Background Postoperative pain and periapical tissue healing are considered essential parameters for evaluating the success of endodontic treatment. In recent years, advances in obturation techniques, irrigation protocols, and calcium silicate–based sealers have substantially influenced clinical endodontic practice. Despite these innovations, the extent to which these factors affect patient-centered outcomes and long-term periapical repair is still not fully clarified. Objective This systematic review aimed to critically assess the available clinical evidence regarding the influence of obturation techniques, endodontic sealers, and irrigation strategies on postoperative pain and periapical healing after root canal therapy. Methods An extensive literature search was conducted to identify randomized clinical trials and prospective studies investigating postoperative pain and/or radiographic healing after primary root canal treatment. The selected studies evaluated different obturation techniques, including single-cone obturation, lateral condensation, warm vertical compaction, and thermoplasticized systems, as well as different sealer formulations such as calcium silicate–based and resin-based materials. Variations in irrigation protocols were also considered. The primary outcome was postoperative pain evaluated using validated assessment tools, predominantly the visual analogue scale (VAS). Secondary outcomes included radiographic evidence of periapical healing, obturation quality, incidence of sealer extrusion, flare-up occurrence, and overall treatment success. Risk of bias and methodological variability among the included studies were qualitatively analyzed. Results The analyzed evidence indicates that postoperative pain following root canal treatment is usually mild to moderate and progressively decreases during the first postoperative days, regardless of the obturation technique used. Studies comparing calcium silicate–based sealers with resin-based sealers reported similar short-term postoperative symptoms, although some investigations suggested improved biological behavior associated with calcium silicate materials. Differences among obturation techniques appeared to have minimal impact on early postoperative discomfort. Furthermore, long-term radiographic evaluations demonstrated comparable periapical healing among the investigated treatment protocols. Nevertheless, variability in study design, follow-up duration, and outcome reporting limited the possibility of direct quantitative comparison between studies. Conclusions Current evidence suggests that contemporary obturation techniques and modern endodontic sealers provide similar short- and medium-term clinical outcomes in terms of postoperative pain and periapical healing. Postoperative discomfort appears to depend on multiple factors and cannot be related exclusively to the obturation technique or sealer type. Additional well-designed long-term clinical studies using standardized methodologies are required to strengthen the evidence supporting clinical decision-making in endodontics.
Inchingolo et al. (Mon,) studied this question.