Aim: This study aimed to evaluate the intensity of pain after unintentional extrusion of resin-based and calcium hydroxide (Ca[OH]2)-based endodontic sealers as well as their influence on the periradicular tissues.
Materials and methods: A total of 120 single-rooted teeth exhibiting extrusion of sealer in the postoperative radiographs were included in the study. According to the sealers used, the teeth were divided into four groups (n = 30): Group I - AH Plus®, Group II - Resino Seal, Group III - Sealapex™, and Group IV - Apexit® Plus. Postoperative pain was assessed at 0-6 h, 6-12 h, 12-24 h, and 24-48 h of obturation using Visual Analog Scale. Radiographs were taken at 3, 6, and ≥9 months to 1-year follow-up and compared with baseline radiographs to assess the dissolution of extruded sealers and healing of periradicular tissues.
Statistical analysis: ANOVA, Kruskal-Wallis, and Pearson's Chi-square test were used. Statistical significance level was set at P ≤ 0.05.
Results: Postoperative pain intensity was higher in case of AH Plus® sealer followed by Sealapex™ up to 12 h of obturation and was statistically nonsignificant. Apexit® Plus at all time intervals showed statistically significant less pain intensity than AH Plus® and Sealapex™ but not from Resino Seal group. At 9-month follow-up, better healing of periradicular tissues was shown by AH Plus® (48.1%) followed by Apexit® Plus (44.4%) and Sealapex™ (41.2%) with statistically nonsignificant difference.
Conclusion: In case of periapical extrusion, both resin-based and Ca(OH)2-based sealers caused postoperative pain. Both Ca(OH)2- and resin-based sealers did not influence the treatment outcome.
Keywords: Pain assessment; Visual Analog Scale; periradicular tissue healing; sealer dissolution; sealer extrusion.