MAIN ETIOLOGICAL FACTORS OF FAILURE IN ENDODONTIC TREATMENT: A NARRATIVE REVIEW

Abstract

Despite continuous advances in endodontic treatment, it still represents a significant clinical challenge.The aim of this study was to identify and analyze the main etiological factors associated with endodontic treatment failure, considering biological, technical/anatomical, and restorative factors. A narrative, descriptive, and qualitative literature review was carried out using recognized databases (PubMed and Google Scholar), combining descriptors related to endodontic failure, prognosis, microleakage, biofilm, and root canal anatomy. After screening, the evidence was organized into three thematic axes: biological factors, technical/anatomical factors, and restorative/periodontal factors. The findings indicated a multifactorial etiology, with recurrence of three main determinants: microbial persistence within the root canal system, especially microorganisms associated with persistent infections; technical limitations and/or anatomical complexity that hindered instrumentation, disinfection, and obturation; and post-endodontic restorative failures, particularly when coronal sealing was insufficient, favoring microleakage and reinfection. It was concluded that clinical predictability depended on an integrated approach, with emphasis on infection control, proper anatomical assessment, including imaging resources when indicated, and definitive coronal rehabilitation with effective sealing and appropriate occlusal adjustment.