Root canal therapy versus dental implant

Damage to the tissue of the tooth
Four major types of tissue make up the human tooth. Enamel is the hardest; in fact, enamel is the hardest tissue in the human body. The softest tissue is in the centre of the tooth and contains blood vessels, nerves and other types of tissue. The soft tissue extends to the root inside a chamber known as the root canal.

The hard tissue protects the tooth very well, but a crack or a deep area of decay can cause pain and infection in the soft tissue of the tooth. An infected root canal can cause swelling. The infection can spread to the face and neck. At this stage, the tooth is badly damaged. An infected tooth should be treated by a dentist as soon as possible.

With a severe infection, RCT is sometimes performed to eliminate bacteria from the infected root canal. The aim of this procedure is to prevent reinfection and save the natural tooth.

RCT procedure
The dentist will consider the history of the tooth when examining it and will check the radiographic images to assess whether the tooth is restorable. If the tooth requires RCT, then this procedure can eliminate bacteria from the infected root canal. This may prevent reinfection and save the tooth. With RCT, the dentist drills the tooth to access the pulp, then removes the dead or infected tissue from the canal, and cleans the inside of the canal and finally seals it. This process can cause the structure of the tooth to become brittle, and further treatment, such as a dental crown, may be required.

RCT is a repair to the tooth. Dentists use this repair technique to restore a badly decayed or infected tooth. However, when the tooth is damaged in such a way that it cannot be saved, then extraction and replacement with an artificial tooth may be the only option.

The dilemma: repair or replace?
For some patients, the decision between RCT or extraction becomes difficult when there is no certainty of the success of RCT. There is a spectrum of tooth damage, from slightly damaged pulp to badly damaged pulp. With slightly damaged pulp, RCT generally has a high level of success. However, on moving towards the other end of the damage spectrum, the success rate of RCT drops. Extensive damage may cause the tooth to fail at a later stage. It may be necessary to repeat the RCT or remove the tooth.

RCT may be the first treatment to attempt to save the natural tooth to avoid tooth loss. Many dentists agree with this approach. The reason is that, even with the best current technology, there is still no perfect replacement for a natural tooth. No artificial tooth feels or functions like a natural tooth. Therefore, many believe that it should be retained for as long as possible.

RCT and crown, or implant?
When RCT is combined with a proper restoration method, such as a crown, the tooth structure can be relatively strong again. However, replacement with a dental implant requires a considerable amount of maintenance; for example, there are certain foods that should be avoided.

Pain of RCT
Some patients are afraid of RCT because they think that it is painful. RCT itself is a painless dental procedure that is generally done under local anaesthesia. The procedure feels similar to the replacement of an old filling.

Pain of extraction
Extraction is an alternative treatment to RCT. Extraction can be done under local anaesthesia and as such is deemed to be a painless procedure; however, tooth extraction is regarded as the most traumatic dental procedure. Most extractions are done without any complications. After a tooth is removed, there will be some level of pain. Extraction may also sometimes lead to dry socket. Dry socket requires treatment by the dentist.

Treatment cost
Extraction and implant placement tends to be more expensive than RCT and crown placement. The second option also tends to be quicker.