Assessment of pain and dissolution of apically extruded sealers and their effect on the periradicular tissues

AIM: This study aimed to evaluate the intensity of pain after unintentional extrusion of resin-based and calcium hydroxide (Ca[OH](2))-based endodontic sealers as well as their influence on the periradicular tissues. MATERIALS AND METHODS: A total of 120 single-rooted teeth exhibiting extrusion of sealer in the postoperative radiographs were included in the study. According to the sealers used, the teeth were divided into four groups (n = 30): Group I – AH Plus(®), Group II – Resino Seal, Group III – Sealapex™, and Group IV – Apexit(®) Plus. Postoperative pain was assessed at 0–6 h, 6–12 h, 12–24 h, and 24–48 h of obturation using Visual Analog Scale. Radiographs were taken at 3, 6, and ≥9 months to 1-year follow-up and compared with baseline radiographs to assess the dissolution of extruded sealers and healing of periradicular tissues. STATISTICAL ANALYSIS: ANOVA, Kruskal–Wallis, and Pearson's Chi-square test were used. Statistical significance level was set at P ≤ 0.05. RESULTS: Postoperative pain intensity was higher in case of AH Plus(®) sealer followed by Sealapex™ up to 12 h of obturation and was statistically nonsignificant. Apexit(®) Plus at all time intervals showed statistically significant less pain intensity than AH Plus(®) and Sealapex™ but not from Resino Seal group. At 9-month follow-up, better healing of periradicular tissues was shown by AH Plus(®) (48.1%) followed by Apexit(®) Plus (44.4%) and Sealapex™ (41.2%) with statistically nonsignificant difference. CONCLUSION: In case of periapical extrusion, both resin-based and Ca(OH)(2)-based sealers caused postoperative pain. Both Ca(OH)(2)- and resin-based sealers did not influence the treatment outcome.