Iranian Endodontic Journal

Abstract

Introduction:
Successful management of apical periodontitis relies on effective root canal obturation to eliminate microbial activity and promote periapical healing. Bioceramic sealers have emerged as promising alternatives to conventional sealers, offering superior biocompatibility and regenerative potential. However, their comparative clinical efficacy and safety remain uncertain.

Materials and Methods:
This systematic review evaluated the effectiveness and safety of bioceramic sealer-assisted obturation compared with conventional sealer methods in the treatment of apical periodontitis. A comprehensive search was performed in PubMed, Scopus, Web of Science, and Embase following PRISMA 2020 guidelines. Randomized controlled trials comparing bioceramic and conventional sealers were included. Three independent reviewers conducted study selection, data extraction, and risk of bias assessment using the RoB 2.0 tool. Primary outcomes were apical healing and postoperative pain; secondary outcomes included adverse events and procedural complications.

Results:
From 491 identified records, 12 randomized controlled trials met the inclusion criteria.  

Meta-analysis of four trials revealed no statistically significant difference in healing rates between bioceramic and conventional sealers (RR = 1.05, 95% CI 0.89–1.23, p = 0.61; I² = 0%). No major adverse events were reported. Bioceramic sealers showed comparable or superior results in apical healing and postoperative pain reduction, particularly in cases with extensive periapical lesions. No serious adverse events were reported. Methodological variability and differences in sealer composition limited interstudy comparability.

Conclusion:
Bioceramic sealers may offer clinical advantages over conventional sealers by enhancing periapical healing and minimizing postoperative discomfort. Nevertheless, further high-quality trials with standardized protocols are necessary to confirm these findings.

Keywords: Apical Periodontitis, Postoperative Pain, Standard Sealers.