Question 1

What does the AAE say about root canal vs. implant?

Accepted Answer

The AAE's Position Statement on Implants is unambiguous: 'Both endodontic therapy and dental implants are highly successful, and clinicians should make treatment decisions based on factors other than success rates of the two procedures.' The position explicitly cautions against extracting restorable teeth in favor of implants on the grounds that implants are 'better' — they aren't categorically better; they're different.

Question 2

Which lasts longer — a root canal or an implant?

Accepted Answer

In long-term outcome studies, both have approximately 90% survival at 10 years. The honest answer is that both can last for decades when well-indicated and well-executed; both can fail when poorly indicated, poorly executed, or poorly maintained. Comparing average survival numbers across all cases hides the fact that the right treatment for the right tooth dramatically outperforms the wrong treatment for the same tooth.

Question 3

If I have a root canal and it fails, can I still get an implant?

Accepted Answer

Yes — failed root canals usually leave enough bone for an implant after the tooth is extracted, sometimes with a small graft. Saving the tooth first does not eliminate the implant as a backup plan. The reverse is not true: once a tooth is extracted for an implant, you cannot get the natural tooth back.

Question 4

Are implants safer for diabetic patients?

Accepted Answer

No — the opposite, when diabetes is uncontrolled. Poorly controlled diabetes (HbA1c >8%) is associated with higher implant failure rates and slower osseointegration. For uncontrolled-diabetes patients, preserving the natural tooth is often the safer choice. Well-controlled diabetes is not a major implant contraindication.

Question 5

What about bisphosphonates / osteoporosis medications?

Accepted Answer

Patients on oral or IV bisphosphonates (alendronate, zoledronate) and similar antiresorptive drugs have an elevated risk of medication-related osteonecrosis of the jaw (MRONJ) following extraction and implant placement. The AAE Position Statement on MRONJ generally recommends preserving the natural tooth via endodontic treatment rather than extracting and placing an implant in these patients. Always disclose your full medication list before any oral surgery.

Question 6

Will my insurance affect the decision?

Accepted Answer

It often does — PPO dental insurance typically covers a substantial portion of a root canal and crown, while implant coverage is limited or absent on many plans. We provide written cost estimates for both options before treatment so you can see what your share actually is.

Save the Tooth or Get an Implant? — Decision Aid · Sunnyvale Endodontist