Three-dimensional Filling Quality of Cold Lateral Versus Warm Vertical Condensation: A Micro-CT and CBCT-based Systematic Review and Meta-analysis

This systematic review and meta-analysis compared the efficacy of cold lateral condensation (CLC) and warm vertical condensation (WVC) in endodontic obturation. The primary focus was to evaluate three-dimensional (3D) obturation quality, including void volume, gutta-percha adaptation, and filling completeness, using Micro-Computed Tomography (Micro-CT) and Cone-Beam Computed Tomography (CBCT). A systematic search was conducted in PubMed, Embase, Scopus, and Web of Science up to December 2024 following PRISMA guidelines. Studies were included if they had compared CLC and WVC using Micro-CT or CBCT imaging and reported quantitative outcomes on gutta-percha filling and void volume. A randomeffects meta-analysis was performed because of high heterogeneity (I²=80%), with standardized mean differences (SMD) and 95% confidence intervals (CIs) calculated. Twelve studies were included in the review, with five contributing to the meta-analysis. WVC showed superior obturation quality along the full canal length (SMD=-2.19; 95% CI:-3.78 to-0.60; p=0.02). However, in the apical third, the difference was not statistically significant (SMD=-0.79; 95% CI:-1.92 to 0.35; p=0.13). While WVC offered superior adaptation and fewer voids, it also presented a higher risk of sealer extrusion. CLC, while cost-effective and widely used, exhibited more voids and poorer adaptation, particularly in complex canals. However, substantial heterogeneity (I²=80-85%) among included studies limits confidence in these pooled estimates. WVC achieves superior obturation quality along the full length; however, the evidence remains inconclusive for the apical third, reflecting uncertainty in this anatomically complex region. High study heterogeneity underscores the need for methodological standardization. Given the high heterogeneity and methodological variation among included studies, including studies using alternative models or techniques, the findings should be interpreted with caution and serve as a basis for future standardized research.