Objective: To compare the clinical outcomes of mineral trioxide aggregate (MTA) used as root-end filling with other materials in endodontic surgery to determine which modality offers more favorable outcomes. Method and Materials: A computerized literature search was performed in the Cochrane Library (1993-2009), MEDLINE (1993-2009), EMBASE (1993-2009), Science Citation Index (SCI) (1993-2009), Chinese Biomedicine Database (1993-2009), and China National Knowledge Infrastructure (CNKI) (1993-2009) to collect randomized controlled trials and quasi-controlled trials comparing MTA with other materials or placebo. The Cochrane Collaboration's RevMan5 software was used for data analysis. Results: Five studies involving MTA and three other materials were included. No statistically significant difference was found in the clinical effectiveness of MTA and intermediate restorative material (IRM), with relative risk (RR) 0.62 and 95% CI 0.34 to 1.16. A statistically significant difference exists between MTA and amalgam in terms of outcome, with RR 0.35 and 95% CI 0.13 to 0.94. The difference between the gutta-percha and the MTA groups was statistically significant, with RR 0.08 and 95% CI 0.01 to 0.57. Conclusion: MTA as root-end filling is better than amalgam and purely gutta-percha but similar to IRM. There is a limited number of well-designed clinical trials within this research area. Further highquality, large-scale, and long-term follow-up randomized controlled trials are still required to confirm the long-term outcomes of MTA as root-end filling in endodontic surgery. Keywords: endodontic surgery, meta-analysis, MTA, RCT, root-end filling, root-end resection