Decision guide
Root Canal vs Extraction — What the Next 20 Years Cost
Root canal + crownvsExtraction + replacement
Saving the tooth or pulling it looks like a $1,000 decision. It is a $6,000 one. The long math, the honest exceptions, and the question that decides.
Every year, thousands of Miami teeth are pulled that could have been saved — and a smaller, quieter number are heroically saved when they should have been let go. Both mistakes come from answering the wrong question. The question is not “root canal or extraction?” It is: what does each path cost by year twenty?
The day-one illusion
An extraction is a few hundred dollars and thirty minutes. A root canal on a molar is $800–$1,900, plus $1,200–$2,500 for the crown — call it $2,000–$4,400 to keep the tooth. On day one, extraction wins by a mile, and that is precisely how it gets sold.
But an extraction is not a treatment; it is the first half of one. The missing tooth either gets replaced — implant at $3,500–$6,000, or a bridge that conscripts two neighbors — or it does not, and the bite slowly reorganizes itself around the hole. Add the replacement and the “cheap” option costs more. Skip the replacement and you have not saved money; you have borrowed it against your future bone.
When the tooth deserves to die
The root canal is not always the righteous answer, and a good dentist will tell you so. Vertical cracks below the gum line, decay past the point where a crown has anything to grip, teeth with severe bone loss, third failed retreatments — these are teeth whose war is over. Extracting them promptly (and grafting the socket if an implant is the plan) is the competent move, not the lazy one.
The one-sentence screen
Ask: “Would an endodontist agree this tooth is unrestorable?” If the answer is a shrug, get the consult before the extraction — specialists save teeth that generalists condemn, because their tools move the line. A tooth can always be extracted next month. It can never be un-extracted.
The questions that decide it
Isn't pulling the tooth cheaper?
On the day, yes — an extraction runs a few hundred dollars against $800–$1,900 for the root canal plus $1,200–$2,500 for the crown that protects it. But the extraction quote is incomplete: the empty space needs an implant ($3,500–$6,000), a bridge, or it needs you to accept drifting neighbors, a collapsing bite, and bone loss. Priced honestly over twenty years, keeping the tooth is usually the cheaper path — often by thousands.
When is extraction genuinely the right call?
When the tooth is not worth saving: a crack running below the gum line, decay that has consumed the structure a crown needs to hold onto, severe bone loss around the root, or a failed retreatment. A dentist who shows you why the tooth is unrestorable on the X-ray is making a clinical argument. One who jumps to extraction because it is faster is making a scheduling argument.
Do root canals actually work, or do they just delay the extraction?
Modern endodontics succeeds in roughly 85–95% of first treatments, and a well-done root canal under a well-made crown routinely outlives the twenty-year window this page is priced on. The failures cluster where the anatomy was complex and the work was rushed — which is why molars belong with endodontists working under microscopes.
My dentist says the tooth is 'questionable.' Who decides?
An endodontist — before anyone picks up forceps. Specialists save teeth general dentists would extract, because microscopes and retreatment experience move the line of what is restorable. A consult costs little; an unnecessary extraction costs a tooth. This is exactly the case we route to second opinions.
What happens if I extract and do nothing?
Nothing dramatic — for a while. Then the opposing tooth over-erupts into the gap, neighbors tilt, the bite shifts, and bone in the empty site quietly resorbs. Five years later, the implant that would have been straightforward now needs grafting first. Doing nothing is a choice with a price tag; it is just invoiced later.