Introduction: Successful management of apical periodontitis relies on effective root canal obturation to eliminate microbial activity and promote periapical healing. Bioceramic sealers have emerged as alternatives to conventional sealers due to their favorable biocompatibility and potential regenerative properties. However, their comparative clinical efficacy remains uncertain. Materials and Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Four electronic databases (PubMed, Scopus, Web of Science, and Embase) were searched for randomized controlled trials (RCTs) comparing bioceramic and conventional sealers. Three reviewers independently performed study selection, data extraction, and risk of bias assessment using the RoB 2.0 tool. The primary outcomes were apical healing and postoperative pain; secondary outcomes included adverse events and procedural complications. Meta-analysis was performed using a random-effects model. Results: From 491 identified records, 12 RCTs met the inclusion criteria. Meta-analysis of four studies found no statistically significant difference in healing rates between bioceramic and conventional sealers (RR=1.05, 95% CI: 0.89-1.23, P=0.61; I²=0%). No major adverse events were reported. Although bioceramic sealers have theoretical advantages, the current evidence does not support their clinical superiority over conventional sealers, as the meta-analysis showed non-significant results and some methodological limitations were identified. Conclusion: Bioceramic sealers appear to be clinically comparable to conventional sealers regarding periapical healing and postoperative outcomes. However, due to the limited and heterogeneous data, further high-quality RCTs with standardized outcome measures are needed to determine their relative effectiveness.
Mendoza et al. (Thu,) studied this question.