The treatment of diseased and necrotic pulpal tissue in teeth spans has been well known throughout history. Root canal treatment in the twentieth century has included complete removal of pulpal remnants to remove the failing tissue and then obturating the canal space with biocompatible material. This treatment preserves individual teeth to further function as part of a whole dentition for the patient's well-being. Failed root canal treatment, however, sometimes requires surgical intervention to treat the teeth from the root end. This article reviews the materials placed in intimate contact with tissues in this surgical procedure. The implications of these various materials within the tissues are discussed, along with clinical signs and symptoms a healthcare provider might encounter when examining these patients. There is no clear-cut "best" material for root-end surgical obturation at this time. Therefore, major materials that might be used are included in this discussion.