If an infected or damaged tooth can be saved, a root canal followed by a crown or filling keeps your natural tooth. It is often completed in one or two visits and generally costs less up front. A dental implant replaces a tooth that is too damaged to save or already lost. It typically takes several months and involves surgery. Both have high survival rates in research.
What is the difference between a root canal and an implant?
A root canal saves the tooth. An implant replaces it.
- Root canal treatment removes the inflamed or infected pulp from inside the tooth. The inside is cleaned and sealed, and the tooth is then restored with a crown or filling for protection. Your own tooth and root stay in place.
- A dental implant is a post placed in the jawbone to act as a new root after the tooth has been removed. Once the bone has bonded to it, it holds a crown.
Choosing an implant means the tooth must come out first. So the real choice is "root canal and crown" vs "extraction, then an implant and crown." See our pages on root canal therapy, tooth extractions and dental implants.
When is a root canal the better choice?
A root canal makes sense when the tooth can be saved and restored. The American Association of Endodontists says saving the tooth is typically less invasive, less expensive and needs fewer appointments than removing and replacing it.
A large review of root canal treated teeth found four things linked with the tooth lasting longer:
- A crown placed after the root canal.
- Teeth on both sides of the treated tooth.
- The tooth not being used to anchor a bridge or partial denture.
- The tooth not being a molar (molars, the large back teeth, had lower survival).
That is why your dentist looks at how much healthy tooth is left, the gums and bone around it, and how the tooth fits your bite before suggesting a root canal.
When is an implant the better choice?
An implant may be recommended when a tooth is too damaged to be saved or has already been lost. Examples include a tooth with a deep crack into the root, or one with too little sound structure left to hold a crown.
You may be a good candidate for an implant if you are in good general and oral health, have enough jawbone to hold the implant and have healthy gums free of gum disease. Smoking and diabetes raise the risk of implant failure, so your dentist asks about both.
Root canal vs implant: how do they compare?
| Option | Root canal and crown | Extraction and implant |
|---|---|---|
| What it does | Keeps your natural tooth and root | Replaces the tooth with a post in the bone and a crown |
| Typical visits | One to two visits, then the crown or filling | Several stages over several months, including healing time |
| Recovery | Mild soreness for a few days | Longer healing while the implant bonds to the bone |
| Surgery | No | Yes, to place the implant (the tooth is removed first) |
| Upfront cost | Generally lower | Generally higher, because of surgery and more parts |
| Survival in research | 86 to 93 percent of teeth still in place 2 to 10 years after treatment | 96.4 percent of implants in place after 10 years (93.2 percent in a stricter analysis) |
| Best suited to | A tooth that can be saved and restored | A tooth that cannot be saved, or one already lost |
Swipe the table sideways to see every column.
A note on the survival numbers: they come from different reviews with different patients and methods, so they cannot be compared head to head. No dentist can promise how long either one will last.
Does a root canal or an implant hurt?
Both are done with local anesthetic, so the area is numb during treatment. You may feel pressure. Tell your dentist if anything feels sharp, and more anesthetic can be given. Ask about comfort options if you feel nervous.
The American Association of Endodontists describes mild soreness for a few days after a root canal. After an implant is placed, healing takes longer while the implant bonds to the bone. Your dentist will tell you what to expect.
How much does each option cost?
A root canal with a crown generally costs less up front than an extraction and implant, because an implant involves surgery and more parts. The American Association of Endodontists notes that replacing an extracted tooth with an implant or bridge tends to cost more than a root canal and restoration.
Your own cost depends on the tooth, whether a crown is needed, whether bone grafting is needed and your insurance plan. Call us for insurance details, and ask about payment options on our insurance and payment page.
When should you see a dentist about a painful tooth?
See a dentist soon if you have any of these signs of a possible tooth infection:
- A throbbing toothache that does not go away
- Pain when chewing
- Sensitivity to hot or cold
- Swelling of the gum over a tooth, or a pimple on the gum
- Swelling in the jaw, a fever or swollen glands in the neck
A root canal may be recommended to try to save an infected tooth. With a severe infection, the tooth may need to be removed. The sooner the tooth is checked, the more options you may have. If you have swelling or severe pain, call the office and say so; see our emergency dentistry page.
An exam and X-rays show whether the tooth can be saved. Your dentist explains what each option involves and what drives the cost, so you can decide.
