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Meta-Analysis
. 2016 Dec 17;12(12):CD005517.
doi: 10.1002/14651858.CD005517.pub2.

Materials for retrograde filling in root canal therapy

Xiangyu Ma  1   2 , Chunjie Li  3 , Liuhe Jia  2   4 , Yan Wang  5 , Wenwen Liu  6   7 , Xuedong Zhou  2 , Trevor M Johnson  8 , Dingming Huang  2
Affiliations
Meta-Analysis

Materials for retrograde filling in root canal therapy

Xiangyu Ma et al. Cochrane Database Syst Rev. .

Update in

  • Materials for retrograde filling in root canal therapy.
    Li H, Guo Z, Li C, Ma X, Wang Y, Zhou X, Johnson TM, Huang D. Li H, et al. Cochrane Database Syst Rev. 2021 Oct 14;10(10):CD005517. doi: 10.1002/14651858.CD005517.pub3. Cochrane Database Syst Rev. 2021. PMID: 34647617 Free PMC article.

Abstract

Background: Root canal therapy is a sequence of treatments involving root canal cleaning, shaping, decontamination and obturation. It is conventionally performed through a hole drilled into the crown of the affected tooth, namely orthograde root canal therapy. For teeth that cannot be treated with orthograde root canal therapy, or for which it has failed, retrograde root filling, which seals the root canal from the root apex, is a good alternative. Many materials, such as amalgam, zinc oxide eugenol and mineral trioxide aggregate (MTA), are generally used. Since none meets all the criteria an ideal material should possess, selecting the most efficacious material is of utmost importance.

Objectives: To determine the effects of different materials used for retrograde filling in children and adults for whom retrograde filling is necessary in order to save the tooth.

Search methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 13 September 2016); the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8) in the Cochrane Library (searched 13 September 2016); MEDLINE Ovid (1946 to 13 September 2016); Embase Ovid (1980 to 13 September 2016); LILACS BIREME Virtual Health Library (1982 to 13 September 2016); and OpenSIGLE (1980 to 2005). ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. We also searched Chinese BioMedical Literature Database (in Chinese, 1978 to 20 September 2016); VIP (in Chinese, 1989 to 20 September 2016); China National Knowledge Infrastructure (in Chinese, 1994 to 20 September 2016); and Sciencepaper Online (in Chinese, to 20 September 2016). No restrictions were placed on the language or date of publication when searching the electronic databases.

Selection criteria: We selected randomised controlled trials (RCTs) only that compared different retrograde filling materials, with reported success rate that was assessed by clinical or radiological methods for which the follow-up period was at least 12 months.

Data collection and analysis: Two review authors extracted data independently and in duplicate. Original trial authors were contacted for any missing information. Two review authors independently carried out risk of bias assessments for each eligible study following Cochrane methodological guidelines.

Main results: We included six studies (916 participants with 988 teeth) reported in English. All the studies had high risk of bias. The six studies examined five different comparisons, including MTA versus intermediate restorative material (IRM), MTA versus super ethoxybenzoic acid cement (Super-EBA), Super-EBA versus IRM, dentine-bonded resin composite versus glass ionomer cement and glass ionomer cement versus amalgam. There was therefore little pooling of data and very little evidence for each comparison.There is weak evidence of little or no difference between MTA and IRM at the first year of follow-up (risk ratio (RR) 1.09; 95% confidence interval (CI): 0.97 to 1.22; 222 teeth; quality of evidence: low). Insufficient evidence of a difference between MTA and IRM on success rate at the second year of follow-up (RR 1.06; 95% CI: 0.89 to 1.25; 86 teeth, 86 participants; quality of evidence: very low). All the other outcomes were based on a single study. There is insufficient evidence of any difference between MTA and Super-EBA at the one-year follow-up (RR 1.03; 95% CI: 0.96 to 1.10; 192 teeth, 192 participants; quality of evidence: very low), and only weak evidence indicating there might be a small increase in success rate at the one-year follow-up in favour of IRM compared to Super-EBA (RR 0.90; 95% CI: 0.80 to 1.01; 194 teeth; quality of evidence: very low). There was also insufficient and weak evidence to show that dentine-bonded resin composite might be a better choice for increasing retrograde filling success rate compared to glass ionomer cement at the one-year follow-up (RR 2.39; 95% CI: 1.60 to 3.59; 122 teeth, 122 participants; quality of evidence: very low). And there was insufficient evidence of a difference between glass ionomer cement and amalgam at both the one-year (RR 0.98; 95% CI: 0.86 to 1.12; 105 teeth; quality of evidence: very low) and five-year follow-ups (RR 1.00; 95% CI: 0.84 to 1.20; 82 teeth; quality of evidence: very low).None of these studies reported an adverse event.

Authors' conclusions: Based on the present limited evidence, there is insufficient evidence to draw any conclusion as to the benefits of any one material over another. We conclude that more high-quality RCTs are required.

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Conflict of interest statement

Xiangyu Ma: none known. Chunjie Li: none known. Liuhe Jia: none known. Yan Wang: none known. Wenwen Liu: none known. Xuedong Zhou: none known. Trevor M Johnson: none known. Dingming Huang: none known.

Figures

1
1
A: an infected tooth. The inner space of the tooth is the root canal system, where the pulp is located. The pulp of this tooth is irreversibly inflamed from bacterial infection due to decay. B and C: the process of root canal therapy. B: a hole has been drilled from the top of the crown of the tooth. The dentist could then remove the infected tissues and toxic irritants by a combination of mechanical cleaning and irrigation in the root canal system through the hole. C: after cleaning and irrigation, the dentist fills the space with an inert packing material and seals the opening. D and E: the process of retrograde filling. D: when retrograde filling is indicated, the dentist needs to cut a flap in the gum and creates a hole in the bone to get access to the bottom tip of the root. E: after cutting off the tip, then thorough preparation, the apex is sealed (the apical seal) and the hole made by the dentist filled with a dental material.
2
2
Study flow diagram.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 MTA versus IRM, Outcome 1 Success rate ‐ 1‐year outcome (teeth as unit of analysis).
1.2
1.2. Analysis
Comparison 1 MTA versus IRM, Outcome 2 Success rate ‐ 2‐year outcome (participants as unit of analysis).
2.1
2.1. Analysis
Comparison 2 MTA versus Super‐EBA, Outcome 1 Success rate ‐ 1‐year outcome (participants as unit of analysis).
3.1
3.1. Analysis
Comparison 3 Super‐EBA versus IRM, Outcome 1 Success rate ‐ 1‐year outcome (teeth as unit of analysis).
4.1
4.1. Analysis
Comparison 4 Dentine‐bonded resin composite versus glass ionomer cement, Outcome 1 Success rate ‐ 1‐year outcome PP analysis (participants as unit of analysis).
4.2
4.2. Analysis
Comparison 4 Dentine‐bonded resin composite versus glass ionomer cement, Outcome 2 Success rate ‐ 1‐year outcome ITT analysis (participants as unit of analysis).
4.3
4.3. Analysis
Comparison 4 Dentine‐bonded resin composite versus glass ionomer cement, Outcome 3 Success rate ‐ 1‐year outcome PP analysis (root as unit of analysis).
4.4
4.4. Analysis
Comparison 4 Dentine‐bonded resin composite versus glass ionomer cement, Outcome 4 Success rate ‐ 1‐year outcome ITT analysis (root as unit of analysis).
5.1
5.1. Analysis
Comparison 5 Glass ionomer cement versus amalgam, Outcome 1 Success rate ‐ 1‐year outcome (tooth as unit of analysis).
5.2
5.2. Analysis
Comparison 5 Glass ionomer cement versus amalgam, Outcome 2 Success rate ‐ 5‐year outcome (tooth as unit of analysis).
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