Comparison of Mineral Trioxide Aggregate and iRoot BP Plus Root Repair Material as Root-end Filling Materials in Endodontic Microsurgery: A Prospective Randomized Controlled Study



      This prospective randomized controlled study evaluated the clinical and radiographic outcome of endodontic microsurgery when using iRoot BP Plus Root Repair Material (BP-RRM; Innovative BioCeramix Inc, Vancouver, BC, Canada) or mineral trioxide aggregate (MTA) as the retrograde filling material and analyzed the relationship between some potential prognostic factors and the outcome of the surgery.


      By using strict inclusion and exclusion criteria, 240 teeth were successfully enrolled and randomly and equally allocated to either the MTA or BP-RRM treatment group. A standardized surgical procedure was performed by a single operator. The patients were followed up at 1 week, 3 months, 6 months, and 12 months; follow-up included clinical and radiographic examination. Clinical and radiographic evaluations acquired at the 12-month follow-up were taken as the primary outcome. For the identification of prognostic factors, the dichotomous outcome (success vs failure) was taken as the dependent variable.


      A total of 158 teeth were analyzed at the 12-month follow-up, including 87 teeth in the MTA group and 71 teeth in the BP-RRM group. The success rate in the MTA and BP-RRM groups was 93.1% (81/87 teeth) and 94.4% (67/71 teeth), respectively (P > .05). Three significant outcome predictors were identified: quality of root filling (P < .05), tooth type (P < .05), and size of the lesion (P < .05)


      These results suggest that BP-RRM is comparable with MTA in clinical outcome when used as root-end filling materials in endodontic microsurgery.

      Key Words

      To read this article in full you will need to make a payment


        • Wu M.K.
        • Dummer P.M.
        • Wesselink P.R.
        Consequences of and strategies to deal with residual post-treatment root canal infection.
        Int Endod J. 2006; 39: 343-356
        • Kim S.
        • Kratchman S.
        Modern endodontic surgery concepts and practice: a review.
        J Endod. 2006; 32: 601-623
        • Johnson B.R.
        • Fayad M.I.
        • Witherspoon D.E.
        Periradicular surgery.
        in: Cohen S. Hargreaves K. Pathways of the Pulp. 10th ed. Mosby Elsevier, St Louis2010: 720-776
        • Setzer F.C.
        • Shah S.B.
        • Kohli M.R.
        • et al.
        Outcome of endodontic surgery: a meta-analysis of the literature–part 1: comparison of traditional root-end surgery and endodontic microsurgery.
        J Endod. 2010; 36: 1757-1765
        • Parirokh M.
        • Torabinejad M.
        Mineral trioxide aggregate: a comprehensive literature review–part III: clinical applications, drawbacks, and mechanism of action.
        J Endod. 2010; 36: 400-413
        • Alanezi A.Z.
        • Jiang J.
        • Safavi K.E.
        • et al.
        Cytotoxicity evaluation of endosequence root repair material.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 109: e122-e125
        • Antunes H.S.
        • Gominho L.F.
        • Andrade-Junior C.V.
        • et al.
        Sealing ability of two root-end filling materials in a bacterial nutrient leakage model.
        Int Endod J. 2016; 49: 960-965
        • Ciasca M.
        • Aminoshariae A.
        • Jin G.
        • et al.
        A comparison of the cytotoxicity and proinflammatory cytokine production of EndoSequence root repair material and ProRoot mineral trioxide aggregate in human osteoblast cell culture using reverse-transcriptase polymerase chain reaction.
        J Endod. 2012; 38: 486-489
        • Damlar I.
        • Ozcan E.
        • Yula E.
        • et al.
        Antimicrobial effects of several calcium silicate-based root-end filling materials.
        Dent Mater J. 2014; 33: 453-457
        • De-Deus G.
        • Canabarro A.
        • Alves G.G.
        • et al.
        Cytocompatibility of the ready-to-use bioceramic putty repair cement iRoot BP Plus with primary human osteoblasts.
        Int Endod J. 2012; 45: 508-513
        • Nair U.
        • Ghattas S.
        • Saber M.
        • et al.
        A comparative evaluation of the sealing ability of 2 root-end filling materials: an in vitro leakage study using Enterococcus faecalis.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 112: e74-e77
        • Chen I.
        • Karabucak B.
        • Wang C.
        • et al.
        Healing after root-end microsurgery by using mineral trioxide aggregate and a new calcium silicate-based bioceramic material as root-end filling materials in dogs.
        J Endod. 2015; 41: 389-399
        • Tsesis I.
        • Rosen E.
        • Taschieri S.
        • et al.
        Outcomes of surgical endodontic treatment performed by a modern technique: an updated meta-analysis of the literature.
        J Endod. 2013; 39: 332-339
        • von Arx T.
        • Penarrocha M.
        • Jensen S.
        Prognostic factors in apical surgery with root-end filling: a meta-analysis.
        J Endod. 2010; 36: 957-973
        • Song M.
        • Kim S.G.
        • Shin S.J.
        • et al.
        The influence of bone tissue deficiency on the outcome of endodontic microsurgery: a prospective study.
        J Endod. 2013; 39: 1341-1345
        • Song M.
        • Jung I.Y.
        • Lee S.J.
        • et al.
        Prognostic factors for clinical outcomes in endodontic microsurgery: a retrospective study.
        J Endod. 2011; 37: 927-933
        • Rahbaran S.
        • Gilthorpe M.S.
        • Harrison S.D.
        • Gulabivala K.
        Comparison of clinical outcome of periapical surgery in endodontic and oral surgery units of a teaching dental hospital: a retrospective study.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 91: 700-709
        • Rud J.
        • Andreasen J.O.
        • Jensen J.E.
        Radiographic criteria for the assessment of healing after endodontic surgery.
        Int J Oral Surg. 1972; 1: 195-214
        • Molven O.
        • Halse A.
        • Grung B.
        Observer strategy and the radiographic classification of healing after endodontic surgery.
        Int J Oral Maxillofac Surg. 1987; 16: 432-439
        • Shinbori N.
        • Grama A.M.
        • Patel Y.
        • et al.
        Clinical outcome of endodontic microsurgery that uses EndoSequence BC root repair material as the root-end filling material.
        J Endod. 2015; 41: 607-612
        • Lustmann J.
        • Friedman S.
        • Shaharabany V.
        Relationofpre-andintraoperativefactors to prognosis of posterior apical surgery.
        J Endod. 1991; 17: 239-241
        • Caliskan M.K.
        • Tekin U.
        • Kaval M.E.
        • Solmaz M.C.
        The outcome of apical microsurgery using MTA as the root-end filling material: 2- to 6-year follow-up study.
        Int Endod J. 2016; 49: 245-254
        • Song M.
        • Kim E.
        A prospective randomized controlled study of mineral trioxide aggregate and super ethoxy-benzoic acid as root-end filling materials in endodontic microsurgery.
        J Endod. 2012; 38: 875-879
        • Halse A.
        • Molven O.
        • Grung B.
        Follow-up after periapical surgery: the value of the one-year control.
        Endod Dent Traumatol. 1991; 7: 246-250
        • Jesslen P.
        • Zetterqvist L.
        • Heimdahl A.
        Long-term results of amalgam versus glass ionomer cement as apical sealant after apicectomy.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995; 79: 101-103
        • Rubinstein R.A.
        • Kim S.
        Long-term follow-up of cases considered healed one year after apical microsurgery.
        J Endod. 2002; 28: 378-383
        • Wesson C.M.
        • Gale T.M.
        Molar apicectomy with amalgam root-end filling: results of a prospective study in two district general hospitals.
        Br Dental J. 2003; 195: 707-714
        • Yazdi P.M.
        • Schou S.
        • Jensen S.S.
        • et al.
        Dentine-bonded resin composite (Retroplast) for root-end filling: a prospective clinical and radiographic study with a mean follow-up period of 8 years.
        Int Endod J. 2007; 40: 493-503
        • Song M.
        • Nam T.
        • Shin S.J.
        • Kim E.
        Comparison of clinical outcomes of endodontic microsurgery: 1 year versus long-term follow-up.
        J Endod. 2014; 40: 490-494
        • Li H.
        • Zhai F.
        • Zhang R.
        • Hou B.
        Evaluation of microsurgery with SuperEBA as root-end filling material for treating post-treatment endodontic disease: a 2-year retrospective study.
        J Endod. 2014; 40: 345-350
        • von Arx T.
        • Jensen S.S.
        • Hanni S.
        Clinical and radiographic assessment of various predictors for healing outcome 1 year after periapical surgery.
        J Endod. 2007; 33: 123-128
        • von Arx T.
        • Jensen S.S.
        • Hänni S.
        • Friedman S.
        Five-year longitudinal assessment of the prognosis of apical microsurgery.
        J Endod. 2012; 38: 570-579
        • Lui J.N.
        • Khin M.M.
        • Krishnaswamy G.
        • Chen N.N.
        Prognostic factors relating to the outcome of endodontic microsurgery.
        J Endod. 2014; 40: 1071-1076
        • Dietrich T.
        • Zunker P.
        • Dietrich D.
        • Bernimoulin J.P.
        Periapical and periodontal healing after osseous grafting and guided tissue regeneration treatment of apicomarginal defects in periradicular surgery: results after 12 months.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003; 95: 474-482
        • von Arx T.
        • Cochran D.
        Rationale for the application of the GTR principle using a barrier membrane in endodontic surgery: a proposal of classification and literature review.
        Int J Periodontics Restorative Dent. 2001; 21: 127-139
        • Rankow H.J.
        • Krasner P.R.
        Endodontic applications of guided tissue regeneration in endodontic surgery.
        J Endod. 1996; 22: 34-43
        • Walivaara D.A.
        • Abrahamsson P.
        • Fogelin M.
        • Isaksson S.
        Super-EBA and IRM as root-end fillings in periapical surgery with ultrasonic preparation: a prospective randomized clinical study of 206 consecutive teeth.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 112: 258-263