European Society of Endodontology recommends that the advantages and disadvantages of both treatments should be considered carefully

Natural tooth or artificial false tooth? That is the question. Every year thousands of patients are asked to decide between saving a tooth by root canal treatment or having the tooth extracted and replaced by some form of artificial false tooth. The European Society of Endodontology (ESE) advises patients to consider the treatment options carefully and with the long-term consequences in mind. Recently, there has been a tendency to extract and replace teeth that could have been saved with root canal treatment and replacing them with an implant, placed within the bone of the jaws. Although keeping teeth or extracting teeth have advantages and disadvantages, it is obvious that priority should be given to treatments through which natural teeth can be saved thus avoiding the need of tooth replacement by an artificial prosthesis – a false tooth. 

Unfortunately, many millions of teeth are still extracted every year throughout Europe. In the vast majority of cases root canal treatment could save these teeth. The benefit of an implant or a prosthesis should be to replace teeth that are already missing Thus, as far as implants or artificial teeth are concerned the question should not be: ‘natural versus artificial teeth’ but ‘no teeth versus implants/artificial teeth?’

High-quality root canal treatment can preserve a tooth provided good oral hygiene and subsequent patient-centred professional care is maintained. Although implants are a potential solution for missing teeth they are no more successful than root fillings placed in natural teeth. Indeed, implants will often need more follow‐up maintenance and extra costs to ensure their survival. It is obvious that most patients would prefer to retain their natural teeth than have implants or other forms of false teeth. 

Both root canal treatment and implants are usually pain-free thanks to modern techniques of local anaesthesia. However, having a tooth extracted and replaced by an implant or a dental prosthesis is inevitably more expensive than a root canal treatment followed by an appropriate restoration of the natural tooth. Furthermore, natural teeth allow patients to chew efficiently, in fact, after a successful root canal treatment a tooth functions just like any other tooth, ensuring comfortable chewing as well as a natural appearance. Chewing with a false tooth is likely to be impaired and less pleasant.

No matter how effective modern dental prostheses might be, no artificial tooth can ever fully replace the natural tooth. From the patients perspective preserving teeth is easy and worth the effort, with the bonus being the saving of healthy and natural teeth for the rest of their lives. Unfortunately there is a trend for teeth, which could be preserved, being unnecessarily replaced by implants. Dentists have to make sure that patients get the right information and advice thus enabling them to enjoy the best possible dental care.