When root canal fails: Tooth extraction as a last resort

tooth extraction as the last resort
Root canal treatment is a highly successful procedure that can save teeth from extraction for many years. According to numerous studies, the survival rate of root canal teeth can be as high as 97% within 8 years.

However, the not-so-good news is that the risk of eventually extracting root canal teeth is still present, increasing on average by 1-2% per year.

In this article, we will explore why root canal teeth may need to be extracted in the future and what to expect during and after the extraction process.

How do I know if a root canal has failed?

Root canal failure means that the root canal treatment was not able to heal the tooth or an infection has returned.

Pain is one of the most common symptoms of root canal failure. If you suddenly experience pain or if your tooth continues to hurt even months after the treatment, it's a sign that something is wrong.

However, not all cases of root canal failure have immediate symptoms.

Sometimes an infection may develop silently around the tooth for a long time without causing any pain or discomfort. In such cases, only an X-ray can reveal it.

This is why regular check-ups with your dentist are essential to detect these asymptomatic complications in their early stages.

When extraction of a tooth with a failed root canal is the last resort?

When root canal treatment fails, we always try to save the tooth by giving it a second chance through retreatment or surgery. However, there are situations where the tooth cannot be saved, and extraction becomes the only option.

Unlike what you might think, the root canal itself is the least to blame. The most common causes that can lead us to extract teeth with a failed root canal treatment are:

1. Lack of restoration:

Many studies have shown that teeth without proper restoration after root canal treatment are more likely to be extracted than those that do.

One study showed that teeth without restoration after root canal treatment are three times more likely to be extracted later than restored teeth.

Another study showed that delaying restoration for more than 60 days after treatment significantly increases the risk of extraction by 73%.

Therefore, it is essential to protect a root canal tooth with a crown or other restoration as soon as possible to prevent complications that may lead to tooth loss.

2. The tooth is too damaged:

When the tooth is too damaged to support a crown or filling, extraction may be the only option. This can be due to extensive decay, fracture, or advanced gum disease with severe bone loss.

3. Root fracture:

During root canal treatment, part of the tooth structure is removed, making the roots more brittle and increasing the risk of fracture. Unfortunately, this type of injury is difficult to repair, making extraction sometimes necessary.

4. Tooth decay:

According to one study, subgingival decay, which extends under the gum line, is the most common cause of the extraction of molar teeth with root canal treatment. So, maintaining optimal oral hygiene is essential to prevent decay and increase the lifespan of root canal teeth.

5. Persistent infection:

If the tooth continues to reinfect even after root canal retreatment or surgery, extraction may be the only remaining option.

Is extracting a root canal tooth any different from a regular tooth extraction?

After several attempts to save a tooth, you and your dentist may come to the difficult decision to extract it.

When it comes to a tooth that has undergone a root canal, the procedure can be challenging.

If the tooth is strong enough and can be held by the extraction instruments without breaking, the procedure can be simple and quick with little risk of fracture and complications.

simple extraction technique step by step

Simple extraction technique

However, if the tooth is crowned or has a post (a kind of artificial root that fits into the root canals), the risks of fracture during the procedure are higher.

Tooth with post-and-core crown

In this case, your dentist or surgeon may need to use specialized techniques to remove the tooth. These include removing some of the bone surrounding the tooth to make it looser and easier to extract. Your dentist may also use another technique called "sectioning" where the tooth is divided into two or more pieces.

These complex techniques require some experience and may cause more post-operative pain than simple extractions. So it is recommended to consult a specialist (an oral surgeon) in case the extraction turns out to be difficult.

Healing after failed root canal extraction:

The good news is that the healing process after a root canal tooth extraction is similar to that of a normal tooth.

Initially, a blood clot will form within the first two days. Over time, this clot will transform into granulation tissue, which provides support for bone and gum regeneration.

Within a few weeks, the bone will start filling the empty socket while the gum covers the wound.

After about 2-3 months of healing and tissue maturation, you can receive your implant.

Here are some things to consider if you have chosen the implant solution:

  • It's crucial not to delay treatment. Without the tooth to stimulate the bone, it will start to collapse rapidly in the first year. So immediate implant placement is necessary.

  • If your jawbone was already weak before the extraction, you can request a bone graft at the same time as the extraction to prevent further resorption, which could make implant treatment impossible.

  • Alternatively, if you want to avoid the healing time that can take up to three months, you can ask for an immediate implant. This procedure involves placing an implant right after extracting the tooth, saving you time and preventing bone loss, a common issue after tooth extraction.

The potential complication of root canal tooth extraction:

The potential complications of root canal tooth extraction are quite low if the procedure has gone well and you follow your dentist's post-operative instructions carefully. However, here are some possible complications to be aware of:

Dry socket:

This occurs when the blood clot that normally forms in the extraction socket is disturbed or dislodged, exposing the underlying bone. This condition usually appears 2 to 3 days after the procedure, causes intense pain, and delays healing.

To prevent dry socket, avoid smoking, drinking through a straw, or doing anything else that creates suction in the mouth for the first few days after the extraction.


This complication can occur if the dentist doesn't properly remove all of the infected tissue in the socket where the root canal tooth was or if bacteria enter the open wound during the healing process.

Signs of infection include fever, persistent pain, and pus draining from the extraction site. If you suspect an infection, contact your dentist immediately.


Some bleeding is normal after an extraction, but if it persists or becomes heavy, contact your dentist immediately. They may need to place additional stitches to stop it.

Bone loss:

If the tooth has been missing for some time or the bone surrounding the tooth is already weak, the bone may start resorbing after extraction. This can make implant treatment impossible. So, it's important to discuss options for preventing bone loss with your dentist, such as a bone graft at the time of extraction.

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