Retrograde filling material in periapical surgery: a systematic review

Abstract

Background Periapical surgery focuses on the treatment of teeth with persistent periapical lesions when orthograde root canal treatment fails. Although MTA® is the gold standard material for retrograde filling, Biodentine® - a tricalcium silicate-based cement - has been proposed in order to resolve several of its limitations. A systematic review has been carried out to compare the physicochemical properties of Biodentine® versus MTA® as root-end filling material in periapical surgery. Material and Methods An electronic search was conducted by two independent examiners during March 2020 in the Cochrane, PubMed-MEDLINE and Scopus databases. In addition, a manual search was made in specialized journals. Comparative human or in vitro studies that evaluated bond strength, the presence of marginal gap and sealing ability were included. No restriction on publication date was applied. Animal studies, clinical cases, cases series and expert opinions were excluded. Results After analyzing 147 initially selected studies, 13 publications were included. Regarding bond strength, the studies seemed to evidence better performance of Biodentine® in both acidic and blood contaminated environments. In relation to the presence of marginal gap and sealing ability, the studies yielded contradictory results. According to some authors, the sealing ability of Biodentine® is greater than that of MTA® during the first 24 hours, though both materials prove equal after one week. Other authors recorded no significant differences. Conclusions Considering the limitations and heterogeneity of the studies included, there is not sufficient evidence to confirm the clinical superiority of Biodentine® as a root-end filling material in periapical surgery. Key words: Biodentine, MTA, retrograde filling, periapical surgery.

Marginal Adaptation and Porosity of a Novel MTA Brand Applied as Root-End Filling Material: A Micro-CT Study

“…One of the most important requirements for the root-end filling material is the ability to ensure a hermetic seal of the apical area. Inadequate sealing of the retrograde cavity is considered the main reason for the failure of endodontic surgery [17][18][19]. Good marginal adaptation to dentin and internal porosity of calcium silicate cements are related to their sealing capacity and ability to resist bacteria penetration and prevent the percolation of tissue fluids [20,21].…”

Antibacterial Activity and Sustained Effectiveness of Calcium Silicate-Based Cement as a Root-End Filling Material against Enterococcus faecalis

“…Retrograde filling, also known as apicoectomy or root-end filling, is an endodontic treatment procedure that involves the removal of the apex of the tooth root and its replacement with biocompatible material [ 23 ]. When root canal treatment fails, the anatomical complex of the root-end region is removed and retrograde filling is performed to seal the apex and promote healing.…”

Effectiveness of different root-end filling materials in modern surgical endodontic treatment: A systematic review and network meta-analysis

“… 58 Besides, there are also many studies interested in using Biodentine as a root-end filling material, but still need more clinical evidence and comparative studies presently. 59 , 60 …”