Abstract
Introduction: Parendodontic surgery or periapical surgery has been described in the literature for several decades as a treatment option for endodontic failure. Several techniques have been described; however, we can currently say that the success of periapical surgery is directly linked to new technologies, such as operating microscopy, ultrasonic inserts for proper decontamination of the region, and new materials that provide adequate sealing of the retrograde filling cavity. Objective: It was to conduct a concise systematic review on the main considerations of sealing materials in periapical surgery. Methods: The PRISMA Guidelines were followed. The search was conducted from January to February 2026 across the Web of Science, Scopus, Embase, PubMed, ScienceDirect, SciELO, and Google Scholar databases. The quality of the studies was assessed using the GRADE instrument, and the risk of bias was evaluated according to the Cochrane instrument. Results and Conclusion: According to the GRADE instrument, most studies presented homogeneous results, with X2 = 78.7% > 50%. A total of 126 articles were found and submitted for eligibility analysis, with 30 final studies selected to compose the results of this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 30 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2 standards. Among the desired properties of new materials for sealing the retrograde filling cavity, low cytotoxicity, good radiopacity, ease of handling, and the ability to seal and adhere to dentin stand out. With the discovery of MTA in the 1990s, a new class of materials, bioceramics, has been developed for this purpose.