Non-Cochrane · intervention · PM42088728
Efficacy of Bioceramic Cements Versus Conventional Cements in the Prognosis of Endodontic Treatments in Patients with Apical Periodontitis: A Systematic Review with Meta-Analysis.
Mendoza Ruby Melissa Portilla, Iuga Maria Mihaela, Gamonal Mario George Casaretto · Iranian endodontic journal · 2026 · PubMed · doi:10.22037/iej.v21i1.50633
Findings
Population Patients with apical periodontitis undergoing root canal treatment
3 findings
| Bioceramic sealers (e.g., BioRoot RCS, iRoot SP, Meta CeraSeal) | Conventional sealers (AH Plus, zinc oxide-eugenol, calcium hydroxide-based) | Periapical healing (healing success) 6 to 12 months follow-up · Endodontic clinics (RCTs) · Random-effects model (DerSimonian-Laird) | RR 1.05 [0.89, 1.23] GRADE not reported 4 studies · 199 participants |
| Bioceramic sealers (e.g., BioRoot RCS, iRoot SP, Meta CeraSeal) | Conventional sealers (AH Plus, zinc oxide-eugenol, calcium hydroxide-based) | Periapical healing (healing success) 6 to 12 months follow-up · Endodontic clinics (RCTs) · Trim-and-fill adjusted (2 imputed studies) | RR 0.995 [0.875, 1.132] GRADE not reported 6 studies |
| Bioceramic sealers (e.g., BioRoot RCS, iRoot SP, Meta CeraSeal) | Conventional sealers (AH Plus, zinc oxide-eugenol, calcium hydroxide-based) | Periapical healing (healing success) 6 to 12 months follow-up · Endodontic clinics (RCTs) · Common-effect (fixed-effect) model | RR 1.08 [0.94, 1.24] GRADE not reported 4 studies · 199 participants |
Included primary studies 22
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Bardini 2021 matched by author and year (probable) | NR | 1 other review | Periapical healing (healing success) | not extracted yet |
| Ferreira 2020 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Graunaite 2018 Effect of Resin-based and Bioceramic Root Canal Sealers on Postoperative Pain: A Split-mouth Randomized Controlled Trial. PMID:29571915 | 2018 | 1 other review | not stated | not extracted yet |
| Hu 2023 Outcome of root canal treatment using warm vertical compaction with bioceramic and resin-based sealers: A randomised clinical trial. PMID:36378149 | 2023 | 1 other review | Periapical healing (healing success) | not extracted yet |
| Alzoubi 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Alzoubi 2024 Post-operative pain in non-surgical root canal treatment after sealer-based obturation versus warm vertical compaction: A randomized… PMID:38813933 | 2024 | this review only | not stated | not extracted yet |
| Bardini 2021 Correction to: A 12-month follow-up of primary and secondary root canal treatment in teeth obturated with a hydraulic sealer. PMID:34143308 | 2021 | this review only | Periapical healing (healing success) | not extracted yet |
| Buker 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Buker 2023 The Effects of Calcium Silicate- and Calcium Hydroxide-based Root Canal Sealers on Postoperative Pain: A Randomized Clinical Trial. PMID:37683888 | 2023 | this review only | not stated | not extracted yet |
| Ferreira 2020 Postoperative pain after root canal filling with different endodontic sealers: a randomized clinical trial. PMID:32696911 | 2020 | this review only | not stated | not extracted yet |
| Graunaite 2018 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Khandelwal 2022 matched by author and year (probable) | NR | this review only | Periapical healing (healing success) | not extracted yet |
| Khandelwal 2022 Comparative evaluation of postoperative pain and periapical healing after root canal treatment using three different base endodontic… PMID:35173897 | 2022 | this review only | Periapical healing (healing success) | not extracted yet |
| Nagpal 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Nagpal 2024 The effect of bioactive glass-based, bioceramic based and epoxy amine resin based root canal sealers on post-obturation pain: A double… PMID:38989484 | 2024 | this review only | not stated | not extracted yet |
| Nathani 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Nathani 2024 Post-operative pain after single-visit root canal treatment using resin-based and bioceramic sealers in teeth with apical periodontitis: A… PMID:38887839 | 2024 | this review only | not stated | not extracted yet |
| Pandey 2024 matched by author and year (probable) | NR | this review only | Periapical healing (healing success) | not extracted yet |
| Pandey 2024 Comparative evaluation of postoperative pain and periapical healing after root canal treatment using three different endodontic sealers: A… PMID:39450356 | 2024 | this review only | Periapical healing (healing success) | not extracted yet |
| Supreet 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Supreet 2023 Comparative evaluation of the effect of calcium silicate and epoxy resinbased root canal sealers on postoperative pain in patients with… PMID:37205897 | 2023 | this review only | not stated | not extracted yet |
| Tan 2021 Postobturation Pain Associated with Tricalcium Silicate and Resin-based Sealer Techniques: A Randomized Clinical Trial. PMID:33098889 | 2021 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients with apical periodontitis undergoing root canal treatment | Patients with asymptomatic or symptomatic apical periodontitis, necrotic pulp (12 RCTs, 980 participants) |
| Intervention | Bioceramic sealers | Bioceramic sealers (Total Fill, MTA Fillapex, BioRoot RCS, iRoot SP, Nishika Canal Sealer BG, EndoSeal MTA, Bio-C Sealer Ion+, Meta CeraSeal and others) |
| Comparison | Conventional sealers (e.g., epoxy resin, zinc oxide-eugenol) | AH Plus, resin-based sealers, zinc oxide-eugenol sealers, calcium hydroxide sealers |
| Outcomes | Periapical healing (primary); postoperative pain; adverse effects; tooth survival; periapical index | Periapical healing (4 RCTs pooled); postoperative pain (not pooled); adverse events |
| Study designs | Randomized controlled trials; no language or date restrictions | 12 RCTs (n=12); 4 in the meta-analysis |
| Timing | Not specified | Follow-up from 24 hours to 24 months; healing meta-analysis 6 to 12 months |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | No | No | yes |
| 3Choice of study designs explained | Yes | Yes | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | RCT: Yes · NRSI: N/A | yes |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | RCT: Yes · NRSI: N/A | yes |
| 12Impact of risk of bias on the pooled results | Yes | Yes | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |