Do resin-based root canal sealers cause more postoperative pain than other sealers? A systematic review of clinical studies and meta-analysis

Objective: To evaluate whether root canal obturation with resin-based sealers increases the incidence and intensity of post-operative pain compared to other sealer types. Data sources: brary, and gray literature were searched through December 2020. Clinical studies evaluating postoperative pain after obturation with resin-based sealers and other sealer types were included. Risk of bias was assessed through the Cochrane RoB 2.0 tool for randomized clinical trials (RCTs) and ROBINS-I tool for non-ran-domized clinical trials (nRCTs). Pooled relative risks (RR), standard-ized mean differences (SMD), and 95% confidence intervals were calculated for quantitative analyses. Of 524 studies, 11 clinical studies (eight RCTs and three nRCTs) involving 1,123 teeth were included. Four studies were assigned low risk of overall bias while seven studies presented high risk of overall bias. Quantitative analyses were performed with six studies for pain incidence, five studies for pain intensity, and four studies for analgesic intake. There was no significant difference between resin- based sealers and other sealer types in postoperative pain incidence at 24 hours (RR 1.102, P = .53), 48 hours (RR 0.943, P = .93), 72 hours (RR 1.019, P = .93), and 1 week (RR 0.559, P = .31), in pain intensity at 12 hours (SMD 0.100, P = .35), 24 hours (SMD 0.090, P = .25), and 48 hours (SMD 0.217, P = .26), and in analgesic intake at 24 hours (RR 2.253, P = .15) and 72 hours (RR 0.650, P = .59). Conclusion: Based on the available evidence, resin -based sealers do not increase the post- operative pain incidence, intensity, and analgesic intake com- pared to other sealer types. (Quintessence Int 2022;53: 472-483; doi: 10.3290/j.qi.b2887687)