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To investigate the clinical outcomes, including survival and periapical healing rates and failure causes, of root canal treatment for patients with periapical lesion. A retrospective cohort study was conducted which enrolled patients admitted for the evaluation and management of periapical lesion with root canal treatment. The primary predictor variables were difficulty assessment of root canal therapy (DARCT),which was divided into lower(DARCT =3-4), medium (DARCT =5-7) and higher (DARCT =8-9) difficulty root canal, in terms of canal length, curvature and