Prevalence and determinants of clinical and radiographic outcomes of endodontic treatment at Jimma Medical Center: an ambispective single-cohort study

Abstract

BACKGROUND: Endodontic treatment is fundamental to preserving teeth affected by pulpal and periapical diseases. Robust evidence on treatment outcomes and their determinants is essential for optimizing clinical practice, yet data from sub-Saharan Africa remain scarce. This study assessed the prevalence, clinical and radiographic outcomes, and determinants of endodontic treatment success and failure among patients treated at Jimma Medical Center (JMC), Ethiopia. METHODS: An ambispective single-cohort study was conducted among a sample of 404 patients who received endodontic treatment at JMC from September 1, 2025, to November 30, 2025. Data were collected on socio-demographics, preoperative clinical and radiographic characteristics, procedural details, and patient-reported outcomes. Clinical and radiographic success was assessed using the Periapical Index (PAI) and symptom resolution. Logistic regression analyses were performed to identify determinants of treatment outcomes, with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) estimated, and statistical significance set at p < 0.05. RESULTS: The majority of participants were aged 25-44 years (49.6%) and female (55.8%), with an overall treatment success rate of 84.2%. Most teeth were non-vital (96.4%) and presented with symptomatic pulpitis or apical periodontitis. Irrigation was primarily performed with saline (85.2%), and optimal obturation quality was achieved in 90.1% of cases. At follow-up, 84.2% of teeth were classified as successful, defined as absence of symptoms and PAI ≤ 2, while 15.8% failed. The most frequent causes of failure were persistent infection (42.6%) and coronal leakage (41.0%). Patient-reported outcomes indicated high satisfaction, with 89.1% of patients reporting satisfaction and 73.0% reporting complete absence of pain post-treatment. Multivariable logistic regression analysis identified several independent determinants of treatment success. Male patients had 2.86 times higher odds of treatment success than female patients (AOR = 2.86, 95% CI: 1.98-3.53; p < 0.04). Conversely, symptomatic periapical lesions or abscesses were associated with 43% lower odds of treatment success (AOR = 0.57, 95% CI: 0.05-0.86; p < 0.03). Similarly, the use of saline as the primary irrigant was associated with 54% lower odds of treatment success than H₂O₂ alone or saline combined with H₂O₂ (AOR = 0.46, 95% CI: 0.21-0.91; p < 0.04). In addition, a temporary or inadequate coronal seal at treatment completion was associated with 62% lower odds of treatment success than a composite restoration or crown (AOR = 0.38, 95% CI: 0.16-0.88; p < 0.02). CONCLUSION: Endodontic treatment at JMC demonstrates a high success rate, with most teeth showing favorable clinical, radiographic, and patient-reported outcomes. Male gender, preoperative periapical pathology, type of primary irrigant, and coronal restoration quality were significant determinants of treatment outcome. These findings underscore the importance of meticulous procedural protocols and proper coronal sealing to enhance treatment success.