Root Canal or Extraction? How a Restorative Dentist Helps You Choose

By Greg Vigoren, DDS

Severe tooth pain or infection can make it hard to know what to do next. Should you save the tooth with a root canal or remove it entirely? At Vigoren Restorative Dentistry in Newport Beach, CA, Dr. Greg Vigoren draws on nearly 50 years of clinical experience to help you choose the most predictable path. The profession’s consensus—reflected in ADA and AAE guidance—is to preserve natural teeth whenever possible, because they support bone, bite, comfort, and long-term health.

TL;DR

• Root canal therapy removes infection and preserves your natural tooth; long-term survival commonly exceeds 90% when properly restored and maintained (evidence).

• Extraction is reserved for teeth that are fractured beyond repair or non-restorable; it can lead to bone loss and shifting and often requires replacement options.

• Guideline principle: Save teeth when feasible; modern anesthesia and techniques make treatment comparable in comfort to a filling (JADA overview).

• Get a personalized plan: start with a comprehensive exam and imaging on our Services page.

What a Root Canal Actually Does (and Why It’s Often Preferred)

A root canal removes inflamed or infected pulp, disinfects the canals, and seals the tooth to prevent reinfection. The tooth is then rebuilt—often with a crown or onlay—to restore strength and function. Modern evidence shows that endodontically treated teeth can last for decades, particularly when properly restored and followed (long-term data; JADA).

• Preserves natural bite, feel, and proprioception.

• Helps avoid bone loss that follows extraction.

• Comfortable with modern anesthesia; typically similar to a filling (AAE: myths & facts).

When Extraction Is the Right Call

Extraction may be necessary if a tooth is split below the gumline, severely decayed/non-restorable, or compromised by advanced periodontal disease. While effective at removing infection quickly, extraction creates an anatomic void that can cause bone resorption and shifting of adjacent teeth, often requiring replacement (implant or bridge) to restore function. Implants have high 5-year survival but carry biological/technical complication risks over time (NIH Bookshelf review; PubMed).

Root Canal vs. Extraction: Evidence at a Glance

• Endodontic survival: Long-term studies report high survival for root-canal-treated teeth (often 86–93% at 10–20 years; higher when restored and maintained) (systematic data).

• Retreatment: When needed, retreatments can still achieve strong success (≈77–83%) (Europe PMC).

• Implants: 5-year survival often ≈95–98%, but biological (peri-implant) and technical complications are not rare, and they don’t replicate natural tooth feel (NIH review; NIH review—fixed prostheses).

How Dr. Vigoren Guides the Decision

At your consult, we evaluate structural integrity, crack depth, periodontal support, bite forces, and risk of reinfection using high-magnification and (when indicated) CBCT imaging. Our north star is simple: if a tooth can be predictably saved, we prefer to save it. Explore our full capabilities on the Services page.

FAQs

What’s the typical success of a root canal?

With proper disinfection and restoration, long-term survival commonly exceeds 90% in the literature, and many teeth last decades (systematic evidence).

When would you recommend extraction instead?

When the tooth is fractured below the gumline, non-restorable from decay, or has insufficient periodontal support. We follow the profession’s principle to preserve teeth whenever feasible (JADA overview).

Will a root canal hurt?

Modern local anesthesia and techniques make it comparable in comfort to a filling. The procedure relieves infection pain (AAE facts).

If I extract, do I need an implant?

Often yes, to restore function and prevent shifting. Implants have high survival but are not free of complications and don’t replace a tooth’s natural feel (NIH review).

Next step: Get a clear diagnosis and plan. Visit our Services page or call (949) 760-1152.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Individual results may vary. Please consult a licensed dentist for diagnosis and treatment.

Author Bio

Greg Vigoren, DDS is a restorative dentist in Newport Beach, CA. Over nearly 50 years, he has pioneered high-magnification techniques and precision restorative protocols focused on preserving natural teeth and long-term oral health.