Endodontic Obturation Materials in Primary Teeth: A Systematic Review

Background: The selection of an optimal obturating material remains a major challenge in pediatric endodontics because no currently available material fulfills all the biological and clinical requirements for primary teeth. Objective: This systematic review aimed to evaluate and compare the clinical and radiographic performance of obturating materials used in primary teeth based on evidence from randomized controlled trials. 1.2. Methods: A systematic search of PubMed, Scopus, and Web of Science identified randomized clinical trials published between January 2016 and July 2026. Studies comparing different root canal filling materials in primary teeth were selected according to PRISMA guidelines and predefined PICO criteria. Methodological quality was assessed using the Cochrane RoB 2 tool. Results: Eleven randomized clinical trials were included. Conventional materials such as zinc oxide–eugenol (ZOE) and Endoflas demonstrated consistent clinical and radiographic success. Calcium hydroxide–iodoform formulations showed satisfactory short-term outcomes but less favorable long-term performance due to rapid resorption. Bioactive materials containing propolis, neem oil, and ozonated olive oil demonstrated promising results, whereas curcumin-based formulations did not consistently improve treatment outcomes. Overall, no material fulfilled all the characteristics of an ideal obturating material. Conclusions: Conventional materials remain reliable options for pulpectomy in primary teeth, while bioactive formulations represent promising alternatives. Further high-quality randomized controlled trials (RCTs) with longer follow-up are needed to establish the long-term effectiveness and biological behavior of emerging obturating materials.