Purpose: To conduct a systematic review regarding the outcomes, and beneficial and harmful effects of initial non-surgical endodontic care compared to extraction and placement of implant, fixed partial denture or extraction without tooth replacement. Methods: Electronic database searches as well as hand searches were performed based on specific inclusion and exclusion criteria. After assessing the quality of the articles and forming evidence tables, the mean success and survival rates, with associated confidence intervals, were calculated for initial non-surgical endodontic treatments, single tooth implants, and fixed partial dentures. The data related to extraction without tooth replacement was evaluated by a narrative review due to limited and varied information. Results: From over 13,000 titles initially reviewed, 143 articles were selected. Included studies varied considerably in definitions of success, methods of assessment, type of operators, sample size, and types and management of complications. Very few comparative studies were found. Short, medium or long-term success rates for dental implants were 3-11% higher than those for initial endodontic treatments and (15-21%) higher then for fixed partial dentures. At 97%, long-term survival was essentially the same for implant and initial endodontic treatments and was superior to extraction and replacement of the missing tooth with a fixed partial denture. Psychosocial data was limited; economic and biologic data was almost non-existent. Conclusions: Based on available evidence it appears that initial endodontic treatment has high long-term survival rate for periodontally sound teeth that have pulpal and/or periapical pathosis. Equivalent long-term survival rates have been also reported for extraction and replacement of the missing tooth with an implant-supported restoration. Substantially lower long-term survival rates have been reported for extraction and replacement of the missing tooth with fixed partial dentures. Clinical Implications. Within the limitations noted in this systematic review, it appears that single tooth implant should be incorporated in discussions as first alternative treatment options for patients who require extraction and replacement of a missing tooth.