Root Canal Therapy Versus Single-Tooth Dental Implants for Compromised Teeth: A Retrospective Comparative Study

Selecting between root canal therapy (RCT) and extraction followed by dental implant placement for a compromised tooth remains clinically challenging. Treatment decisions should consider survival, complications, treatment burden, cost, and patient satisfaction rather than survival alone.

To compare treatment survival, clinical and radiographic success, complications, treatment visits, duration, direct cost, and patient satisfaction between RCT-restored teeth and single implant-supported crowns.

This retrospective comparative cohort study included 100 patients, comprising 50 patients treated with RCT, followed by definitive restoration, and 50 patients treated with extraction, followed by single implant-supported crown rehabilitation, each with a minimum follow-up of 12 months. Demographic, clinical, radiographic, complication-related, economic, and patient-satisfaction data were evaluated. Categorical variables were compared using the chi-square or Fisher's exact test, continuous variables using the independent-samples t-test, and the ordinal satisfaction score using the Mann-Whitney U test. Effect estimates are reported with 95% confidence intervals (CIs). Statistical significance was set at p < 0.05.

Treatment survival was 100% following RCT and 96% following implant treatment (risk difference: 4.0%, 95% CI: -3.7 to 13.5; p = 0.495). Clinical and radiographic success did not differ significantly. Biological complications were less frequent after RCT than after implant treatment (4% versus 20%; risk difference: -16.0%, 95% CI: -29.4 to -3.1; Fisher's exact test, p = 0.028). RCT was associated with fewer visits (mean difference: -2.12, 95% CI: -2.47 to -1.77), a shorter treatment duration (-87.10 days, 95% CI: -96.57 to -77.63), and a lower direct cost (-INR: 29,966, 95% CI: -32,203 to -27,729); all p < 0.001. Documented patient satisfaction scores were higher in the RCT group than in the implant group (median: 5 (IQR: 4-5) versus 4 (IQR: 4-5); p = 0.012, Mann-Whitney U test).

Both treatments demonstrated favorable short- to intermediate-term outcomes. In this retrospective cohort, RCT was associated with fewer biological complications, lower treatment burden and cost, and higher satisfaction. Because treatment was not randomized, these associations may partly reflect treatment-selection differences, and natural-tooth preservation should be considered when a compromised tooth remains predictably restorable.