Told you need an extraction? Modern root canal care may save the tooth.

Not long ago, a tooth with a failed root canal, a deep infection or a crack was often simply removed.

Better imaging, magnification and materials have changed that. Many of those teeth can now be kept, and kept working for years.

The question is no longer only whether a tooth is damaged. It is whether the damage can be treated predictably, and that is what a careful exam shows.

What is a root canal, and how does it save a tooth?

A root canal treats the soft tissue inside a tooth, called the pulp, when it becomes infected or badly inflamed.

The infected tissue is removed, the canals inside the root are cleaned and shaped, and they are sealed. A filling or crown then protects the tooth from breaking.

The tooth keeps its own root, its feel when you bite, and the bone around it.

Why were these teeth traditionally extracted?

Older techniques had real limits. Flat, two-dimensional X-rays could miss extra canals, cracks and the true size of an infection.

Surgery at the root tip was done without magnification and succeeded far less often. In a meta-analysis by Setzer and colleagues, the traditional technique succeeded in about 59% of cases, compared with about 94% for modern microsurgery.

With odds like the older ones, extraction often seemed the safer advice. With today’s methods, the same tooth may be worth saving.

What modern methods can save a tooth?

These are the main methods dentistry now uses to keep teeth that were once routinely extracted.

• 3D CBCT imaging. A cone-beam scan shows the root, the bone and any infection in three dimensions, including canals and cracks that flat X-rays can miss. We take CBCT scans in our own office.
• Root canal retreatment. When an earlier root canal has failed, the old filling is removed and the canals are cleaned and sealed again. A 2015 meta-analysis found an overall success rate of about 80%.
• Endodontic microsurgery (apicoectomy). When retreatment isn’t enough, the infected tip of the root is removed through a small opening and sealed, under a microscope. Modern microsurgery succeeded in about 94% of cases in a meta-analysis.
• Pulpotomy (vital pulp therapy). Instead of removing all of the pulp, only the inflamed part is removed and the healthy part is protected. Studies of painful, inflamed adult teeth report clinical success of about 94% at three years, though the evidence is still developing.
• Crown lengthening or orthodontic extrusion. When a tooth breaks at or below the gumline, the gum and bone can be reshaped, or the tooth gently moved up, so a crown has enough healthy tooth to hold onto.
• Crowns for cracked teeth. Many cracked teeth can be held together with a full or partial crown. In a national study that followed cracked teeth in everyday dental practices, over 98% were still in place after three years.
• Intentional replantation. In selected cases, a tooth is gently removed, treated outside the mouth and put back in the same visit. A systematic review found about 88% of replanted teeth survived.

Not every method suits every tooth. Your written plan explains which of these fit your case, and how and where each step would be done.

Which problems can be treated instead of extracted?

What does a root canal cost compared with an implant in NYC?

At US average fees, a root canal and a porcelain crown together cost about $2,400–$2,700, compared with about $4,344 for a standard implant. Manhattan fees generally run above national averages.

Sources: CareCredit, based on ASQ360° cost studies, 2023–2024; Pearl Dental Costs (apicoectomy), based on ADA fee survey data, May 2026.

A tooth that needs several steps can approach the cost of an implant. Your written plan shows the cost of saving the tooth and of replacing it, side by side.

How long does a root-canal-treated tooth last?

About 95% of root-canal-treated teeth were still in place after four years in a prospective study by Ng, Mann and Gulabivala. That included teeth treated for the second time.

Over the long term, well-restored root-canal-treated teeth and single implants survive at similar rates, about 94% and 96% in a systematic review led by Mahmoud Torabinejad.

How long your tooth lasts depends on your own dental condition. The same study found these factors mattered most:

• A proper crown or onlay rather than a temporary filling.
• Neighboring teeth on both sides to share the load.
• Healthy gums without deep pockets around the tooth.
• General health, including well-controlled diabetes.

We assess each of these at your consultation and tell you what we expect for your tooth.

When can’t a tooth be saved?

Some teeth can’t be saved predictably. Common reasons are a crack that runs deep down the root, severe bone loss that leaves the tooth loose, or too little healthy tooth left to hold a crown.

If that is your situation, we will tell you plainly, show you why on your own images, and plan the replacement with the same care.

Why get a second opinion before an extraction?

Because an extraction can’t be undone, and a second look often changes the plan. Our approach is comprehensive and conservative: we examine the whole mouth, not only the tooth in question, and we start with the least invasive option that can work.

An in-person second-opinion visit at Shin Dental takes about 60 minutes.

1. Examination. Dr. Shin examines the tooth in question and every other tooth, filling and crown.
2. Imaging. X-rays, and a 3D CBCT scan in our office when it’s needed.
3. Gums and bite. Healthy gums and an even bite are what keep a saved tooth working.
4. A written plan. Your options, the order of treatment and the exact fees, including what it would cost to save the tooth and to replace it.

The visit is $150, credited toward treatment if you begin with us. If you can’t come in yet, a 30-minute video consultation is available. Read more in our guide to second opinions.

Why do patients trust Dr. Shin and his team?

Dr. Shin has saved hundreds of teeth that patients had been told to remove.

Dr. Peter Shin grew up watching his father practice dentistry. He runs his own practice the same way: unhurried appointments, clear explanations, and treatment planned around what will last.

• Training: DDS from the New York University College of Dentistry, an Advanced Education in General Dentistry (AEGD) residency at NYU, and live-surgery implant training.
• Clear costs: every recommended treatment comes with an itemized cost breakdown, reviewed with you in person before anything starts.
• No surprise bills: once treatment is complete, you will not owe anything beyond what was disclosed beforehand.
• Insurance: we are an out-of-network provider for PPO plans, file your claims for you, and can request a pre-determination of benefits before you commit.

“It was clean office with friendly staffs. I did feel very comfortable during the treatment and doctor explained all information that I have to know in detail. I'm highly satisfied and will recommend to my friends and visit again!”

Where is Shin Dental?

• Address: 30 Central Park South, Suite 11D, New York, NY 10019, between Fifth and Sixth Avenues in Midtown Manhattan.
• Subway: 5 Av/59 St (N, R, W) is a one- to two-minute walk. The F stops at 57 St and Sixth Avenue, about four minutes away.
• Bus: the M5 stops at Central Park South and Sixth Avenue.
• Hours: Monday to Friday, 9:00 AM – 7:00 PM. Saturday, 9:00 AM – 1:00 PM. Closed Sunday.
• Phone and text: (917) 773-1353.

Questions patients ask

This article is general information, not a diagnosis. Fees and how long treatment lasts depend on each patient’s dental condition, which Dr. Shin assesses at your consultation. US and New York figures are published averages and estimates, shown for comparison only. Individual results vary.