Non-Cochrane · intervention · PM42712471
Comparative effects of ultrasonic and conventional sealer placement techniques on endodontic sealer layer quality: a systematic review and meta-analysis of in vitro studies.
Banerjee Avishikta, Harikrishna Niranjan, Bhattacharyya Aritro, et al. · Frontiers in dental medicine · 2026 · PubMed · doi:10.3389/fdmed.2026.1909391
Findings
17 findings
| Population | ||||
|---|---|---|---|---|
| Instrumented root canals in extracted human teeth | Ultrasonic sealer placement or activation | Non-ultrasonic sealer placement techniques | Sealer penetration depth (µm) Laboratory | WMD 254.66 [180.88, 328.44] GRADE not reported 3 studies |
| Instrumented root canals in extracted human teeth | Ultrasonic sealer placement or activation | Non-ultrasonic sealer placement techniques | Sealer penetration depth (µm) Laboratory · 3 mm from apex | WMD 425.64 [36.65, 814.64] GRADE not reported Studies not reported |
| Extracted human teeth (instrumented root canals), in vitro | Ultrasonic sealer placement or activation | Non-ultrasonic sealer placement (Lentulo spiral, hand or rotary file, sonic activation) | Percentage of canal wall coverage with sealer Immediately after obturation (laboratory) · Laboratory; extracted human teeth · Sensitivity: cluster-robust variance estimation (CR2, clustered by study) | WMD 17.79 [4.51, 31.08] GRADE not reported 4 studies |
| Instrumented root canals in extracted human teeth | Ultrasonic sealer placement or activation | Non-ultrasonic sealer placement techniques | Canal wall coverage (%) Laboratory · Epoxy resin-based sealers | WMD 17.30 [7.47, 27.13] GRADE not reported 4 studies |
| Instrumented root canals in extracted human teeth | Ultrasonic sealer placement or activation | Non-ultrasonic sealer placement techniques | Sealer penetration depth (µm) Laboratory · 6 mm from apex | WMD 232.41 [184.25, 280.56] GRADE not reported Studies not reported |
| Extracted human teeth (instrumented root canals), in vitro | Ultrasonic sealer placement or activation | Non-ultrasonic sealer placement (Lentulo spiral, hand or rotary file, sonic activation) | Sealer penetration depth into dentinal tubules (micrometers) Immediately after obturation (laboratory) · Laboratory; extracted human teeth · Sensitivity: one comparison retained per ultrasonic arm | WMD 233.72 [124.47, 342.98] GRADE not reported 3 studies |
| Extracted human teeth (instrumented root canals), in vitro | Ultrasonic sealer placement or activation | Non-ultrasonic sealer placement (Lentulo spiral, hand or rotary file, sonic activation) | Sealer penetration depth into dentinal tubules (micrometers) Immediately after obturation (laboratory) · Laboratory; extracted human teeth · Sensitivity: covariance of shared ultrasonic arms incorporated | WMD 255.51 [179.93, 331.08] GRADE not reported 3 studies |
| Instrumented root canals in extracted human teeth | Ultrasonic sealer placement or activation | Non-ultrasonic sealer placement techniques | Canal wall coverage (%) Laboratory · Calcium silicate-based sealers | WMD 13.42 [8.74, 18.09] GRADE not reported 2 studies |
| Instrumented root canals in extracted human teeth | Ultrasonic sealer placement or activation | Non-ultrasonic sealer placement techniques | Canal wall coverage (%) Laboratory · Exclude Banerjee et al. 2026 | WMD 13.99 [8.80, 19.18] GRADE not reported 3 studies |
| Extracted human teeth (instrumented root canals), in vitro | Ultrasonic sealer placement or activation | Non-ultrasonic sealer placement (Lentulo spiral, hand or rotary file, sonic activation) | Percentage of canal wall coverage with sealer Immediately after obturation (laboratory) · Laboratory; extracted human teeth · Sensitivity: one comparison retained per ultrasonic arm | WMD 12.85 [8.84, 16.86] GRADE not reported 4 studies |
| Extracted human teeth (instrumented root canals), in vitro | Ultrasonic sealer placement or activation | Non-ultrasonic sealer placement (Lentulo spiral, hand or rotary file, sonic activation) | Sealer penetration depth into dentinal tubules (micrometers) Immediately after obturation (laboratory) · Laboratory; extracted human teeth · Sensitivity: cluster-robust variance estimation (CR2, clustered by study) | WMD 254.66 [90.62, 418.69] GRADE not reported 3 studies |
| Instrumented root canals in extracted human teeth | Ultrasonic sealer placement or activation | Non-ultrasonic sealer placement techniques | Sealer penetration depth (µm) Laboratory · Exclude Banerjee et al. 2026 | WMD 283.66 [160.98, 406.35] GRADE not reported 2 studies |
| Instrumented root canals in extracted human teeth | Ultrasonic sealer placement or activation | Non-ultrasonic sealer placement techniques | Sealer penetration depth (µm) Laboratory · Epoxy resin-based sealers | WMD 248.86 [162.51, 335.22] GRADE not reported 3 studies |
| Instrumented root canals in extracted human teeth | Ultrasonic sealer placement or activation | Non-ultrasonic sealer placement techniques | Canal wall coverage (%) Laboratory | WMD 17.79 [9.73, 25.86] GRADE not reported 4 studies |
| Instrumented root canals in extracted human teeth | Ultrasonic sealer placement or activation | Non-ultrasonic sealer placement techniques | Canal wall coverage (%) Laboratory · Shared-arm covariance incorporated | WMD 17.80 [9.72, 25.87] GRADE not reported 4 studies |
| Instrumented root canals in extracted human teeth | Ultrasonic sealer placement or activation | Lentulo spiral | Sealer penetration depth (µm) Laboratory | WMD 179.65 [128.86, 230.45] GRADE not reported 3 studies |
| Instrumented root canals in extracted human teeth | Ultrasonic sealer placement or activation | Sonic activation (EndoActivator) | Sealer penetration depth (µm) Laboratory | WMD 363.85 [171.14, 556.57] GRADE not reported 2 studies |
Included primary studies 10
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Alcalde 2017 Intradentinal antimicrobial action and filling quality promoted by ultrasonic agitation of epoxy resin-based sealer in endodontic… PMID:29211285 | 2017 | this review only | not stated | not extracted yet |
| Banerjee 2025 Micro-computed tomography analysis of void volume in sealer layer placed using Vibrospiral novel instrument: an in vitro study. PMID:41159004 | 2025 | this review only | not stated | not extracted yet |
| Banerjee 2026 Evaluating the efficacy of Vibrospiral novel sealer placing instrument: a Confocal and Scanning Electron Microscope in-vitro study. PMID:41654848 | 2026 | this review only | Sealer penetration depth (µm); Canal wall coverage (%) | not extracted yet |
| Carneiro 2023 Effect of ultrasonic agitation on marginal adaptation, intratubular penetration and bonding strength of calcium-silicate-based endodontic… PMID:37363860 | 2023 | this review only | not stated | not extracted yet |
| De Bem 2020 Effect of Ultrasonic Activation of Endodontic Sealers on Intratubular Penetration and Bond Strength to Root Dentin. PMID:32615175 | 2020 | this review only | Canal wall coverage (%) | not extracted yet |
| Guimaraes 2014 Influence of ultrasonic activation of 4 root canal sealers on the filling quality. PMID:24935544 | 2014 | this review only | not stated | not extracted yet |
| Nikhil 2013 Confocal laser scanning microscopic investigation of ultrasonic, sonic, and rotary sealer placement techniques. PMID:23956528 | 2013 | this review only | Sealer penetration depth (µm); Canal wall coverage (%) | not extracted yet |
| Nikhil 2015 Effect of technique of sealer agitation on percentage and depth of MTA Fillapex sealer penetration: A comparative in-vitro study. PMID:25829689 | 2015 | this review only | Sealer penetration depth (µm); Canal wall coverage (%) | not extracted yet |
| Prasad 2018 Influence of ultrasonics on the penetration depth of AH plus, acroseal, and EndoREZ root canal sealers: An in vitro study. PMID:29674829 | 2018 | this review only | not stated | not extracted yet |
| Wiesse 2018 Effect of ultrasonic and sonic activation of root canal sealers on the push-out bond strength and interfacial adaptation to root canal… PMID:28543092 | 2018 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Extracted human teeth with instrumented root canals (in vitro) | Extracted human teeth, single-rooted, canines, premolars, molar roots (n=10 studies; sample size 30 to 100 per study) |
| Intervention | Ultrasonic sealer placement or activation | Ultrasonic activation with tips, files, NiTi finger spreader or Vibrospiral (n=10) |
| Comparison | Non-ultrasonic sealer placement (hand files, paper or gutta-percha points, Lentulo spirals, sonic activation) | Lentulo spiral, sonic EndoActivator, hand or rotary file, no activation (n=10) |
| Outcomes | Sealer penetration depth, canal wall coverage, interfacial adaptation, voids, push-out bond strength | Sealer penetration depth (n=3), canal wall coverage (n=6), interfacial adaptation (n=2), void volume (n=2), push-out bond strength (n=3) |
| Study designs | In vitro or laboratory-based experimental studies | In vitro studies (n=10) |
| 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 | Yes | Yes | yes |
| 4Comprehensive literature searchcritical | No | Partial Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | No | No | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: N/A · NRSI: Yes | NRSI: N/A · RCT: N/A | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: N/A · NRSI: Yes | NRSI: N/A · RCT: N/A | no |
| 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 | Low | no |