Calcium Silicate and Epoxy Sealer in Endodontic Treatment: A Randomized Controlled Trial Short title: Calcium Silicate and Epoxy Resin Sealers

Calcium Silicate and Epoxy Sealer in Endodontic Treatment: A Randomized Controlled Trial Short title: Calcium Silicate and Epoxy Resin Sealers | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Calcium Silicate and Epoxy Sealer in Endodontic Treatment: A Randomized Controlled Trial Short title: Calcium Silicate and Epoxy Resin Sealers Duyen Tran Ngoc Minh, Anh Nguyen Ho Quynh, Vu Dien Hoa Anh, Minh Nguyen Duc, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4600018/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The selection of an appropriate sealer is critical for the success of endodontic treatments. Although calcium silicate-based sealers (CSS) and epoxy resin-based sealers (ERS) have exhibited promise in short-term studies, a comprehensive understanding of their long-term clinical effectiveness in single-visit root canal treatment remains essential. Objectives This study aimed to compare and evaluate the long-term clinical effectiveness of a calcium silicate-based sealer and an epoxy resin-based sealer in the context of single-visit root canal treatment. Materials and methods A prospective, longitudinal clinical trial was conducted involving 42 teeth diagnosed with irreversible pulpitis conditions. The teeth were randomly assigned to two groups based on the obturation sealer used: calcium silicate-based sealer (CSS) and epoxy resin-based sealer (ERS). Postoperative parameters, including pain, swelling, fistula, and sensitivity under biting pressure, were assessed at regular intervals for up to 36 months following the single-visit endodontic treatment. Treatment outcomes were determined based on established criteria, categorizing cases as success, failure, or uncertain. Statistical analysis employed the Chi-squared test, t-test, Mann-Whitney U-test, and Wilcoxon signed-rank test (p < 0.05). Results Preliminary results indicate comparable incidences of postoperative complications between the two groups over the long-term follow-up period. Conclusion This study suggests that both calcium silicate-based and epoxy resin-based sealers demonstrate similar long-term clinical effectiveness in single-visit root canal treatments. These findings offer valuable insights for practitioners aiming to achieve sustained treatment success through sealer selection. Clinical relevance: We can use two types of cement Calcium silicate-based and epoxy resin-based sealersinterchangeably in root canal treatment. ClinicalTrials registration number: NCT05904184 calcium silicate-based sealer epoxy resin-based sealer single-visit root canal treatment long-term clinical effectiveness endodontic treatment postoperative complications Figures Figure 1 Figure 2 INTRODUCTION Endodontic sealers, classified based on composition, include epoxy resin-based sealers considered the gold standard, frequently utilized in comparative studies with new obturation materials ( 1 – 3 ). However, this sealer type has limitations, potentially causing moderate to severe tissue damage when exiting into periapical tissues. In contrast, calcium silicate-based sealer, composed mainly of zirconium oxide, calcium silicate, and calcium phosphate, has gained popularity in endodontic treatment. In-vitro studies indicate favorable properties such as biocompatibility, chemical stability, hydrophilicity, flowability, photoresistance, and antibacterial effects ( 4 , 5 ). Post-endodontic pain, ranging from 3–58% in incidence, persists as a common and undesirable sensation even with adherence to established endodontic protocols ( 6 ). Despite meticulous compliance, this discomfort may initiate shortly after treatment, enduring for days thereafter ( 7 ). The etiology of post-endodontic pain encompasses various factors, including changes in periapical tissue pressure, chemical and cyclic mediators, microbial influences, and physiological considerations. Notably, endodontic cement has been scrutinized for its impact on postoperative pain, with authors attributing pain to operative techniques or obturation material properties. For instance, the irrigation process during endodontic treatment may lead to the expulsion of debris or bacteria toward the apex, leaving residual bacteria and incompletely sealed canals ( 8 ). A randomized controlled clinical trial by Ates A. et al. revealed that over 50% of patients experienced pain after obturation, underscoring the critical criterion of completely sealing the dental pulp system for endodontic treatment success ( 9 ). Yet, clinical studies evaluating the efficacy, particularly regarding post-endodontic pain, remain limited ( 10 ). Thus, our study aims to investigate the clinical effectiveness of Calcium Silicate-based sealers compared to epoxy resin-based sealers. By rigorously examining the clinical outcomes and postoperative pain associated with these two sealers, our study seeks to contribute valuable insights to the existing body of knowledge. The comparison between the well-established epoxy resin-based sealer and the emerging calcium silicate-based sealer holds significant implications for refining endodontic practices and enhancing treatment success. Through a robust research design and statistical analysis, we aim to elucidate potential differences or similarities in clinical effectiveness, thereby informing clinicians about the optimal selection of obturation materials for improved patient outcomes in endodontic treatments. Our null hypothesis posits that "There is no difference in clinical signs after obturation using Calcium Silicate-based sealer and epoxy resin-based sealer." Materials and Methods Study Design This investigation constituted a prospective, single-blind clinical trial conducted from June 2020 to December 2023 at the Department of Endodontics, Odonto-Maxillo Facial Hospital of Hochiminh City, Vietnam. The trial targeted patients diagnosed with irreversible pulpitis seeking examination and treatment. Participant Selection The inclusion criteria included individuals aged 18 years or older, confirmed with a positive diagnosis of irreversible pulpitis through electrical and thermal tests, displaying clinical symptoms of continuous or spontaneous pain, and having teeth sensitive to abrupt temperature changes, especially cold stimuli. Additionally, the teeth were required to exhibit healthy periodontal tissue and possess an adequate clinical crown for isolation with a rubber dam. Randomization and Blinding To ensure group homogeneity, a randomization process was performed. A blinded nurse executed the random assignment using a shuffled deck of cards, categorizing participants into either the Epoxy Resin Sealers (ERS) group or the Calcium Silicate Sealers (CSS) group. Research Procedures Pre-intervention Stage Patients received comprehensive study information and were invited to participate upon meeting eligibility criteria. Subsequently, informed consent was obtained, and patients were instructed on the utilization of the Heft-Parker self-assessment scale to measure pain intensity. Binary variables encompassed the presence of swelling, fistula, and sensitivity under biting pressure. Intervention Stage All enrolled patients underwent single-visit endodontic treatment following the protocol established by the Vietnamese Ministry of Health. This involved the use of three-dimensional imaging equipment and an endodontic machine. Unique obturation materials, either Epoxy Resin Sealers (ERS) or Calcium Silicate Sealers (CSS), were employed for each respective group. Post-intervention Stage : Patients were provided with information sheets for the systematic assessment of pain and associated symptoms. Ibuprofen 400mg was prescribed on an as-needed basis for pain intolerance, accompanied by specific instructions. Patients diligently documented pain intensity, medication frequency, and any symptoms at designated intervals following treatment: 6 hours (T6), 12 hours (T12), 24 hours (T24), 48 hours (T48), and 72 hours (T72). Subsequent re-examinations were scheduled after 7 days (T7d), 3 months (T3m), and 6 months (T6m) by the principal investigator. Outcome Measures Symptomatic parameters, including pain, swelling, fistula, and sensitivity under biting pressure, were thoroughly compared between the Epoxy Resin Sealers (ERS) and Calcium Silicate Sealers (CSS) groups. The assessment of treatment outcomes relied on Strindberg's criteria, classifying cases as success, failure, or uncertain based on symptom presentation. This rigorous and methodologically sound approach was designed to systematically investigate and compare the clinical effectiveness of Calcium Silicate-based sealers and Epoxy Resin-based sealers regarding post-endodontic pain and broader treatment outcomes. Statistical Analysis: Statistical analyses were conducted using Stata version 14.0 for Windows (Stata Corp., College Station, Texas, USA). The normality of outcome variable distributions was assessed via the Shapiro-Wilk test. Categorical variables were analyzed using the Chi-squared test, while continuous variables were assessed using the T-test for normally distributed data and the Mann-Whitney U-test for non-normally distributed variables. Paired continuous variables underwent assessment with the Wilcoxon signed-rank test. A significance level of p < 0.05 was set for all analyses. RESUTLS Among the 39 included patients, 69% were women, and 31% were men. The mean age of the patients was 30.9 years. The Epoxy Resin-based Sealer group had an average age of 32.5, while the Calcium Silicate-based Sealer group had an average age of 29.3. No significant differences were observed in gender distribution between the groups ( p = 0.317), and the age difference was not statistically significant ( p = 0.234) (Table 1 ). Table 1 Demographic Characteristics Characteristics Epoxy resin-based sealers group (n%) Calcium Silicate-based sealers group (n%) Total (n%) p -value Gender 0.317 a Men 5 (23.8%) 8 (38.1%) 13 (31.0%) Women 16 (76.2%) 13 (61.9%) 29 (69.0%) Mean age 32.5 ± 9.9 29.3 ± 7.0 30.9 ± 8.6 0.234 b a Chi-square test b Student t test Pain Intensity Over Time The pain intensity ranged from "Moderate" (94.9 ± 7.9) to "Strong" (111.4 ± 5.8) before treatment, with no significant differences between the Epoxy Resin-based Sealer and Calcium Silicate-based Sealer groups over time ( p > 0.05) (Fig. 1 ). Pain Relief Over Time Changes in pain relief over time showed statistically significant differences at specific intervals for both groups. The Epoxy Resin-based Sealer group exhibited significance at "before treatment − 6 hours," "6 hours − 12 hours," and "48 hours − 72 hours," while the Calcium Silicate-based Sealer group showed significance at "before treatment − 6 hours," "12 hours − 24 hours," "24 hours − 48 hours," and "48 hours − 72 hours" (p < 0.05) (Fig. 2 ). Treatment Outcome Evaluation Over Time After 1 week, the overall success rate was 90.5%. The Epoxy Resin-based Sealer group had a lower success rate (85.7%) compared to the Calcium Silicate-based Sealer group (95.2%). After 3 and 6 months, both groups achieved a 100% success rate, with no reports of spontaneous pain, swelling, fistula, or sensitivity under biting pressure ( Fig. 2 ). Out of the 42 teeth examined in this research, we were able to follow up on 37. None of these 37 teeth exhibited pain, swelling, fistula, or sensitivity under biting pressure. Additionally, all the contacted patients reported being satisfied with the treatment outcomes 3 years post-treatment. Discussion A Comprehensive Exploration of Post-Endodontic Pain and Sealer Impact This study undertook a meticulous investigation into the clinical efficacy of two commonly employed endodontic obturation sealers, Calcium Silicate-based Sealer (CSS) and Epoxy Resin-based Sealer (ERS). The primary focus was on assessing pain intensity and clinical symptoms, including spontaneous pain, sensitivity under biting pressure, swelling, or fistula, following endodontic treatments. The findings not only shed light on the temporal dynamics of post-endodontic pain relief but also offer valuable insights into the comparative effectiveness of these sealers. Moreover, the multifaceted discussion delves into the underlying mechanisms of post-endodontic pain and explores the broader clinical implications. Temporal Dynamics of Pain Relief: Post-endodontic pain, a common concern, was examined in this study. The temporal analysis revealed a notable reduction in average pain intensity within the first 12 hours, evolving to "Very little" by day 7, consistent with previous research ( 11 ). These results resonate with the observations of Ates A. ( 9 ), emphasizing a comparable decrease in pain intensity, albeit using the Visual Analog Scale (VAS) ( 9 ). The gradual decline in post-operative pain aligns with established patterns, demonstrating the resilience of patients' pain tolerance and the effectiveness of endodontic interventions over time ( 11 ). Factors Influencing Post-Endodontic Pain: The multifactorial nature of post-endodontic pain was explored, referencing ( 12 ) proposed hypotheses. Changes in periapical tissue pressure, chemical mediators, immune responses, and psychological factors were identified as potential contributors ( 12 ). Understanding these diverse influences is crucial for effective pain management. The study's findings contribute to the growing body of knowledge surrounding post-endodontic pain etiology, emphasizing the complex interplay between biological and psychological factors. Sealer Impact on Pain Relief Comparative analysis between CSS and ERS groups demonstrated a statistically significant decrease in pain intensity within the "before treatment − 6 hours" period, indicating the immediate impact of correct endodontic treatment intervention. This echoes the work of Ates A. ( 9 ), emphasizing the pivotal role of early intervention in mitigating patient discomfort ( 9 ). The absence of statistically significant differences in overall pain severity between the two sealer groups challenges the conventional notion that sealer choice is the primary determinant of pain outcomes. The study also unearthed intriguing insights into the use of analgesia after endodontic treatment, specifically within the first 24 hours. Instances of patients taking analgesics were more prevalent in the ERS group, potentially attributed to the pro-inflammatory effects of AH Plus, a component of ERS ( 13 ). This highlights the nuanced impact of sealer composition on postoperative pain, necessitating a thorough understanding of the chemical constituents of sealers and their potential inflammatory consequences. Clinical Implications and Considerations: The broader clinical implications of these findings are paramount for endodontic practitioners. While the study acknowledges the subtle variations in success rates between CSS and ERS groups, it emphasizes that the choice of sealer alone may not decisively determine treatment success. Instead, meticulous adherence to appropriate techniques, instruments, and control of endodontic procedures plays a more significant role in achieving favorable outcomes ( 14 ). The controversial aspect of occlusal reduction for pain control was also explored in this study. Despite differing opinions on its efficacy, the present meta-analysis emphasized the absence of significant differences between intervention and no intervention, except on the third day after treatment. The potential benefits of occlusal reduction at 72 hours suggest a nuanced approach to pain management, acknowledging that its impact may extend beyond the immediate post-treatment period ( 15 , 16 ). Long-Term Treatment Success and Patient Counseling The study evaluated treatment success rates over 3 months and 6 months, revealing a 100% success rate in both sealer groups by the 6-month mark. This finding aligns with the conventional wisdom suggesting that pain gradually decreases in the first three days and completely dissipates after 7 days ( 11 ). Furthermore, the absence of spontaneous pain, swelling, or fistula post-treatment affirms the long-term efficacy of both sealers. From our findings, we suggest that within 6 months after root canal treatment, if clinical symptoms such as pain or discomfort appear, we should continue monitoring before deciding to re-endodontics. Practitioners are encouraged to counsel patients about the expected trajectory of post-endodontic pain, reassuring them that discomfort typically diminishes within the initial days and ceases entirely after 7 days. These findings align with the study by Seltzer S, supporting the notion that successful endodontic treatments yield sustained positive outcomes over an extended period ( 12 ). Conclusion In conclusion, this comprehensive discussion elucidates the intricate dynamics of post-endodontic pain and compares the effectiveness of CSS and ERS. The study emphasizes the multifactorial nature of pain perception, highlighting the necessity for a holistic approach to endodontic practice. These implications extend beyond sealer choice, emphasizing the critical role of procedural precision and patient-centric care in achieving successful treatment outcomes. Future research avenues may delve into the intricate interplay between sealer characteristics, biological responses, and longer-term clinical outcomes, further enriching our understanding of endodontic treatment efficacy. Declarations No funding was received for conducting this study. The authors have no relevant financial or non-financial interests to disclose. Ethical Approval: Ethical approval was obtained in advance from the Institutional Review Board and Ethics Committee at the University of Medicine and Pharmacy in Ho Chi Minh City, Vietnam, under Approval Number 452/HD-DHYD. Informed consent was obtained from all individual participants included in the study. The study protocol was registered on ClinicalTrials.gov with identifier: NCT05904184. References Komabayashi T, Colmenar D, Cvach N, Bhat A, Primus C, Imai Y (2020) Comprehensive review of current endodontic sealers. Dent Mater J 39(5):703–720. https://doi.org/10.4012/dmj.2019-288 Grossman LISCB, Gopi Krishna V (2014) Endodontic practice. 13P th P. Wolters Kluwer, New Delhi, p 343. https://doi.org/10.4103/0972-0707.190011 Gabriela A, Marin-Bauza FJAR-J, Aline Evangelista Souza-Gabriel, Manoel Damião Sousa-Neto, Carlos Eduardo Saraiva Miranda, Silva-Sousa YTC (2010) Physicochemical properties of methacrylate resin–based root canal sealers. Journal of endodontics. ;36(9):1531-6. https://doi.org/10.1016/j.joen.2010.05.002 Singh G, Gupta I, Elshamy FM, Boreak N, Homeida HE (2016) In vitro comparison of antibacterial properties of bioceramic-based sealer, resin-based sealer and zinc oxide eugenol based sealer and two mineral trioxide aggregates. Eur J dentistry 10(03):366–369. 10.4103/1305-7456.184145 Wang Z (2015) Bioceramic materials in endodontics. Endodontic Top 32(1):3–30. https://doi.org/10.1111/etp.12075 Sathorn C, Parashos P, Messer H (2008) The prevalence of postoperative pain and flare-up in single‐and multiple‐visit endodontic treatment: a systematic review. Int Endod J 41(2):91–99. https://doi.org/10.1111/j.1365-2591.2007.01316.x Abdel Hameed H, ElMubarak NHA-b YE (2010) Ibrahim Postoperative pain in multiple-visit and single-visit root canal treatment. J Endod 36(1):36–39. https://doi.org/10.1016/j.joen.2009.09.003 Siqueira JF Jr, Rôças IN, Favieri A, Machado AG, Gahyva SM, Oliveira JC et al (2002) Incidence of postoperative pain after intracanal procedures based on an antimicrobial strategy. J Endod 28(6):457–460. https://doi.org/10.1097/00004770-200206000-00010 Ates AA, Dumani A, Yoldas O, Unal I (2019) Post-obturation pain following the use of carrier-based system with AH Plus or iRoot SP sealers: a randomized controlled clinical trial. Clin Oral Invest 23(7):3053–3061. https://doi.org/10.1007/s00784-018-2721-6 David Donnermeyer SB, Dammaschke T, Schäfer E (2018) Endodontic sealers based on calcium silicates: a systematic review. Odontology 1–16. https://doi.org/10.1007/s10266-018-0400-3 Pak JG, White SN (2011) Pain prevalence and severity before, during, and after root canal treatment: a systematic review. J Endod 37(4):429–438. https://doi.org/10.1016/j.joen.2010.12.016 Seltzer S (2004) Pain in endodontics. J Endod 30(7):501–503. https://doi.org/10.1097/00004770-200407000-00010 Ruparel NB, Ruparel SB, Chen PB, Ishikawa B, Diogenes A (2014) Direct effect of endodontic sealers on trigeminal neuronal activity. J Endod 40(5):683–687. https://doi.org/10.1016/j.joen.2014.01.030 Nabi S, Farooq R, Purra A, Ahmed F (2019) Comparison of various sealers on postoperative pain in single-visit endodontics: a randomized clinical study. Indian J Dent Sci 11(2):99. 10.4103/IJDS.IJDS_81_18 Owatz CB, Khan AA, Schindler WG, Schwartz SA, Keiser K, Hargreaves KM (2007) The incidence of mechanical allodynia in patients with irreversible pulpitis. J Endod 33(5):552–556. https://doi.org/10.1016/j.joen.2007.01.023 Shamszadeh S, Shirvani A, Asgary SJJ (2020) Does occlusal reduction reduce post-endodontic pain? A systematic review and meta‐analysis. 47(4):528–535. https://doi.org/10.1111/joor.12929 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4600018","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":324846557,"identity":"d6af8416-b48d-4d56-a82d-e1f9197cc785","order_by":0,"name":"Duyen Tran Ngoc Minh","email":"","orcid":"","institution":"Odonto-Maxillo Facial Hospital of Ho Chi Minh City","correspondingAuthor":false,"prefix":"","firstName":"Duyen","middleName":"Tran Ngoc","lastName":"Minh","suffix":""},{"id":324846560,"identity":"8f412b5c-5f74-417d-8b3a-eb87f40926e4","order_by":1,"name":"Anh Nguyen Ho 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12:36:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4600018/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4600018/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60598795,"identity":"8f74aef3-aeba-432e-b9fd-a3b80a406137","added_by":"auto","created_at":"2024-07-18 15:55:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":64332,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eChange in pain relief over time between the two groups of sealers\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4600018/v1/a18638fa077211cdc9091b7e.png"},{"id":60598796,"identity":"7d662b07-4378-463f-b0ad-5296a2f0ba94","added_by":"auto","created_at":"2024-07-18 15:55:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":85633,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of success rate in two groups at 1 week, 3 months and 6 months\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4600018/v1/d6c9a87498283ceb0c4fbe4c.png"},{"id":61812729,"identity":"1e8ab8d6-4b6d-4a92-a348-9bcfae49fa45","added_by":"auto","created_at":"2024-08-05 21:04:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":595774,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4600018/v1/5bab917e-a516-47d5-9552-2a36ef92a91b.pdf"},{"id":60598797,"identity":"facd1691-c1dd-495e-8c44-7b41f24dcdb3","added_by":"auto","created_at":"2024-07-18 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However, this sealer type has limitations, potentially causing moderate to severe tissue damage when exiting into periapical tissues. In contrast, calcium silicate-based sealer, composed mainly of zirconium oxide, calcium silicate, and calcium phosphate, has gained popularity in endodontic treatment. In-vitro studies indicate favorable properties such as biocompatibility, chemical stability, hydrophilicity, flowability, photoresistance, and antibacterial effects (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePost-endodontic pain, ranging from 3\u0026ndash;58% in incidence, persists as a common and undesirable sensation even with adherence to established endodontic protocols (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Despite meticulous compliance, this discomfort may initiate shortly after treatment, enduring for days thereafter (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The etiology of post-endodontic pain encompasses various factors, including changes in periapical tissue pressure, chemical and cyclic mediators, microbial influences, and physiological considerations. Notably, endodontic cement has been scrutinized for its impact on postoperative pain, with authors attributing pain to operative techniques or obturation material properties. For instance, the irrigation process during endodontic treatment may lead to the expulsion of debris or bacteria toward the apex, leaving residual bacteria and incompletely sealed canals (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). A randomized controlled clinical trial by Ates A. et al. revealed that over 50% of patients experienced pain after obturation, underscoring the critical criterion of completely sealing the dental pulp system for endodontic treatment success (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Yet, clinical studies evaluating the efficacy, particularly regarding post-endodontic pain, remain limited (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Thus, our study aims to investigate the clinical effectiveness of Calcium Silicate-based sealers compared to epoxy resin-based sealers. By rigorously examining the clinical outcomes and postoperative pain associated with these two sealers, our study seeks to contribute valuable insights to the existing body of knowledge. The comparison between the well-established epoxy resin-based sealer and the emerging calcium silicate-based sealer holds significant implications for refining endodontic practices and enhancing treatment success. Through a robust research design and statistical analysis, we aim to elucidate potential differences or similarities in clinical effectiveness, thereby informing clinicians about the optimal selection of obturation materials for improved patient outcomes in endodontic treatments. Our null hypothesis posits that \"There is no difference in clinical signs after obturation using Calcium Silicate-based sealer and epoxy resin-based sealer.\"\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e \u003cstrong\u003eStudy Design\u003c/strong\u003e \u003cp\u003eThis investigation constituted a prospective, single-blind clinical trial conducted from June 2020 to December 2023 at the Department of Endodontics, Odonto-Maxillo Facial Hospital of Hochiminh City, Vietnam. The trial targeted patients diagnosed with irreversible pulpitis seeking examination and treatment.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eParticipant Selection\u003c/strong\u003e \u003cp\u003eThe inclusion criteria included individuals aged 18 years or older, confirmed with a positive diagnosis of irreversible pulpitis through electrical and thermal tests, displaying clinical symptoms of continuous or spontaneous pain, and having teeth sensitive to abrupt temperature changes, especially cold stimuli. Additionally, the teeth were required to exhibit healthy periodontal tissue and possess an adequate clinical crown for isolation with a rubber dam.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRandomization and Blinding\u003c/strong\u003e \u003cp\u003eTo ensure group homogeneity, a randomization process was performed. A blinded nurse executed the random assignment using a shuffled deck of cards, categorizing participants into either the Epoxy Resin Sealers (ERS) group or the Calcium Silicate Sealers (CSS) group.\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eResearch Procedures\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003ePre-intervention Stage\u003c/strong\u003e \u003cp\u003ePatients received comprehensive study information and were invited to participate upon meeting eligibility criteria. Subsequently, informed consent was obtained, and patients were instructed on the utilization of the Heft-Parker self-assessment scale to measure pain intensity. Binary variables encompassed the presence of swelling, fistula, and sensitivity under biting pressure.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eIntervention Stage\u003c/strong\u003e \u003cp\u003eAll enrolled patients underwent single-visit endodontic treatment following the protocol established by the Vietnamese Ministry of Health. This involved the use of three-dimensional imaging equipment and an endodontic machine. Unique obturation materials, either Epoxy Resin Sealers (ERS) or Calcium Silicate Sealers (CSS), were employed for each respective group.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePost-intervention Stage\u003c/b\u003e: Patients were provided with information sheets for the systematic assessment of pain and associated symptoms. Ibuprofen 400mg was prescribed on an as-needed basis for pain intolerance, accompanied by specific instructions. Patients diligently documented pain intensity, medication frequency, and any symptoms at designated intervals following treatment: 6 hours (T6), 12 hours (T12), 24 hours (T24), 48 hours (T48), and 72 hours (T72). Subsequent re-examinations were scheduled after 7 days (T7d), 3 months (T3m), and 6 months (T6m) by the principal investigator.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eOutcome Measures\u003c/strong\u003e \u003cp\u003eSymptomatic parameters, including pain, swelling, fistula, and sensitivity under biting pressure, were thoroughly compared between the Epoxy Resin Sealers (ERS) and Calcium Silicate Sealers (CSS) groups. The assessment of treatment outcomes relied on Strindberg's criteria, classifying cases as success, failure, or uncertain based on symptom presentation.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThis rigorous and methodologically sound approach was designed to systematically investigate and compare the clinical effectiveness of Calcium Silicate-based sealers and Epoxy Resin-based sealers regarding post-endodontic pain and broader treatment outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis:\u003c/h2\u003e \u003cp\u003eStatistical analyses were conducted using Stata version 14.0 for Windows (Stata Corp., College Station, Texas, USA). The normality of outcome variable distributions was assessed via the Shapiro-Wilk test. Categorical variables were analyzed using the Chi-squared test, while continuous variables were assessed using the T-test for normally distributed data and the Mann-Whitney U-test for non-normally distributed variables. Paired continuous variables underwent assessment with the Wilcoxon signed-rank test. A significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was set for all analyses.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESUTLS","content":"\u003cp\u003eAmong the 39 included patients, 69% were women, and 31% were men. The mean age of the patients was 30.9 years. The Epoxy Resin-based Sealer group had an average age of 32.5, while the Calcium Silicate-based Sealer group had an average age of 29.3. No significant differences were observed in gender distribution between the groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.317), and the age difference was not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.234) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eDemographic Characteristics\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eEpoxy resin-based sealers group (n%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCalcium Silicate-based sealers group (n%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal (n%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.317\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (23.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e8 (38.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (31.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (76.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e13 (61.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29 (69.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e29.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.234\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003ea\u003c/sup\u003e Chi-square test \u003csup\u003eb\u003c/sup\u003e Student \u003cem\u003et\u003c/em\u003e test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePain Intensity Over Time\u003c/strong\u003e \u003cp\u003eThe pain intensity ranged from \"Moderate\" (94.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9) to \"Strong\" (111.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8) before treatment, with no significant differences between the Epoxy Resin-based Sealer and Calcium Silicate-based Sealer groups over time (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cstrong\u003ePain Relief Over Time\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eChanges in pain relief over time showed statistically significant differences at specific intervals for both groups. The Epoxy Resin-based Sealer group exhibited significance at \"before treatment \u0026minus;\u0026thinsp;6 hours,\" \"6 hours \u0026minus;\u0026thinsp;12 hours,\" and \"48 hours \u0026minus;\u0026thinsp;72 hours,\" while the Calcium Silicate-based Sealer group showed significance at \"before treatment \u0026minus;\u0026thinsp;6 hours,\" \"12 hours \u0026minus;\u0026thinsp;24 hours,\" \"24 hours \u0026minus;\u0026thinsp;48 hours,\" and \"48 hours \u0026minus;\u0026thinsp;72 hours\" (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTreatment Outcome Evaluation Over Time\u003c/strong\u003e\u003c/p\u003e \u003cp\u003eAfter 1 week, the overall success rate was 90.5%. The Epoxy Resin-based Sealer group had a lower success rate (85.7%) compared to the Calcium Silicate-based Sealer group (95.2%). After 3 and 6 months, both groups achieved a 100% success rate, with no reports of spontaneous pain, swelling, fistula, or sensitivity under biting pressure ( Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOut of the 42 teeth examined in this research, we were able to follow up on 37. None of these 37 teeth exhibited pain, swelling, fistula, or sensitivity under biting pressure. Additionally, all the contacted patients reported being satisfied with the treatment outcomes 3 years post-treatment.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eA Comprehensive Exploration of Post-Endodontic Pain and Sealer Impact\u003c/h2\u003e \u003cp\u003eThis study undertook a meticulous investigation into the clinical efficacy of two commonly employed endodontic obturation sealers, Calcium Silicate-based Sealer (CSS) and Epoxy Resin-based Sealer (ERS). The primary focus was on assessing pain intensity and clinical symptoms, including spontaneous pain, sensitivity under biting pressure, swelling, or fistula, following endodontic treatments. The findings not only shed light on the temporal dynamics of post-endodontic pain relief but also offer valuable insights into the comparative effectiveness of these sealers. Moreover, the multifaceted discussion delves into the underlying mechanisms of post-endodontic pain and explores the broader clinical implications.\u003c/p\u003e \u003cp\u003eTemporal Dynamics of Pain Relief: Post-endodontic pain, a common concern, was examined in this study. The temporal analysis revealed a notable reduction in average pain intensity within the first 12 hours, evolving to \"Very little\" by day 7, consistent with previous research (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). These results resonate with the observations of Ates A. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), emphasizing a comparable decrease in pain intensity, albeit using the Visual Analog Scale (VAS) (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The gradual decline in post-operative pain aligns with established patterns, demonstrating the resilience of patients' pain tolerance and the effectiveness of endodontic interventions over time (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eFactors Influencing Post-Endodontic Pain:\u003c/h2\u003e \u003cp\u003eThe multifactorial nature of post-endodontic pain was explored, referencing (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) proposed hypotheses. Changes in periapical tissue pressure, chemical mediators, immune responses, and psychological factors were identified as potential contributors (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Understanding these diverse influences is crucial for effective pain management. The study's findings contribute to the growing body of knowledge surrounding post-endodontic pain etiology, emphasizing the complex interplay between biological and psychological factors.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSealer Impact on Pain Relief\u003c/strong\u003e \u003cp\u003eComparative analysis between CSS and ERS groups demonstrated a statistically significant decrease in pain intensity within the \"before treatment \u0026minus;\u0026thinsp;6 hours\" period, indicating the immediate impact of correct endodontic treatment intervention. This echoes the work of Ates A. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), emphasizing the pivotal role of early intervention in mitigating patient discomfort (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The absence of statistically significant differences in overall pain severity between the two sealer groups challenges the conventional notion that sealer choice is the primary determinant of pain outcomes.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe study also unearthed intriguing insights into the use of analgesia after endodontic treatment, specifically within the first 24 hours. Instances of patients taking analgesics were more prevalent in the ERS group, potentially attributed to the pro-inflammatory effects of AH Plus, a component of ERS (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). This highlights the nuanced impact of sealer composition on postoperative pain, necessitating a thorough understanding of the chemical constituents of sealers and their potential inflammatory consequences.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eClinical Implications and Considerations:\u003c/h2\u003e \u003cp\u003eThe broader clinical implications of these findings are paramount for endodontic practitioners. While the study acknowledges the subtle variations in success rates between CSS and ERS groups, it emphasizes that the choice of sealer alone may not decisively determine treatment success. Instead, meticulous adherence to appropriate techniques, instruments, and control of endodontic procedures plays a more significant role in achieving favorable outcomes (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe controversial aspect of occlusal reduction for pain control was also explored in this study. Despite differing opinions on its efficacy, the present meta-analysis emphasized the absence of significant differences between intervention and no intervention, except on the third day after treatment. The potential benefits of occlusal reduction at 72 hours suggest a nuanced approach to pain management, acknowledging that its impact may extend beyond the immediate post-treatment period (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLong-Term Treatment Success and Patient Counseling\u003c/strong\u003e \u003cp\u003eThe study evaluated treatment success rates over 3 months and 6 months, revealing a 100% success rate in both sealer groups by the 6-month mark. This finding aligns with the conventional wisdom suggesting that pain gradually decreases in the first three days and completely dissipates after 7 days (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Furthermore, the absence of spontaneous pain, swelling, or fistula post-treatment affirms the long-term efficacy of both sealers. From our findings, we suggest that within 6 months after root canal treatment, if clinical symptoms such as pain or discomfort appear, we should continue monitoring before deciding to re-endodontics.\u003c/p\u003e \u003c/p\u003e \u003cp\u003ePractitioners are encouraged to counsel patients about the expected trajectory of post-endodontic pain, reassuring them that discomfort typically diminishes within the initial days and ceases entirely after 7 days. These findings align with the study by Seltzer S, supporting the notion that successful endodontic treatments yield sustained positive outcomes over an extended period (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this comprehensive discussion elucidates the intricate dynamics of post-endodontic pain and compares the effectiveness of CSS and ERS. The study emphasizes the multifactorial nature of pain perception, highlighting the necessity for a holistic approach to endodontic practice. These implications extend beyond sealer choice, emphasizing the critical role of procedural precision and patient-centric care in achieving successful treatment outcomes. Future research avenues may delve into the intricate interplay between sealer characteristics, biological responses, and longer-term clinical outcomes, further enriching our understanding of endodontic treatment efficacy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eNo funding was received for conducting this study. The authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical Approval:\u003c/strong\u003e \u003cp\u003e Ethical approval was obtained in advance from the Institutional Review Board and Ethics Committee at the University of Medicine and Pharmacy in Ho Chi Minh City, Vietnam, under Approval Number 452/HD-DHYD. Informed consent was obtained from all individual participants included in the study. The study protocol was registered on ClinicalTrials.gov with identifier: NCT05904184.\u003c/p\u003e \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKomabayashi T, Colmenar D, Cvach N, Bhat A, Primus C, Imai Y (2020) Comprehensive review of current endodontic sealers. 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A systematic review and meta‐analysis. 47(4):528\u0026ndash;535. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/joor.12929\u003c/span\u003e\u003cspan address=\"10.1111/joor.12929\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"calcium silicate-based sealer, epoxy resin-based sealer, single-visit root canal treatment, long-term clinical effectiveness, endodontic treatment, postoperative complications","lastPublishedDoi":"10.21203/rs.3.rs-4600018/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4600018/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe selection of an appropriate sealer is critical for the success of endodontic treatments. Although calcium silicate-based sealers (CSS) and epoxy resin-based sealers (ERS) have exhibited promise in short-term studies, a comprehensive understanding of their long-term clinical effectiveness in single-visit root canal treatment remains essential.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study aimed to compare and evaluate the long-term clinical effectiveness of a calcium silicate-based sealer and an epoxy resin-based sealer in the context of single-visit root canal treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA prospective, longitudinal clinical trial was conducted involving 42 teeth diagnosed with irreversible pulpitis conditions. The teeth were randomly assigned to two groups based on the obturation sealer used: calcium silicate-based sealer (CSS) and epoxy resin-based sealer (ERS). Postoperative parameters, including pain, swelling, fistula, and sensitivity under biting pressure, were assessed at regular intervals for up to 36 months following the single-visit endodontic treatment. Treatment outcomes were determined based on established criteria, categorizing cases as success, failure, or uncertain. Statistical analysis employed the Chi-squared test, t-test, Mann-Whitney U-test, and Wilcoxon signed-rank test (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePreliminary results indicate comparable incidences of postoperative complications between the two groups over the long-term follow-up period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study suggests that both calcium silicate-based and epoxy resin-based sealers demonstrate similar long-term clinical effectiveness in single-visit root canal treatments. These findings offer valuable insights for practitioners aiming to achieve sustained treatment success through sealer selection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical relevance: \u003c/strong\u003eWe can use two types of cement Calcium silicate-based and epoxy resin-based sealersinterchangeably in root canal treatment.\u003c/p\u003e\n\u003cp\u003eClinicalTrials registration number: NCT05904184\u003c/p\u003e","manuscriptTitle":"Calcium Silicate and Epoxy Sealer in Endodontic Treatment: A Randomized Controlled Trial Short title: Calcium Silicate and Epoxy Resin Sealers","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 15:55:35","doi":"10.21203/rs.3.rs-4600018/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b7af16d2-21a8-4eb9-8f34-db9e99b77b00","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-05T20:56:00+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-18 15:55:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4600018","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4600018","identity":"rs-4600018","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}