Comparative In Vitro Assessment of Retro-MTA Cement and Endoseal MTA Sealer for Apical Perforation Sealing

Abstract

Featured Application: This study helps clinicians select the most effective material for sealing apical perforations, showing that Retro-MTA provides a more reliable apical seal than Endoseal MTA. Apical perforation is a possible complication during root canal treatment, often caused by instrumentation beyond the working length, and requires prompt, precise sealing. In immature teeth needing endodontic therapy, the same principles used for managing apical perforations apply. Despite the widespread use of calcium silicate cement (CSC)-based materials, there is limited evidence comparing the sealing performance of putty-type CSCs and injectable bioceramic sealers in apical perforations under standardized laboratory conditions. This study aimed to compare the sealing ability of Retro-MTA cement and Endoseal MTA sealer in standardized apical perforations using the fluid-filtration method. In this in vitro study, 34 extracted human maxillary central incisors were used and divided into two groups. In Group 1, apical perforations were sealed with Retro-MTA and obturated using warm vertical compaction. In Group 2, perforations were sealed with Endoseal MTA and obturated using the single-cone technique. Micro-leakage was assessed using the fluid-filtration method. Data were analyzed with an independent t-test (α = 0.05). All samples exhibited leakage after two weeks. However, Retro-MTA demonstrated significantly lower micro-leakage than Endoseal MTA (0.265 vs. 0.473 μL/min/cmH2O; p < 0.001), corresponding to approximately a 44 difference in leakage values between the two materials. The findings indicate that Retro-MTA provides a superior apical seal and lower leakage rates than Endoseal MTA. Therefore, Retro-MTA appears to be the more effective material for sealing apical perforations and managing open apices, potentially providing more stable apical seal under controlled laboratory conditions. © 2026 by the authors.