Prevalence and Associated Factors of Endodontic Treatment Failure among Patients in Saudi Arabia

Abstract

Introduction: Endodontic treatment failure is one of the most common challenges in dentistry. Root canal therapy
aims to eliminate bacterial infection and preserve natural teeth, with reported success rates ranging from 86% to
98%. However, treatment failure can still occur due to multiple factors, most notably missed canals, especially in
molars with complex root anatomy. Other common causes include open apices, inadequate obturation, and persistent
periapical radiolucency. Studies from Saudi Arabia have associated treatment failures with technical errors, operator
inexperience, and limited utilization of advanced imaging modalities, such as cone-beam computed tomography.
Despite observed high failure rates in some areas, national-level data remains limited, and few studies have
explored patient-centered aspects, such as symptoms, satisfaction, and follow-up care. This underscores the need
for research evaluating the prevalence and contributing factors of endodontic treatment failure using structured,
patient-focused questionnaires. Objectives: This study aims to evaluate the self-reported prevalence of endodontic
treatment failure among patients in Saudi Arabia based on their symptoms, personal experiences, and perceived
treatment outcomes. It also seeks to identify patient-reported factors associated with perceived treatment failure,
including pain persistence, swelling, and treatment satisfaction. Materials and Methods: A cross-sectional study
was conducted in Saudi Arabia between July and December 2025 using a structured questionnaire distributed
online via social media platforms. The target population included both Saudi citizens and residents, male and
female, aged 18 years or older, who had previously undergone non-surgical root canal treatment and agreed to
participate by completing the questionnaire. Participants were excluded if they were under 18 years of age, non
residents of Saudi Arabia, or declined to participate. 384 was the minimum sample size of participants to achieve
a 95% confidence level with a 5% margin of error.