Effect of Resin-based and Bioceramic Root Canal Sealers on Postoperative Pain: A Split-mouth Randomized Controlled Trial Indre Graunaite, MD, Neringa Skucaite, PhD, Greta Lodiene, PhD, Indre Agentiene, MD, and Vita Machiulskiene, PhD Abstract Introduction: The aim of this study was to compare the effect of resin-based and bioceramic root canal sealers on the occurrence and intensity of postoperative pain in patients with asymptomatic apical periodontitis (AAP). Methods: Patients presenting with AAP in previ- ously endodontically treated teeth were included in this split-mouth blinded randomized controlled trial. For each patient, 2 single-rooted teeth were retreated and obturated using the warm vertical condensation technique and different obturation materials (ie, a gutta-percha point with resin-based sealer and a bioceramic-coated gutta-percha point with bioceramic sealer). Treatment of 1 root canal was performed in a single visit. Postoperative pain was recorded by a visual analog scale (VAS) at 24 hours, 48 hours, 72 hours, and 7 days after obturation. Results: Of the 61 included pa- tients, 57 individuals presenting 114 teeth completed the study. There was no statistically significant differ- ence between the tested root canal sealers regarding postoperative pain at any time points assessed (P > .05). In total, 20 (35%) patients perceived pain. Only 1 patient reported severe pain. VAS scores of 80 and 70 were reported in the AH Plus (Dentsply Maillefer, Ballaigues, Switzerland) and Total Fill (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) groups, respectively. Pain intensity decreased about 2-fold in both groups at 48 hours after treatment. There were no reports of pain since 72 hours after obturation. The odds ratio for pain occurrence in the lower premolars was 7.2 (95% confidence interval, 1.708–30.352) compared with the upper front teeth. Conclusions: AH Plus and Total Fill perform similarly in terms of the occurrence and intensity of postoperative pain in teeth with AAP with no material extrusion beyond the apex. (J Endod 2018;-:1–5) Key Words Calcium silicate–based sealer, epoxy resin–based sealer, postoperative pain, root canal obturation R eports about postoper- ative pain in endodon- tics range from 3%–58% in different studies (1). Pain can be provoked by mechanical, chemical, or microbiological injuries to periodontal tissues (2).A number of treatment- related parameters have been shown to be associated with the presence of postoperative pain, including working length (WL) estimation with an apex locator connected to every file (3), the number of visits (4), the choice of instrumentation (5), and the choice of root canal sealer (6). Sealers placed in the root canals interfere with periodontal tissues through the apical foramina, lateral canals, or leaching and can potentially affect the heal- ing process in the periodontium. Thus, the local inflammation caused by root canal obtu- ration materials may result in postoperative pain. The intensity of inflammatory reactions depends on a number of different factors, including the composition of the sealer (7). It has been suggested that bioceramic materials improve the outcome of endodon- tic treatment by promoting the differentiation of odontoblasts (8) and by releasing bio- logically active substances (9). The bioceramic materials have been shown to be less cytotoxic compared with resin-based AH Plus (Dentsply Maillefer, Ballaigues, Switzerland) in vitro (10). However, AH Plus (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) exhibited stronger bonding capacity (11) and higher radiopacity (9) compared with bioceramic sealers. The clinical significance of these characteristics is still unclear. Data on the clinical behavior of bioceramic sealers are scarce and of great interest. The aim of this randomized clinical trial was to compare the potential effects of resin-based and bioceramic sealers on the occurrence and intensity of postoperative pain in patients with asymptomatic apical periodontitis (AAP). Materials and Methods The protocol of the trial was approved by the local research ethics committee (no. BE-2-23). From the Faculty of Odontology, Clinic of Dental and Oral Pathology, Lithuanian University of Health Sciences, Kaunas, Lithuania. Address requests for reprints to Indre Graunaite, Faculty of Odontology, Clinic of Dental and Oral Pathology, Lithuanian University of Health Sciences, Eiveniu g 2, LT-50009, Kaunas, Lithuania. E-mail address: indre.graunaite@lsmuni.lt 0099-2399/$ - see front matter Copyright ª 2018 American Association of Endodontists. https://doi.org/10.1016/j.joen.2018.02.010 Significance This randomized controlled trial investigated the incidence of postoperative pain after root canal obturation with resin-based and bioceramic root canal sealers in patients with asymptomatic apical periodontitis. The results indicate that both sealers perform similarly in terms of postoperative pain. CONSORT Randomized Clinical Trial JOE — Volume -, Number -, - 2018 Resin-based and Bioceramic Root Canal Sealers 1