Hello, I can understand your concern. With Root Canal treatment, the decayed tooth is disinfected of debris and infection till the end of the root and is sealed at the root end and from above so that there is no place for the bacteria to enter the tooth again and cause infection. However, when a vertical crack develops in the tooth, even if the root canals are properly disinfected and filled, there will be micro-seepage of fluid in the tooth which will bring bacteria along with it and the tooth will never actually heal. So in vertically cracked tooth, extraction is the only option for permanent relief. I would explain a normal mechanism of the teeth in mouth. Our teeth are in contact with each other and with the teeth on the opposite arch because there is no place for them in the arch to move. Teeth are in constant micro-movements. Now, when a tooth is extracted, the adjacent teeth and the opposing tooth start to move in the direction of the unfilled space left by the extracted tooth. Thus, the adjacent teeth migrate in a way that chewing becomes difficult and the upper tooth starts growing in the area where the lower tooth should be situated. In addition, first molar is a very important tooth for chewing and it should be replaced for better chewing efficiency. You can decide to get an implant or making a bridge based on the expense you want to have on the treatment. I hope this information helps you. Thank you for choosing HealthcareMagic. Take care. Best, Dr. Viraj Shah