Should I get a root canal or pull the tooth?

The decision usually isn't "tooth vs implant" — it's "is this tooth restorable?"

Patients (and even some general dentists) often frame this as a comparison between two treatments. The real first question is structural: how much sound tooth is left above the gumline? Endodontic literature uses a "ferrule" rule — roughly 1.5–2 mm of sound tooth circumferentially above the bone is needed for a crown to hold long-term. If that's there, the tooth is restorable and a root canal usually wins on cost, longevity, and biology. If it's not, even a perfectly performed root canal will fail at the restoration in 2–5 years, and extraction was the right call from the start.

Side-by-side: root canal vs extraction-and-implant

Extraction alone is cheaper up front (≈ $200–$400), but a missing tooth lets the neighboring teeth drift and the supporting bone resorb, so the cost of replacing it usually arrives later. Both options are excellent and neither is permanent — the deciding question is whether the tooth is restorable, not which treatment is inherently "better." The natural tooth keeps its periodontal ligament, which gives proprioception (you can feel a single hair between your teeth), shock absorption, and precise pressure sensitivity that an implant cannot replicate.

When extraction is honestly the better choice

Here are the situations where a specialist endodontist will tell you the tooth shouldn't be saved:

• Vertical root fracture. The crack runs lengthwise through the root. No amount of cleaning the canal will repair it.
• Insufficient sound tooth structure for a crown to seal long-term (the ferrule problem above).
• Severe periodontal bone loss — if the bone supporting the tooth is already gone, the tooth won't have a stable foundation even after the root canal succeeds.
• Unfavorable crown-to-root ratio — the tooth above the bone is much longer than the root below it.
• Strategic value is low — for example, a wisdom tooth or a tooth in an arch where an implant or bridge would actually function better.

The second-opinion rule

If your general dentist has recommended extraction and you haven't seen a specialist endodontist with CBCT (3D imaging), it's worth a 20-minute consult. About one in eight patients we see for a retreatment or surgical second opinion leave with a different recommendation — sometimes "save it," sometimes "don't save it," but always one based on better imaging and specialist evaluation. The consult fee is small. The cost of the wrong call is large.

Our bottom line

We save teeth when they are restorable and worth saving, and we tell you honestly when they're not. We don't get paid more to recommend treatment than to recommend extraction, and we have no financial relationship with the oral surgeons or implant offices we may refer you to. If you'd like a structural and biological assessment of a specific tooth — including a CBCT scan on-site — call (669) 234-2354.