The Washout Resistance of Bioactive Root-End Filling Materials-A Systematic Review

When performing an apicoectomy avoiding the microleakage is desired. That is why materials used for this procedure should be resistant to washout. Washout refers to the tendency of freshly prepared materials to disintegrate upon contact with fluids. Background/Objectives: The aim of this paper is to provide a literature review on the washout resistance of bioactive root-end filling materials. Methods: This systematic review was conducted following the PRISMA 2020 guidelines. International databases (PubMed, Google Scholar, ScienceDirect, and Wiley Online Library) were searched, and articles published in the last 20 years were selected for analysis. The following keywords were used "antiwashout", "washout resistance", "washout in dentistry", "root-end filling materials", "calcium silicate-based cements", "bioceramic materials". A total of 6 in vitro studies that met all the inclusion criteria were included in the analysis. The overall risk of bias was low in all six studies. Results: Most tested bioceramic materials are Endocem, Capasio, and Ceramicrete-D. Generex-A, MTA-Plus, MTA-AW, Bioaggregate, and MTA HP usually demonstrate very good washout resistance. ProRoot and MTA Angelus performed differently depending on the test; however, generally they showed good washout resistance. The Biodentine material showed significant washout, and requires further research. There is still a lack of a unified method for washout evaluation in dentistry, which makes it difficult to compare different studies. Conclusions: The study the confirmed excellent washout resistance of EndoCem, Capasio, Ceramicrete-D, Generex-A, Bioaggregate, MTA-Plus, and MTA HP. ProRoot, MTA-Angelus, and MTA Angelus White exhibited lower washout resistance. Biodentine shows poor washout resistance, and requires further research. A unified method for assessing washout would be beneficial for comparing different studies.