically into the jawbone and, after a healing period of three to six months, a porcelain crown is attached. The result is a standalone, fixed replacement that functions independently of neighbouring teeth.]
Is root canal treatment always the first option before considering an implant?
In most cases, yes. Saving a natural tooth is generally preferable to replacing it when the root structure is sound, the surrounding bone is adequate, and the tooth is restorable. The natural root preserves bone in a way no implant fully replicates, and a well-treated, well-restored tooth avoids the surgical component of implant placement entirely. However, not every tooth is worth saving, and an honest clinical assessment sometimes concludes that extraction and implant placement offer a better long-term outcome.
What makes a tooth not worth saving with root canal treatment?
Several factors tip the balance toward extraction and implant rather than root canal treatment:
- Extensive bone loss around the root due to longstanding infection or advanced gum disease, leaving insufficient support for the tooth
- A vertical root fracture, which cannot be successfully treated and typically means the tooth cannot be saved
- Significant resorption of the root itself, reducing the remaining root length below what is needed to support a crown
- A tooth that is so structurally broken down that restoring it would be clinically unpredictable or require a disproportionate investment for a likely poor outcome
- Previous root canal treatment that has failed and cannot be retreated due to canal anatomy or existing posts
How do the long-term outcomes of root canal treatment compare with dental implants?
Both treatments perform well when carried out by experienced clinicians on appropriate cases. Studies suggest that dental implants achieve long-term survival rates consistently above 95% over fifteen years in suitable patients. Endodontically treated teeth with good restorations and adequate bone support also show strong long-term survival, though success rates vary more depending on the tooth type, the complexity of the original infection, and the quality of the coronal restoration placed after treatment.
The comparison is not straightforward because the starting conditions differ. An implant placed into healthy bone typically has favourable conditions from the outset. A tooth requiring root canal treatment may already have significant structural compromise, which affects long-term prognosis regardless of how well the root canal itself is performed.
How long does root canal treatment last before a tooth might need replacing?
A successfully treated and well-restored tooth can remain functional for many years, and studies suggest that a large proportion of root-treated teeth remain in place for fifteen years or more. The longevity depends heavily on three factors: the adequacy of the root canal treatment, the quality of the crown or restoration placed afterwards, and the patient’s ongoing oral hygiene and attendance at routine dental check-ups. A tooth with a perfect root canal but a poorly sealed restoration above it is significantly more likely to fail than one where both components were done well.
Do root canals fail, and what happens if they do?
Root canal treatment can fail, typically because bacteria re-enter the treated tooth through a leaking restoration, a missed canal, or a crack. Signs of failure include the return of pain, swelling, or a shadow reappearing at the root tip on an X-ray. In many cases, root canal retreatment can resolve the problem. Where retreatment is not possible, root canal surgery (an apicoectomy) may be an option. If neither is achievable, extraction followed by implant placement becomes the pathway. Knowing this in advance does not mean root canal treatment is not worth attempting; it means understanding the full picture if things do not go as planned.
How do the costs compare between root canal treatment and a dental implant?
This comparison requires looking at the complete treatment cost for each pathway rather than the headline procedure fee alone.
For root canal treatment and crown on a molar at a private London practice, the combined cost typically runs between £1,600 and £2,700. For a single dental implant including the post, abutment, and crown, the typical range at a quality London practice is £1,800 to £2,800. On this basis, the upfront costs are broadly comparable for a back tooth.
Where the comparison shifts is over the long term. A natural tooth that remains healthy and functional for twenty or more years after root canal treatment represents excellent value. An implant, similarly maintained, also offers long-term value. The significant cost difference arises if the root-treated tooth eventually fails and requires extraction, leaving the patient facing an implant cost on top of the original root canal and crown investment.
Is root canal treatment cheaper than an implant when you factor in everything?
It depends on the outcome. If the root canal treatment succeeds and the tooth remains functional for fifteen to twenty years, the total cost is typically lower than an implant. If the tooth eventually fails and requires extraction and implant placement, the combined lifetime cost exceeds what an implant alone would have cost at the outset. This is not an argument against attempting root canal treatment on a tooth with reasonable prognosis; it is an argument for honest clinical assessment of that prognosis before committing.
Does the NHS cover root canal treatment and dental implants?
Root canal treatment is available on the NHS under Band 2, which carries a fixed patient charge of £76.60. Dental implants are not routinely available on the NHS and require private funding in the vast majority of cases. For patients weighing up treatment options, this means root canal treatment carries a significantly lower immediate cost under NHS provision, though NHS dental access in central London is limited and waiting times can be considerable.
How do I decide between root canal treatment and extraction with an implant?
The decision rests on three things: whether the tooth is clinically saveable, what the realistic prognosis is if it is saved, and what the patient’s priorities are in terms of timeline, cost, and risk tolerance. A thorough assessment including clinical examination, X-rays, and where appropriate a CBCT scan gives the clearest picture of root structure, bone levels, and restorability.
A straightforward framework for thinking through the decision:
- If the tooth has a sound root, adequate bone support, and is restorable: root canal treatment is typically the recommended first step
- If the tooth has a vertical root fracture, extensive bone loss, or has already failed root canal treatment: extraction and implant planning is usually the more predictable path
- If the prognosis for root canal treatment is uncertain: an honest conversation with your dentist about the likelihood of long-term success versus the known reliability of implant treatment in that position is the right next step
Should I get a second opinion before choosing between root canal and implant?
For any treatment decision of this significance, a second opinion is entirely reasonable and a confident, experienced dentist will welcome it. The recommendation should be the same regardless of which qualified clinician you consult if the clinical findings are clear. Where two dentists give conflicting advice, understanding their reasoning helps you make a more informed choice. Avoid practices that default to extraction and implant for every tooth regardless of restorability, or conversely, that attempt to save every tooth regardless of the clinical reality.
What is the treatment timeline for each option?
Root canal treatment for a straightforward case typically completes in one to two appointments over two to four weeks, with a crown placed shortly afterwards. The total timeline from starting treatment to a fully restored tooth is most commonly four to eight weeks.
A dental implant takes considerably longer. After extraction, most patients wait three to four months for bone healing before implant placement, followed by a further three to six months for osseointegration before the final crown is fitted. Where bone grafting is needed, the timeline extends further. Patients who need a tooth replaced without a gap period may be candidates for immediate loading, where a provisional crown is placed on the implant on the day of surgery, though this is not suitable for every case.
Is there a temporary option whilst I decide between root canal and implant?
Yes. Where a tooth requires extraction but you are not yet ready to commit to a definitive replacement, options including a removable partial denture or a temporary adhesive bridge can fill the gap whilst you plan. Your dentist will advise on the most appropriate temporary solution based on the position of the tooth and the expected timeline for your definitive treatment.
If you have a tooth that may need root canal treatment or extraction, and you would like an honest clinical assessment of your options, the team at Fitzroy Dental Practice would be glad to help. Visit our dental implants page or find us at 14 Fitzroy Square, Fitzrovia, London W1T 6AH. Call us on 020 7387 3317 or book online.
Common Questions Asked About Dental Implant vs Root Canal
Is it better to get a root canal or get an implant?
A root canal preserves your natural tooth, while a dental implant replaces a tooth after extraction. Dentists generally consider root canal treatment when the tooth remains restorable, while an implant provides an option when the natural tooth cannot be saved.
Which is more painful, a root canal or a dental implant?
Both root canal treatment and dental implant surgery use local anaesthetic to control discomfort during treatment. Root canal treatment typically causes mild tenderness afterwards, while implant surgery can cause temporary soreness and swelling as the surgical site heals.
Why would a dentist not recommend an implant?
A dentist might not recommend a dental implant when you have insufficient bone, active gum disease, poor oral hygiene or other factors that reduce implant success. Your dentist also considers whether preserving your natural tooth through root canal treatment provides a suitable alternative.
What I wish I knew before dental implants?
Before dental implants, understand that treatment involves surgical placement, healing time and ongoing maintenance. Your dentist also needs to assess your gums, bone levels and overall oral health, while some cases require bone grafting or several months of treatment.
What's a healthier alternative to a root canal?
Preserving the natural tooth through appropriate root canal treatment is often preferable to extraction when the tooth remains restorable. If the pulp is irreversibly damaged, current NHS guidance recommends root canal treatment when vital pulp therapy is not suitable, while extraction is considered when the tooth cannot be restored.
