Pattern Of Endodontic Treatment Failure In South Eastern Region Of Uttar Pradesh- A Retrospective Study

RESULT-

A total of hundred root canal treated teeth records were assessed of which 58% percent belongs to male and 42% were females. The selected patients were divided into three age groups, group 1) 18-25 years, group 2) 26 -35 years and group 3) ≥ 36 years.

Group1) comprised 20% of the patients, Group 2) 25% of the patients and Group 3) 55% of the patients. Out of hundred cases 27% had periapical pathology 31% had under-obturation,12% had over-obturation, 5% had crown fracture, 4% had instrument fracture, 6% had an untreated canal due to abnormal anatomy, 2% had an overextended crown, 3% had perforation, 3% had obturation with periapical pathology,1% had unusual anatomy, 1% had fractured crown and fractured instrument, 2% had an untreated canal with periapical pathology, 1% had instrument fracture and periapical pathology, and 2% had fractured crown and periapical pathology.(table 3)

 Eighteen teeth (18%) were in the upper right quadrant, 30 (30%) in the upper left quadrant, 29 (29%) in lower left quadrant and 23 (23%) in the lower right quadrant. (table 4)

The most commonly affected tooth in males is the upper right quadrant the1^st molar (75%), the upper left quadrant is the 2^ndmolar (75%) and the lower quadrant is 1^st molar (41.7% in the lower right quadrant and 42.9% in the lower left quadrant). In contrast females showed involvement of the first molar in the upper quadrant as well as the lower quadrant. (UR- 25%, UL- 57%, LR-58%, LL- 60%).

The common cause of RCT failure in both male and females was under observation that is males 20% female 11% a total of 31% is this is followed by Barrier Packer pathology that is 27% then over observation that is 12% the Chi Square value for gender versus reason of RCT failure is 18.451 and the P value was equal to 0 .141 which is statistically not significant. The most commonly involved quadrants in male and female are the upper left and lower left quadrants respectively. The upper left quadrant involved 32.8% of males and 26.2% of females and the lower left quadrant involved 24.1% of males and 35.7% of females. The chi-square value for sex vs quadrant involved in RCT failure was 3.29 and the P value was 0.349 which was not statistically significant. In the case of age range vs reason of failure, the common reason for our city failure is 40% and it occurs mostly in age group three that is 36 years and above. The chi square value is 25.26 and the P value is equal to 0.504 which is not statistically significant. (TABLE – 5).

In the case of age range vs quadrant involved in this age group three were more commonly affected than in the other groups. The upper left quadrant (32.7%) and lower left quadrant (30.9%) were most commonly involved with the chi-square value of 2.480 and P value of 0.871 which was not statistically significant. (table 6)

DISCUSSION

The present study analysed the different causes and patterns of root canal treatment (RCT) failure in a sample of 100 patients. Demographic analysis revealed a male predominance (58%) over females (42%), with the highest incidence of RCT failure observed in the age group of 36 years and above (55%). Notably, the association between sex and reason for RCT failure was not statistically significant (p = 0.141), suggesting that technical or anatomical factors may play a more influential role than sex in treatment failure.

This could be attributed to cumulative dental issues with advancing age, including calcification of the canals, anatomical variations, and delayed dental care, which may complicate endodontic procedures and compromise treatment outcomes. The primary cause of RCT failure was under-obturation (31%), followed by periapical pathology (27%) and over-obturation (12%). These findings highlight the importance of proper working length determination and obturation quality as critical factors influencing the success of endodontic treatment.

The quadrant-wise distribution revealed that the upper left quadrant (30%) and lower left quadrant (29%) were the most frequently affected sites, with the first molar being the most commonly involved tooth across both sexes. In males, the upper right 1st molar and upper left 2nd molar were most frequently affected, whereas in females, the first molar was the most commonly involved tooth in all quadrants. This suggests that molars are more prone to endodontic complications due to their complex anatomy and higher occlusal load. Although the Chi-square values for associations between sex, age, and quadrant involvement with reasons for RCT failure were not statistically significant (p > 0.05), the trends observed provide valuable clinical insights. The high failure rate in patients above 36 years of age and in posterior teeth underscores the need for meticulous treatment planning, advanced imaging, and possible referral to endodontic specialists in complex cases.

Endodontic treatment is often perceived as successful when the treated tooth is asymptomatic. However, the absence of pain does not necessarily equate to the successful healing or resolution of the underlying pathology. As Seltzer (1988) emphasized, the term "adequate clinical function" is more appropriate, as the primary goal of endodontic therapy is to maintain the tooth in a functional condition over the long term.

Various criteria have been proposed for determining success or failure, including clinical signs, radiographic evidence, and histological outcomes. Clinically, persistence of symptoms such as pain and swelling, even in the absence of radiographic abnormalities, can indicate failure. Radiographically, the development or progression of periapical rarefaction following treatment is a key indicator of treatment failure (Bender et al., 1964; Seltzer et al., 1963).

Histologically, even in cases that appear successful both clinically and radiographically, unresolved inflammation or lesions may still be present. This disconnection between histological and clinical outcomes further complicates the assessment of endodontic success (Seltzer et al., 1963). The timing of the failure varies considerably. While most failures tend to occur within the first two years after treatment, some may not manifest until a decade or later. Therefore, a follow-up of at least two years is recommended for accurate assessment, especially in cases without initial periapical pathology.

Endodontic failure can arise due to preoperative, operative, and postoperative factors. Preoperative issues include incorrect diagnosis, undetected endo-periodontal lesions, or systemic conditions affecting healing. Operative factors such as anatomical variations, poor debridement, use of inadequate aseptic techniques, and technical errors such as over- or under-extension of fillings are the most commonly implicated causes of failure. Postoperative causes include persistent infection, improper restorative procedures, and failure following surgical intervention.

Numerous studies support these findings. Grossman (1972) reported that failure was largely due to technical inadequacies and poor treatment planning. Ingle (1985) grouped the causes of failure into three main categories: apical perforations, operative errors, and poor case selection. Ray and Trope (1995) demonstrated that both the quality of root canal fillings and subsequent restorations significantly influence long-term success.

Almakrami et al. (2018) suggested that endodontic failure depends on the skill of the person who performed an RCT. Almeshari et al. (2018) suggested that posterior teeth had higher failure rates than anterior teeth due to underfilling and Ni-Ti rotary instruments are better in RCT treatment and less iatrogenic.

Mustafa et al. (2019) found that the first molars were the most commonly affected teeth in cases of failure of endodontic treatment. Poor adjunctive treatment and inadequate filling of the root canals were the most common causes of endodontic failure, and were more commonly seen in male than in women. Most of the failure cases were found in the age group of 26–45 years

Carmen et al., 2020 suggested that the maximum period between RCTs and the placement of coronal restorations was 2 weeks, the instrumentation technique used in RCT, whether manual or rotary, may also influence its outcome, It is generally considered as “adequate” if the gutta percha filling extends 0–2 mm from the radiographic apex, teeth with a favorable coronal restoration have a 1.82 times higher probability of success than an unfavorable restoration. Greater periapical lesion size was negatively associated with healing.

Mohsen et al. (2020) found that endodontic treatment failures mostly occur in under filled root canals, followed by coronal leakage. Premolars had a higher failure rate than anterior and molar teeth. Laukkanen et al., 2021 found that RCTs were more likely to succeed in non-molars, teeth with optimal root fillings and teeth without apical periodontitis. Improvement in the quality of RCTs by GDPs is needed.

Rao et al., 2023 found that the maximum primary root canal treatment failure was noted in molars, quality of obturation is a prognostic factor determining endodontic treatment outcome, and endodontic treatment failures mostly occurred in under-filled root canals and poorly sealed post-endodontic coronal restoration, along with periapical radiolucency.

Ahmad et al., 2024 suggested that mandibular first molars had the highest endodontic treatment failure rate. Poor coronal seal and underfilled root canal caused most root canal failures. Jang et al., 2024 found that the presence of untreated additional canals was a predictor of endodontic failure within 5 years of initial root canal treatment.

CONCLUSION

In conclusion, this study emphasizes that technical factors such as obturation quality and anatomical challenges are predominant contributors to RCT failure. Ultimately, a multidisciplinary approach that includes thorough diagnosis, meticulous operative techniques, and well-executed restorative procedures is critical for minimizing endodontic failure. Continued research and adherence to evidence-based protocols remain essential for improving the outcomes of root canal therapy. Future studies with larger sample sizes and prospective designs are warranted to validate these findings and to develop targeted interventions to reduce endodontic failures.

REFERENCES

1. Mustafa M, Almuhaiza M, Alamri HM, Abdulwahed A, Alghomlas ZI, Alothman TA, et al. Evaluation of the causes of failure of root canal treatment among patients in the City of Al-Kharj, Saudi Arabia. Niger J Clin Pract 2021;24:621-8.
2. Fornari VJ, Silva Sousa YT, Vanni JR, Pécora JD, Versiani MA, Sousa Neto MD. Histological evaluation of the effectiveness of increased apical enlargement for cleaning the apical third Of curved canals. Int Endod J 2010;43:988 94.
3.  Mangat P, Tomer AK, Muni S. Three dimensional Obturation “Thrill to fill”. Int J Oral Care Res 2016;4:25 8.
4.  Tewari R, Mishra S, Sharma S, Kharade P. Nonsurgical endodontic retreatment: A case of dental quackery. Int J Exp Dent Sci 2012; 1:34 6.
5.  Chaurasiya S, Yadav G, Tripathi AM, Dhinsa K. Endodontic failures and its management: A Review. Int J Oral Health Med Res 2016; 2:144 8.
6.  Mustafa M, Saujanya KP, Jain D, Sajjanshetty S, Arun A, Uppin L, et al. Role of calcium hydroxide in endodontics: A Review. Glob J Med Public Health 2012;1:66 70.
7. . Peciuliene V, Maneliene R, Balcikonyte E, Drukteinis S, Rutkunas V. Microorganisms in root canal infections: A review. Stomatologija 2008; 10:4 9.
8.  Bamise CT, Dada B, Gureje GA. Analysis of extracted and retreated root Canal treatment failures in a Nigerian university teaching hospital. Clin Pract 2015;4:12 7.
9. Naik M. Root canal failure demystified. Int J Curr Res 2017;9:50506 10.
10. Saeed HMM, Talabani RM, Gharib DSH, Khursheed DA, Mohammad KM, Noori AJ, et al. Cross –Sectional analysis for reasons of failure in endodontic treatment. IOSR J Dent Med Sci 2015; 14:53 5.
11. Damman D, Grazziotin Soares R, Farina AP, Cecchin D. Coronal microleakage of restorations with or without cervical barrier in root filled teeth. Rev Odonto Cienc 2012;27:208 12.
12. Gillen BM, Looney SW, Gu LS, Loushine BA, Weller RN, Loushine RJ, et al. Impact of the quality of coronal restoration versus the quality of root canal fillings on success of root canal treatment: A systematic review and meta analysis. J Endod 2011;37:895 902.
13. Endang S, Ratna M. Comparison of two electronic root canal length measurement devices: The differences between ratio two impedance frequencies and multi frequencies. Open J Stomatol 2014;4:263 267.
14. Akbar I. Radiographic study of the problems and failures of endodontic treatment. Int J Health Sci (Qassim) 2015;9:111 8.
15. Gautam S, Thapa A, Rajkumar B. Reasons for failure of nonsurgical root canal treatment in Nepali population. Nepal Med Coll J 2012;14:142 5.
16. Mustafa M, Mahmood S, AlJeaidi ZA. An analysis of root canal treatments in student clinics of a Saudi University. J Pak Dent Assoc 2016;25:67 70.
17. Tabassum S, Khan FR. Failure of endodontic treatment: The usual suspects. Eur J Dent 2016;10:144 7.
18. Giuseppe C, Elio B, Arnaldo C. Missed anatomy: Frequency and clinical impact. Endod Topics 2009;15:3 31.
19. Kielbassa AM, Frank W, Madaus T. Radiologic assessment of quality of root canal fillings and periapical status in an Austrian subpopulation – An observational study. PLoS One 2017;12:e0176724.
20. Mustafa M, Alaajam WH, Azeim AA, Alfayi NA, Alqobty RM, Alghannam S. Diffusion of calcium hydroxide through dentinal tubules of retreated root canals: An in vitro study. Eur J Dent 2018;12:386 92.
21. Khan SQ, Khabeer A, Al Harbi F, Arrejaie AS, Moheet IA, Farooqi FA, et al. Frequency of root canal treatment among patients attending a teaching dental hospital in Dammam, Saudi Arabia. Saudi J Med Sci 2017;5:145 8.
22. Harish Babu P , Sameer P , Jamila H. Early Failures in Root Canal Treatment: A Systematic Review and Meta-Analysis. AMMS J 2025;04: 288 – 296.