Evidence synthesis of postoperative pain with bioceramic vs. epoxy resin sealers: umbrella review of randomized trials within existing systematic reviews

Objective: The evidence on postoperative pain and clinical outcomes in patients receiving primary non-surgical root canal therapy with bioceramic vs. resin-based sealers was compiled in this comprehensive review from systematic reviews and meta-analyses. Methods: The review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD42023461029). Systematic reviews included randomized or quasi-randomized trials of adult patients having treatment with either sealer type for postoperative pain, and used validated scales. Screening, data extraction, and quality assessment by A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR-2) were completed independently by two reviewers and review overlap was measured with the Corrected Covered Area (CCA). Where feasible, de novo random-effects meta-analyses were conducted to estimate standardized mean differences (SMD) in pain at 24 and 48 h. Heterogeneity was measured using the I² statistic and certainty of evidence with GRADE. Results: Seven reviews (2020–2024) met eligibility, five with quantitative synthesis. Pooled analyses showed no significant differences in pain between sealer types within the first 6–48 h. Detected differences were small and clinically negligible. Both sealers showed similar analgesic use and flare-up rates. Methodological quality ranged from moderate to low; certainty of evidence for early pain was moderate and low for pain at >48 h due to study inconsistency and imprecision. Conclusions: Bioceramic sealers offer only a minimal, clinically insignificant reduction in early postoperative pain compared to resin-based sealers. Both nevertheless remain suitable options for reducing patient discomfort. Future studies should standardize pain evaluation, include retreatment cases, and explain clinically significant findings. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023461029, PROSPERO CRD42023461029.