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Decision Engine

Root Canal vs Extraction: What Is Right For You?

About 41,000 root canal procedures are performed each day in the US per AAE data, with 10-year success rates of 86 to 93% on well-restored teeth. Answer six questions about pain level, prior treatment, tooth position, remaining tooth structure, budget, and long-term goal to see whether the situation leans toward saving the tooth or extracting and replacing it. A dental exam confirms restorability.

Last updated: May 2026

A save-versus-extract lean weighs the trade-offs between root canal therapy on the natural tooth and extraction followed by replacement (implant, bridge, or partial denture). Lean = (Restorability) + (Tooth Position Value) + (Prior Treatment) + (Long-Term Goal). Root canal 10-year survival with crown typically target 86-93%.

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What is Save Versus Extract Lean?

A save-versus-extract lean weighs the trade-offs between root canal therapy on the natural tooth and extraction followed by replacement (implant, bridge, or partial denture). The lean is informed by pain pattern, prior treatment, tooth position, the structure remaining above the gum, budget, and long-term goal. Only an in-person exam with an x-ray can confirm whether the tooth is restorable.

The Formula

Lean = (Restorability) + (Tooth Position Value) + (Prior Treatment) + (Long-Term Goal)

Restorability is the heaviest single signal: a tooth broken at or below the gum line is usually not salvageable regardless of other factors.

Worked Example

A 45-year-old with a deeply broken upper first molar after a failed large filling, no prior root canal, plenty of pain on biting, budget around $2,000, wants the most durable solution.

Pain level: sharp on biting, common in pulpal involvement
Prior treatment: previous large filling
Tooth position: first molar, anchor of the bite
Restorability: most of the tooth is broken; uncertain whether crown lengthening can save it
Budget: $2,000 borderline between root canal plus crown and extraction plus implant
Long-term goal: most durable solution

📌 Lean is exam-needed rather than a clear save or extract. The restorability signal is the deciding factor and a clinical evaluation is required. If the tooth is restorable, root canal plus crown is the natural-tooth path; if not, extraction with planned implant is the durable replacement.

Why This Matters

Natural teeth are still the benchmark

A well-treated, well-restored natural tooth typically outperforms any replacement on chewing function, proprioception, and bone preservation. Saving when possible is usually the right long-term play.

A crown is not optional

Root canal success depends on a prompt, well-fitting crown. Teeth root-canaled but left without full coverage have noticeably lower long-term survival.

Common Mistakes

❌ Choosing extraction because it is cheaper today

A bridge or implant replacement, plus the long-term effects on adjacent teeth and bone, often costs more across a decade than the root canal plus crown would have. The full-life-cycle cost matters.

❌ Delaying the crown after a root canal

A root-canaled tooth left without the crown for months can crack or develop new decay through the temporary filling. The crown belongs in the same treatment phase, not as a maybe-later step.

Industry Benchmarks

Category	Good	Average	Poor
Root canal 10-year survival with crown	86-93%	80-86%	Under 80% without crown
Root canal plus crown cost (US)	$1,500-2,200	$2,000-2,800	$2,800+
Single implant plus crown cost (US)	$3,000-4,500	$4,000-5,500	$5,500+

Source: American Association of Endodontists Endodontic Survey 2024

Benchmark data sourced from American Association of Endodontists Endodontic Survey 2024.

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One of the most common mistakes we see when working with clients: choosing extraction because it is cheaper today. A bridge or implant replacement, plus the long-term effects on adjacent teeth and bone, often costs more across a decade than the root canal plus crown would have. The full-life-cycle cost matters.

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Frequently Asked Questions

Is it better to get a root canal or have the tooth pulled?

For a restorable tooth in a position that matters to the bite or appearance, saving the natural tooth with a root canal and crown is usually the better long-term outcome. For a tooth that is broken at or below the gum, has failed a previous root canal, or is in a less critical position (some second or third molars), extraction with a planned replacement may be the more durable path. Only an exam with an x-ray can confirm restorability for your specific tooth.

How much does a root canal cost compared to an implant?

A root canal with a crown typically lands between $1,500 and $2,500 in the US. A single implant with crown averages $3,000 to $5,000 once the implant body, abutment, and crown are included. Bridge replacement of an extracted tooth runs $2,500 to $5,000. The cost picture often favors the root canal when the tooth is restorable.

How long does a root-canaled tooth last?

Published studies report 10-year survival rates of 86 to 93% for well-restored root-canaled teeth (with a crown placed promptly). Teeth that receive a root canal but never get the full-coverage crown have noticeably lower long-term survival. The crown is not a cosmetic upgrade; it is part of the structural success of the treatment.

Can a tool tell me whether to save or pull my tooth?

No tool can replace the in-person exam plus x-ray that confirms whether a tooth is restorable. This tool surfaces the most common signals that influence the decision and helps you arrive at the consult with the right questions. The final lean depends on what the dentist can see clinically and radiographically.

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