Save vs remove an infected tooth

Local anaesthetic is usually used, so the patient is awake without pain. The tooth is opened, infected pulp is removed, the inside is cleaned and shaped, then it is filled and sealed.

Removing a tooth does not itself replace it. The comparison considered extraction without replacement, an implant-supported single crown, and a fixed partial denture as distinct routes after tooth loss.

Root canal treatment usually takes two or more appointments, commonly one to two hours or longer each. A temporary filling may be used between visits, and a badly infected tooth may need a crown.

In the systematic review, long-term survival for implant-supported single crowns and root canal treatment was similar and both were superior to fixed partial dentures. Direct success-rate comparisons were limited because studies used different criteria.

The reviewed studies varied in design, definitions of success, assessment methods, operator type and sample size. Direct comparisons between treatment types were rare, so success rates could not be compared cleanly.

Limited data in the review suggested worse psychosocial outcomes after extraction without replacement than after the alternative treatment routes. Loss of a visible tooth was also reported as traumatic in the available psychosocial data.

The decision compares keeping a tooth through root canal treatment and restoration with removing it, replacing it with an implant-supported crown or fixed partial denture, or leaving the gap unreplaced.