Depending on the severity and type of injury or infection in the tooth, there may be alternatives to root canal treatment. These options may include:

• Tooth extraction. Pulling the tooth. In certain facial and dental trauma cases, it may be impossible to save the tooth. Patients may insist on pulling the tooth because they fear root canal procedures or cannot afford to pay for the procedure. In general, pulling the tooth is avoided whenever possible because it opens the door for other problems such as misaligned or shifting teeth, gum recession and bite obstructions (malocclusion). The patient will need bridges, partial dentures or implants to replace the extracted tooth.
  
  
• Pulp capping. Placing a medicated dressing over exposed pulp. This is performed when a child’s primary teeth (baby teeth) are cracked or fractured leaving the pulp exposed. This saves the baby tooth so the permanent tooth can grow in normally. Pulp capping can also be used on adult teeth that have fractured crowns or crown/root fractures.
  
  
• Pulpotomy. Removing the part of the pulp that is dead (necrotic) and leaving the vital portions in the canal. This is typically performed on primary or permanent teeth where cracked or fractured teeth or roots cause death of some of the pulp tissue.

There is risk of failure in both pulp capping and pulpotomies because the procedures may not prevent further pulp necrosis. In that case, a root canal treatment would still have to be performed.

A variation of the root canal treatment involves gum surgery that is performed after a root canal has failed and infection recurs in the root’s tip (apex). When that happens, the endodontist performs an apicoectomy (endodontic microsurgery). This is also called a root end resection or root resection. An incision is made in the gums to open a flap near the infected root tip. The infected tissue is removed along with the root tip. A sealant is used to close the tip and the patient’s gums are sutured back together.