Root Canal Treatment vs Implants: Survival and Costs in a National Cohort

 

Journal of Dentistry

Available online 25 August 2026, 107000

Abstract

Objective

To evaluate tooth/implant survival and function time, as well as costs of root canal treatment versus extraction and replacement through implant therapy in the management of endodontic disease.

Methods

This retrospective register-based cohort study used data from the Swedish Dental Health Register. Adults (≥20 yrs) diagnosed with endodontic disease (2015–2016) and provided with either root canal therapy (ENDO) or extraction and implant-supported replacement (IMPLANT) were followed until 2023. Survival was assessed in propensity score-matched groups (ENDO: 10,654; IMPLANT: 5,327 individuals) using Kaplan-Meier and Cox regression analyses. Function time was expressed through restricted mean survival time (RMST), truncated at 7 yrs. Cumulative costs (3% annual discount applied) were estimated using mixed-effects regression models, and incremental cost-effectiveness ratios (ICERs) were calculated as cost per additional yr in function.

Results

9-yr survival was 83.4% for ENDO and 97.9% for IMPLANT. RMST was 5.8 yrs for ENDO and 6.6 yrs for IMPLANT and respective mean cumulative costs were USD 1,243 and USD 2,667. With the exception of mandibular anterior sites, IMPLANT showed longer mean function times. The overall ICER was USD 1,874 per yr gained, ranging from USD 1,352 (maxillary molar sites) to USD 4,836 (maxillary anterior sites).

Conclusions

Overall, survival and function time of implants replacing endodontically diseased teeth was greater than that of teeth following root canal treatment. Cumulative costs were higher for implant therapy. At mandibular anterior sites, however, root canal treatment resulted in higher survival and function time, at lower costs.

Clinical significance

While implant-based tooth replacement provided greater survival and function time than root canal treatment in general, benefits came at considerably higher cumulative costs. Site-specific differences were also evident as root canal treatment at anterior sites in the mandible resulted in both higher survival and lower treatment costs.