Background: Selecting an appropriate root canal filling material for primary teeth remains a challenge in pediatric endodontics. Ineffective root canal treatment can seriously affect a child’s psychological development and the eruption process of permanent teeth. An ideal material should exhibit antibacterial properties, biocompatibility, resorb in synchrony with physiological root resorption, provide an adequate seal, avoid tooth discoloration, and possess clear radiopacity. This study aimed to provide current evidence and to compare the clinical and radiographic efficacy of materials used for filling primary teeth.
Methods: This study is a systematic review combined with a network meta-analysis based on randomized controlled trials retrieved from the PubMed database (from January 2000 to May 2025). The study population comprised pediatric patients with primary teeth undergoing pulpectomy (root canal obturation of primary teeth). The primary outcomes included clinical and radiographic success rates at 12 months. Data were extracted, risk of bias was assessed, and analyses were performed using STATA 17.0, a fixed-effects model was applied to estimate and compare relative risks and 95% confidence intervals of clinical and radiographic efficacy among the materials.
Results: A total of seven studies were included in the systematic review. The results suggest that ZOE, Endoflas, Metapex, MPRCF, ZON, and ZOP demonstrate favorable clinical and radiographic outcomes in pediatric endodontic treatment. However, the certainty of the evidence remains limited due to the small number of available studies.
Conclusion: The effectiveness of root canal filling materials in primary teeth varies. Next-generation materials tend to demonstrate more favorable treatment outcomes; however, the current evidence remains limited. Further large-scale clinical trials with longer follow-up periods and rigorous study designs are required.
