ROOT CANAL TREATMENT FAILURE AND RETREATMENT OUTCOMES IN PESHAWAR, PAKISTAN: A CROSS-SECTIONAL ANALYSIS OF CONTRIBUTING FACTORS

Abstract

Root canal therapy (RCT) is an used and generally effective treatment for conditions like irreversible pulpitis and pulp necrosis. However with its success rate, a noticeable number of treated teeth still fail. These failures often result from infections inside the root canal mistakes made during the procedure or leakage around the tooth’s crown. Objective This study aimed to look at what factors—like the type of dentist the tooth involved or the patient’s background—are linked to RCT failure in patients in Peshawar. It also wanted to find out what patients would prefer if their root canal treatment didn’t work: to try or to have the tooth removed. Methods The research was carried out over six months from February to August 2025. It took place at three dental centers in Peshawar: Northwest General Hospital, Lady Reading Hospital and the Dental Clinic of the Sarhad Institute of Allied Health Sciences. A total of 377 patients who had previously undergone RCT were interviewed using a questionnaire. The questions covered things like the patient’s age, gender, the dentist who treated them, the type of tooth the details of the treatment and what they would do if the root canal failed again. The data collected were analyzed using SPSS version 26 with statistics such as frequencies and percentages used to describe the findings. Results The results showed that root canal treatments done by dental practitioners (GDPs) failed much more often than those done by specialists. Specifically, 81.72% of RCTs performed by GDPs failed, compared to 17.74% of those done by specialists. When looking at teeth maxillary molars had the highest failure rate at 32.79% followed by maxillary premolars at 25.26% and mandibular molars at 20.43%. Mandibular canines had the failure rate at just 1.61%. The main reasons for treatment failure were related to the side of the procedure. The common issues were missed or unfilled canals, which accounted for 27.41% of failures and underfilled canals, which made up 22.04%. Broken instruments inside the tooth were found in 6.45% of cases and overfilling—when material goes beyond the root tip—was seen in 4.83%. These latter two problems were less common. Overall nearly half of the patients (187 out of 377 or 49.6%) reported that their root canal treatment had not worked well.. When asked what they would do if it failed again 80.4% said they would choose retreatment instead of having the tooth extracted. Conclusion The study concludes that the experience of the dentist and how well the core steps of root canal treatment are followed are the factors in whether the treatment succeeds or fails. These steps include finding all the root canals, cleaning and shaping them properly filling them completely and sealing them well and making sure the tooth is properly restored on top. The study recommends that complex cases should be referred to specialists and that general dentists should get regular training to improve their skills and reduce failure rates in Peshawar.