View the CAT printer-friendly / share this CAT
Title Bioceramic Sealers Result in Less Postoperative Pain as Compared to Resin Sealers for Patients Receiving Nonsurgical Root Canal Therapy
Clinical Question For patients receiving non-surgical root canal treatment, does obturation with a bioceramic (calcium silicate) sealer as compared to a resin sealer, result in more postoperative pain?
Clinical Bottom Line For patients receiving nonsurgical root canal treatment performed with bioceramic sealers or calcium silicate-based sealers, there is not an increase in postoperative pain as compared to resin-based sealers. In fact, bioceramic sealers led to a reduction of pain after root canal treatment. This is supported by a recent systemic review of 9 studies and meta-analysis of 5 randomized controlled trials in which the bioceramic sealer resulted in less postoperative pain at 24 and 48 hours as compared to resin-based sealer techniques. Further study is needed to standardize patient self-reported postoperative pain measurement methods to better compare future randomized controlled studies as well as to assess the level of clinical applicability of the findings.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 34640531Mekhdieva/2021426 teeth in 5 studies at 24-hr follow-up; 270 teeth in 3 studies at 48-hr follow-upSystematic Review and Meta-analysis of Randomized Controlled Trials
Key resultsBioceramic sealer demonstrated significantly lower postoperative pain at 24 hours and 48 hours after treatment as compared to resin-based sealer in randomized controlled trials.
Evidence Search (postoperative pain) AND ((bioceramic sealer[Title/Abstract]) OR (Calcium Silicate[Title/Abstract]))
Comments on
The Evidence
Mekhdieva et al reviewed available literature from January 2010 until January 2021 to compare postoperative pain in adults receiving root canal treatment with gutta percha and bioceramic sealers for the root canal filling as compared to those treated with gutta percha and resin-based sealers. The terms used to complete the search include “postoperative pain” AND “endodontic sealer” OR “root canal treatment”. The exploration was conducted on PubMed, Springer Link, DOSS, Scopus, Nature, Wiley Online Library, Web of Science Core Collection, BMJ, Cochrane Library, Oxford scholarship online, CINAHL complete, Access medicine, Science direct, as well as looking for studies in SIGLE and clinicaltrial.gov. To be included in the results, the studies had to be randomized controlled trials (RCT) that evaluated postoperative pain and compared bioceramic sealer with resin sealer treatment in adult patients. Extensive exclusion criteria were utilized, excluding studies which further compared one and two visit treatment or evaluating pain management after the root canal treatment beyond the original search area. If there was a question about a study, the investigators attempted to communicate with authors. Initially, 695 studies were identified, after review and exclusion, 9 records were used for the systematic review. The Cochrane Risk of Bias Tool was used to assess quality of each study. Of the 9 studies, 2 were low risk, 6 were unclear risk, and 1 was high risk of bias. All 9 records were single center RCTs with similar treatment procedures, but there was some variance in obturation techniques that included: warm vertical, single-cone, lateral condensation, and carrier-based obturation. There was dissimilarity in the reporting of pain scale ratings between studies. Interestingly, none of the individual studies had results of a significant difference in postoperative pain between bioceramic and resin sealers. The authors included forest plots for postoperative pain at 24 hours and at 48 hours, which both had results favoring bioceramic sealer techniques. Five studies were used to evaluate pain at 24 hours and three studies were used at 48 hours. This is a small number of studies. For the postoperative pain forest plot at 24 hours, the 95% confidence interval diamond nearly touches the line of no effect suggesting that there is a trend to favor bioceramic sealer rather than a significant difference in postoperative pain at 24 hours between the two sealers. Heterogeneity was evaluated for postoperative pain at 24 and 48 hours in the meta-analysis and found no observed heterogeneity at 24 hours and low heterogeneity for the data at 48 hours postoperatively.
Applicability As more clinicians adopt the use of bioceramic sealers into endodontic treatment practices due to their biocompatibility, it is imperative to evaluate patient-based outcomes like postoperative pain, as compared to conventional treatment techniques or resin-based sealers in this investigation. This meta-analysis shows a trend for less postoperative pain at 24 hours and statistically significant less postoperative pain at 48 hours after root canal treatment, a noteworthy finding which may improve the patient’s endodontic treatment experience. The increased product cost for the clinician may be justified given the postoperative pain advantage for patients along with other benefits of using bioceramic sealer over a resin-based sealer.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords bioceramic sealer, calcium silicate sealer, postoperative pain, nonsurgical root canal therapy, resin sealer, resin-based sealer, post-operative pain
ID# 3486
Date of submission: 12/02/2021spacer
E-mail shannona@livemail.uthscsa.edu
Author Abby Shannon, DDS, MPH
Co-author(s) Paul T. Pryor, DMD
Co-author(s) e-mail pryorp@livemail.uthscsa.edu
Faculty mentor/Co-author Vanessa Chrepa, DDS, MS
Faculty mentor/Co-author e-mail chrepa@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
post a comment
None available

Return to Found CATs list