Comparison of Postobturation Pain Experience after Apical Extrusion of Calcium Silicate- and Resin-Based Root Canal Sealers

Introduction: This study compared the intensity of postobturation pain after unintentional apical extrusion of calcium silicate-based root canal sealers (EndoSequence BC Sealer [Brasseler USA, Savannah, GA] and Bio-C Sealer [Angelus, Londrina, PR, Brazil]) with a resin-based sealer (AH Plus; Dentsply Sirona, York, PA). Methods: A total of 330 patients referred for root canal treatment on molar teeth with asymptomatic irreversible pulpitis were recruited. Root canals were prepared using WaveOne Gold instruments (Dentsply Sirona) in a crown-down technique and irrigated with 2% chlorhexidine gel and saline solution. Next, patients were randomly distributed into 3 groups according to the root canal sealer used (n = 110): AH Plus, BC Sealer, and Bio-C Sealer. Root canal filling was then accomplished with a vertical compaction technique. Patients presenting with an unintentional extrusion of sealers (n = 13/ group) were assessed for postobturation pain experience using a visual descriptor scale ranging from 0-10 at 6-, 12-, 24-, and 48-hour and 1-week intervals after treatment. Mixed analysis of variance repeated measures were used to assess the results (alpha = 0.05). Results: The extrusion rate was similar for all sealers (similar to 12%). There was no significant difference in the postobturation pain results between the root canal sealers evaluated (P > .05). However, after the time interval of 12 hours, AH Plus (P = .04073) and Bio-C Sealer (P = .04327) demonstrated a significant reduction in pain, whereas BC Sealer did not show differences in pain intensity, even in the maximum period evaluated of 1 week (P > .05). Conclusions: The occurrence of unintentional apical extrusion of calcium silicate-based root canal sealers presents similar postoperative pain results compared with resin-based sealers with low-intensity pain.

Automated summary

This study compared the intensity of post-obturation pain after unintentional apical extrusion of calcium silicate-based root canal sealers with a resin-based sealer. The results showed similar postoperative pain results between the root canal sealers evaluated, but AH Plus and Bio-C Sealer demonstrated significant pain reduction at 12 hours, whereas BC Sealer did not show differences in pain intensity even after 1 week.