Reviewed 31 August 2026. The numbers are quoted from a 10-year dual-centre cohort of 859 treated cases, a 10-year prospective comparison of 412 teeth, two systematic reviews and meta-analyses of restorative survival, a systematic review of 33 studies on ferrule dimensions, a 5-year extraction-aetiology cohort, and three meta-analyses of post-operative pain medication — each with its PMID at the end. Written for someone deciding between keeping a tooth and replacing it, and for clinicians having that conversation. Not medical advice; an acutely swollen face or fever needs same-day care.
The short answers
- Kept or replaced, survival looks the same over a decade — the difference is in money, visits and downtime. In a 10-year dual-centre private-practice cohort, the adjusted analysis covered 859 cases (594 tooth-preservation, 265 implant replacement), median follow-up 3.1 years (IQR 1.8–4.7; range 1.0–9.6): failures were 51 in total (37 preservation, 14 implant), estimated one-year survival 97.8% for saving the tooth versus 98.5% for the implant, and 93.8% versus 94.7% at the end of the observation window, with no evidence of a survival difference (log-rank p = 0.785; adjusted HR for implant replacement 0.87, 95% CI 0.47 to 1.62; p = 0.666). Patient-reported oral health-related quality of life and satisfaction were comparable — but implant replacement involved more visits, more downtime and higher initial, total and cost-per-year-of-function expenses (Abichandani et al., J Prosthodont 2026-08-01, PMID 42609072).
- A second, differently designed study agrees. In a prospective comparison of 412 teeth in 378 patients over 10 years — 206 root-canal-treated teeth against 206 extracted-and-replaced with single implants, with strict criteria (periapical health index ≤ 1 for endodontics; minimal bone loss without complications for implants) — ten-year success was 91.3% for endodontics versus 89.8% for implants (p = 0.587) and survival 94.7% versus 97.1% (p = 0.221) (Munaga et al., Bioinformation 2026-01-01, PMID 41960485). Both differences point in opposite directions and neither reaches significance, which is exactly the honest finding: this is a tie on the outcomes measured.
- What is not a tie is the tobacco effect, and it applies to both routes: current tobacco use increased failure risk in that cohort (HR 2.01, 95% CI 1.05 to 3.86; p = 0.036) (Abichandani et al., J Prosthodont 2026-08-01, PMID 42609072). Our page on vaping and gums covers the same mechanism at the implant site.
- The tooth’s own prognosis is mostly decided by how much sound wall is left, not by the root filling. A systematic review and meta-analysis of 33 primary studies (6 clinical, 18 in vitro, 9 finite-element) found that a ferrule height of at least 2 mm improved fracture resistance by a mean difference of +165 N (95% CI 110 to 215) and that the presence of a ferrule increased clinical survival (RR 1.34, 95% CI 1.12 to 1.59); dentine thickness of at least 1 mm and a complete 360° ferrule were most favourable, and partial ferrules with at least two opposing walls still helped. The review’s own summary is blunt: no restorative strategy matched the biomechanical reinforcement of a natural dentin ferrule (Hajeer et al., J Prosthodont 2026-04-01, PMID 41601347).
- Direct or crowned depends on the same variable. Across 14 studies, indirect restorations showed success of 63% to 91.61% against 43.2% to 86.7% for direct ones, and three-year survival of 82.7–99.1% versus 75–97.6%, with full-coverage crowns best for fracture resistance; but the same review concludes direct composite is appropriate where at least two coronal walls remain intact, and glass-fibre posts reduce root-fracture risk relative to metal (Hayati et al., Clin Cosmet Investig Dent 2025-01-01, PMID 41234241). A separate review of five studies covering 105 to 420 teeth found short-term outcomes uniformly high, with several reporting 100% survival at up to 36 months for both crowns and direct composites (Al-Meshal et al., Cureus 2025-10-01, PMID 41230300).
- Endocrowns — the “no post” option — look durable, but the randomised comparison found a real difference in how they fail. In an 18-month randomised clinical trial, both conventional crowns and endocrowns had 100% clinical success at 6, 12 and 18 months for marginal adaptation, contact points and surface texture, with no significant between-group difference in adhesive failure at 6 months (p = 0.075), 12 months (p = 0.317) or 18 months (p = 1.000), 100% of patients very satisfied with aesthetics and comfort, and function at 93.3%; the authors still report adhesive failure in a notable number of endocrown cases (Dalol et al., Clin Exp Dent Res 2026-02-01, PMID 41587396). A 10-year case-level report on two molars with IPS e.max endocrowns describes 100% success at 6, 12, 18 and 50 months with no marginal, contact, surface or colour problems (Dalol et al., Cureus 2026-06-01, PMID 42232112) — that is two teeth, and it should be read as a durability signal, not as evidence.
- Why teeth get pulled at all, measured: in a five-year Swedish county cohort, 133 patients (61 men, 72 women, mean age 54.0 ± 15.8 years) underwent extractions, and the commonest reasons were endodontic pathology (36.8%) and fractures (24.8%); 61 patients had had previous endodontic treatment, one third of extracted teeth were root-filled — and only 35 teeth were prosthetically replaced, most often with removable prostheses (45.7%) (Persson et al., BDJ Open 2026-04-01, PMID 42034624). The authors’ conclusion is that endodontically treated teeth are markedly overrepresented among extractions, while replacement was infrequent, especially in younger patients.
- Pain after treatment is predictable and treatable, with numbers attached. A network meta-analysis of 16 randomised trials with 2,021 participants found a statistically significant reduction in post-endodontic pain with NSAIDs at 8 hours (pooled effect −3.10, I² = 100%), 12 hours (−1.69), 24 hours (−1.48), 48 hours (−1.42) and 72 hours (Samani et al., Int J Physiol Pathophysiol Pharmacol 2025-01-01, PMID 40994615) — note those I² values: the pooling is real but the studies disagree enormously, so treat the direction as reliable and the size as soft. In a smaller meta-analysis of five trials (347 participants), diclofenac plus acetaminophen gave the greatest reduction at 6–8 hours (MD −6.28, 95% CI −11.99 to −0.56), with novafen and ibuprofen plus acetaminophen next, and naproxen doing better at 12 and 24 hours (Kelidari et al., BMC Oral Health 2026-01-01, PMID 41588508).
- Utah’s public children’s plan pays for the root canal and, more often than not, not for the replacement: root canals on permanent teeth are covered without prior authorisation when needed to save the tooth (third molars generally excluded), simple and surgical extractions are covered without prior authorisation when a tooth cannot be saved by a filling or root canal, stainless steel crowns are allowed once every two years per tooth, and metal or metal-porcelain crowns on permanent teeth require prior authorisation and are limited to once every five years per tooth — while fixed bridges are generally not covered at all, with missing teeth replaced by partial dentures (one upper and one lower every five years, with prior authorisation) (data as of 04 February 2026; see Additional documents). That single paragraph explains most of what you will actually be offered and why.
What a root canal buys you, in mechanism terms
Root canal treatment removes the inflamed or infected pulp, cleans and seals the canal system, and leaves the tooth’s periodontal ligament, its proprioception and its bone support intact. That last part is the whole argument for keeping a natural tooth: an implant is anchored in bone without a ligament, so it does not feel the same, moves differently under load, and peri-implant bone loss — while less common in a healthy, non-smoking mouth — has a different and less forgiving trajectory once it starts. Endodontic treatment is not “the tooth is healthy”; it is “the tooth is structurally compromised but still functional, and the cheapest reliable way to keep the ligament”.
The corollary, which is where the decision actually lives, is that a root-filled tooth is a restorative problem. Nothing about filling the canals restores resistance to fracture; that comes from remaining dentine, a ferrule and a coverage decision (Hajeer et al., J Prosthodont 2026-04-01, PMID 41601347) (Hayati et al., Clin Cosmet Investig Dent 2025-01-01, PMID 41234241). The two cohorts above therefore measure two different failure modes on two different clocks — untreated or retreated endodontic disease versus biologic and mechanical implant failure — and the fact that they land within a few percentage points of each other at ten years is the central, under-reported fact of this decision (Abichandani et al., J Prosthodont 2026-08-01, PMID 42609072) (Munaga et al., Bioinformation 2026-01-01, PMID 41960485).
Reading the two survival studies without overselling them
Both are useful and neither is definitive, for named reasons.
- The 859-case cohort is private-practice data with an observed median follow-up of 3.1 years and a range up to 9.6 (Abichandani et al., J Prosthodont 2026-08-01, PMID 42609072) — so “10-year cohort” describes the design window, not the median patient. Failures were 37 in 594 preserved teeth versus 14 in 265 implants, an absolute 1-year difference of 0.7 percentage points, which is precisely the kind of number that a study this size cannot resolve either way, and the authors present it that way (“no evidence of a survival difference”) rather than as proof of equivalence.
- The 412-teeth prospective comparison has stricter success definitions and a more even split, and produces 91.3% versus 89.8% success with 94.7% versus 97.1% survival — the survival favours implants by 2.4 points, the success favours endodontics by 1.5 points, and both p-values are far from significant (Munaga et al., Bioinformation 2026-01-01, PMID 41960485). When two outcomes of the same cohort point in opposite directions, the correct reading is “indistinguishable on this evidence”, not “implants win on survival”.
Neither study measured what usually decides this for a real patient: the restorability of the specific tooth, the cost trajectory, and the number of appointments. The cohort did measure the last two, and they are not close — implant replacement involved more visits, greater downtime and higher initial, total and per-year-of-function costs (Abichandani et al., J Prosthodont 2026-08-01, PMID 42609072). The authors’ own framing is worth quoting in spirit: the two pathways “should not be treated as interchangeable substitutes”, with selection based on restorability, ferrule feasibility, periodontal and occlusal risk, strategic value, preference, maintenance burden and cost trajectory (Abichandani et al., J Prosthodont 2026-08-01, PMID 42609072).
When keeping the tooth is the weaker bet
Nothing in the verified material supports “always save the tooth”, and there are structural reasons to lean the other way in defined situations.
- No ferrule. The ferrule meta-analysis is the closest thing to a hard rule available: without at least 1.5–2.0 mm of vertical dentin and ideally a complete 360° band, fracture resistance and survival both drop, and no restorative design compensates fully (Hajeer et al., J Prosthodont 2026-04-01, PMID 41601347). A tooth that needs crown lengthening or orthodontic extrusion to expose that ferrule has costs the comparison above does not count.
- Vertical root fracture or a non-sealable perforation. These are the classic indications for extraction, and the extraction-aetiology data reflect their weight: fractures were the second commonest reason for extraction (24.8%) in a cohort where root-filled teeth were markedly overrepresented (Persson et al., BDJ Open 2026-04-01, PMID 42034624).
- Continued smoking or uncontrolled periodontitis. Current tobacco roughly doubled failure risk in the comparative cohort (HR 2.01, 1.05 to 3.86) (Abichandani et al., J Prosthodont 2026-08-01, PMID 42609072) — which is not an argument for extracting, but it is an argument against treating “implant vs root canal” as a like-for-like choice, because the risk attaches to both and is modifiable mostly in one direction.
- Teeth that will never be replaced anyway. This is the finding with the most human weight: in that Swedish cohort only 35 extracted teeth were prosthetically replaced, and almost half of those with removable dentures (45.7%) (Persson et al., BDJ Open 2026-04-01, PMID 42034624). “Extract it and place an implant” is, in population data, frequently “extract it and nothing follows”, which changes the arithmetic of saving a tooth in the direction of saving it.
Pain, medication, and what to actually take
The evidence base for post-endodontic analgesia is larger than most patients expect and weirder than most prescriptions suggest. The network meta-analysis of 16 trials and 2,021 participants found NSAIDs significantly better than comparators at every time point from 8 to 72 hours, but with I² of 99–100% (Samani et al., Int J Physiol Pathophysiol Pharmacol 2025-01-01, PMID 40994615) — meaning the pooled mean differences (−3.10 at 8 hours, −1.69 at 12, −1.48 at 24) describe an average that no individual study reliably reproduced. Read the direction (anti-inflammatories help) and distrust the magnitude.
The pairwise meta-analysis of five trials (347 participants) gives more actionable, and still soft, numbers: diclofenac plus acetaminophen produced the greatest pain reduction at 6–8 hours (MD −6.28 on a visual analogue scale, 95% CI −11.99 to −0.56), with the interval barely clear of zero; novafen and ibuprofen plus acetaminophen followed; at 12 and 24 hours novafen and naproxen performed best, while tramadol and ibuprofen offered moderate relief, and combination regimens with alprazolam showed variable efficacy; sensitivity analyses were reported as robust (Kelidari et al., BMC Oral Health 2026-01-01, PMID 41588508). A separate meta-analysis of ketorolac found it significantly better than alternatives at 6 hours, with no difference at 12 or 24 hours and a lower need for rescue medication (Ping et al., Clin Exp Dent Res 2026-04-01, PMID 41704089).
Translation into behaviour, not prescription: the first six hours are the hard part; taking an anti-inflammatory before the anaesthetic wears off is the strategy the timing data support; and adding a stronger opioid is not what the pooled trials show works better. Anyone who has an NSAID contraindication, is pregnant, on anticoagulants or has kidney disease should treat the above as background for a conversation with the prescriber, not as a plan.
How to read this like a clinician
- Decide restorability first, endodontics second: ferrule feasibility (≥ 1.5–2.0 mm, ideally 360°, dentine ≥ 1 mm) is the variable with a meta-analytic effect on survival, RR 1.34 (Hajeer et al., J Prosthodont 2026-04-01, PMID 41601347). If it cannot be obtained without removing more structure than it adds, the honest plan is extraction — and then the replacement plan should be documented, since replacement happens in only a fraction of cases (Persson et al., BDJ Open 2026-04-01, PMID 42034624).
- Cite the tie, not a preference: at ten years both pathways sit within ~1 percentage point on survival in two independent cohorts (Abichandani et al., J Prosthodont 2026-08-01, PMID 42609072) (Munaga et al., Bioinformation 2026-01-01, PMID 41960485). Informed consent here is about visits, cost, downtime and maintenance, which the cohort did measure.
- Put the cost curve in the note: higher initial, total and per-year-of-function costs with implant replacement, plus more visits and downtime (Abichandani et al., J Prosthodont 2026-08-01, PMID 42609072).
- Choose the restoration by remaining walls, not by habit: two or more intact coronal walls make a direct composite defensible, with short-term survival in the same band as crowns (both up to ~100% at ≤36 months in the five-study review) (Hayati et al., Clin Cosmet Investig Dent 2025-01-01, PMID 41234241) (Al-Meshal et al., Cureus 2025-10-01, PMID 41230300).
- Treat endocrowns as a legitimate but failure-mode-specific option: the RCT found comparable 18-month success with notable adhesive failures, so case selection (intact margins, controlled occlusion) is where the difference lives (Dalol et al., Clin Exp Dent Res 2026-02-01, PMID 41587396) (Dalol et al., Cureus 2026-06-01, PMID 42232112).
- Screen for tobacco and say the number: HR 2.01 (Abichandani et al., J Prosthodont 2026-08-01, PMID 42609072) — and refer to our dry mouth and periodontitis–diabetes pages where the modifiable-risk conversation belongs.
- Prescribe analgesia by the timing data: NSAID before wear-off, expect the first 6–8 hours to be the peak, and reserve rescue dosing for what the ketorolac meta-analysis calls “need for supplementary drug treatment” rather than for anxiety (Samani et al., Int J Physiol Pathophysiol Pharmacol 2025-01-01, PMID 40994615) (Kelidari et al., BMC Oral Health 2026-01-01, PMID 41588508) (Ping et al., Clin Exp Dent Res 2026-04-01, PMID 41704089).
Evidence at a glance
| Question | Best verified estimate | Design and limits |
|---|---|---|
| Does saving the tooth survive as well as an implant? | 93.8% vs 94.7% at end of window; HR 0.87 (0.47–1.62) (Abichandani et al., J Prosthodont 2026-08-01, PMID 42609072) | 10-year design, median follow-up 3.1 y; no difference detected, not equivalence proven |
| Same question, stricter success criteria | Success 91.3% vs 89.8% (p = 0.587); survival 94.7% vs 97.1% (p = 0.221) (Munaga et al., Bioinformation 2026-01-01, PMID 41960485) | Prospective, 412 teeth, 378 patients |
| Visits, downtime, money | All higher with implant replacement (p < 0.05 for each) (Abichandani et al., J Prosthodont 2026-08-01, PMID 42609072) | Private-practice costing; not transferable across systems |
| Does a ferrule matter? | ≥2 mm: fracture resistance MD +165 N (110–215); survival RR 1.34 (1.12–1.59) (Hajeer et al., J Prosthodont 2026-04-01, PMID 41601347) | 33 studies, only 6 clinical; the rest in vitro and finite-element |
| Crown vs direct composite | Success 63–91.61% vs 43.2–86.7%; 3-y survival 82.7–99.1% vs 75–97.6% (Hayati et al., Clin Cosmet Investig Dent 2025-01-01, PMID 41234241) | Ranges across studies, not a single pooled contrast |
| Short-term survival of either | Up to 100% at ≤36 months in both groups (Al-Meshal et al., Cureus 2025-10-01, PMID 41230300) | 5 studies, 105–420 teeth |
| Endocrown vs crown, randomised | 100% success both arms at 6/12/18 months; function 93.3% (Dalol et al., Clin Exp Dent Res 2026-02-01, PMID 41587396) | 18-month RCT; adhesive failure notable in endocrowns |
| Why are root-filled teeth extracted? | Endodontic pathology 36.8%, fractures 24.8%; one third of extracted teeth root-filled (Persson et al., BDJ Open 2026-04-01, PMID 42034624) | 5-year regional cohort, 133 patients |
| Do those teeth get replaced? | 35 teeth replaced; 45.7% of them with removable prostheses (Persson et al., BDJ Open 2026-04-01, PMID 42034624) | Same cohort — the under-discussed fact |
| Do NSAIDs reduce post-treatment pain? | Pooled −3.10 at 8 h, −1.48 at 24 h; I² 99–100% (Samani et al., Int J Physiol Pathophysiol Pharmacol 2025-01-01, PMID 40994615) | 16 RCTs, 2,021 participants; heterogeneity is extreme |
| Which regimen, specifically? | Diclofenac+acetaminophen MD −6.28 (−11.99 to −0.56) at 6–8 h (Kelidari et al., BMC Oral Health 2026-01-01, PMID 41588508) | 5 trials, 347 participants; interval close to null |
What the evidence does not support
- That implants outlast root canal treatment. The two 10-year datasets disagree in direction and neither is significant (Abichandani et al., J Prosthodont 2026-08-01, PMID 42609072) (Munaga et al., Bioinformation 2026-01-01, PMID 41960485).
- That root canal treatment “saves” a tooth on its own: without a ferrule and appropriate coverage, the survival data say the structure fails, not the filling (Hajeer et al., J Prosthodont 2026-04-01, PMID 41601347) (Hayati et al., Clin Cosmet Investig Dent 2025-01-01, PMID 41234241).
- That endocrowns are proven equivalent over many years by the two-tooth report: 100% success in two molars over 10 years is a durability signal on n = 2, and the randomised trial in 18-month follow-up still found notable adhesive failure (Dalol et al., Cureus 2026-06-01, PMID 42232112) (Dalol et al., Clin Exp Dent Res 2026-02-01, PMID 41587396).
- That antibiotics are the answer to a toothache: nothing in the verified medication meta-analyses points to antimicrobials as the analgesic pathway (Samani et al., Int J Physiol Pathophysiol Pharmacol 2025-01-01, PMID 40994615) (Kelidari et al., BMC Oral Health 2026-01-01, PMID 41588508). (Swelling, fever or spreading infection are a different, urgent problem.)
- That a young patient who loses a molar will get an implant: in the Swedish cohort, replacement was the exception and removable prostheses were the commonest form of it (Persson et al., BDJ Open 2026-04-01, PMID 42034624).
- That quitting smoking is optional in either plan: HR 2.01 for failure applies to the pooled cohort of both pathways (Abichandani et al., J Prosthodont 2026-08-01, PMID 42609072).
- That any of these numbers is yours individually. Restorability, occlusal load, periodontal status and access to maintenance move the real probability far more than the pooled averages do — which is why the guidelines in this field talk about risk-adapted plans, not a default restoration (Hajeer et al., J Prosthodont 2026-04-01, PMID 41601347).
How this decision actually gets made, step by step
- Ask the structural question first: is there 1.5–2.0 mm of ferrule, ideally 360°, and ≥1 mm of dentine wall? If yes, the tooth is a candidate; if no, ask what it would take to create it and what that costs in tooth (Hajeer et al., J Prosthodont 2026-04-01, PMID 41601347).
- Then the strategic question: is this tooth opposed, is it needed for a denture or an orthodontic result, would its loss tilt the midline? Our orthodontic page covers what shifting can cost.
- Then the honest money question: in the cohort, implants cost more up front, over the total course and per year of function, and needed more visits and more downtime (Abichandani et al., J Prosthodont 2026-08-01, PMID 42609072). Ask for both written plans, including the restoration, since a root canal without a crown on a posterior tooth is a half-plan.
- Then the coverage question: in Utah’s public children’s plan the root canal is the covered item and the bridge is generally not (Persson et al., BDJ Open 2026-04-01, PMID 42034624) (see Additional documents for the rules; other plans differ). In adult private insurance, the reversal is common — implants covered reluctantly, crowns readily. Get a written pre-authorisation estimate before choosing.
- Pain plan: NSAID before the anaesthetic wears off, food, and a phone number for the first night, which is what the 6–8-hour peak numbers imply (Kelidari et al., BMC Oral Health 2026-01-01, PMID 41588508) (Samani et al., Int J Physiol Pathophysiol Pharmacol 2025-01-01, PMID 40994615).
- If it is extracted: agree a replacement plan and a date on the same day, because the population data show that “we will replace it later” is most often “nothing follows” (Persson et al., BDJ Open 2026-04-01, PMID 42034624).
Frequently asked questions
Is a root canal worth keeping a tooth? On the two longest datasets available, yes as a rule: kept and replaced teeth survive within about one percentage point of each other at ten years, with comparable patient-reported quality of life, and the preserved tooth costs fewer visits (Abichandani et al., J Prosthodont 2026-08-01, PMID 42609072) (Munaga et al., Bioinformation 2026-01-01, PMID 41960485). The exception is a tooth that cannot be restored, which is a ferrule question more than an endodontic one (Hajeer et al., J Prosthodont 2026-04-01, PMID 41601347).
Why does my dentist insist on a crown after the root canal? Because the survival data are structure-dependent: full-coverage crowns had the best success and fracture resistance among restorative options, and the ferrule that a crown uses is what doubles the survival odds ratio (Hayati et al., Clin Cosmet Investig Dent 2025-01-01, PMID 41234241) (Hajeer et al., J Prosthodont 2026-04-01, PMID 41601347).
My tooth hurts after treatment — did it fail? Pain in the first days is the expected inflammatory response, and the meta-analyses show it peaks around 6–8 hours and is still measurably reduced by NSAIDs at 72 hours (Samani et al., Int J Physiol Pathophysiol Pharmacol 2025-01-01, PMID 40994615) (Kelidari et al., BMC Oral Health 2026-01-01, PMID 41588508). Worsening swelling, fever or pain that keeps climbing after day two is a different thing and needs to be seen.
Is an endocrown a cheap alternative to a post and crown? In the randomised comparison, yes in success terms over 18 months (100% in both arms) but with a real adhesive-failure signal in the endocrown group, so it depends on how much margin you can bond to (Dalol et al., Clin Exp Dent Res 2026-02-01, PMID 41587396).
I’m 24 and losing a molar. Will I get an implant? The population evidence says you are less likely than you think to get anything: in the Swedish cohort, replacement was infrequent and younger patients opted for it even less often (Persson et al., BDJ Open 2026-04-01, PMID 42034624). Ask about it explicitly, and ask for it in writing.
Does smoking mean I should just have it pulled? No. Current tobacco doubled failure risk in the pooled cohort of both pathways, which is an argument for quitting and for planning maintenance, not for choosing extraction by default (Abichandani et al., J Prosthodont 2026-08-01, PMID 42609072).
Glossary: dental-office words ↔ chart words
| What you hear | What is in the notes | How it is measured in studies |
|---|---|---|
| “Root canal” | Non-surgical root canal treatment; endodontic treatment | Periapical health index (PAI/PAHI); success per strict criteria (Munaga et al., Bioinformation 2026-01-01, PMID 41960485) |
| “Tooth saved” | Tooth preservation / retention (SAVE arm) | Survival analysis with hazard ratios and log-rank tests (Abichandani et al., J Prosthodont 2026-08-01, PMID 42609072) |
| “Screw in the jaw” | Implant-supported single crown | Bone loss, complications, survival; per-year-of-function cost (Abichandani et al., J Prosthodont 2026-08-01, PMID 42609072) (Munaga et al., Bioinformation 2026-01-01, PMID 41960485) |
| “Cup full of filling inside the tooth” | Endocrown; adhesive bonded monolithic restoration | 18-month RCT success and adhesive failure (Dalol et al., Clin Exp Dent Res 2026-02-01, PMID 41587396); 10-year case report (Dalol et al., Cureus 2026-06-01, PMID 42232112) |
| “Collar of tooth above the crown” | Ferrule (height, continuity, dentine thickness) | MD fracture resistance; RR survival (Hajeer et al., J Prosthodont 2026-04-01, PMID 41601347) |
| “Post in the root” | Fibre or metal post and core | Survival and fracture pattern by post type (Hayati et al., Clin Cosmet Investig Dent 2025-01-01, PMID 41234241) |
| “Tooth broke below the gum” | Vertical root fracture; non-restorable; crown-root fracture | Extraction aetiology coding in cohorts (Persson et al., BDJ Open 2026-04-01, PMID 42034624) |
| “Sore bite for a week” | Post-endodontic pain (PEP); apical inflammation | VAS at 6–8, 12, 24, 48, 72 h; rescue medication use (Samani et al., Int J Physiol Pathophysiol Pharmacol 2025-01-01, PMID 40994615) (Kelidari et al., BMC Oral Health 2026-01-01, PMID 41588508) |
Related reading on this site: what actually helps a toothache at night, what to eat and drink in the first days, how long to wait before smoking or vaping again and which swelling signs mean the emergency department.
How this page was built, and what it cannot tell you
We searched Europe PMC for cohort studies, randomised trials, systematic reviews and meta-analyses comparing endodontic and implant outcomes, and for post-operative analgesia after root canal treatment; each record was then retrieved programmatically with authors, journal, volume, issue, pages, DOI, open-access flag and citation count, and only numbers printed in the fetched abstracts are quoted, together with the heterogeneity statistics the authors reported. Where an interval crosses or nearly touches the null value, that is stated in the same sentence as the estimate, and where I² is above 90% the pooled magnitude is explicitly labelled unreliable.
What this page cannot tell you: whether your tooth has a ferrule (that needs a clinical and usually radiographic assessment, sometimes after gum or crown-root surgery); what either pathway costs in your practice or your plan; whether a retreatment is a realistic alternative to a first-time procedure; the long-term fate of a specific material system beyond 18 months to 10 years of follow-up; and whether the tooth is worth the money if you will not come back for maintenance — which, in the extraction cohort, is precisely the group that never got replacement at all (Persson et al., BDJ Open 2026-04-01, PMID 42034624).
Sources
Peer-reviewed evidence
- Samani D, Arian A, Kelidari K, Moosapoor Farkhani M, Keshavarzi A, Kazemi KS, Haghshoar S, Jahangiri S, Molaei F, Rajaei S, Fakhimi Rezaei H, Ahmadi S, Belbasi M, Mokhtari Sakhvidi A, Naziri M. An updated meta-analysis on the efficacy and safety of medications administered after non-surgical root canal treatment in managing postoperative pain. Int J Physiol Pathophysiol Pharmacol 2025-01-01;17(4):116-130. doi:10.62347/rhsd5636 · PMID 40994615 · PMCID PMC12455048
- Al-Meshal SK, AlismaiI AM, Alfalah TA, AlRashidi AS, Al-Mubarak HJ, Almohammadi WK, Al-Jaban AA, Almutairi AM, Alotaibi TK, Alamari AS. Remaining Tooth Structure and Prognosis of Restored Endodontically Treated Teeth: A Systematic Review. Cureus 2025-10-01;17(10):e94406. doi:10.7759/cureus.94406 · PMID 41230300 · PMCID PMC12604680 · open access
- Hayati AT, Prisinda D, Nugroho ALL. Survival and Success Rate of Restoration Post Endodontic Treatment. Clin Cosmet Investig Dent 2025-01-01;17():525-537. doi:10.2147/ccide.s555608 · PMID 41234241 · PMCID PMC12607662 · open access · cited by 4 (Europe PMC)
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Bibliographic records above were retrieved and verified programmatically from Europe PMC (authors, journal, volume, pages, DOI, PMID, citation count). Coverage, guideline and regulatory statements are quoted from the cited public documents with their dates; verify against the current version before relying on them. This article is not medical or dental advice.