The efficacy of premixed bioceramic sealers versus standard sealers on root canal treatment outcome, extrusion rate and post‐obturation pain: A systematic review and meta‐analysis

Background Limited evidence is available regarding the superior clinical properties of bioceramic sealers comparted with traditional standard sealers. Objectives This review aimed to answer the following research questions: ‘In healthy patients requiring a root canal treatment (P), what is the efficacy of premixed bioceramic sealers (I) compared with traditional root canal epoxy resin‐based sealers (C) in terms of survival, success rates (PICO1) sealer extrusion and resorption (PICO2) post‐obturation pain (PICO3) (O)?’ Methods Authors independently searched three electronic databases: PubMed (including MEDLINE), Web of Science, Embase and Scopus up to 31 October 2023. This was accompanied by both grey literature and manual search. Detailed selection criteria were applied, namely mature permanent teeth requiring root canal treatment, premixed bioceramic sealer with gutta‐percha as an intervention group, a standard filling technique as control group and full‐text available in English. A random‐effect meta‐analysis was used to synthesize the body of evidence regarding the use of bioceramic sealers in root canal treatment and their impact on post‐obturation pain. Effect sizes were represented as relative risks on a logarithmic scale for binary outcomes and as mean differences for continuous outcomes. Results A total of 941 articles were identified. Fifteen Comparative clinical studies were finally included. Eleven were randomized clinical trials, and four were prospective clinical trials with control group. The follow‐up of these studies was not greater than 2 years. No publication bias was observed in any study. No significant differences were observed between the two groups in terms of survival and success rates. A small non‐significant lower risk of extrusion was observed for bioceramics. A small, non‐significantly lower post‐operative‐pain within 24‐h was observed when bioceramics were used. Discussion The majority of current evidence shows inconsistencies in reporting and is of short‐term duration. Robust prospective long‐term trials are needed in this area to better support future recommendations. Conclusion This systematic review is the first to analyse several clinical outcomes using premixed sealers. Included studies differed in terms of clinical protocol and operator expertise, but reported a similar outcome when comparing bioceramic versus standard sealers. Tooth survival, treatment outcome, post‐operative pain and periapical extrusion were similar