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Postoperative pain after root canal filling with bioceramic sealers: a systematic review and meta-analysis of randomized clinical trials

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Abstract

The aim of this systematic review and meta-analysis (SRM) was to assess postoperative pain (PP) after endodontic treatment with bioceramic root canal sealer compared to AH Plus® sealer. This SRM was carried out in accordance with the items on the PRISMA 2020 checklist and Cochrane guidelines and registered in PROSPERO (CRD42021259283). Only randomized clinical trials (RCTs) were included. Meta-analysis was conducted using R software, the standardized means difference (SMD) measure of effect was calculated for quantitative variables, and the odds ratio (OR) for binary variables. The Cochrane tool (RoB 2.0) was used to assess the risk of bias, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence. Qualitative and quantitative analysis included 18 and 17 studies, respectively. For quantitative variables, the bioceramic root canal sealer presented less occurrence of postoperative pain than the AH Plus® sealer in 24 h (SMD − 0.17 [− 0.34; − 0.01], p = 0.0340). For binary variables, there was no difference observed between the sealers evaluated, except for sealer extrusion where the bioceramic group had lower post-filling material extrusion (OR 0.52 [0.32; 0.84], p = 0.007). Regarding the risk of bias analysis, low risk was observed for most domains, except allocation that was considered unclear, while the certainty of evidence ranged from moderate to low. The results showed that bioceramics sealers reduced postoperative endodontic pain only after 24 h and showed less sealer extrusion compared to the AH Plus® sealer. However, more robust and standardized clinical trials are needed to confirm the results with less heterogeneity and higher quality of evidence.

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Data availability

All the data generated or analyzed during this study are included in this published article and its supplementary information files.

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Acknowledgements

This study was supported in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001.

Funding

This study was supported in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001.

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Authors and Affiliations

  1. School of Dentistry, Araçatuba, Department of Preventive and Restorative Dentistry, Araçatuba School of Dentistry, São Paulo State University - UNESP, Rua José Bonifácio 1193, Araçatuba, SP, 1193, Brazil

    Marcelo Augusto Seron, Gabriel Pereira Nunes, João Eduardo Gomes-Filho, Luciano Tavares Angelo Cintra & Gustavo Sivieri-Araujo

  2. Oral Medicine, Department of Diagnosis and Surgery, Araraquara School of Dentistry, São Paulo State University – UNESP, Araraquara, SP, Brazil

    Tulio Morandin Ferrisse

  3. Department of Dental Materials and Prosthodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil

    Henrico Badaoui Strazzi-Sahyon & Paulo Henrique dos Santos

  4. Department of Dentistry, Cesumar University Center - UNICESUMAR, Maringá, PR, Brazil

    Fausto Rodrigo Victorino

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  1. Marcelo Augusto Seron
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Contributions

All authors contributed to the study conception and design. Data collection and analysis were performed by MAS, GPN, TMF, HBSS, and PHS. The first draft of the manuscript was written by MAS and GPN. The final draft was written and revised by MAS, GPN, TMF, GSA (systematic review methods), FRV, JEGF, LTAC, and GSA (endodontics), and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Gabriel Pereira Nunes.

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Seron, M.A., Nunes, G.P., Ferrisse, T.M. et al. Postoperative pain after root canal filling with bioceramic sealers: a systematic review and meta-analysis of randomized clinical trials. Odontology 111, 793–812 (2023). https://doi.org/10.1007/s10266-023-00830-z

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