A Comparative Evaluation of Post-operative Pain in Patients Undergoing Root Canal Treatment With Four Different Types of Sealers: A Randomized Controlled Trial

This study aimed to comparatively evaluate post-operative pain, unintentional apical extrusion, and radiopacity following root canal therapy using four different classes of sealers.

Hundred patients requiring root canal treatment in single-rooted teeth diagnosed with symptomatic irreversible pulpitis, with or without symptomatic apical periodontitis, were recruited. Pre-operative pain levels were recorded using the visual analog scale. Patients were randomized into four sealer groups (Tubli-Seal: Kerr Endodontics, California; AH Plus: Dentsply Sirona, Charlotte; BioRoot RCS: Septodont Healthcare India Pvt. Ltd., Maharashtra, India; and Nishika Canal Sealer BG: Nippon Shika Yakuhin, Shimonoseki, Japan). A single operator performed the treatment in a single visit, using the crown-down technique with Hand Protaper instruments (Dentsply Tulsa Dental, Tulsa), irrigation with 3% sodium hypochlorite (Dentpro, Mohali, India), 17% ethylenediaminetetraacetic acid (EDTA) (MD-Cleanser, EDTA Solution, Meta Biomed, Korea), and distilled water, followed by obturation using the cold lateral condensation technique. Post-operative pain levels were recorded at 24 hours, 72 hours, and seven days. The Kruskal-Wallis H test was employed to compare the pre- and post-operative pain scores across the groups.

Post-operative pain, apical extrusion, and radiopacity showed no statistically significant differences among the four sealer groups (p > 0.05). However, BioRoot RCS had the lowest pain levels at 24 and 72 hours, Tubli-Seal showed the least apical extrusion, and AH Plus and BioRoot RCS exhibited higher and comparable radiopacity.

All the sealers perform similarly in regards to post-operative pain reduction, unintentional apical extrusion, and radiopacity with minor variations.