Non-Cochrane · intervention · PM42645470
In Vitro Comparison of Void Formation Between Calcium Silicate-Based Sealers and AH Plus: A Systematic Review and Meta-Analysis.
Komora Péter, Vámos Orsolya, Agócs Gergely, et al. · Dentistry journal · 2026 · PubMed · doi:10.3390/dj14080496
Findings
67 findings
| Population | ||||
|---|---|---|---|---|
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All calcium silicate-based sealers (CSBS) with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, coronal region In vitro (micro-CT mostly) · AH-Plus (single); extracted teeth; coronal region | Estimated mean % void volume (back-transformed, multilevel model) 4.488 [1.629, 12.367] Moderate Downgraded: risk of bias 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All calcium silicate-based sealers (CSBS) with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, middle region In vitro (micro-CT mostly) · CSBS (single); artificial teeth; middle region | Estimated mean % void volume (back-transformed, multilevel model) 0.178 [0.056, 0.570] Moderate Downgraded: risk of bias 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All calcium silicate-based sealers (CSBS) with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, total volume In vitro (micro-CT mostly) · AH-Plus (single); extracted teeth | Estimated mean % void volume (back-transformed, multilevel model) 2.063 [0.422, 10.098] Moderate Downgraded: risk of bias 11 studies · 410 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All calcium silicate-based sealers (CSBS) with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, middle region In vitro (micro-CT mostly) · CSBS (single); extracted teeth; middle region | Estimated mean % void volume (back-transformed, multilevel model) 2.816 [1.089, 7.280] Moderate Downgraded: risk of bias 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All calcium silicate-based sealers (CSBS) with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, total volume In vitro (micro-CT mostly) · CSBS (single); extracted teeth | Estimated mean % void volume (back-transformed, multilevel model) 1.794 [0.419, 7.683] Moderate Downgraded: risk of bias 11 studies · 410 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All calcium silicate-based sealers (CSBS) with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, total volume In vitro (micro-CT mostly) · CSBS (single); artificial teeth | Estimated mean % void volume (back-transformed, multilevel model) 2.261 [0.486, 10.514] Moderate Downgraded: risk of bias 11 studies · 410 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All calcium silicate-based sealers (CSBS) with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, three regions combined (regional model) In vitro (micro-CT mostly) · AH Plus (single) vs CSBS (single) | Log-scale regression coefficient (log mean % void volume difference) 0.375 [-0.109, 0.860] Moderate Downgraded: risk of bias 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All calcium silicate-based sealers (CSBS) with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, coronal region In vitro (micro-CT mostly) · CSBS (single); extracted teeth; coronal region | Estimated mean % void volume (back-transformed, multilevel model) 3.083 [1.193, 7.968] Moderate Downgraded: risk of bias 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All calcium silicate-based sealers (CSBS) with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, total volume In vitro (micro-CT mostly) · AH Plus (single) vs CSBS (single) | Log-scale regression coefficient (log mean % void volume difference) 0.1398 [-0.652, 0.931] Moderate Downgraded: risk of bias 11 studies · 410 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All calcium silicate-based sealers (CSBS) with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, apical region In vitro (micro-CT mostly) · CSBS (single); artificial teeth; apical region | Estimated mean % void volume (back-transformed, multilevel model) 0.178 [0.056, 0.567] Moderate Downgraded: risk of bias 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All calcium silicate-based sealers (CSBS) with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, apical region In vitro (micro-CT mostly) · AH-Plus (single); artificial teeth; apical region | Estimated mean % void volume (back-transformed, multilevel model) 0.259 [0.077, 0.871] Moderate Downgraded: risk of bias 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All calcium silicate-based sealers (CSBS) with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, middle region In vitro (micro-CT mostly) · AH-Plus (single); artificial teeth; middle region | Estimated mean % void volume (back-transformed, multilevel model) 0.260 [0.077, 0.874] Moderate Downgraded: risk of bias 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All calcium silicate-based sealers (CSBS) with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, coronal region In vitro (micro-CT mostly) · CSBS (single); artificial teeth; coronal region | Estimated mean % void volume (back-transformed, multilevel model) 0.195 [0.061, 0.627] Moderate Downgraded: risk of bias 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All calcium silicate-based sealers (CSBS) with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, apical region In vitro (micro-CT mostly) · AH-Plus (single); extracted teeth; apical region | Estimated mean % void volume (back-transformed, multilevel model) 4.086 [1.476, 11.308] Moderate Downgraded: risk of bias 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All calcium silicate-based sealers (CSBS) with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, coronal region In vitro (micro-CT mostly) · AH-Plus (single); artificial teeth; coronal region | Estimated mean % void volume (back-transformed, multilevel model) 0.284 [0.084, 0.959] Moderate Downgraded: risk of bias 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All calcium silicate-based sealers (CSBS) with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, apical region In vitro (micro-CT mostly) · CSBS (single); extracted teeth; apical region | Estimated mean % void volume (back-transformed, multilevel model) 2.807 [1.086, 7.254] Moderate Downgraded: risk of bias 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All calcium silicate-based sealers (CSBS) with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, middle region In vitro (micro-CT mostly) · AH-Plus (single); extracted teeth; middle region | Estimated mean % void volume (back-transformed, multilevel model) 4.099 [1.483, 11.327] Moderate Downgraded: risk of bias 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All calcium silicate-based sealers (CSBS) with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, total volume In vitro (micro-CT mostly) · AH-Plus (single); artificial teeth | Estimated mean % void volume (back-transformed, multilevel model) 2.600 [0.495, 13.646] Moderate Downgraded: risk of bias 11 studies · 410 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All CSBS with single-cone technique | AH Plus with warm vertical compaction | Percentage volume of voids, total volume In vitro (micro-CT mostly) · AH-Plus (vertical); extracted teeth | Estimated mean % void volume (back-transformed, multilevel model) 0.938 [0.193, 4.565] Moderate Downgraded: risk of bias 11 studies · 410 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All CSBS with single-cone technique | AH Plus with warm vertical compaction | Percentage volume of voids, total volume In vitro (micro-CT mostly) · AH-Plus (vertical); artificial teeth | Estimated mean % void volume (back-transformed, multilevel model) 1.181 [0.225, 6.217] Moderate Downgraded: risk of bias 11 studies · 410 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All CSBS with single-cone technique | AH Plus with warm vertical compaction | Percentage volume of voids, three regions combined (regional model) In vitro (micro-CT mostly) · AH Plus (vertical) vs CSBS (single) | Log-scale regression coefficient (log mean % void volume difference) -0.274 [-0.974, 0.426] Moderate Downgraded: risk of bias 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All CSBS with single-cone technique | AH Plus with warm vertical compaction | Percentage volume of voids, coronal region In vitro (micro-CT mostly) · AH-Plus (vertical); artificial teeth; coronal region | Estimated mean % void volume (back-transformed, multilevel model) 0.149 [0.041, 0.544] Moderate Downgraded: risk of bias 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All CSBS with single-cone technique | AH Plus with warm vertical compaction | Percentage volume of voids, total volume In vitro (micro-CT mostly) · AH Plus (vertical) vs CSBS (single) | Log-scale regression coefficient (log mean % void volume difference) -0.6489 [-1.474, 0.177] Moderate Downgraded: risk of bias 11 studies · 410 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All CSBS with single-cone technique | AH Plus with warm vertical compaction | Percentage volume of voids, middle region In vitro (micro-CT mostly) · AH-Plus (vertical); extracted teeth; middle region | Estimated mean % void volume (back-transformed, multilevel model) 2.140 [0.701, 6.532] Moderate Downgraded: risk of bias 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All CSBS with single-cone technique | AH Plus with warm vertical compaction | Percentage volume of voids, apical region In vitro (micro-CT mostly) · AH-Plus (vertical); extracted teeth; apical region | Estimated mean % void volume (back-transformed, multilevel model) 2.133 [0.698, 6.517] Moderate Downgraded: risk of bias 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All CSBS with single-cone technique | AH Plus with warm vertical compaction | Percentage volume of voids, apical region In vitro (micro-CT mostly) · AH-Plus (vertical); artificial teeth; apical region | Estimated mean % void volume (back-transformed, multilevel model) 0.135 [0.037, 0.493] Moderate Downgraded: risk of bias 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All CSBS with single-cone technique | AH Plus with warm vertical compaction | Percentage volume of voids, coronal region In vitro (micro-CT mostly) · AH-Plus (vertical); extracted teeth; coronal region | Estimated mean % void volume (back-transformed, multilevel model) 2.343 [0.768, 7.149] Moderate Downgraded: risk of bias 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | All CSBS with single-cone technique | AH Plus with warm vertical compaction | Percentage volume of voids, middle region In vitro (micro-CT mostly) · AH-Plus (vertical); artificial teeth; middle region | Estimated mean % void volume (back-transformed, multilevel model) 0.136 [0.037, 0.495] Moderate Downgraded: risk of bias 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | Artificial teeth, all CSBS and AH Plus groups | Extracted teeth | Percentage volume of voids, three regions combined (regional model) In vitro (micro-CT mostly) · Artificial vs extracted teeth Unresolved: the two extractors disagree on this row. | Log-scale regression coefficient (log mean % void volume difference) -2.759 [-3.705, -1.812] GRADE not reported 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | Artificial teeth, all CSBS and AH Plus groups | Extracted teeth | Percentage volume of voids, total volume In vitro (micro-CT mostly) · Artificial vs extracted teeth Unresolved: the two extractors disagree on this row. | Log-scale regression coefficient (log mean % void volume difference) 0.2311 [-0.516, 0.978] GRADE not reported 11 studies · 410 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, coronal region In vitro (micro-CT mostly) · Endosequence (single); artificial teeth; coronal region | Estimated mean % void volume (back-transformed, multilevel model) 0.169 [0.045, 0.635] Moderate Downgraded: risk of bias 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, total volume In vitro (micro-CT mostly) · AH Plus (single) vs EndoSequence (single) | Log-scale regression coefficient (log mean % void volume difference) 0.339 [-0.832, 1.509] Moderate Downgraded: risk of bias 6 studies · 150 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, coronal region In vitro (micro-CT mostly) · Endosequence (single); extracted teeth; coronal region | Estimated mean % void volume (back-transformed, multilevel model) 3.206 [1.113, 9.237] Moderate Downgraded: risk of bias 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, middle region In vitro (micro-CT mostly) · Endosequence (single); artificial teeth; middle region | Estimated mean % void volume (back-transformed, multilevel model) 0.188 [0.050, 0.706] Moderate Downgraded: risk of bias 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, middle region In vitro (micro-CT mostly) · Endosequence (single); extracted teeth; middle region | Estimated mean % void volume (back-transformed, multilevel model) 3.563 [1.242, 10.227] Moderate Downgraded: risk of bias 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, middle region In vitro (micro-CT mostly) · AH Plus (single); extracted teeth; middle region | Estimated mean % void volume (back-transformed, multilevel model) 4.086 [1.389, 12.016] Moderate Downgraded: risk of bias 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, total volume In vitro (micro-CT mostly) · Endosequence (single); extracted teeth | Estimated mean % void volume (back-transformed, multilevel model) 1.734 [0.420, 7.166] Moderate Downgraded: risk of bias 6 studies · 150 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, apical region In vitro (micro-CT mostly) · Endosequence (single); extracted teeth; apical region | Estimated mean % void volume (back-transformed, multilevel model) 4.066 [1.414, 11.690] Moderate Downgraded: risk of bias 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, total volume In vitro (micro-CT mostly) · AH Plus (single); extracted teeth | Estimated mean % void volume (back-transformed, multilevel model) 2.433 [0.565, 10.482] Moderate Downgraded: risk of bias 6 studies · 150 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, coronal region In vitro (micro-CT mostly) · AH Plus (single); artificial teeth; coronal region | Estimated mean % void volume (back-transformed, multilevel model) 0.194 [0.051, 0.740] Moderate Downgraded: risk of bias 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, total volume In vitro (micro-CT mostly) · AH Plus (single); artificial teeth | Estimated mean % void volume (back-transformed, multilevel model) 3.298 [0.650, 16.730] Moderate Downgraded: risk of bias 6 studies · 150 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, apical region In vitro (micro-CT mostly) · AH Plus (single); artificial teeth; apical region | Estimated mean % void volume (back-transformed, multilevel model) 0.246 [0.065, 0.940] Moderate Downgraded: risk of bias 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, apical region In vitro (micro-CT mostly) · AH Plus (single); extracted teeth; apical region | Estimated mean % void volume (back-transformed, multilevel model) 4.662 [1.585, 13.718] Moderate Downgraded: risk of bias 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, total volume In vitro (micro-CT mostly) · Endosequence (single); artificial teeth | Estimated mean % void volume (back-transformed, multilevel model) 2.351 [0.478, 11.557] Moderate Downgraded: risk of bias 6 studies · 150 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, apical region In vitro (micro-CT mostly) · Endosequence (single); artificial teeth; apical region | Estimated mean % void volume (back-transformed, multilevel model) 0.215 [0.057, 0.804] Moderate Downgraded: risk of bias 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, middle region In vitro (micro-CT mostly) · AH Plus (single); artificial teeth; middle region | Estimated mean % void volume (back-transformed, multilevel model) 0.216 [0.056, 0.826] Moderate Downgraded: risk of bias 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, three regions combined (regional model) In vitro (micro-CT mostly) · AH Plus (single) vs EndoSequence (single) | Log-scale regression coefficient (log mean % void volume difference) 0.137 [-0.459, 0.733] Moderate Downgraded: risk of bias 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with single-cone technique | Percentage volume of voids, coronal region In vitro (micro-CT mostly) · AH Plus (single); extracted teeth; coronal region | Estimated mean % void volume (back-transformed, multilevel model) 3.677 [1.250, 10.812] Moderate Downgraded: risk of bias 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with warm vertical compaction | Percentage volume of voids, apical region In vitro (micro-CT mostly) · AH Plus (vertical); extracted teeth; apical region | Estimated mean % void volume (back-transformed, multilevel model) 2.942 [0.912, 9.490] Moderate Downgraded: risk of bias 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with warm vertical compaction | Percentage volume of voids, middle region In vitro (micro-CT mostly) · AH Plus (vertical); artificial teeth; middle region | Estimated mean % void volume (back-transformed, multilevel model) 0.136 [0.034, 0.550] Moderate Downgraded: risk of bias 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with warm vertical compaction | Percentage volume of voids, total volume In vitro (micro-CT mostly) · AH Plus (vertical) vs EndoSequence (single) | Log-scale regression coefficient (log mean % void volume difference) -0.262 [-1.485, 0.962] Moderate Downgraded: risk of bias 6 studies · 150 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with warm vertical compaction | Percentage volume of voids, coronal region In vitro (micro-CT mostly) · AH Plus (vertical); artificial teeth; coronal region | Estimated mean % void volume (back-transformed, multilevel model) 0.123 [0.030, 0.494] Moderate Downgraded: risk of bias 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with warm vertical compaction | Percentage volume of voids, coronal region In vitro (micro-CT mostly) · AH Plus (vertical); extracted teeth; coronal region | Estimated mean % void volume (back-transformed, multilevel model) 2.320 [0.721, 7.465] Moderate Downgraded: risk of bias 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with warm vertical compaction | Percentage volume of voids, apical region In vitro (micro-CT mostly) · AH Plus (vertical); artificial teeth; apical region | Estimated mean % void volume (back-transformed, multilevel model) 0.155 [0.039, 0.628] Moderate Downgraded: risk of bias 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with warm vertical compaction | Percentage volume of voids, middle region In vitro (micro-CT mostly) · AH Plus (vertical); extracted teeth; middle region | Estimated mean % void volume (back-transformed, multilevel model) 2.579 [0.803, 8.281] Moderate Downgraded: risk of bias 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with warm vertical compaction | Percentage volume of voids, total volume In vitro (micro-CT mostly) · AH Plus (vertical); artificial teeth | Estimated mean % void volume (back-transformed, multilevel model) 1.809 [0.357, 9.177] Moderate Downgraded: risk of bias 6 studies · 150 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with warm vertical compaction | Percentage volume of voids, total volume In vitro (micro-CT mostly) · AH Plus (vertical); extracted teeth | Estimated mean % void volume (back-transformed, multilevel model) 1.335 [0.313, 5.688] Moderate Downgraded: risk of bias 6 studies · 150 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | EndoSequence CSBS with single-cone technique | AH Plus with warm vertical compaction | Percentage volume of voids, three regions combined (regional model) In vitro (micro-CT mostly) · AH Plus (vertical) vs EndoSequence (single) | Log-scale regression coefficient (log mean % void volume difference) -0.324 [-1.135, 0.488] Moderate Downgraded: risk of bias 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | Artificial teeth, EndoSequence and AH Plus groups | Extracted teeth | Percentage volume of voids, total volume In vitro (micro-CT mostly) · Artificial vs extracted teeth Unresolved: the two extractors disagree on this row. | Log-scale regression coefficient (log mean % void volume difference) 0.304 [-0.808, 1.417] GRADE not reported 6 studies · 150 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | Artificial teeth, EndoSequence and AH Plus groups | Extracted teeth | Percentage volume of voids, three regions combined (regional model) In vitro (micro-CT mostly) · Artificial vs extracted teeth Unresolved: the two extractors disagree on this row. | Log-scale regression coefficient (log mean % void volume difference) -2.940 [-4.046, -1.834] GRADE not reported 6 studies · 94 participants |
| Extracted teeth (lateral compaction comparator) | All CSBS with single-cone technique | AH Plus with lateral compaction | Percentage area of voids, middle section In vitro (micro-CT mostly) · middle section | MD -0.23 [-1.69, 1.23] Moderate Downgraded: risk of bias 3 studies · 148 participants |
| Extracted teeth (lateral compaction comparator) | All CSBS with single-cone technique | AH Plus with lateral compaction | Percentage area of voids, apical section In vitro (micro-CT mostly) · apical section | MD -0.16 [-2.11, 1.79] Moderate Downgraded: risk of bias 3 studies · 148 participants |
| Extracted teeth (lateral compaction comparator) | All CSBS with single-cone technique | AH Plus with lateral compaction | Percentage area of voids, coronal section In vitro (micro-CT mostly) · coronal section | MD 0.12 [-1.00, 1.23] Moderate Downgraded: risk of bias 3 studies · 148 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | Apical or middle region (all CSBS and AH Plus groups) | Coronal region | Percentage volume of voids, regional model In vitro (micro-CT mostly) · Middle vs coronal region Unresolved: the two extractors disagree on this row. | Log-scale regression coefficient (log mean % void volume difference) -0.091 [-0.551, 0.370] GRADE not reported 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | Apical or middle region (all CSBS and AH Plus groups) | Coronal region | Percentage volume of voids, regional model In vitro (micro-CT mostly) · Apical vs coronal region Unresolved: the two extractors disagree on this row. | Log-scale regression coefficient (log mean % void volume difference) -0.094 [-0.554, 0.366] GRADE not reported 10 studies · 276 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | Apical or middle region (EndoSequence and AH Plus groups) | Coronal region | Percentage volume of voids, regional model In vitro (micro-CT mostly) · Apical vs coronal region Unresolved: the two extractors disagree on this row. | Log-scale regression coefficient (log mean % void volume difference) 0.237 [-0.263, 0.738] GRADE not reported 6 studies · 94 participants |
| Permanent mature extracted teeth and artificial teeth (root canal fillings) | Apical or middle region (EndoSequence and AH Plus groups) | Coronal region | Percentage volume of voids, regional model In vitro (micro-CT mostly) · Middle vs coronal region Unresolved: the two extractors disagree on this row. | Log-scale regression coefficient (log mean % void volume difference) 0.106 [-0.392, 0.603] GRADE not reported 6 studies · 94 participants |
Included primary studies 21
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Alfayate 2021 Root Canal Filling Quality Comparison of a Premixed Calcium Silicate Endodontic Sealer and Different Carrier-Based Obturation Systems. PMID:33803893 | 2021 | this review only | not stated | not extracted yet |
| Celikten 2016 Evaluation of root canal sealer filling quality using a single‐cone technique in oval shaped canals: An <i>In vitro</i> Micro‐CT study DOI:10.1002/sca.21249 | 2015 | this review only | not stated | not extracted yet |
| Eltair 2018 Evaluation of the interface between gutta-percha and two types of sealers using scanning electron microscopy (SEM) DOI:10.1007/s00784-017-2216-x | 2017 | this review only | not stated | not extracted yet |
| Gandolfi 2013 3 <scp>D</scp> micro‐ <scp>CT</scp> analysis of the interface voids associated with <scp>T</scp> hermafil root fillings used with <scp>AH… DOI:10.1111/j.1365-2591.2012.02124.x | 2012 | this review only | not stated | not extracted yet |
| Haridas 2024 Efficacy of New Bioceramic Materials in Root Canal Obturation. PMID:39926986 | 2024 | this review only | not stated | not extracted yet |
| Jin 2021 Comparison of Obturation Quality between Calcium Silicate-Based Sealers and Resin-Based Sealers for Endodontic Re-treatment. PMID:35009220 | 2021 | this review only | not stated | not extracted yet |
| Kim 2018 Root Canal Filling Quality of a Premixed Calcium Silicate Endodontic Sealer Applied Using Gutta-percha Cone-mediated Ultrasonic Activation DOI:10.1016/j.joen.2017.07.023 | 2018 | this review only | not stated | not extracted yet |
| Kim 2020 A micro-computed tomographic evaluation of root canal filling with a single gutta-percha cone and calcium silicate sealer. PMID:32483535 | 2020 | this review only | not stated | not extracted yet |
| Kim 2021 Effects of Ultrasonic Activation on Root Canal Filling Quality of Single-Cone Obturation with Calcium Silicate-Based Sealer. PMID:33800442 | 2021 | this review only | not stated | not extracted yet |
| Kooanantkul 2023 Comparison of obturation quality in natural and replica teeth root-filled using different sealers and techniques DOI:10.1007/s00784-023-04884-9 | 2023 | this review only | not stated | not extracted yet |
| Lee 2022 The Retrievability of Calcium Silicate-Based Sealer during Retreatment and the Effectiveness of Additional Passive Ultrasonic Irrigation:… DOI:10.1155/2022/3933305 | 2022 | this review only | not stated | not extracted yet |
| Li 2025 The biocompatibility, penetrability, sealing ability, and antibacterial properties of iRoot SP compared to AH plus: An In Vitro evaluation DOI:10.1016/j.archoralbio.2025.106188 | 2025 | this review only | not stated | not extracted yet |
| Lin 2023 Comparison sealing ability in three bioceramic sealers applied in hydraulic condensation technique by using micro-computed tomography DOI:10.1016/j.jds.2023.02.016 | 2023 | this review only | not stated | not extracted yet |
| Milanovic 2020 Immediate and Long-Term Porosity of Calcium Silicate–Based Sealers DOI:10.1016/j.joen.2020.01.007 | 2020 | this review only | not stated | not extracted yet |
| Nouroloyouni 2023 Single Cone Obturation versus Cold Lateral Compaction Techniques with Bioceramic and Resin Sealers: Quality of Obturation and Push-Out… DOI:10.1155/2023/3427151 | 2023 | this review only | not stated | not extracted yet |
| Pinto 2021 Evaluation of curved root canals filled with a new bioceramic sealer: A microcomputed tomographic study using images with different voxel… DOI:10.1002/jemt.23855 | 2021 | this review only | not stated | not extracted yet |
| Roizenblit 2020 Root canal filling quality of mandibular molars with EndoSequence <scp>BC</scp> and <scp>AH</scp> Plus sealers: A micro‐ <scp>CT</scp> study DOI:10.1111/aej.12373 | 2019 | this review only | not stated | not extracted yet |
| Tavares 2021 <scp>Micro‐CT</scp> evaluation of filling of flattened root canals using a new premixed ready‐to‐use calcium silicate sealer by… DOI:10.1002/jemt.23658 | 2020 | this review only | not stated | not extracted yet |
| Viapiana 2016 Porosity and sealing ability of root fillings with gutta‐percha and BioRoot <scp>RCS</scp> or <scp>AH</scp> Plus sealers. Evaluation by… DOI:10.1111/iej.12513 | 2015 | this review only | not stated | not extracted yet |
| Wisawawatin 2023 Gap volume and sealer penetration of C‐shaped root canals obturated with cold hydraulic technique and calcium silicate sealer DOI:10.1111/aej.12696 | 2022 | this review only | not stated | not extracted yet |
| Yanpiset 2018 Bacterial leakage and micro-computed tomography evaluation in round-shaped canals obturated with bioceramic cone and sealer using matched… PMID:30135849 | 2018 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Permanent mature extracted teeth and artificial teeth | Extracted and artificial teeth (n=656 teeth in 18 studies in the quantitative analysis) |
| Intervention | Calcium silicate-based sealers (CSBS) | CSBS with single-cone technique, mainly EndoSequence, EndoSeal MTA, Bio-C, BioRoot RCS, others |
| Comparison | AH Plus (epoxy-amine resin sealer) | AH Plus with single-cone, warm vertical compaction or lateral compaction |
| Outcomes | Percentage volume of voids; percentage area of voids | Percentage void volume (total, apical, middle, coronal; 6 to 11 studies); percentage void area, lateral compaction (n=3 studies) |
| Study designs | Randomized in vitro studies | 21 randomized in vitro studies (18 in meta-analysis) |
| Timing | Not specified | Not specified |
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 | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | 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 | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | NRSI: N/A · RCT: Partial Yes | NRSI: N/A · RCT: Partial Yes | 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 | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |