Understanding the Causes and Management Strategies of Root Canal Treatment Failure

Root canal treatment (RCT) aims to eliminate infection and preserve the natural tooth, but failure may occur due to persistent or secondary infection, inadequate cleaning, missed canals, or coronal leakage. Microbial persistence within complex canal anatomies and procedural errors, such as underfilling or perforation, are the most common causes. Diagnosis involves clinical evaluation and radiographic assessment to detect periapical pathology or incomplete obturation. Management depends on the underlying cause and includes non-surgical retreatment, surgical endodontics (apicoectomy), or extraction in non-restorable cases. Advanced imaging, magnification, and biocompatible sealers have improved success rates. Effective prevention relies on meticulous asepsis, proper canal instrumentation, and high-quality coronal restoration to ensure long-term tooth preservation.