Endodontic Treatment Outcomes And Failure Rates In Saudi Arabia: A Systematic Review

Abstract

Background: Success in endodontic treatment depends on biological control of infection and technical quality of preparation, obturation and restoration. Although international benchmarks report a success rate of 92–98% in teeth without apical periodontitis and 74–84% in teeth with pre-existing lesions. The outcomes reported from Saudi Arabia seem heterogeneous and often below the optimum standards, particularly in a non-specialist and training environment. Objective: To systematically synthesize the available randomized controlled trial (RCT) data on endodontic treatment outcomes and endodontic treatment failure determinants in Saudi Arabia, specifically regarding success, radiographic success, post-operative morbidity and treatment procedural factors that could influence endodontic treatment failure. Methods: A systematic review in accordance with the requirements of the PRISMA statement was conducted by searching in PubMed, Scopus and Google Scholar (2000-2026). For the purpose of this systematic review, only RCTs from Saudi Arabia were considered eligible. Goals of interest were treatment success, survival, failure, pain after surgery and quality of the procedure. Assessment of risk of bias was conducted by applying the RoB 2.0 tool provided by the Cochrane Collaboration. No meta-analysis was carried out. Results: There were six RCTs included in this study with three studies on permanent NSRCT with emphasis on long-term periapical healing ranging between 75.0 and 87.5%, with a survival rate of 83.3-100% on or after 2.5 years, with no significant differences between MTA and gutta-percha on long-term success in terms of periapical healing. However, there were a few studies showing significantly fewer cases of postoperative pain with the use of NSRCT compared with MTA, as examined in a large RCT with approximately 390 patients, whereby significant differences were noted in the pain rate but no difference in the mean VAS score. On the other hand, primary tooth NSRCT studies revealed that the rate of success after 12 months always reached above 94%, ranging from 97-100% with MTA, where there is an RCT on NSRCT showing significant differences in residual intracanal medicament with propolis compared with CH, indicating possible mechanistic evidence on success and possible leakage with potential risk of failure due to its lower residual value of 23.2% compared with 38.6% (p = 0.001). Risk of bias assessment revealed Conclusions: Randomized data from Saudi Arabia indicate favorable short-term results in pediatric pulpotomy and satisfactory but inconsistent results for permanent tooth NSRCT. Deviation from global success criteria was most likely due to technical causes rather than material considerations alone. Improved standardization of procedural excellence, canal recognition and achievement of standard results is crucial for significant success rates for the population.