Effect of Resin-based and Bioceramic Root Canal Sealers on Postoperative Pain: A Split-mouth Randomized Controlled Trial

Introduction: The aim of this study was to compare the effect of resin-based and bioceramic root canal sealers on the occurrence and intensity of postoperative pain in patients with asymptomatic apical periodontitis (AAP). Methods: Patients presenting with AAP in previously endodontically treated teeth were included in this split-mouth blinded randomized controlled trial. For each patient, 2 single-rooted teeth were retreated and obturated using the warm vertical condensation technique and different obturation materials (ie, a gutta-percha point with resin-based sealer and a bioceramic-coated gutta-percha point with bioceramic sealer). Treatment of 1 root canal was performed in a single visit. Postoperative pain was recorded by a visual analog scale (VAS) at 24 hours, 48 hours, 72 hours, and 7 days after obturation. Results: Of the 61 included patients, 57 individuals presenting 114 teeth completed the study. There was no statistically significant difference between the tested root canal sealers regarding postoperative pain at any time points assessed (P > .05). In total, 20 (35%) patients perceived pain. Only 1 patient reported severe pain. VAS scores of 80 and 70 were reported in the AH Plus (Dentsply Maillefer, Ballaigues, Switzerland) and Total Fill (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) groups, respectively. Pain intensity decreased about 2-fold in both groups at 48 hours after treatment. There were no reports of pain since 72 hours after obturation. The odds ratio for pain occurrence in the lower premolars was 7.2 (95% confidence interval, 1.708-30.352) compared with the upper front teeth. Conclusions: AH Plus and Total Fill perform similarly in terms of the occurrence and intensity of postoperative pain in teeth with AAP with no material extrusion beyond the apex.