By Dr. Russell Kiser, DDS, MS, Advanced Dentistry & Dental Implant Center, Mansfield, Ohio
Reviewed by Dr. Charmaine Johnson-Leong, DDS, Premier Smile Center, Fort Lauderdale. Reviewed September 2026.
You have a tooth that is cracked, deeply decayed or aching at night, and you have been handed two options that sound nothing alike: keep it with a root canal, or take it out and replace it with an implant.
Most of the time the tooth makes that decision for you. Before anything else, your dentist is answering one question: is there enough solid tooth left, above the bone, to rebuild and hold a restoration? If there is, keeping your own tooth is the first option worth trying. If there isn’t, no amount of good dentistry changes it, and replacing the tooth is the honest recommendation. I place implants most weeks of the year, and I still open every one of these conversations by asking whether the tooth can stay.
The Short Answer
- The choice is decided by restorability, meaning how much healthy tooth and bone is left, not by which procedure sounds better.
- A root canal is often finished in one to two visits plus the crown. An implant runs in stages across several months.
- A crack that stays above the gum line can usually be treated and crowned. A crack that runs below it means the tooth comes out.
- Implants survive well, above 95% in the published literature, and they still need cleaning, checkups and a bite that is not overloading them.
- When the tooth can be saved, the American Association of Endodontists says to save it. Nothing replaces a natural root.
Table Of Contents
- Can This Tooth Still Be Rebuilt?
- What A Root Canal Actually Does
- When A Tooth Cannot Be Saved
- What Replacing A Tooth With An Implant Involves
- How I Decide, Case By Case
- What The Cost Comparison Usually Leaves Out
- What To Ask Before You Decide
- Other Questions Patients Ask
- Further Reading
- Your Next Step
Can This Tooth Still Be Rebuilt?
A tooth is worth saving when enough healthy structure remains above the bone to hold a crown, the root is whole, and the gum and bone around it are sound. That’s the test, and it has very little to do with how much the tooth hurts. Pain tells us the nerve inside is inflamed or infected, which is treatable. A tooth that has broken off at the gum line may not hurt at all and may still be beyond saving.
This is why two people with the same symptom get different recommendations. Deep decay, a crack, an injury or repeated work on the same tooth can all inflame the pulp, and any of them can bring on lingering sensitivity to hot and cold, swelling or a toothache that won’t settle. What separates the two paths is what is left to build on once the decay or the broken piece is cleared away.
How Does A Dentist Decide If A Tooth Can Be Saved?
By looking at what is left, not at what hurts. Your dentist checks whether enough solid tooth structure remains above the bone to grip a crown, whether the root is intact, and whether the bone and gum around the tooth are healthy. A crack running below the gum line is the common dealbreaker: the American Association of Endodontists is direct that past that point the tooth cannot be saved and needs to come out.
What A Root Canal Actually Does
A root canal treats the inside of the tooth. The inflamed or infected pulp is removed, the canal is cleaned and shaped, and it is sealed, then the tooth is restored with a filling or, more often on a back tooth, a crown. The outside of the tooth, the part that does the chewing and the smiling, stays yours. One visit root canal therapy at Premier Smile Center is often done in one visit, and the crown follows.
Outcomes are good. The published success rate for root canal treatment sits in the range of roughly 80% to 95%, depending on how long patients were followed and what the study counted as success, and many treated teeth go on to last a lifetime when they are restored and cared for properly. On recovery, the endodontists association reports that patients who have a root canal are six times more likely to describe it as painless than patients who have the tooth pulled. The treated tooth does become more brittle, and that’s exactly why a molar gets a crown instead of a filling. If root canals still carry a fearsome reputation in your head, Premier Smile Center’s own video on the truth about root canals is a straighter account than most of what circulates.
How Many Visits Does A Root Canal Take?
Often one or two, plus a visit for the crown that protects the tooth afterward. The American Association of Endodontists puts treatment at one to two visits followed by the final restoration. Back teeth absorb the most chewing force, so they are usually crowned rather than filled. If an infection needs time to settle before the tooth is sealed, your dentist may deliberately space the visits further apart.
“The front staff especially Dominique was very friendly and helpful, especially when trying to book an appointment. Dr Bui did awesome with my root canal and calmed my nerves, I didnt feel pain even during the numbing process.”
Sheranda L, Google review of Premier Smile Center, July 2026
When A Tooth Cannot Be Saved
Some teeth are past the point where treatment helps, and the sooner that is said out loud the better the replacement goes. A crack that has reached the pulp but stays above the gum line can usually be treated with a root canal and held together with a crown. Once the crack extends below the gum line, the American Association of Endodontists is clear that it is no longer treatable and the tooth needs to be extracted. A split tooth, which is where a long-running crack finally separates the segments, is usually in the same category, and so is a vertical root fracture, a crack that begins down in the root and travels up toward the chewing surface. Before that conclusion is final, ask whether retreatment or endodontic surgery, most often an apicoectomy, could still save the tooth.
The other common reason has nothing to do with cracks. When decay or old dentistry has eaten the tooth down to or below the bone, there’s nothing left for a crown to hold onto, and a crown that cannot get a grip fails. In that situation the extraction is not a defeat, it is the step that lets the replacement be planned properly instead of rescuing a failure later.
Does A Cracked Tooth Always Have To Come Out?
No, and where the crack ends decides it. A crack that reaches the nerve but stops above the gum line can often be treated with a root canal, then covered with a crown that keeps it from spreading. Once the crack runs below the gum line the tooth cannot be saved. That’s the reason a cracked tooth gets examined quickly rather than watched for a few months.
What Replacing A Tooth With An Implant Involves
An implant replaces the root as well as the crown, and that is its real advantage. Because the post sits in the bone and gets loaded when you chew, it helps hold the jawbone that otherwise shrinks after a tooth is lost. The survival rate in the published literature commonly runs above 95%, varying with a person’s health, the quality of the bone and the site in the mouth. The post itself is titanium, and it sits where the root used to be.
The trade is time. After placement, bone grows around the implant in a process called osseointegration, which commonly takes about three to four months in the lower jaw and six to eight months in the upper jaw before the permanent crown goes on. Healthy gums and enough bone density are part of qualifying at all, and smoking, uncontrolled diabetes and some medications, including certain osteoporosis drugs, can affect healing enough to change the plan. Implants aren’t maintenance free either: failure is uncommon but real, usually from infection around the implant, which is called peri-implantitis, from incomplete integration with the bone, or from a bite that overloads it, so pain, looseness or swelling always gets looked at promptly. Oral hygiene and regular checkups matter for an implant as much as they do for a natural tooth. If the tooth is already gone, dental implants in Fort Lauderdale are one route and a bridge is another, and Premier Smile Center’s write-up on choosing between an implant and a bridge walks through how that call gets made.
How Long Does An Implant Take From Start To Finish?
Plan in months rather than weeks. Osseointegration alone commonly runs about three to four months in the lower jaw and six to eight in the upper jaw before the permanent crown is placed. An extraction that has to heal first, or a bone graft, adds to that. Your own health sets the pace as much as the schedule does, which is why the timeline is given as a range and not a date.
How I Decide, Case By Case
Here’s the framework I use out loud with patients, because the decision is easier to live with when you can see what it turned on.
Saving The Tooth Usually Wins When:
- Enough solid tooth remains above the bone for a crown to grip, so the restoration has something to hold.
- The crack, if there is one, has not run below the gum line.
- The gum and bone around the tooth are healthy, so the tooth is steady in its socket.
- You want this finished in weeks instead of months, since treatment plus a crown is a far shorter road than surgery and healing.
- Healing is complicated for you by smoking, diabetes that is not well controlled, or medication that affects bone, all of which weigh on implant candidacy more than they weigh on a root canal.
Replacing The Tooth Usually Wins When:
- The crack runs below the gum line, or the tooth has split.
- Too little tooth is left above the bone to hold a crown even after building it up.
- The tooth has been treated, retreated and is failing again, and the pattern is not changing.
- The tooth is already out, or is coming out for another reason, in which case the question is only which replacement fits.
The association of endodontists takes a firm position on the first list, and it’s worth quoting because they see the outcomes: when given a choice between extraction and root canal treatment, opt for the root canal, because no denture, bridge or implant looks, feels and functions as well as a natural tooth. I agree with that as a default. It’s a default and not a rule, and the exam is what tells us which list your tooth belongs on.
What The Cost Comparison Usually Leaves Out
Both options cost more than the number you were first quoted, and they hide the extra in different places. A root canal is usually quoted without the crown that follows it, and on a back tooth that crown is not optional. An implant is quoted as a procedure, while the full sequence can include the extraction, sometimes a graft, the implant, the abutment and the crown, spread over months of visits. The endodontists’ own comparison puts the natural tooth as typically less invasive, less expensive and fewer appointments, with the implant carrying the higher upfront cost because of the surgery and the components.
Prices and insurance coverage vary enough that no article should put a figure on either one. The practice and your insurer are the only reliable source for your number, so ask both for the full sequence in writing before you choose. Lifespan is the other number people want, and neither option comes with one you can bank on. Treated teeth commonly last a lifetime when they are properly restored, implant survival rates run high over the long term, and both depend more on care and bite than on which path was chosen.
Is An Implant Cheaper In The Long Run?
It depends on the tooth, and neither one is cheap. A root canal usually needs a crown on top of it, and an implant is surgery, components and months of appointments. Coverage differs between plans and between the two treatments, sometimes sharply. Ask each office for the whole sequence and what your plan pays on each step, then compare the totals rather than the headline prices.
What To Ask Before You Decide
Take these into the consultation. They’re the questions that change the answer, and any dentist will be glad you asked.
- Is This Tooth Restorable: ask what specifically was seen on the exam or the scan that says it’s savable or not.
- What Holds The Crown: ask how much tooth is left above the bone and whether it is enough to hold a restoration.
- What Happens If I Wait: ask what the tooth is likely to do over the next six months if nothing is done now.
- What Is The Whole Sequence: ask for every visit and every part from today to the finished tooth, for both options.
- Who Does Each Step: ask which procedures happen in that office and which are referred out, because a referral adds time.
If the answer to the first question is that the tooth cannot be saved, a second opinion is a reasonable thing to want, particularly from someone who performs both procedures. No dentist worth seeing will take it personally.
“i had petty complicated issue involving an extraction of a molar and a subsequent discussion of what to do next ie implant.it was clearly explained what my options were by the dental staff and i was pleased with one particular option which avoided sinus surgery.All in all a pleasant professional experience”
Eric Lodewijk, Google review of Premier Smile Center, January 2026
Other Questions Patients Ask
Can A Root Canal Be Redone If It Fails?
Often, yes. When a treated tooth does not heal or starts hurting again later, retreatment gives it a second chance. The endodontists’ association names two frequent causes: a narrow or curved canal that went untreated the first time, and a restoration that let saliva reach the inside of the tooth. Ask about retreatment before agreeing to remove a tooth that has already been treated once.
Does A Root Canal Change How The Tooth Looks?
The tooth keeps its own shape, and the crown that usually follows is matched to the teeth beside it. A treated tooth is more brittle than it was, which is why back teeth are typically crowned rather than filled. If a front tooth darkens in the years after treatment, the dentists at Premier Smile Center can walk you through the options that lighten or cover it.
Further Reading
- Root Canal vs. Dental Implant: Which Is Right for You?, American Association of Endodontists. The side by side version of this article from the association whose members do this work, including visits, stages and cost direction.
- Saving Your Natural Tooth, American Association of Endodontists. Read this one if you’re leaning toward extraction because it sounds simpler.
- Cracked Teeth, American Association of Endodontists. The five kinds of cracks explained, including which are treatable and which are not.
- Endodontic Retreatment, American Association of Endodontists. What to ask about before you let a previously treated tooth be pulled.
- Endodontic Surgery, American Association of Endodontists. What an apicoectomy is, for the case where a treated tooth still has infection in the bone around the root end.
- Implants, MouthHealthy from the American Dental Association. Plain language on what an implant is, how healing works and which health conditions complicate it.
Your Next Step
If a tooth is hurting, cracked or already broken down, the useful next move is an exam that answers the restorability question, because everything else follows from it. Premier Smile Center’s team in Fort Lauderdale, including an endodontist and a periodontist in the same practice, can make that call and handle either path without sending you across town. Call (954) 566-7479 or book a visit at their Fort Lauderdale office.
If you are in north central Ohio, my own practice handles the same conversation. Either way, don’t let a cracked tooth sit and decide for itself.
About The Authors
Dr. Russell Kiser, DDS, MS practices at Advanced Dentistry & Dental Implant Center, 1221 S Trimble Rd Suite A1, Mansfield, OH 44907, (419) 756-2880. He is cross-trained in endodontics and dental surgery and places dental implants, which means he sees both sides of this decision in the same week.
Dr. Charmaine Johnson-Leong, DDS owns Premier Smile Center at 2717 East Oakland Park Boulevard, Suite 100, Fort Lauderdale, FL 33306, (954) 566-7479, where an endodontist and a periodontist work alongside the general and cosmetic team.
General Information, Please Talk To Your Dentist: this article is general information and not a diagnosis or treatment advice. Your mouth is its own case, and whether a specific tooth can be saved is answered by an exam and x-rays, not by an article. Your situation may differ from the general information here. Talk to your dentist about what applies to you.
