Short- and Long-term Clinical Outcomes of Hydraulic Calcium Silicate-Based Sealers: A Systematic Review and...

This meta-analysis compared hydraulic calcium silicate-based (HCSS) versus other types of root canal sealers regarding postoperative pain and treatment outcomes.

Five electronic databases were searched for randomized and non-randomized clinical studies from 1947 to 2026. Post-operative pain assessment was extracted as visual analogue scale scores (0-10). Treatment success and failure were recorded according to prespecified loose and strict radiographic criteria. For continuous and dichotomous outcomes, pooled effect estimates (e.g. standardized mean differences (SMD), odds ratios (OR)) with 95% confidence intervals (95%CI) were calculated using fixed- or random-effects models.

Fifty-five articles were included, reporting on 53 cohorts comprising 5913 teeth at the end of the observation period. Forty studies investigated postoperative pain; 21 assessed treatment outcome using loose criteria and 14 strict criteria, with both reported in 12 studies. Sealer extrusion or resorption was documented for 25 cohorts. Patients treated with HCSS reported slightly lower postoperative pain scores after 6 hours (OR=-0.27, 95%CI:-0.51--0.04, moderate level of evidence), although this tendency was inconsistent over different postoperative intervals. For treatment success defined according to loose criteria, use of HCSS resulted in significantly fewer failures than other types of sealers (OR=0.70, 95%CI:0.50-0.99,high level of evidence), whereas no significant difference between sealer types was observed when strict criteria were applied (OR=0.89, 95%CI:0.67-1.19, high level of evidence).

HCSS represent a clinically validated sealer group with no increased risk of elevated postoperative pain and can contribute to successful root canal treatment, with success rates comparable to those of other types of sealers.

Hydraulic calcium silicate-based root canal sealers were promoted for their biocompatibility and bioactivity. The results of clinical trials show that HCSS perform similar to other types of root canal sealers in terms of postoperative pain and treatment outcomes and display a well-investigated alternative to epoxy resin or zinc oxide eugenol sealers.

PROSPERO database CRD420261365434.