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CC BY-NC-ND 4.0 · Eur J Dent 2021; 15(02): 347-359
DOI: 10.1055/s-0041-1724157
Review Article

Calcium Silicate-Based Sealers Do Not Reduce the Risk and Intensity of Postoperative Pain after Root Canal Treatment when Compared with Epoxy Resin-Based Sealers: A Systematic Review and Meta-Analysis

Emílio Carlos Sponchiado Junior 
1   Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
2   Division of Endodontics, Dental School, Federal University of Amazonas, Manaus, Amazonas, Brazil
,
Walbert de Andrade Vieira
1   Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
,
Ana Gabriela Costa Normando
1   Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
,
Juliana Vianna Pereira
1   Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
2   Division of Endodontics, Dental School, Federal University of Amazonas, Manaus, Amazonas, Brazil
,
Caio Cezar Randi Ferraz
1   Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
,
José Flávio A. Almeida
1   Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
,
Marina Angélica Marciano
1   Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
,
Brenda P.F.A. Gomes
1   Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
,
Adriana de-Jesus-Soares
1   Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
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Abstract

This review aims to evaluate whether root canal obturation with calcium silicate-based (CSB) sealers reduces the risk and intensity of endodontic postoperative pain when compared to epoxy resin-based (ERB) sealers. The review was registered at PROSPERO (CRD42020169255). Two independent reviewers conducted an electronic search in PubMed, Scopus, EMBASE, Web of Science, Cochrane Library and LILACS until November 2020 and included only randomized clinical trials with adult health participants undergoing root canal treatment. After selection, the JBI Critical Appraisal tool was used to assess the risk of bias. A fixed-effect meta-analysis was performed to summarize the results of pain risk and pain intensity at time intervals of 24 and 48 hours. Finally, the certainty of evidence was assessed using the GRADE approach. The search resulted in 1,206 records, of which five studies (n = 421 patients) met the eligibility criteria and presented moderate to low risk of bias. There was no significant difference between groups in the risk of pain in the first 24 hours (relative risk or RR = 0.83, 95% confidence interval or CI: 0.60, 1.16, I 2 =) or 48 hours (RR = 0.56, 95% CI: 0.26, 1.21, I 2 =). Silicate-based sealers led to lower pain intensity only at 48 hours (mean and standard deviation = 0.37, 95% CI: 0.69, 0.05). All analyses revealed low heterogeneity (I 2 < 25%). The evidence presented moderate level of certainty. Currently available evidence has shown that there is no difference between CSB and ERB sealers in the risk or intensity of postoperative pain.

Keywords

endodontic pain - endodontic sealers - postoperative pain - root canal obturation - systematic review

Appendix and Supplementary



Publication History

Article published online:
23 March 2021

© 2021. European Journal of Dentistry. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Gotler M, Bar-Gil B, Ashkenazi M. Postoperative pain after root canal treatment: a prospective cohort study. Int J Dent 2012; 2012: 310467
    CrossrefPubMedSearch in Google Scholar
  • 2 Sipavičiūtė E, Manelienė R. Pain and flare-up after endodontic treatment procedures. Stomatologija 2014; 16 (01) 25-30
    PubMedSearch in Google Scholar
  • 3 Relvas JB, Bastos MM, Marques AA, Garrido AD, Sponchiado Jr. EC. Assessment of postoperative pain after reciprocating or rotary NiTi instrumentation of root canals: a randomized, controlled clinical trial. Clin Oral Investig 2016; 20 (08) 1987-1993
    CrossrefPubMedSearch in Google Scholar
  • 4 Lopes LPB, Herkrath FJ, Vianna ECB, Gualberto Júnior EC, Marques AAF, Sponchiado Júnior EC. Effect of photobiomodulation therapy on postoperative pain after endodontic treatment: a randomized, controlled, clinical study. Clin Oral Investig 2019; 23 (01) 285-292
    CrossrefPubMedSearch in Google Scholar
  • 5 Nunes EC, Herkrath FJ, Suzuki EH, Gualberto Júnior EC, Marques AAF, Sponchiado Júnior EC. Comparison of the effect of photobiomodulation therapy and Ibuprofen on postoperative pain after endodontic treatment: randomized, controlled, clinical study. Lasers Med Sci 2020; 35 (04) 971-978
    CrossrefPubMedSearch in Google Scholar
  • 6 Vianna ECB, Herkrath FJ, Martins IEB, Lopes LPB, Marques AAF, Sponchiado Júnior EC. Effect of occlusal adjustment on postoperative pain after root canal treatment: a randomized clinical trial. Braz Dent J 2020; 31 (04) 353-359
    CrossrefPubMedSearch in Google Scholar
  • 7 Pak JG, White SN. Pain prevalence and severity before, during, and after root canal treatment: a systematic review. J Endod 2011; 37 (04) 429-438
    CrossrefPubMedSearch in Google Scholar
  • 8 Mostafa MEHAA, El-Shrief YAI, Anous WIO. et al. Postoperative pain following endodontic irrigation using 1.3% versus 5.25% sodium hypochlorite in mandibular molars with necrotic pulps: a randomized double-blind clinical trial. Int Endod J 2020; 53 (02) 154-166
    CrossrefPubMedSearch in Google Scholar
  • 9 Comparin D, Moreira EJL, Souza EM, De-Deus G, Arias A, Silva EJNL. Postoperative pain after endodontic retreatment using rotary or reciprocating instruments: a randomized clinical trial. J Endod 2017; 43 (07) 1084-1088
    CrossrefPubMedSearch in Google Scholar
  • 10 Elzaki WM, Abubakr NH, Ziada HM, Ibrahim YE. Double-blind randomized placebo-controlled clinical trial of efficiency of nonsteroidal anti-inflammatory drugs in the control of post-endodontic pain. J Endod 2016; 42 (06) 835-842
    CrossrefPubMedSearch in Google Scholar
  • 11 Sadaf D, Ahmad MZ. Factors associated with postoperative pain in endodontic therapy. Int J Biomed Sci 2014; 10 (04) 243-247
    CrossrefPubMedSearch in Google Scholar
  • 12 Alonso-Ezpeleta LO, Gasco-Garcia C, Castellanos-Cosano L, Martín-González J, López-Frías FJ, Segura-Egea JJ. Postoperative pain after one-visit root-canal treatment on teeth with vital pulps: comparison of three different obturation techniques. Med Oral Patol Oral Cir Bucal 2012; 17 (04) e721-e727
    CrossrefPubMedSearch in Google Scholar
  • 13 Peng L, Ye L, Tan H, Zhou X. Outcome of root canal obturation by warm gutta-percha versus cold lateral condensation: a meta-analysis. J Endod 2007; 33 (02) 106-109
    CrossrefPubMedSearch in Google Scholar
  • 14 Emara RS, Abou El Nasr HM, El Boghdadi RM. Evaluation of postoperative pain intensity following occlusal reduction in teeth associated with symptomatic irreversible pulpitis and symptomatic apical periodontitis: a randomized clinical study. Int Endod J 2019; 52 (03) 288-296
    CrossrefPubMedSearch in Google Scholar
  • 15 Anitasari S, Wahab DE, Barlianta B, Budi HS. Determining the effectivity of infrared distance to eliminate dental pain due to pulpitis and periodontitis. Eur J Dent 2020; 14 (03) 360-365
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Gençoglu N, Oruçoglu H, Helvacıoḡlu D. Apical leakage of different gutta-percha techniques: thermafil, js quick-fill, soft core, microseal, system B and lateral condensation with a computerized fluid filtration meter. Eur J Dent 2007; 1 (02) 97-103
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Tennert C, Jungbäck IL, Wrbas KT. Comparison between two thermoplastic root canal obturation techniques regarding extrusion of root canal filling—a retrospectivein vivostudy. Clin Oral Investig 2013; 17 (02) 449-454
    CrossrefPubMedSearch in Google Scholar
  • 18 Wong AW, Zhang S, Li SK, Zhang C, Chu CH. Clinical studies on core-carrier obturation: a systematic review and meta-analysis. BMC Oral Health 2017; 17 (01) 167
    CrossrefPubMedSearch in Google Scholar
  • 19 Sari S, Duruturk L. Radiographic evaluation of periapical healing of permanent teeth with periapical lesions after extrusion of AH Plus sealer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 104 (03) e54-e59
    CrossrefPubMedSearch in Google Scholar
  • 20 Zhang W, Peng B. Tissue reactions after subcutaneous and intraosseous implantation of iRoot SP, MTA and AH Plus. Dent Mater J 2015; 34 (06) 774-780
    CrossrefPubMedSearch in Google Scholar
  • 21 Camargo CH, Camargo SE, Valera MC, Hiller KA, Schmalz G, Schweikl H. The induction of cytotoxicity, oxidative stress, and genotoxicity by root canal sealers in mammalian cells. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108 (06) 952-960
    CrossrefPubMedSearch in Google Scholar
  • 22 Zhang W, Li Z, Peng B. Ex vivo cytotoxicity of a new calcium silicate-based canal filling material. Int Endod J 2010; 43 (09) 769-774
    CrossrefPubMedSearch in Google Scholar
  • 23 Fonseca DA, Paula AB, Marto CM. et al. Biocompatibility of root canal sealers: a systematic review of in vitro and in vivo studies. Materials (Basel) 2019; 12 (24) E4113
    CrossrefPubMedSearch in Google Scholar
  • 24 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097
    CrossrefPubMedSearch in Google Scholar
  • 25 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 2009; 6 (07) e1000100
    CrossrefPubMedSearch in Google Scholar
  • 26 Tufanaru CMZ, Aromataris E, Campbell J, Hopp L. Systematic reviews of effectiveness. In: Aromataris E, Munn Z, eds. Joanna Briggs Institute Reviewer’s Manual. The Joanna Briggs Institute 2017
  • 27 Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.1 (updated September 2020). Cochrane, 2020. Available at: www.training.cochrane.org/handbook.
  • 28 Bodian CA, Freedman G, Hossain S, Eisenkraft JB, Beilin Y. The visual analog scale for pain: clinical significance in postoperative patients. Anesthesiology 2001; 95 (06) 1356-1361
    CrossrefPubMedSearch in Google Scholar
  • 29 Dawdy J, Halladay J, Carrasco-Labra A, Araya I, Yanine N, Brignardello-Petersen R. Efficacy of adjuvant laser therapy in reducing postsurgical complications after the removal of impacted mandibular third molars: a systematic review update and meta-analysis. J Am Dent Assoc 2017; 148 (12) 887-902.e4
    CrossrefPubMedSearch in Google Scholar
  • 30 Balshema H, Helfand M, Scheunemannc HJ. et al. GRADE guidelines: 3. Rating the quality of evidence. original. J Clin Epidemiol 2011; 64: 5
    Search in Google Scholar
  • 31 Fonseca B, Coelho MS, Bueno CEDS, Fontana CE, Martin AS, Rocha DGP. Assessment of extrusion and postoperative pain of a bioceramic and resin-based root canal sealer. Eur J Dent 2019; 13 (03) 343-348
    Thieme ConnectPubMedSearch in Google Scholar
  • 32 Atav Ates A, Dumani A, Yoldas O, Unal I. Post-obturation pain following the use of carrier-based system with AH Plus or iRoot SP sealers: a randomized controlled clinical trial. Clin Oral Investig 2019; 23 (07) 3053-3061
    CrossrefPubMedSearch in Google Scholar
  • 33 Graunaite I, Skucaite N, Lodiene G, Agentiene I, Machiulskiene V. Effect of resin-based and bioceramic root canal sealers on postoperative pain: a split-mouth randomized controlled trial. J Endod 2018; 44 (05) 689-693
    CrossrefPubMedSearch in Google Scholar
  • 34 Aslan T, Dönmez Özkan H. The effect of two calcium silicate-based and one epoxy resin-based root canal sealer on postoperative pain: a randomized controlled trial. Int Endod J 2020; 54: 190-197
    CrossrefPubMedSearch in Google Scholar
  • 35 Seh Gabriel TH, Chong LK, Nee LJ, Ming Clement LW, Hoon Yu VS. Post-obturation pain associated with tricalcium silicate and resin-based sealer techniques - a randomized clinical trial. J Endod 2020; (e-pub ahead of print)
    CrossrefPubMedSearch in Google Scholar
  • 36 Nagendrababu V, Gutmann JL. Factors associated with postobturation pain following single-visit nonsurgical root canal treatment: a systematic review. Quintessence Int 2017; 48 (03) 193-208
    PubMedSearch in Google Scholar
  • 37 Vengerfeldt V, Mändar R, Saag M, Piir A, Kullisaar T. Oxidative stress in patients with endodontic pathologies. J Pain Res 2017; 10: 2031-2040
    CrossrefPubMedSearch in Google Scholar
  • 38 Rosen E, Goldberger T, Taschieri S, Del Fabbro M, Corbella S, Tsesis I. The prognosis of altered sensation after extrusion of root canal filling materials: a systematic review of the literature. J Endod 2016; 42 (06) 873-879
    CrossrefPubMedSearch in Google Scholar
  • 39 González-Martín M, Torres-Lagares D, Gutiérrez-Pérez JL, Segura-Egea JJ. Inferior alveolar nerve paresthesia after overfilling of endodontic sealer into the mandibular canal. J Endod 2010; 36 (08) 1419-1421
    CrossrefPubMedSearch in Google Scholar
  • 40 Alves FR, Coutinho MS, Gonçalves LS. Endodontic-related facial paresthesia: systematic review. J Can Dent Assoc 2014; 80: e13
    PubMedSearch in Google Scholar
  • 41 Santoro V, Lozito P, Donno AD, Grassi FR, Introna F. Extrusion of endodontic filling materials: medico-legal aspects. two cases. Open Dent J 2009; 3: 68-73
    CrossrefPubMedSearch in Google Scholar
  • 42 Lodienė G, Kopperud HM, Ørstavik D, Bruzell EM. Detection of leachables and cytotoxicity after exposure to methacrylate- and epoxy-based root canal sealers in vitro. Eur J Oral Sci 2013; 121 (05) 488-496
    CrossrefPubMedSearch in Google Scholar
  • 43 Seo DG, Lee D, Kim YM, Song D, Kim SY. Biocompatibility and mineralization activity of three calcium silicate-based root canal sealers compared to conventional resin-based sealer in human dental pulp stem cells. Materials (Basel) 2019; 12 (15) E2482
    CrossrefPubMedSearch in Google Scholar
  • 44 Rodríguez-Lozano FJ, García-Bernal D, Oñate-Sánchez RE, Ortolani-Seltenerich PS, Forner L, Moraleda JM. Evaluation of cytocompatibility of calcium silicate-based endodontic sealers and their effects on the biological responses of mesenchymal dental stem cells. Int Endod J 2017; 50 (01) 67-76
    CrossrefPubMedSearch in Google Scholar
  • 45 Moher D, Hopewell S, Schulz KF. et al. Consolidated Standards of Reporting Trials Group. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol 2010; 63 (08) e1-e37
    CrossrefPubMedSearch in Google Scholar
  • 46 Nagendrababu V, Duncan HF, Bjørndal L. et al. PRIRATE 2020 guidelines for reporting randomized trials in Endodontics: a consensus-based development. Int Endod J 2020; 53 (06) 764-773
    CrossrefPubMedSearch in Google Scholar
  • 47 Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs 2005; 14 (07) 798-804
    CrossrefPubMedSearch in Google Scholar