Root canal vs extraction: the ten-year cost comparison
A root canal plus crown costs about $1,900 to $3,200 and saves the tooth. An extraction costs $180 to $350 today, but replacing the tooth with an implant brings the ten-year total to roughly $4,000 to $6,000. Extraction is only cheaper if you never replace the tooth — and not replacing it has its own bill.
This is the decision patients most often get wrong on price, because the two options are quoted on completely different timescales. One is a bill today. The other is a bill today plus a much larger one later, and the later one is easy to not think about while a tooth is hurting.
The numbers, side by side
| Root canal + crown | Extract + implant | Extract, no replacement | |
|---|---|---|---|
| Today | $1,900 – $3,200 | $180 – $350 | $180 – $350 |
| Replacement | — | $3,100 – $5,800 | — |
| Likely retreatment | $900 – $1,500 (~1 in 8) | ~1 in 20 fails | — |
| Crown replacement at yr 10 | $1,100 – $2,300 | Rare | — |
| Ten-year total | $2,100 – $4,200 | $3,400 – $6,300 | $180 – $350 |
| Tooth still there? | Yes, your own | No, a replacement | No |
Figures are ranges collected from published fee schedules across the practices in this directory, current to August 2026. They are not a quote. Only an examination produces a quote.
The column everyone chooses and nobody prices
The third column looks unbeatable, and for a wisdom tooth or a second molar with a healthy neighbour it often genuinely is. For anything further forward it is a deferred cost rather than a saved one.
A gap does not stay a gap. The teeth either side drift into it, typically two to four millimetres over a decade, and the opposing tooth over-erupts into the space because nothing is meeting it. That changes your bite. Ten years on, the implant that would have cost $4,200 now needs orthodontics first to reopen the space, and the over-erupted tooth above may need a crown or extraction of its own.
Where the root canal option goes wrong
Root canal treatment has an excellent record — around 86–93% of treated teeth are still functioning at ten years — but two things reliably ruin the economics.
- Skipping the crown. A root-treated back tooth without a crown fractures at several times the rate of one with a crown. Saving $1,300 on the crown is the single most expensive economy in dentistry, because the fracture usually takes the tooth with it and you end up paying for the extraction and implant anyway.
- Treating a tooth that was not savable. A tooth with a vertical root fracture, or with too little sound structure above the gum to hold a crown, has a poor prognosis whatever is done to it. A dentist who says "we can try" is being honest; ask what the odds are and what the plan is if it fails.
The middle option: extract and bridge
A three-unit bridge runs $2,400 to $4,500 and is faster than an implant — a few weeks rather than several months. The catch is that it requires cutting down the two healthy teeth either side to serve as anchors, and it typically needs replacing at ten to fifteen years, at which point those anchor teeth have been drilled twice.
It is a reasonable choice when the neighbouring teeth already need crowns anyway. It is a poor one when they are pristine.
How to decide
- Ask for the prognosis as a number, not an adjective. "Good" means nothing; "about 85% at ten years" means something.
- Ask how much sound tooth structure remains above the gum line. Under about 2mm all round and the crown has nothing to grip.
- Ask whether the tooth is cracked, and whether that was checked under magnification. A vertical root fracture changes the answer entirely.
- If the tooth is a molar and the treatment is complex, ask whether an endodontist should do it. Their success rates on retreatment cases are meaningfully higher, and the fee difference is $300 to $600.
- Price the whole decade, not the appointment.
The cheapest dentistry is the treatment you only pay for once.
Dr. Ramy Khoury, DDS — clinical reviewer
Common questions
Is a root canal painful?
The treatment itself is usually no more uncomfortable than a filling, because the tooth is anaesthetised. The pain people remember is the infection beforehand, which the treatment relieves.
How long does a root canal last?
Roughly 86–93% of root-treated teeth are still functioning at ten years, provided a crown was placed. Without a crown on a back tooth, that figure falls sharply.
Is it cheaper to just pull the tooth?
Today, yes, by a factor of about ten. Over a decade, only if you never replace it — and not replacing a tooth in front of the second molar creates drift and bite problems that cost more to fix than the implant would have.
Can I get an implant immediately after extraction?
Sometimes. Immediate placement works when the socket walls are intact and there is no active infection. Otherwise the site needs three to six months to heal, often with a socket preservation graft.
