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February 28, 2026Open Access

Comparative Study on the Biomechanical Properties of Three Root Canal Filling Materials in Microscopic Apical Surgery

Key Points

This study aims to compare the biological and mechanical properties of three root canal filling materials used in microscopic apical surgery.
Included 96 patients with failed root canal therapy.
Used three root canal filling materials: PMTA, ZoE, BP-RRM.
Conducted in vitro simulated microsurgical apicoectomy using forward and reverse placement techniques.
Evaluated marginal adaptation, surface hardness, and push-out bond strength using appropriate testing equipment.
Forward placement led to significantly greater gap width compared to reverse placement across all materials.
Push-out bond strength (POBS) was significantly higher in the forward direction for all materials.
ZoE showed significantly lower surface hardness than PMTA and BP-RRM, but higher POBS compared to them.

Abstract

Abstract Aim: To create a comparative analysis of the biological and mechanical performance of three different root canal filling materials in microscopic apical surgery. Methods: A total of 96 patients who underwent failed root canal therapy at our hospital between January 2020 and November 2021 were included in this study. The 96 extracted single-rooted mandibular premolars from these patients were selected. Their 96 single-rooted mandibular premolars were randomly divided into six groups (based on G*Power effect size calculations, 16 teeth per group), performing in vitro simulated microsurgical apicoectomy by using three different root canal filling materials proRoot mineral trioxide aggregate (PMTA), zinc oxide-eugenol (ZoE), and bioceramic putty plus root repair material (BP-RRM). Both forward and reverse placement techniques were employed during the surgical procedure. Postoperatively, two 1-mm-thick sections were excised from the apical region of each tooth. Marginal adaptation, surface hardness, and push-out bond strength (POBS) were evaluated using a Vickers hardness tester and a universal testing machine, respectively. Results: In the same material, the maximum gap width placed in the forward direction was significantly greater than the maximum gap width placed in the reverse direction (PMTA: forward 3.06 ± 0.82 μm vs. reverse 1.06 ± 0.92 μm, ZoE: forward 3.05 ± 0.90 μm vs. reverse 1.10 ± 0.51 μm, BP-RRM: forward 3.07 ± 0.68 μm vs. reverse 0.98 ± 0.36 μm, P < 0.05). POBS placed in the forward direction was significantly greater than POBS placed in the reverse direction (PMTA: forward 19.80 ± 5.18 MPa vs. reverse 14.80 ± 6.85 MPa, ZoE: forward 25.58 ± 9.80 MPa vs. reverse 18.60 ± 5.80 MPa, BP-RRM: forward 18.62 ± 7.69 MPa vs. reverse 13.10 ± 4.48 MPa, P < 0.05). Within the same placement method, the surface hardness of ZoE was significantly lower than that of PMTA and BP-RRM ( P < 0.05), while the POBS value was significantly higher than that of PMTA and BP-RRM ( P < 0.05). Conclusion: In postoperative filling following microsurgical apicoectomy, the reverse placement technique offers superior marginal adaptation, while the forward placement technique provides better anti-shedding property. The surface hardness of PMTA and BP-RRM is superior to that of ZoE, but their anti-shedding property is inferior to that of ZoE.

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