Dental implants have proven over the past 20+ years to be a fantastic alternative to many traditional dental therapies. They have proven to be between 88% and 96% successful in replacing one or many teeth. However, they do tend to be more costly than traditional dentistry in many situations, require specially trained dentists and surgeons, and cannot be placed in some people for various reasons. Furthermore, most dental insurance companies do not provide coverage for dental implant therapy.
Root canal therapy has been a very effective traditional therapy for severely broken down or abscessed teeth for decades. However, success depends highly on the skill of the treating dentist, the circumstances surrounding the need for the root canal, the age of the patient, and the quality of the filling or crown placed on the tooth after the root canal is completed. By far, root canal therapy is one of the most difficult and unpredictable procedures in dentistry, but it is “the last resort” for saving a crippled natural tooth. Incidentally, most dental insurance companies do provide coverage for root canal therapy, or endodontia.
Saving a tooth that requires extensive repair may require root canal therapy, some type of post or filling to rebuild the center of the tooth where root canals of the tooth have been accessed, and then usually a crown (gold, porcelain/gold, resin, or porcelain). If there is not enough natural tooth below the filling for the dentist to place the crown margin, then gum surgery may also be needed to save the tooth. The cost, inconvenience to the patient, and discomfort associated with these procedures may outweigh the benefits of saving the tooth. After completion, the success of a tooth saved in this manner probably falls in the 80-85% range. Alternatively, the tooth could be extracted and replaced with a dental implant and implant-supported restoration and have a 95% success rate with a lot less discomfort and inconvenience to the patient.
Whether to save a crippled tooth or to replace it with a dental implant is not a straight-forward issue. Many factors come into play in the decision-making process. From a cost perspective, the fees involved may be very similar for both options, but insurance involvement may need to play a part for the patient. From a longevity perspective, implant therapy is probably best. However, there may be other factors to consider such as esthetics, training of the dentist, patient expectations, etc.