Root canal or implant?

Help patients choose between implants and root canals with this article. Read more here.
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One of the benefits of modern dentistry are dentist and patient options in choosing a treatment. If you work in the dental profession, you will eventually get asked by friends, family members, or patients questions such as:

  • Soft or hard bristle toothbrush?
  • Waxed or unwaxed floss?
  • Dental veneers or crowns?
  • Amalgam or composite filling?

Due to the success, marketing, and popularity of dental implants, someone will probably ask you whether they should save their tooth with a root canal treatment and crown or get an implant. This decision is a complex dilemma in dentistry that requires consideration of several factors.

The history of root canal treatments

Pierre Fauchard, a French physician, discovered the dental pulp inside of a tooth in 1728. Over a century later, Edwin Maynard constructed the first root canal instrument from a watch spring. Gutta-percha started filling root canals in 1848 and remains in use today. The next achievement that changed root canals occurred in 1900 with the invention of x-ray machines.

In recent years rotary nickel-titanium root canal instruments, electric handpieces, endodontic irrigation systems, and Cone-beam computed tomography systems have continued to improve endodontic treatment for patients and dental professionals. The global market for root canals is forecast to reach $21 billion by 2023. Many researchers have studied the success rate of root canal treatments, and one concluded that “nearly 95% of all endodontically treated teeth were successful.”

The dental implant era

It is doubtful that Dr. Per-Ingvar Brånemark was thinking about the future of root canals when he placed the first dental implant in 1965. This Swedish orthopedic surgeon placed the first titanium dental implant and learned that bone could attach to it through osteointegration. The early days of dental implants were fraught with dramatic failures and a high level of unpredictability. 

However, the dental implant pioneers persevered. Newer materials, better techniques, and improved patient case selection led to higher success rates. Dental implants lost their reputation as a frowned upon dental procedure with a high failure rate. Recent studies reveal that dentists now perceive that dental implants offer a superior outcome when compared with root canal treatment.

It is not uncommon to hear questions such as, “In the dental implant era, why do we still bother to save teeth.” Many patients look to their dental hygienist for help in making treatment decisions because of their high level of trust and respect for their dental knowledge. The root canal vs. implant question is complicated for even the most experienced dental professionals. The answer in many cases is, “It depends.”

Which one hurts the most?

Despite dentistry’s advances in pain control and efforts to educate patients on this, many people choose the most comfortable solution. Your answer might include the results of this study ,which found no significant difference between the discomfort of a root canal treatment and placement of an implant. 

There was a difference between the timing of the maximum discomfort. Patients receiving a root canal experienced the most pain the day after treatment. Patients who had an implant placed had their highest pain level at the end of a week after the surgery. It is worth noting that both groups of patients were highly satisfied with their treatment and the minimal amount of discomfort they experienced.

Which procedure takes the most time?

Whether you are a dentist or RDH, you know that most people want to know how long they will be in your chair. Keeping a tooth with a root canal and a permanent restoration such as a crown takes much less time than extracting a tooth, placing an implant, and restoring it with a crown. 

What about the cost?

The main reason people give for not going to the dentist is cost. The current COVID-19 has brought increases in overhead and the further challenge of keeping dentistry affordable. In most cases, a root canal treatment and permanent restoration cost significantly less than an implant and permanent restoration.

One of the challenges when discussing the cost is, “What if the root canal does not work?” Fortunately, this is not a common occurrence, but those who paid for a root canal and crown, only to have the tooth removed a few months later, are always willing to share their story with friends and family. The possibility of a failed root canal makes preoperative education and documentation critical. 

Aren’t dental implants more permanent?

Extracting a tooth essentially removes the problem. The patient no longer needs to worry about a compromised tooth causing any more pain. However, patients do need to understand that problems can and do occur with dental implants. Possible complications with implants include:

  • Infection around the implant.
  • Injury to surrounding teeth or blood vessels.
  • Damage to nerves during implant placement.
  • Sinus problems with upper jaw implants.
  • Gum recession around the implant.
  • Failure of bone to bond to the implant.

Root canal treatments have saved millions of teeth over the past several decades. Dental implants do not yet have the same long history, but the rate of success does look promising. Currently, the research shows similar success rates between root canal treatments and dental implants in the short term but a decreased long-term rate for root canals.

The importance of patient preference

Some patients want to avoid the removal of a natural tooth at all costs. Others prefer to avoid risking the future extraction of a failed root canal. This personal preference is of paramount importance and needs to be respected. 

The responsibility of dentists, dental hygienists, and other dental staff is to provide accurate information when educating patients. Modern dentistry can now offer viable alternatives with high success rates. However, it also presents “one of the most challenging aspects in dentistry” by forcing a choice between extraction of a natural tooth and implant placement and a root canal treatment.

The best decision is more likely to take place when:

  • The dental staff remains thoroughly educated on this topic and knows how to communicate it with the patient.
  • The patient takes part in the treatment planning process.

Dental hygienists will continue to expand their responsibilities in the delivery of quality dental care. This includes helping educate patients on complex procedures such as root canal treatments and placement of dental implants. 

If you are looking for more flexibility and control over your career as a dental hygienist, visit Cloud Dentistry to learn how you can have a more rewarding and fulfilling career as a dental professional.

Written By Dr. Steven Tuggle