If you have been told a tooth is infected, you may be offered a choice: save it with root canal treatment, or take it out. In the moment, with a painful tooth, extraction can sound simpler and cheaper. Sometimes it is the right choice. Often it is not. This guide explains how dentists weigh the two, so you can make the decision with your eyes open.
The two options
Root canal treatment
The infected pulp inside the tooth is removed, the inside is cleaned and shaped, and the tooth is filled and sealed (NHS). It is done under local anaesthetic. Afterwards the tooth usually needs a filling or a crown to protect it. You keep your own tooth, its root and its place in your bite.
Extraction
The tooth is removed under local anaesthetic. The infection goes with it. The socket heals over the following weeks. You are then left with a gap, which you can leave or fill with an implant, a bridge or a partial denture.
What the evidence says
Root canal treatment has a good long-term record. A systematic review of tooth survival found that about 86–93% of root canal treated teeth were still in place 2 to 10 years later (Ng et al., 2010). The factor most strongly linked to survival was having a crown placed after treatment.
A large review that compared the options found that long-term survival of root canal treated teeth and of single-tooth implants was similar, and better than for bridges. The limited data on taking a tooth out and not replacing it suggested people were less satisfied with that outcome (Torabinejad et al., 2007).
In plain terms: if a tooth can be restored well, saving it is usually a sound choice. Implants are an excellent replacement when a tooth cannot be saved, but they are not automatically “better” than your own tooth.
Side by side
| Root canal + crown | Extraction + implant | Extraction, gap left | |
|---|---|---|---|
| Keeps your own tooth | Yes | No | No |
| Visits | One or more for the root canal, then the crown | Extraction, then a few months to the final crown | One |
| Cost | Middle | Usually highest overall | Lowest on the day |
| Effect on other teeth | None; the bite stays as it is | None once the implant is in | Neighbours can tilt and the opposite tooth can drift |
| Long-term record | Good, especially with a crown | Good | Problems can build up over years |
When a tooth cannot be saved
Root canal treatment is not always possible or sensible. Your dentist may advise extraction when:
- There is a crack running down into the root, so the tooth cannot be sealed.
- Too little tooth is left above the gum to hold a filling or crown, even after treatment.
- Advanced gum disease has destroyed much of the bone around the tooth, so it is loose.
- The tooth is a wisdom tooth that has no useful role in your bite and is hard to reach and clean.
- A previous root canal has failed and a repeat is unlikely to succeed.
In these cases, removing the tooth and planning a replacement is the honest advice. Our guide Missing a tooth? Implant, bridge or partial denture explains the replacement options.
Thinking about cost honestly
Extraction usually costs the least on the day. But if the tooth is a back tooth you chew with, or a front tooth you see, most people want the gap filled. Once you add an implant and crown, or a bridge, the total is often higher than a root canal and crown would have been, and it takes longer. If the gap is left, the teeth around it can drift, which can cause problems later.
So compare full plans, not just first steps: “root canal plus crown” against “extraction plus whatever I would put in the gap.” At our clinic, the cost of each option is explained before treatment begins.
Questions to ask your dentist
- Can this tooth be restored well after a root canal? What are its chances?
- Will it need a crown afterwards, and what will that cost?
- If I have it taken out, what would you put in the gap, and when?
- What happens if I take it out and leave the gap?
- Is there anything about my gums, bite or health that changes the advice?
If you are not sure whether you even need treatment yet, start with Do I need a root canal? Signs, tests and next steps.
Frequently asked questions
Is it better to save a tooth or pull it out?
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If the tooth can be restored well, saving it with root canal treatment is usually the better long-term choice. Reviews show root canal treated teeth, especially those crowned afterwards, last well. If the tooth is cracked into the root or too badly broken, extraction is the right advice.
Is an implant better than a root canal?
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Not automatically. Long-term survival of root canal treated teeth and single implants was similar in a large review. An implant is an excellent option when a tooth cannot be saved, but keeping a restorable tooth avoids surgery and usually costs less overall.
Is extraction cheaper than a root canal?
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On the day, usually yes. But if you later fill the gap with an implant or bridge, the total cost is often higher than a root canal and crown. Compare the full plans.
Can I leave the gap after an extraction?
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Sometimes, especially at the very back of the mouth. Over time, neighbouring teeth can tilt and the opposite tooth can drift into the space, so discuss it with your dentist before deciding.
Does a tooth need a crown after a root canal?
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Back teeth usually do, because they take heavy chewing forces. Front teeth with little damage can sometimes be restored with a filling. Your dentist will advise for your tooth.
Sources
- NHS: Root canal treatment (accessed 15 October 2026)
- Ng, Mann & Gulabivala (2010), Tooth survival following non-surgical root canal treatment: a systematic review, Int Endod J 43(3):171–89 (accessed 15 October 2026)
- Torabinejad et al. (2007), Outcomes of root canal treatment and restoration, implant-supported single crowns, fixed partial dentures, and extraction without replacement: a systematic review, J Prosthet Dent 98(4):285–311 (accessed 15 October 2026)
- NHS: Dental treatments (bridges, dentures, implants) (accessed 13 October 2026)
This article is general information, not a diagnosis or treatment plan. What suits you depends on an examination at the clinic, and every treatment plan and cost is explained before treatment begins.
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