The effect of two different root canal sealers on treatment outcome and post‐obturation pain in single‐visit root canal treatment: A prospective randomized clinical trial

Abstract

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.

Clinical applications of calcium silicate‐based materials: a narrative review

“…In prospective studies, similar success rates were reported for the single cone technique using BioRoot RCS and warm vertical compaction technique using an epoxy resin‐based sealer 165 or a zinc oxide‐eugenol sealer 167 . According to a randomized clinical trial, MTA Fillapex showed a similar success rate to an epoxy resin‐based sealer at a 2‐year follow‐up when used with a single cone technique 166 …”

“…163 One of the most commonly used rootfilling techniques with CSSs in clinical studies was the single cone technique. [164][165][166] According to a retrospective study using iRoot SP sealer with a single cone technique, the success rate was 96.8% and iRoot SP extrusion had no adverse effect on the treatment outcome. 164 In prospective studies, similar success rates were reported for the single cone technique using BioRoot RCS and warm vertical compaction technique using an epoxy resin-based sealer 165 or a zinc oxide-eugenol sealer.…”

“…167 According to a randomized clinical trial, MTA Fillapex showed a similar success rate to an epoxy resin-based sealer at a 2-year followup when used with a single cone technique. 166 Recently, a sealer-based root-filling technique using CSSs has become popular due to the good properties of these sealers such as their hydrophilic nature, slight expansion, and high biocompatibility. 168 In this technique, the CSS used is the main content of root canal filling while a single gutta-percha cone that is generally smaller than the size of the master apical file acts as a carrier to deliver the sealer into the root canal space and facilitates the removal of root canal filling during retreatment if necessary.…”

“…According to a randomized clinical trial, iRoot SP resulted in a similar clinical performance and success rate to an epoxy resin‐based sealer at a 2‐year follow‐up when used with a warm vertical compaction technique 163 . One of the most commonly used root‐filling techniques with CSSs in clinical studies was the single cone technique 164–166 . According to a retrospective study using iRoot SP sealer with a single cone technique, the success rate was 96.8% and iRoot SP extrusion had no adverse effect on the treatment outcome 164 .…”

Response to editor

“…As the authors have stated, there are multiple factors that can affect postoperative pain such as; debris extrusion, root canal preparation technique, root canal sealer type and root canal filling technique, which are already mentioned in the published article (Gondim Jr et al, 2010;Ng et al, 2004;Wang et al, 2010). These factors have been the focus of our group for many years (Coşar et al, 2022;Kandemir Demirci et al, 2021;Kandemir Demirci & Çalışkan, 2016;Miçooğulları Kurt & Çalışkan, 2018;Yaylali et al, 2018).…”