How common is root canal treatment?

shutterstock_2296216-root canal xray

Without treatment teeth with irreversible pulpitis and pulp necrosis lead to apical periodontitis (AP). Traditionally root canal treatment is used to manage teeth with AP but less invasive approaches of pulp capping and pulpotomy have been applied to teeth with irreversible pulpitis with good results. Understanding the prevalence of root filled teeth will inform dentists and policy makers on trends and changes in the management of teeth with irreversible pulpitis.

The aim of this review was to analyse the prevalence of root filled teeth in the adult population worldwide.


A protocol was registered on the PROSPERO database. Searches were conducted in the Medline/PubMed, Embase, SciELO, OpenGrey and Google Scholar databases. Studies reporting the prevalence of root filled teeth (RFT) in health adults based on a radiographic examination were considered. Three reviewers independently screened and selected studies and extracted data with quality assessment and risk of bias being assessed based on the Newcastle- Ottawa Scale.  The main outcome was prevalence of RFT with teeth as unit of assessment. Meta-analyses were conducted for global prevalence of RFT with subgroup analysis for geographical distribution, radiographic method and year of the study. The prevalence of patients with at least one RFT was also assessed.


  • 76 studies (72 cross-sectional – 4 longitudinal) involving a total of 32,162 people were included.
  • The 32,162 people had 1,201,255 teeth of which 92 999 were root filled.
  • 35 studies (31,715 people, 18,577 RFT) provided information on the number of patients with at least one RFT
  • 29 studies were considered to be at high risk of bias, 45 at moderate risk and only 2 at low risk of bias.
  • Meta-analyses of overall prevalence and other subgroup analyses are shown in the table below.
No. of studies Prevalence (95%CI) At least 1 RFT (95%CI)
Overall 76 8.2% (7.3% to 9.1%) 55.7% (49.6% to 61.8%)
Africa 3 5.5% (0.8 to 11.8%) 41.2% (1.7% to 80.6%)
Asia 14 6.2 % (4.5% to 7.8%) 58.8% (47.7% to 73.0%)
Europe 46 9.3% (8.2% to 10.4%) 59.6% (52.4% to 66.8%)
North America 5 4.1% (3.0% to 5.2%) 48.5% (31.7% to 65.2%)
Oceania (Australia) 3 4.3% (1.3% to 7.3%) N/A
South America (Brazil) 5 12.0% (5.2% to 18.9%) N/A
20th Century studies 19 10.2% (7.9% to12.5%) N/A
21st Century studies 54 7.6% (6.5% to 8.6%) N/A
Periapical radiographs 21 9.5% (7.4% to 11.6%) N/A
Panoramic radiographs 38 7.2% (6.0% to 8.5%) N/A
CBCT studies 6 10.3% (7.7% to 12.8%) N/A


The authors concluded: –

Root canal treatment is a very common therapy throughout the world. More than half of the studied population have at least one RFT. The percentage of RFT world- wide is, on average, greater than 8%. When studies conducted in the 20th century are compared with those of the 21st century, a decrease in the prevalence of RFT is observed, which could indicate a change in the therapeutic attitudes of dentists in the management of endodontic diseases.


The authors registered a protocol for the trial on PROSPERO and searched a number of major databases with no limitations.  They did note that the grey literature sources did not provide any additional material. The review findings suggest that 8.2% (95%CI; 7.3% to 9.1%) of teeth has been root filled and that 55.7% (95%CI; 49.6% to 61.8%) of people had at least one tooth root filled. Of the 76 studies they included only 2 were at low risk of bias with 29 being considered to be at high risk. The review authors highlighted that most of the studies were based on university/hospital dental patients rather than the general population and only 5 studies undertook a sample size calculation.  Whether the large number of included studies compensates for this is a matter of debate. Consequently, the findings of the review should be evaluated cautiously.


Primary Paper

León-López M, Cabanillas-Balsera D, Martín-González J, Montero-Miralles P, Saúco-Márquez JJ, Segura-Egea JJ. Prevalence of root canal treatment worldwide: A systematic review and meta-analysis. Int Endod J. 2022 Aug 25. doi: 10.1111/iej.13822. Epub ahead of print. PMID: 36016509.

Review protocol on PROSPERO

Other references

Dental Elf – Jul 22nd 2019

Pulpotomy for permanent teeth with irreversible pulpitis?

Dental Elf – 21st Nov 2013

Patients showed a preference to retain a tooth affected by apical periodontitis



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