A Narrative Review of Clinical Trials Comparing Root-End Filling Materials in Endodontic Surgery

Abstract

This narrative review assesses the clinical performance of root-end filling materials used in endodontic microsurgery, with a particular focus on randomized controlled trials (RCTs) published over the last decade. The goal is to determine whether material choice has a significant impact on surgical outcomes or if other procedural factors play a more decisive role. An electronic search was conducted in PubMed (MEDLINE) and Scopus for RCTs published from January 2015 to March 2025. Studies were eligible if they compared at least two root-end filling materials in human patients undergoing apicoectomy and retrograde filling, with a minimum follow-up of six months. Six RCTs met the inclusion criteria. Data were extracted and synthesized narratively due to heterogeneity in study design, outcome reporting, and small sample size. Success rates for evaluated materials, including MTA, iRoot BP Plus, EndoSequence RRM, TotalFill, and Super EBA, ranged from 75% to 96%. While MTA remains a well-established material, newer bioceramic sealers demonstrated comparable outcomes with improved handling. No definitive superiority was observed among materials. Instead, surgical factors such as microsurgical technique, retrocavity depth, use of CBCT imaging, and operator experience emerged as primary determinants of success. The evidence suggests that modern calcium silicate-based materials are all clinically effective when used within an appropriate and dedicated protocol. Given the procedural complexity and multifactorial nature of success in endodontic surgery, material selection should be based on handling preference and clinical familiarity. The absence of standardized application protocols for newer bioceramics highlights an unmet need in clinical practice. While root-end filling material selection remains relevant, procedural precision and surgeon expertise have a more significant influence on outcomes. Further long-term studies are needed to develop consensus protocols for bioceramic materials in endodontic microsurgery.