<b>Pitfalls of the Pulp: An Analysis of the Causes of Root Canal Treatment Failure among Dentists in Pakistan</b>

Background: Root canal therapy (RCT) is an effective procedure for managing pulpal and periapical disease, with reported success rates up to 98%, though failures occur in 7–9% of cases due to technical, microbial, and iatrogenic causes (1–3). In Pakistan, where most RCTs are performed by general dentists with variable training and limited access to advanced technologies, the burden and causes of endodontic treatment failure (ETF) remain poorly characterized. Objective: To evaluate the prevalence, attributed causes, diagnostic tools, and management strategies for ETF among dentists in Pakistan. Methods: A descriptive cross-sectional survey was conducted between January and June 2023 among 240 dental practitioners, including house officers, general dentists, and postgraduate residents. Data were collected using a validated, self-administered online questionnaire, and analyzed using SPSS version 26. Descriptive statistics were reported, and associations between demographic factors and outcomes were assessed using Chi-square tests with significance set at p < 0.05. Results: Most participants (75%) had <5 years of experience and 85.8% held a BDS degree. Inadequate obturation (52.9%), missed canals (47.1%), and iatrogenic errors (45%) were the leading causes of ETF. CBCT was rarely used (5%), while non-surgical retreatment (64.2%) was the most common management strategy. Early-career dentists reported significantly more failures and preferred extractions over retreatment (p < 0.05). Conclusion: Technical shortcomings, inadequate training, and restricted access to advanced diagnostics contribute substantially to RCT failure in Pakistan. Expanding postgraduate education, continuing workshops, and wider CBCT integration could improve treatment outcomes.