Comparative Evaluation of Postoperative Pain and Periapical Healing After Root Canal Treatment Using Three Different Base Endodontic Sealers – A Randomized Control Clinical Trial

Background: ː Endodontic Sealers come in direct contact with periapical tissue through the apical foramen and lateral canals, influencing the postoperative pain and periapical healing. The aim of the present study was to evaluate and compare postoperative pain and periapical healing after root canal treatment using different base endodontic sealers. Methods: ː Primary root canal treatment was initiated in 63 patients diagnosed with necrotic pulp and apical periodontitis, followed by which the endodontic sealers used for obturation were selected based on the random allocation of the participants to the following groups; Tubli-Seal, AH Plus and BioRoot RCS. Postoperative pain was recorded by using 100 mm visual analog scale at 24 h, 48 h, 72 h and 7 d after obturation. Digital periapical radiographic evaluation was done to assess rate of periapical healing at baseline, 1, 3 and 6 months. Statistical analysis was done using Kruskal Wallis test and one-way ANOVA and p-value of less than 0.05 was considered as significance level. Results: ː Significant reduction was seen in the size of periapical lesions in all the study groups at 3 and 6 months (p ˂ 0.05). The mean difference in the size of periapical lesions for BioRoot RCS was 4.05, 10.22, for AH Plus was 2 3.86, 9.80 and Tubli-Seal were 6.27, 13.41 at 3 months and 6 months respectively. The mean pain scores at 24 h for Tubli-Seal, AH Plus, BioRoot RCS were 17.94 ± 11.35, 11.57 ± 11.18 and 4.73 ± 7.72. At 48 h were 5.26 ± 9.04, 1.57 ± 3.74 and 1.57 ± 3.74 respectively. The mean pain score at 72 h for Tubli-Seal was 2.63 ± 7.33 whereas none of the patients had reported pain in AH Plus and BioRoot RCS group. None of the patients had pain 7 d after treatment. Conclusions: ː BioRoot RCS showed less postoperative pain compared to AH Plus and Tubli-Seal. BioRoot RCS showed better periapical healing compared to AH Plus and Tubliseal at 3- and 6-months interval respectively. Trial Registration: Registration of this trial was done prospectively in Clinical trials registry – India (CTRI) with registration number (CTRI/2018/10/015919) dated 08/10/2018.