Outcome of endodontic microsurgery using different calcium silicate-based retrograde filling materials: a cohort retrospective cone-beam computed tomographic analysis

Purpose: To evaluate the outcomes of endodontic microsurgery (EMS) using mineral trioxide aggregate (MTA; Dentsply Sirona, Charlotte, NC, USA), EndoSequence root repair material (RRM putty; Brasseler, Savannah, GA), and injectable Bioceramic (BC) sealer (Brasseler USA) followed by the application of RRM putty (lid-technique) as root-end filling materials. Methods One hundred and ten patients with a minimum follow-up period of 1 year, who underwent EMS in the period between 2016 and 2020 at King Abdulaziz University Dental Hospital, were recruited for clinical and radiographic follow-up. Radiographic assessment was performed using periapical radiographs (PAs) and cone-beam computed tomography (CBCT). Volumetric analysis of periapical radiolucencies (PARLs) was performed using Amira software. Results Seventy-nine patients (103 teeth) attended the follow-up visit, with an average follow-up period of 24 months (recall rate = 74.5%). All three groups of retrograde filling materials (MTA, RRM putty, and lid-technique) showed high success rates on both PA (85.7%, 85.4%, 94.1%, respectively) and CBCT imaging (67.9%, 75.6%, 88.2%, respectively), without any significant difference. Overall, a slight agreement was noted between the PA and CBCT outcomes, with a statistically significant difference ( P  = 0.029). None of the patient-, tooth-, or treatment-related factors significantly influenced the outcomes of EMS. Adequate density of root canal filling material was significantly associated with a high percentage of completely healed cases on CBCT ( P  = 0.044). The volume of PARLs was significantly reduced ( P  < 0.001) during the follow-up period of 1–4 years. Conclusions EMS showed high success rates on both PA and CBCT when MTA, RRM putty or lid-technique were used as retrograde filling materials. CBCT imaging is more precise in detecting the healing outcome of EMS compared with PA.