Effect of continuous wave of condensation on postoperative pain using bioceramic versus resin sealers: a randomized clinical trial

The clinical behavior of bioceramic sealers under heat-based obturation techniques remains insufficiently explored, despite their widespread clinical use. Although these materials are generally recommended for single-cone techniques, their performance when exposed to heat during warm obturation procedures is still controversial. This randomized clinical trial aimed to evaluate postoperative pain following the use of bioceramic and epoxy resin-based sealers in combination with the continuous wave of condensation technique (CWCT), addressing a clinically relevant gap in the literature. Seventy-two patients with single-rooted teeth diagnosed with asymptomatic irreversible pulpitis were randomly assigned to three groups ( n = 24): AH Plus, TotalFill BC Sealer, and Bio-C Sealer. All treatments, including post-endodontic restorations, were completed in a single visit by a single experienced operator using the CWCT. Postoperative pain intensity was assessed using a visual analog scale (VAS; 0–10), and pain incidence was recorded at 6, 24, 48, and 72 h, and 7 days. Statistical analyses included Fisher’s exact test with Monte Carlo simulation, Cochran’s Q test, and binary logistic regression analysis (α = 0.05). No statistically significant differences were observed among the three sealer groups regarding postoperative pain incidence or intensity at any time point ( P > 0.05). Pain incidence was highest within the first 24 h (16.7% at 6 h and 11.1% at 24 h) and decreased significantly over time ( P < 0.001), with complete resolution after 48 h. None of the evaluated variables, including age, gender, jaw, or sealer type, significantly influenced postoperative pain outcomes. No significant difference in short-term postoperative pain was detected among the three root canal sealers when used with the continuous wave of condensation technique. ClinicalTrials.gov NCT06726837, 10 December 2024.