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This study was undertaken to investigate for the first time the distribution and prevalence of apical periodontitis and its determinants in an Italian population. A total of 312 participants (191 women, 121 men) received free clinical examination and full-mouth digital X-ray. Data regarding the oral health status of the patients were collected such as the reason for the visit and the incidence of lesions. We examined 8101 teeth, 6.59% of which had been submitted to endodontic treatment and 15.02% of which were lower molars. Lower molars were reported missing more frequently, in detail 16.24%. Moreover 3.89% of the lower molars had developed an apical lesion, whereas only 0.08% of the lower incisors. Periapical lesions were present in 0.29% of not endodontically treated teeth, while in endodontically treated teeth lesions were present in 17.04%. Additionally, 15.65% of the endodontically treated teeth showed incongruous (long or short) seals. A prevalence of women (61.21%) over men (38.78%) was reported indicating that women attend to their oral health more. Endodontic treatment success and failure in over- or under-filled teeth was evaluated with success being verified in 97% of appropriately treated teeth; the success rate decreases in inappropriately treated teeth (by 72.73% in over-filled and 77.71% under-filled teeth). The prevalence of teeth with periapical lesions amounted to 1.35%. Finally, endodontically treated teeth with periapical lesions amounted to 17.04%. Successful treatment can be achieved when disease is intercepted at an early stage while prevention still remains better than cure.