Aim This randomized clinical trial aimed to evaluate and compare the effect of mineral trioxide aggregate (MTA)‐based bioceramic‐ and resin‐based sealers on the incidence and intensity of post‐obturation pain and treatment outcome in asymptomatic vital molar teeth in single‐visit root canal treatment. Methodology One hundred asymptomatic mandibular molar teeth with vital pulp were randomly assigned into two groups according to the sealer used: MTA Fillapex or AH Plus sealer. WaveOne Gold instruments were used for root canal preparations. Root canals were obturated with WaveOne Gold gutta‐percha cones corresponding in size and taper to the last instrument used. MTA Fillapex was used in the first group and AH Plus was used in the second group as the root canal sealer. The effects of age, gender, tooth types and the level of root canal filling on the treatment outcome were evaluated after 1 and 2 years. Postoperative pain at 6, 12, 24, 48, 72 h, 4, 5, 6, 7 and 30 days after root canal treatment was measured with the Numerical Rating Scale. Chi‐square test was used for the treatment outcome and Mann–Whitney U, chi‐Square and Spearman correlation analyses were used for postoperative pain. α = .05 was the level of significance. Results Twelve patients did not complete the 2‐year follow‐up and the study finished with 88 patients. In the MTA Fillapex group 41 correct, one short, two extruded, and in the AH Plus group 40 correct, one short and three extruded root canal fillings were detected. No significant differences were observed between the first‐ and second‐year treatment outcomes between the groups (p > .05).There was no association between age, gender, tooth number, root canal filling length and the treatment success in all evaluated teeth (p > .05). The differences between the groups in terms of postoperative pain incidence and intensity at all time‐points were not significant (p > .05). There was no correlation between the age and postoperative pain (p > .05), but pain was statistically higher in women (p < .05). Conclusions Mineral trioxide aggregate Fillapex showed similar success rate and post‐obturation pain incidence and intensity as AH Plus sealer and can be used as a root canal sealer in asymptomatic mandibular molars with irreversible pulpitis.

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