Root Canal or Extraction: How to Decide
This page is for anyone told a tooth could be saved with root canal treatment or taken out. It covers the clinical factors, what each route involves, and how fees compare over twenty years once replacing the tooth is counted. The core point: the cheaper option on the day is not always cheaper over time, and the right choice depends on the tooth.
5.0 from 550+ Google reviews
Open 8am to 8pm, seven days
Free parking at the door
CQC & GDC registered
No referral needed
Clinically reviewed by Dr Ibraheem Ijaz, dentist · GDC 301711
Medical disclaimer: This page is for general information only. It does not replace an examination or treatment by a dentist.
Root canal or extraction at a glance
Root canal treatment keeps your own tooth and root, while extraction removes them and leaves a gap to fill or leave. No single route comes out ahead on every row. Lifespans are typical ranges that depend on the patient, their oral hygiene and their habits.
| Root canal treatment and crown | Extraction and replacement | Extraction, gap left | |
|---|---|---|---|
| Visits at Deepcar | Root canal typically 1 to 2; crown 2 to 3 | Bridge typically 2 to 3 after the extraction | No replacement visits |
| Recovery | Soreness should get better within a couple of weeks (NHS) | Socket usually heals over 7 to 14 days (NHS trust guidance) | As for extraction and replacement |
| Fees at the start | From £1,200 | £120 to £260, plus the replacement | £120 to £260 |
| Bone at the site | The tooth and root stay in place | Bone shrinks; an implant needs enough of it | Bone shrinks |
| Further work over time | Crown typically lasts 5 to 20 years | Bridge 5 to 20 years; denture 5 to 10 years before a reline or remake | None for the gap; neighbouring teeth can drift in some cases |
| Chewing and appearance | Your own tooth, rebuilt | Fixed (implant or bridge) or removable (denture) | A visible gap at the front; less chewing surface |
| NHS charge band in England (at NHS practices) | Root canal Band 2; crown Band 3 | Extraction Band 2; bridge or denture Band 3; implants usually only available privately | Band 2 |
The decision variables
Whether to save the tooth or take it out comes down to a few clinical questions, plus cost and preference. The one that often decides it is whether enough sound tooth is left to hold a crown.
- Restorability. If enough sound tooth remains above the gum to rebuild it, saving it is more predictable. Evidence suggests a 1.5 to 2 mm collar of sound tooth, called a ferrule, helps a crowned, root-treated tooth resist fracture (Juloski and colleagues, 2012).
- Periodontal support. If the gum and bone around the root are healthy, a saved tooth has a better outlook. Deep, narrow gum pockets count against it.
- Strategic value. If the tooth holds your bite together or would anchor a bridge or denture, it is usually more worth saving.
- The root itself. If the root is split down its length, extraction is usually the more reliable choice.
- General health. A large UK study (Ng and colleagues, 2011) linked diabetes and steroid medicines that act on the whole body with lower survival of root-treated teeth.
- Cost and position. If the tooth is at the front, a gap shows, so the comparison is with a replacement, not with extraction alone.
- Plans for the gap. If you might want an implant later, the bone at the site matters, so plan the replacement before the extraction.
When a tooth should be saved
Saving a tooth usually makes sense when it can be rebuilt, its gum support is sound and it matters to your bite. Root canal treatment removes infection from inside the tooth, then cleans and seals the canals to stop it returning. It is part of restorative dentistry, which focuses on keeping natural teeth.
Evidence suggests a well-restored root-treated tooth has a good prognosis. A UK prospective study of more than 1,600 treated teeth in a postgraduate hospital setting (Ng and colleagues, 2011) found about 95% still in place after four years. Teeth given a crown or other cast restoration, rather than a temporary one, and teeth with neighbours on both sides did better. More detail is on how long root canal treatment lasts.
At Deepcar Dental Care, root canal treatment is carried out by a dentist with a special interest in root canal treatment, using a rubber dam routinely. Where a crown is needed, it is placed soon afterwards if the tooth is at higher risk, or after around 3 months, decided case by case. NHS guidance says soreness afterwards should get better within a couple of weeks.
A tooth that looks too damaged to save may still be restorable. Crown lengthening, done in house, can expose more sound tooth to create a ferrule, and a post crown can rebuild a tooth with little crown left.
Weighing up a tooth? Book a consultation online or call 0114 288 2121 to have it examined before you decide.
When extraction is the better decision
Extraction is often the sounder choice when too little tooth remains to rebuild, the root is split, or gum disease has destroyed its support. In those cases root canal treatment may only delay a loss.
Extraction can also be reasonable for a back tooth with nothing to bite against, or when you prefer not to keep a heavily restored tooth. A badly broken-down tooth is a common point where this question arises.
Our dentists carry out simple, surgical and same-day extractions, and numbing gel is applied before every injection. NHS trust guidance says healing usually takes 7 to 14 days and smoking raises the risk of dry socket. Read more about tooth extraction.
Twenty-year cost comparison
Measured on the day, extraction is the cheapest route; measured over twenty years with the gap filled, the difference narrows or reverses. Comparing extraction versus root canal cost this way, as a total cost of ownership, uses today's starting fees from our current fees and the typical lifespan of each restoration, which depends on the patient, their oral hygiene and their habits. It shows how costs build up rather than giving a quote.
| Route | At the start | Twenty years, long-lasting restorations | Twenty years, short-lived restorations |
|---|---|---|---|
| Root canal treatment and crown | From £1,200 | From £1,200 (crown lasts 20 years) | From £3,450 (crown replaced every 5 years) |
| Extraction and implant | From £2,520 | Not modelled here; see the implant pages | Not modelled here; see the implant pages |
| Extraction and partial acrylic denture | From £770 | From £1,420 (one remake) | From £2,720 (remade every 5 years) |
| Extraction, gap left | From £120 | From £120 | From £120 |
The implant route starts above the cost of saving the tooth, and over twenty years a denture lands in a similar range to a saved tooth. The model assumes the saved tooth lasts twenty years. A review of back teeth (Patel and colleagues, 2024) found about 87% still in place 8 to 20 years after root canal treatment, so a tooth later lost or re-treated adds cost.
Starting fees are a root canal from £450, an all-ceramic crown from £750, an extraction from £120 and implant treatment from £2,400. The final root canal fee depends on what is found, including how many canals the tooth has. If cost is a concern, look at spreading the cost of treatment.
What replaces an extracted tooth
An extracted tooth can be replaced with a dental implant, a bridge or a partial denture, or the gap can sometimes be left.
Dental implants replace the root as well as the visible tooth; suitability, bone and timing are covered on the implant pages.
A bridge fills the gap with a false tooth held by the neighbouring teeth. Conventional, adhesive (Maryland) and cantilever bridges are offered. A partial denture is removable.
Crowns, bridges and dentures are made without overseas laboratory work and carry 12-month aftercare cover, which excludes accidental trauma or infection and, for dentures, gum recession.
Leaving the gap is sometimes reasonable at the back of the mouth. Neighbouring and opposing teeth can drift or over-erupt into a space, though not all do, so understand what happens if you leave a gap first.
Bone preservation
The jawbone that held a tooth starts to shrink once the tooth is removed. A systematic review (Tan and colleagues, 2012) found the jaw ridge lost 29 to 63% of its width and 11 to 22% of its height within six months of extraction. More width is lost than height, so the ridge mostly narrows.
Most bone change after an extraction happens in the first three to six months. A narrower ridge can mean an implant needs extra bone, and dentures can loosen as the gums and jawbone change shape (NHS guidance), so plan the replacement before the tooth comes out.
Having the tooth examined
At Deepcar Dental Care the decision starts with an examination, with X-rays where needed, so the choice rests on what the tooth shows. Digital X-rays are on site.
Bring the questions on this page to your appointment: restorability, gum support, the tooth's role in your bite and the cost over time. If you are nervous, both treatments can be carried out under sedation, arranged on request, in house by Dr Ibraheem Ijaz or another sedation-trained dentist in our team. Suitability is checked at a separate pre-assessment appointment.
You can read our patient reviews before you book. To weigh up other restorative choices side by side, browse this section.
Book a consultation at book online or call 0114 288 2121. We are open 8am to 8pm, Monday to Sunday, at 334 Manchester Road, Deepcar, Sheffield, S36 2RH, with free parking directly outside.
Frequently asked questions
Is it better to pull a tooth or have a root canal?
Neither is better for everyone. The deciding check is usually an examination with X-rays, which show how much tooth is left to rebuild and the bone around the root. Gum support, the tooth's role in your bite, your general health, cost and your preference then weigh in.
Is a root canal or an implant the better option?
Research has not shown either to be clearly better. A systematic review (Iqbal and Kim, 2007) found similar survival for restored root-treated teeth and single implants, and its authors concluded the choice should rest on factors other than survival. In practice those include how restorable the tooth is, the bone available, cost, treatment time and your preference.
Does a tooth always need a crown after root canal treatment?
Not always. NHS guidance says a crown, a cap covering the whole tooth, may be needed after root canal treatment if the tooth was badly infected. Your dentist decides from how much sound tooth is left. A crown adds cost and typically lasts 5 to 20 years, depending on the patient, oral hygiene and habits.
Can I have the tooth out now and decide on a replacement later?
Yes, but deciding first keeps more options open, because the bone at the site changes after extraction. An immediate denture is made in advance and fitted when the tooth comes out, so you are not left with a visible gap. NHS guidance says immediate dentures often need adjusting or replacing up to a year later as the mouth heals.
What if my root canal treatment has already failed?
A failed root filling does not automatically mean extraction. Repeat root canal treatment is one option, and a large UK study (Ng and colleagues, 2011) found four-year tooth survival after repeat treatment similar to first-time treatment. An apicectomy, a small operation to seal the root end, is another. Extraction remains reasonable when the tooth cannot be rebuilt.
Book a consultation.
Online in under a minute, or call and speak to a real person.
We look after patients from Deepcar, Stocksbridge and Oughtibridge, and from across north Sheffield, including Wadsley, Hillsborough and Fulwood. Many travel further, from Penistone, Barnsley and Rotherham. The practice is on the A6102 at 334 Manchester Road, and no referral is needed.
334 Manchester Road
Deepcar, Sheffield S36 2RH
0114 288 2121
Contact us
Opening hours
Open 8am to 8pm, seven days
Free parking at the door