Root Canal or Implant? The Honest Answer From Amsterdam Dentists Who Do Both

Medically reviewed by the clinical team at 0900 Dentist, Lijnbaansgracht 162, Amsterdam — led by Mehdi Hashemi, co-founder and director.

“Should I save the tooth or pull it?” It is one of the most common questions we hear. The honest answer — one that most dental content glosses over — is: it depends on a specific set of clinical factors, and the right decision sometimes looks counterintuitive.

This post walks through the actual clinical logic we use at 0900 Dentist when a patient is sitting in the chair with an X-ray in front of us.

Why This Decision Is Harder Than It Sounds

Both root canal treatment and dental implants are excellent procedures when applied to the right case. The mistake is treating them as interchangeable options where cost or preference drives the choice.

A root canal treats an infected or dead pulp to preserve the natural tooth structure. An implant replaces a tooth that has been extracted with a titanium post anchored in the jawbone. These are not two ways to solve the same problem — they address different situations. The question is always: is this tooth saveable, and is saving it the best long-term outcome for this patient?

When We Recommend Trying to Save the Tooth First

If the tooth structure above the gum line is largely intact, and if the infection is confined to the root canal system without significantly damaging surrounding bone, we will almost always attempt a root canal first.

• Natural tooth roots are biomechanically superior. The periodontal ligament — a thin tissue layer connecting tooth root to bone — functions as a shock absorber and provides proprioceptive feedback that implants do not replicate.
• Cost and time favour saving when possible. A root canal at 0900 Dentist typically costs €400–€900 depending on which tooth. An implant, fully completed, runs €2,200–€4,500.
• Root canals are more reversible. If a root canal fails — which happens in roughly 5–15% of cases over ten years — extraction and implant placement is still available. An extraction cannot be undone.

When We Recommend Extraction and Implant Instead

• Vertical root fracture — Vertical root fracture — a crack running lengthwise down the root cannot be treated. Extract and implant.
• Insufficient structure — Insufficient remaining tooth structure — too little healthy tooth above the gum line to support a crown reliably long-term.
• Periodontal bone loss — Severe bone loss from periodontal disease — even a successful root canal may leave a mobile tooth without a foundation.

For patients with bone loss due to gum disease, see our periodontitis treatment page — bone health is assessed as a prerequisite before any implant placement.

The Situation Where Patients Get It Wrong Most Often

Patients sometimes request extraction because they want to be done quickly or assume an implant is “better” technology. But an extraction followed by implant placement is almost always more appointments, more healing time, and more cost than a successful root canal treatment.

Conversely, some patients resist extraction of a tooth that genuinely cannot be saved. A failing tooth is not a failure — it is information. The implant that replaces it can function as well or better than the original.

The Question We Always Ask First

Before recommending either, we take a full set of X-rays and examine the tooth completely. The decision is based on actual anatomy, not a general preference for one treatment over another. If you have been told you need a root canal or extraction and are unsure about the recommendation, a second opinion is reasonable. Bring your X-rays.