In short
Can a failing tooth be saved?
Many can. Gum disease is treated with deep cleaning and, where needed, surgery or laser treatment. An infected tooth can usually be kept with a root canal and a crown. A cracked tooth can be crowned if the crack stays above the gum line. A tooth usually can't be kept when too much bone is lost or a crack runs below the gum line.
From the office of Dr. Angela Berkovich, DMD, Deerfield Beach · (954) 427-3000
Last updated
- Infected nerve
- A root canal, then a filling or crown, in 1 or 2 visits9
- Cracked tooth
- Crown or root canal if the crack stays above the gum line8
- Professional view
- Saving your natural tooth is the preferred option whenever possible6
What your dentist checks before deciding
These are the questions behind the answer for each tooth:
- How deep the gum pockets are and how much bone holds the tooth
- How loose the tooth is
- Whether the nerve is infected, and whether a root canal can reach it
- Where a crack runs: above or below the gum line
- How much healthy tooth is left to hold a filling or crown
- Your health and habits, such as smoking or diabetes, which affect healing
How the decision is made
Keep the tooth, or remove and replace it?
When both are possible, these are the trade-offs.
| Aspect | Keep and treat the tooth | Remove and replace it |
|---|---|---|
| What it involves | Gum treatment, a root canal and/or a crown9,13 | Extraction, then an implant, a bridge or a denture |
| Visits | A root canal takes few visits6 | An implant takes multiple stages over several months |
| Neighboring teeth | Left as they are12,13 | A bridge needs them reshaped; an implant does not |
| Afterwards | Maintenance visits for gums; checks of the root canal tooth4,14 | Care and checks of the implant, bridge or denture |
| Professional view | Preferred whenever possible3,6 | When the tooth can't be kept healthy |
When removing the tooth is the better choice
- A crack that runs below the gum line: the tooth can't be saved and needs extraction.8
- Too much bone lost around the tooth: it eventually has to come out, and a replacement is planned.3
- A split tooth can't be kept whole, though part of it can sometimes be saved.8
- If keeping the tooth would need repeated treatment with little chance of lasting, an implant or bridge may serve you longer.13,15
Questions patients ask
Is a root canal worth it, or should I just pull the tooth?
Endodontists' guidance is that saving your natural tooth is the preferred option whenever possible. It is typically less invasive and takes fewer appointments than removing the tooth and placing an implant.6
Can a cracked tooth be saved?
It depends on the crack. Craze lines need no treatment, a broken cusp is fixed with a filling or crown, and a crack reaching the nerve can be treated with a root canal and crown. A crack below the gum line means extraction.8
Does keeping a tooth matter if an implant can replace it?
Endodontists say no denture, bridge or implant will look, feel and function as well as a natural tooth. Implants work well, but they are a replacement, with their own surgery, healing time and upkeep.7,13
How common is gum disease?
Common: the CDC reports that nearly half (42%) of adults aged 30 and older have periodontitis, and about 8% have severe periodontitis.11
Who you'll see
Dr. Angela Berkovich, DMD
Dentist, trained at Oregon Health & Science University School of Dentistry
Dr. Berkovich looks at each tooth on its own merits and tells you plainly which ones can reasonably stay, and which can't.
Medical content reviewed by Dr. Angela Berkovich, DMD on .
Office: 1348 E Hillsboro Blvd Suite A, Deerfield Beach, FL 33441. (954) 427-3000
About Dr. BerkovichSources
- PubMed: Sanz et al. 2020, treatment of stage I–III periodontitis: EFP S3 clinical practice guideline
- American Academy of Periodontology: Non-surgical treatments
- American Academy of Periodontology: Surgical procedures
- American Academy of Periodontology: Frequently asked questions
- Cleveland Clinic: Gum Disease Treatment
- American Association of Endodontists: Root Canal vs. Dental Implant: Which Is Right for You?
- American Association of Endodontists: Saving Your Natural Tooth
- American Association of Endodontists: Cracked Teeth
- American Dental Association (MouthHealthy): Root Canals
- American Dental Association (MouthHealthy): X-rays
- Centers for Disease Control and Prevention: Gum disease facts
- Cleveland Clinic: Dental Bridges: Types & Who Needs Them
- Cleveland Clinic: Dental implants
- PubMed: Jung et al. 2012, survival and complications of implant-supported single crowns: systematic review
- PubMed: Pjetursson et al. 2007, survival of tooth- and implant-supported fixed restorations: systematic review
General information, not a diagnosis or a promise of results. Individual results vary, and whether a treatment suits you depends on your exam.