Being told a tooth needs either root canal treatment or removal can feel like a lot to take in, especially if it is already sore. You may be wondering which will hurt less, which costs less, and whether the tooth is really worth saving. This guide answers those questions so you can go into your consultation knowing what to ask.
For what root canal treatment involves, step by step, see our root canal treatment page. If you are thinking of leaving the tooth alone, our post on what happens if you don't get a root canal covers that. Here we focus on the choice between the two treatments: how we judge whether a tooth can be saved, how the two paths compare, and what each means for the months ahead. If you are in pain now, please see our emergency appointments page first.
Can my tooth be saved?
This is the question everything else depends on. Root canal treatment only makes sense if the tooth can be sealed and rebuilt so it works reliably afterwards. We look at three things.
How much sound tooth is left. Once the inside of the tooth is cleaned and sealed, it needs enough healthy structure to hold a filling or crown. If decay has destroyed too much, the tooth may not be restorable.
Whether there is a crack, and where it runs. A crack that stays in the crown of the tooth can often be managed. A crack that runs down into the root usually cannot. Our cracked tooth page explains more.
How well the gum and bone support the tooth. A tooth loosened by advanced gum disease may not be worth treating, however good the root canal work would be.
At your assessment, we test how the nerve responds and take an X-ray of the tooth. If the tooth is complex or has been treated before, we may take a 3D X-ray (a CBCT scan) for a clearer view. Every root canal at Zenith is carried out under a dental operating microscope, a high-magnification instrument that helps show fine canals and cracks.
When extraction is usually the better choice
We are likely to recommend removing the tooth if:
- a crack runs down into the root
- decay has left too little tooth to rebuild
- the tooth is loose because of advanced gum disease
- a previous root canal has failed and retreatment is not realistic
If extraction is right for your tooth, we will tell you, and explain why.
Root canal treatment at Zenith is carried out by Dr Stefania Stincone, a dentist with a special interest in root canal treatment. Extractions are carried out by Dr Karan Maini, our Principal Dentist. You can meet the rest of our team online. All treatment takes place at our Nottingham clinic.
Is it better to save a tooth or have it taken out?
When a tooth can be restored, the evidence is reassuring.
A 2022 review of 42 studies found that 82% of root canal treated teeth showed complete healing on X-ray. Counting teeth where the area of infection had shrunk as well, the figure was 92.6%.1 Follow-up in those studies ranged from one year to 19 years. An earlier review found that 86% to 93% of treated teeth were still in place two to ten years later.2 Having a crown fitted after treatment was the factor most strongly linked to the tooth lasting.2
People often ask whether it is better to skip the root canal and go straight to an implant. A 2025 review of 12 studies that compared the two found high survival for both. Implants needed further treatment and had complications more often. Pain, satisfaction and quality of life were similar either way.3 One study looked back at the records of 170 patients who had both a root canal treated tooth and an implant. At an average of 7.5 years, 95% of each were still in place. The implants involved more appointments, more additional procedures and higher costs.4
There is also a practical point. Keeping a tooth keeps your options open. If a root canal does not settle, it can often be redone, and removal is still possible later. Once a tooth is out, that choice has gone.
Which is more painful, a root canal or an extraction?
Both are carried out under local anaesthetic, so the tooth and the area around it are numb. Most patients describe root canal treatment as similar to having a large filling. With an extraction, you are likely to feel pressure rather than sharp pain.
Much of the pain people link with root canals actually comes from the infection beforehand. A review of pain before and after treatment found that 81% of patients had pain before their root canal. This fell to 40% one day afterwards and 11% after a week, and the pain that remained was less severe.5 These are averages across many studies.
If you are anxious, please tell us early. Conscious sedation helps you feel deeply relaxed and is available at Zenith. We will talk through which suits you and your treatment.
How many appointments does each option take?
Saving a tooth usually involves fewer steps overall. Removing it is quicker on the day, but replacing it adds more.
|
Stage |
Saving the tooth |
Removing the tooth |
|
First visit |
Tests, X-rays and a quote |
X-rays, a replacement plan and a quote |
|
Treatment |
One or two appointments |
Usually one appointment |
|
Next step |
A crown, usually within a few weeks |
Healing, then any replacement you choose |
|
Overall time |
Usually a few weeks |
Weeks to months, depending on the replacement |
A bridge usually takes two to three appointments. Most single implants take three to six months from consultation to final crown, because the bone needs time to bond with the implant. Our guide to what happens at each dental implant appointment sets out that timeline in detail.
Is a root canal or an extraction cheaper in the long run?
On the day, removing a tooth costs less. At Zenith, a simple extraction starts from £217, and root canal treatment starts from £700. A back tooth normally needs a crown afterwards, which is quoted separately.
The comparison changes if you replace the tooth. A single implant with a crown starts from £2,875. Bridges and dentures are quoted at consultation.
Whichever path you take, you will get a clear written quote before any treatment begins. If you would like to spread the cost, see our finance options.
If I have the tooth out, do I need to replace it?
Not always, but it is worth planning before the tooth comes out.
Once a tooth is removed, the bone that held it starts to shrink. One review found the ridge lost 29% to 63% of its width and 11% to 22% of its height within about six months, with most of the change in the first few months.6 Those figures come from sockets left to heal on their own, and results varied widely between studies. Over time, neighbouring teeth can also tip or drift into the space, though this does not happen to everyone.
The main replacement options are an implant, a bridge or a denture. We compare two of them in dental implants vs dentures, and our missing teeth page covers the wider picture. If an implant is likely, a small bone graft placed at the time of extraction can help preserve the site.
Sometimes leaving the gap is a reasonable choice, for example if it does not affect your bite, your chewing or your smile. We will be honest about whether that applies to you.
What happens after each treatment?
After root canal treatment. The tooth is sealed and protected with a temporary filling. Some mild tenderness for a day or two is normal. If the tooth needs a crown, we fit it once any tenderness has settled.
After an extraction. Gauze is placed over the socket to help a clot form. The gum usually heals within a few days, with full healing in one to two weeks. The bone underneath carries on remodelling for several months. After a simple extraction under local anaesthetic, many people return to work the next day. If you have conscious sedation, plan for one to two days off, and you will need someone to take you home.
In both cases, your dentist will give you written aftercare instructions. Please follow those rather than general advice online.
Clinically reviewed by Dr Karan Maini (BDS, Dip OS), Principal Dentist. Last reviewed: October 2026. This article is for general information only and is not a substitute for a personal consultation. Individual results and treatment plans vary from patient to patient.
References
- Burns LE, Kim J, Wu Y, Alzwaideh R, McGowan R, Sigurdsson A. Outcomes of primary root canal therapy: an updated systematic review of longitudinal clinical studies published between 2003 and 2020. International Endodontic Journal. 2022;55(7):714–731. doi:10.1111/iej.13736. PMID: 35334111.
- Ng YL, Mann V, Gulabivala K. Tooth survival following non-surgical root canal treatment: a systematic review of the literature. International Endodontic Journal. 2010;43(3):171–189. doi:10.1111/j.1365-2591.2009.01671.x. PMID: 20158529.
- Borda MF, Páez-García S, Murcia LF, Venegas-Sanabria LC, Borda MG. Comparative outcomes of endodontically treated teeth versus dental implant-supported prostheses: a systematic review. Acta Odontologica Scandinavica. 2025;84:386–396. doi:10.2340/aos.v84.43871.
- Vahdati SA, Torabinejad M, Handysides R, Lozada J. A retrospective comparison of outcome in patients who received both nonsurgical root canal treatment and single-tooth implants. Journal of Endodontics. 2019;45(2):99–103. doi:10.1016/j.joen.2018.10.018.
- Pak JG, White SN. Pain prevalence and severity before, during, and after root canal treatment: a systematic review. Journal of Endodontics. 2011;37(4):429–438. doi:10.1016/j.joen.2010.12.016.
- Tan WL, Wong TLT, Wong MCM, Lang NP. A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans. Clinical Oral Implants Research. 2012;23(Suppl 5):1–21. doi:10.1111/j.1600-0501.2011.02375.x. PMID: 22211303.
