Root Canal Therapy Versus Single-Tooth Dental Implants for Compromised Teeth: A Retrospective Comparative Study

Background: Selecting between root canal therapy (RCT) and extraction followed by dental implant placement for a compromised tooth remains clinically challenging.Treatment decisions should consider survival, complications, treatment burden, cost, and patient satisfaction rather than survival alone.Objective: To compare treatment survival, clinical and radiographic success, complications, treatment visits, duration, direct cost, and patient satisfaction between RCT-restored teeth and single implant-supported crowns.Materials and methods: This retrospective comparative cohort study included 100 patients, comprising 50 patients treated with RCT, followed by definitive restoration, and 50 patients treated with extraction, followed by single implant-supported crown rehabilitation, each with a minimum follow-up of 12 months.Demographic, clinical, radiographic, complication-related, economic, and patient-satisfaction data were evaluated.Categorical variables were compared using the chi-square or Fisher's exact test, continuous variables using the independent-samples t-test, and the ordinal satisfaction score using the Mann-Whitney U test.Effect estimates are reported with 95% confidence intervals (CIs).Statistical significance was set at p < 0.05.Results: Treatment survival was 100% following RCT and 96% following implant treatment (risk difference: 4.0%, 95% CI: -3.7 to 13.5; p = 0.495).Clinical and radiographic success did not differ significantly.Biological complications were less frequent after RCT than after implant treatment (4% versus 20%; risk difference: -16.0%, 95% CI: -29.4 to -3.1; Fisher's exact test, p = 0.028).RCT was associated with fewer visits (mean difference: -2.12, 95% CI: -2.47 to -1.77), a shorter treatment duration (-87.10 days, 95% CI: -96.57 to -77.63), and a lower direct cost (-INR: 29,966, 95% CI: -32,203 to -27,729); all p < 0.001.Documented patient satisfaction scores were higher in the RCT group than in the implant group (median: 5 (IQR: 4-5) versus 4 (IQR: 4-5); p = 0.012, Mann-Whitney U test).Conclusions: Both treatments demonstrated favorable short-to intermediate-term outcomes.In this retrospective cohort, RCT was associated with fewer biological complications, lower treatment burden and cost, and higher satisfaction.Because treatment was not randomized, these associations may partly reflect treatment-selection differences, and natural-tooth preservation should be considered when a compromised tooth remains predictably restorable.