Studies suggest alternatives to amalgam as a retrograde filling material for apicectomy

Abstract

Data sources: Sources were Medline and the Cochrane Library.

Study selection: Studies included were in vivo with human subjects, had experimental and control groups, and gave quantitative results in English, German or French.

Data extraction and synthesis: Success and failure rates were derived from randomised controlled trials (RCT), clinical controlled trials (CCT), cohort studies (CS) and case-controlled studies (CCS). Qualitative synthesis of results was performed.

Results: Two RCT, six CCT and 14 CCS were identified. The two RCT suggest that glass ionomer may be more effective than amalgam, conversely one CCT showed amalgam to be more effective. CCTs also suggest that EBA (reinforced zinc oxide eugenol) cement, composite with GLUMA (Bayer AG., Leverkusen, Germany) and gold leaf retrograde filling may be more effective than amalgam. A further CCT suggested that gutta-percha used as a retrograde filing is less effective than when used following an orthograde approach.

Conclusions: Based on the outcome of two RCT, glass ionomer appears as effective as amalgam. EBA cement, composite with GLUMA and gold leaf and orthograde gutta-percha may also be as effective as amalgam. Evidence is limited, however, and further research is needed.