Clinical and radiographic success of single-cone bioceramic obturation versus traditional techniques: a systematic review and meta-analysis of randomized controlled trials

Background: Bioceramic sealers, known for their bioactivity and biocompatibility, offer a promising alternative to traditional resin-based sealers. However, clinical evaluations are lacking. This systematic review and meta-analysis compared the clinical and radiographic outcomes of bioceramic single-cone obturation with those of conventional treatment and sealers. Methods: We conducted a systematic search of PubMed, ScienceDirect, and the Cochrane Library for randomized controlled trials (RCTs) published up to March 2024. Our review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD420250212604). Included studies compared bioceramic single-cone obturation with conventional obturation in permanent teeth with a follow-up of ≥6 months. Risk of bias was assessed using the second version of the Cochrane Risk of Bias tool (RoB 2.0). A random-effects meta-analysis was performed to calculate pooled success rates, odds ratios (ORs), and 95 % confidence intervals (CIs). Heterogeneity and publication bias were assessed via I² statistics and Egger's test. Results: Three RCTs involving 259 participants met inclusion criteria. The success rates for the bioceramic group were 88.7 %, 87.1 %, and 92.0 % at 6, 12, and 18 months, respectively, while those for the controls were 76.4 %, 76.4 %, and 90.7 %, respectively. Three studies reported higher success rates in the bioceramic groups than in the controls, although between-group differences were not statistically significant (overall OR range 1.12–2.09; p > 0.05). We observed moderate heterogeneity at the early follow-ups and negligible heterogeneity at the 18-month follow-ups. Conclusion: Single-cone obturation with bioceramic sealers may result in small but clinically relevant advantages; however, more high-quality RCTs with longer-term follow-up are needed.