Dental restoration failure is a high-prevalence and multifactorial etiology with a considerable clinical and economic burden in all countries, but context-specific epidemiological data on the Kingdom of Saudi Arabia were rare, which restricted the construction of specific preventive measures. The objectives of this study were to establish the prevalence, identify the major risk factors, and assess the influence of dental restoration issues on oral health-related quality of life (OHRQoL) of a Saudi patient group. The facet of clinical evaluation was a cross-sectional analytic study of the three large public dental facilities in Riyadh, which consisted of 450 patients and clinical analysis of 1,127 restorations. Standardized examinations and validated questionnaires (OHIP-14) were used to collect data, and multivariate logistic regression was used to analyze them. The general rate of restoration issues was 20.1% and the most frequent problem of failure was secondary caries (43.2%). The patient-reported bruxism (AOR=2.21, 95% CI: 1.6130.44, p<0.001), poor oral hygiene (AOR=2.05, 95% CI: 1.412.99, p<0.001) and excessive intake of sugary beverages (AOR=1.67, 95% CI: 1.232.27, p=0.001) were also The relationship between dose and response was found to be strong with the more the number of failed restorations the worse the OHRQoL scores were found to be (p<0.001). The results clearly show that modifiable behavioral risks that are modifiable are the leading causes of restoration failure in this context, and thus the necessity to incorporate a comprehensive clinical strategy that emphasizes behavioral management that focuses on patients and the technical restorative care that enhances long-term outcomes.