Root Canal Pain: Which Sealer is Best?

clinical-trial PMID: 32696911

Quick Summary: Researchers compared different materials used to fill root canals to see which caused the least pain after the procedure. They found that all three sealers tested resulted in similar levels of pain and the need for pain medication.

What The Research Found

This study looked at how much pain people felt after a root canal, depending on the type of sealer (filling material) used. The good news? All three sealers tested – AH Plus, Endofill, and MTA Fillapex – resulted in similar levels of pain. Most people felt some pain in the first couple of days, but by day 7, everyone reported no pain.

Study Details

Who was studied: 60 people who needed root canals on single-rooted teeth. They all had a specific type of tooth issue (asymptomatic necrosis and apical periodontitis).

How long: The researchers followed the patients for 7 days after their root canal.

What they took: The study compared three different sealers used to fill the root canal: AH Plus, Endofill, and MTA Fillapex. All patients also received calcium hydroxide as part of the treatment between appointments.

What This Means For You

If you need a root canal, this study suggests that the type of sealer your dentist uses likely won't significantly impact your pain levels. You can expect some discomfort for a few days, but it should resolve within a week, regardless of the sealer used. Talk to your dentist about the best option for your specific situation.

Study Limitations

The study only looked at people with a specific type of tooth issue, so the results might not apply to everyone.

The study only followed patients for a week, so we don't know about long-term pain.

The dentists knew which sealer they were using, which could have slightly influenced the results.

The study included a relatively small number of participants, which may have limited the ability to detect small differences between the sealers.

Key Findings

The study found no statistically significant differences in postoperative pain incidence, intensity, or analgesic use among three root canal sealers (AH Plus, Endofill, MTA Fillapex) at 24 hours, 48 hours, or 7 days post-treatment (all p > 0.05). Pain resolution occurred uniformly by day 7 across all groups, with 0% pain incidence at this endpoint. Analgesic consumption patterns showed no intergroup variation. The conclusion states all sealers performed equally regarding postoperative discomfort management.

Study Design

This was a prospective, randomized, single-blind clinical trial (type: clinical-trial) involving 60 single-rooted teeth from patients diagnosed with asymptomatic pulp necrosis and apical periodontitis. Teeth were randomly allocated to three sealer groups (n = 20 per group): AH Plus (epoxy resin-based), Endofill (zinc oxide-eugenol), or MTA Fillapex (calcium silicate-based). Treatment followed a two-visit protocol with calcium hydroxide intracanal dressing between appointments. Pain was self-assessed using a 4-point ordinal scale (none=1, slight=2, moderate=3, severe=4) at 24h, 48h, and 7d. Primary outcomes were pain incidence/intensity and analgesic use, analyzed via chi-square and ordinal chi-square tests.

Dosage & Administration

No calcium or other supplements were administered to participants. The study evaluated sealers used in root canal filling: AH Plus (Dentsply Sirona), Endofill (Odontobrás), and MTA Fillapex (Angelus). Calcium hydroxide (Calen, Coltène/Whaledent) served as the intracanal medicament for 14 days between treatment sessions but was not the intervention under test. Sealers were applied per manufacturer instructions during the obturation phase.

Results & Efficacy

Pain incidence ranged from 55-65% at 24h and 40-50% at 48h across groups, with no significant differences (24h: p = 0.62; 48h: p = 0.79). Mean pain scores were 1.95–2.10 at 24h and 1.55–1.75 at 48h (all p > 0.05 for intergroup comparisons). Analgesic use occurred in 35-45% of patients at 24h and 20-30% at 48h, with no significant variation (p > 0.05). By day 7, 100% of patients reported no pain (score=1) in all groups. Effect sizes for pain intensity comparisons were negligible (Cramer’s V < 0.1).

Limitations

The study was limited to single-rooted teeth with asymptomatic apical periodontitis, reducing generalizability to multi-rooted teeth or acute infections. The 7-day follow-up period may miss longer-term outcomes. Blinding of the operator was not feasible due to sealer color differences (potential performance bias). Sample size (n = 60 teeth) provided limited power to detect small effect sizes. Calcium hydroxide’s role as a confounding variable in pain modulation was not isolated.

Clinical Relevance

This research has no direct implications for calcium supplementation or nutritional use. For dental practitioners, it indicates that sealer choice (including the calcium silicate-containing MTA Fillapex) does not meaningfully affect short-term postoperative pain outcomes in asymptomatic cases. Patients should expect similar pain trajectories regardless of sealer type, with resolution typically by day 7. The findings do not support selecting sealers based on anticipated pain reduction, as all tested materials performed equivalently in this context.