Dental Materials in Pain Management: Exploring the Role of Endodontic Sealers in Reducing Post-Treatment Inflammation

Authors

  • Aliya Kalsoom Federal Postgraduate Medical Institute and UHS, Lahore,Pakistan.
  • Muhammad Saleem Qureshi Baqai Medical University, Baqai Dental College, Karachi,Pakistan.
  • Kelash Kumar Baqai Medical University, Baqai Dental College, Karachi,Pakistan.
  • Aisha Kiran Baqai Medical University, Baqai Dental College, Karachi,Pakistan.
  • Pakeeza Shafique Faculty of Medicine, King Abdul Aziz University, Jeddah, KSA

DOI:

https://doi.org/10.36283/ziun-pjmd14-4/028

Keywords:

Root Canal Therapy, Endodontics, Dental Materials, Zinc Oxide-Eugenol Cement, Epoxy Resins, Ceramics

Abstract

Background: Post-operative pain and inflammation are often the result of endodontic treatment because of the extrusion of root canal filling materials and host tissue reaction. These undesirable consequences could be minimized through the development of dental materials, specifically bioactive and anti-inflammatory endodontic sealers. This study evaluated the clinical effectiveness of various endodontic sealers in reducing pain intensities among patients undergoing root canal treatment. Methods: This cross-sectional study was conducted between January and July 2024 among 90 participants, underwent single root canal treatment. Root canal obturation was performed using zinc oxide eugenol-based sealer, epoxy resin-based sealer, and bio-ceramic-based sealer. Pain intensity with the help Visual Analog Scale (VAS) and clinical signs at the time of assessment were measured. ANOVA and Chi-square tests were used to analyze data, where p < 0.05 was defined as significant. Results: There was a significant difference in the mean VAS scores across groups (p = 0.0008), with the highest figure given by zinc oxide eugenol (2.7 ± 1.0), followed by epoxy resin (1.6 ± 0.8), and bio-ceramic (2.6 ± 0.5). Periapical inflammation (tenderness, swelling) was significantly decreased in the bio-ceramic group (p = 0.01). Pain types distribution indicated that zinc oxide eugenol was significantly more prevalent with moderate and severe pain (p < 0.05). Conclusion: Bio-ceramic-based sealers demonstrated significant lower pain intensity and inflammation signs compared to epoxy resin and zinc oxide eugenol sealers. Their enhanced biocompatibility offers a possibility of better patient outcomes during endodontic treatment.

Author Biographies

  • Aliya Kalsoom, Federal Postgraduate Medical Institute and UHS, Lahore,Pakistan.

    Department of Pathology,

  • Muhammad Saleem Qureshi, Baqai Medical University, Baqai Dental College, Karachi,Pakistan.

    Department of Operative Dentistry ,

  • Kelash Kumar, Baqai Medical University, Baqai Dental College, Karachi,Pakistan.

    Department of Operative Dentistry and Endodontics,

  • Aisha Kiran, Baqai Medical University, Baqai Dental College, Karachi,Pakistan.

    Department of Science of Dental Materials,

References

1. Sabino-Silva R, Cardoso IV, Vitali FC, Alves AMH, Souza BDM, Bortoluzzi EA, et al. Prevalence of postoperative pain after endodontic treatment using low and high concentrations of sodium hypochlorite: a systematic review and meta-analysis. Clin Oral Investig. 2023 Aug;27(8):4157-4171. doi: 10.1007/s00784-023-05151-7.

2. Guo J, Peters OA, Hosseinpour S. Immunomodulatory Effects of Endodontic Sealers: A Systematic Review. Dent J (Basel). 2023 Feb 17;11(2):54. doi: 10.3390/dj11020054.

3. Al-Shamaa RM, Al-Askary RA. Remineralizing capacity of zinc oxide eugenol sealer following the addition of nanohydroxyapatite-tyrosine amino acid: An in vivo animal study. J Oral Biosci. 2025 Mar;67(1):100567. doi: 10.1016/j.job.2024.09.006.

4. Dioguardi M, Alovisi M, Sovereto D, Troiano G, Malagnino G, Di Cosola M, et al. Sealing ability and microbial leakage of root-end filling materials: MTA versus epoxy resin: A systematic review and meta-analysis. Heliyon. 2021 Jul 7;7(7):e07494. doi: 10.1016/j.heliyon.2021.e07494.

5. Song W, Li S, Tang Q, Chen L, Yuan Z. In vitro biocompatibility and bioactivity of calcium silicate based bioceramics in endodontics (Review). Int J Mol Med. 2021 Jul;48(1):128. doi: 10.3892/ijmm.2021.4961.

6. Rekha R, Kavitha R, Venkitachalam R, Prabath SV, Deepthy S, Krishnan V. Comparison of the sealing ability of bioceramic sealer against epoxy resin based sealer: A systematic review & meta-analysis. J Oral Biol Craniofac Res. 2023 Jan-Feb;13(1):28-35. doi: 10.1016/j.jobcr.2022.10.006.

7. Chopra V, Davis G, Baysan A. Clinical and Radiographic Outcome of Non-Surgical Endodontic Treatment Using Calcium Silicate-Based Versus Resin-Based Sealers-A Systematic Review and Meta-Analysis of Clinical Studies. J Funct Biomater. 2022 Apr 7;13(2):38. doi: 10.3390/jfb13020038.

8. Khandelwal A, Jose J, Teja KV, Palanivelu A. Comparative evaluation of postoperative pain and periapical healing after root canal treatment using three different base endodontic sealers - A randomized control clinical trial. J Clin Exp Dent. 2022 Feb 1;14(2):e144-e152. doi: 10.4317/jced.59034.

9. Sabeti M, Ghobrial D, Zanjir M, da Costa BR, Young Y, Azarpazhooh A. Treatment outcomes of regenerative endodontic therapy in immature permanent teeth with pulpal necrosis: A systematic review and network meta-analysis. Int Endod J. 2024 Mar;57(3):238-255. doi: 10.1111/iej.13999.

10. Chopra V, Davis G, Baysan A. Physico-Chemical Properties of Calcium-Silicate vs. Resin Based Sealers-A Systematic Review and Meta-Analysis of Laboratory-Based Studies. Materials (Basel). 2021 Dec 29;15(1):229. doi: 10.3390/ma15010229.

11. Bhardwaj R, Agrawal U, Vashist P, Manna S. Determination of sample size for various study designs in medical research: A practical primer. J Family Med Prim Care. 2024 Jul;13(7):2555-2561. doi: 10.4103/jfmpc.jfmpc_1675_23.

12. Tan HSG, Lim KC, Lui JN, Lai WMC, Yu VSH. Postobturation Pain Associated with Tricalcium Silicate and Resin-based Sealer Techniques: A Randomized Clinical Trial. J Endod. 2021 Feb;47(2):169-177. doi: 10.1016/j.joen.2020.10.013.

13. Alhindi OH, Atmeh AR, Alhawaj H, Omar O. Inflammatory response to epoxy resin and calcium silicate sealers preheated with different temperatures: an in vivo study. Clin Oral Investig. 2023 May;27(5):2235-2243. doi: 10.1007/s00784-023-04960-0.

14. Mekhdieva E, Del Fabbro M, Alovisi M, Comba A, Scotti N, Tumedei M, et al. Postoperative Pain following Root Canal Filling with Bioceramic vs. Traditional Filling Techniques: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med. 2021 Sep 29;10(19):4509. doi: 10.3390/jcm10194509.

15. Ensinas P, Aranguren J, Tosco V, Franco C, Pineda K, Malvicini G, et al. The Impact of Calcium Silicate-Based and Resin-Based Root Canal Sealers on Postoperative Pain and Sealer Extrusion: A Multicenter Randomized Clinical Study. J Endod. 2025 Jul 11:S0099-2399(25)00398-X. doi: 10.1016/j.joen.2025.07.004.

16. Zamparini F, Lenzi J, Duncan HF, Spinelli A, Gandolfi MG, Prati C. The efficacy of premixed bioceramic sealers versus standard sealers on root canal treatment outcome, extrusion rate and post-obturation pain: A systematic review and meta-analysis. Int Endod J. 2024 Aug;57(8):1021-1042. doi: 10.1111/iej.14069.

17. Seron MA, Nunes GP, Ferrisse TM, Strazzi-Sahyon HB, Victorino FR, Dos Santos PH, et al. Postoperative pain after root canal filling with bioceramic sealers: a systematic review and meta-analysis of randomized clinical trials. Odontology. 2023 Oct;111(4):793-812. doi: 10.1007/s10266-023-00830-z.

18. Alfahlawy A, Selim MAA, Hassan HY. Biocompatibility of three different root canal sealers, experimental study. BMC Oral Health. 2023 Oct 4;23(1):715. doi: 10.1186/s12903-023-03473-2.

19. Supare M, Pawar AM, Sawant K, Wahjuningrum DA, Arora S, Elmsmari F, et al. Effect of bioceramic-based and resin-based sealers on postoperative discomfort following root canal therapy: a systematic review and meta-analysis. PeerJ. 2024 Oct 31;12:e18198. doi: 10.7717/peerj.18198.

20. Yılmaz K, Sarı M. Influence of sonic activation of epoxy-resin and calcium silicate sealer on postoperative pain: a patient-blinded, parallel group, randomized clinical trial. BMC Oral Health. 2024 Oct 23;24(1):1268. doi: 10.1186/s12903-024-05049-0.

21. Lepure C, Walsh RM, Attar S, Turner CL, Crawford J, Jalali P. Clinical outcomes of nonsurgical root canal treatment using NeoSealer Flo and Endosequence BC Sealer: A retrospective analysis with short-term follow-up. Clin Oral Investig. 2024 Oct 16;28(11):598. doi: 10.1007/s00784-024-05995-7.

22. Mohd Bakhori SK, Mahmud S, Mohamad D, Masudi SM, Seeni A. Cytotoxicity determination of nano-zinc oxide eugenol on human gingival fibroblast cells. Mater Chem Phys. 2021 Aug;268:124649. doi: 10.1016/j.matchemphys.2021.124649.

23. Saini A, Dheeraj M, Johar S, Goyal S, Chahal S, Garg D. Evaluation of Different Root Canal Sealers on Post Operative Pain in Single Visit RCT - A Comparative Study. J Pharm Bioallied Sci. 2024 Apr;16(Suppl 2):S1679-S1684. doi: 10.4103/jpbs.jpbs_423_23.

24. Algar J, Docampo-Vázquez C, Rico-Romano C, Boquete-Castro A, Obispo-Díaz C, Aragoneses JM. Randomised Clinical Trial: Effect of AH Plus and Neosealer Flo on Postoperative Pain and Healing of Periapical Lesions. Bioengineering (Basel). 2025 Apr 2;12(4):376. doi: 10.3390/bioengineering12040376.

25. Turkyilmaz A, Baris SD, Hancerliogullari D, Erdemir A. Postobturation Pain of three Novel Calcium Silicate-based sealers with asymptomatic irreversible pulpitis or necrotic pulp with chronic apical periodontitis: prospective clinical trial. BMC Oral Health. 2024 Nov 10;24(1):1366. doi: 10.1186/s12903-024-05161-1.

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Published

2025-09-29

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How to Cite

1.
Kalsoom A, Qureshi MS, Kumar K, Kiran A, Pakeeza Shafique. Dental Materials in Pain Management: Exploring the Role of Endodontic Sealers in Reducing Post-Treatment Inflammation. PJMD [Internet]. 2025 Sep. 29 [cited 2026 Jun. 23];14(4). Available from: https://ojs.zu.edu.pk/pjmd/article/view/4237

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