The Impact of Calcium Silicate–Based and Resin-Based Root Canal Sealers on Postoperative Pain and Sealer Extrusion: A Multicenter Randomized Clinical Study

Introduction Postoperative pain remains a critical concern in endodontic treatment, influenced by multiple factors, including the choice of root canal sealer. Calcium silicate–based sealers like NeoSealerFlo offer biocompatibility and bioactivity, while resin-based sealers such as AH Plus are widely regarded as the gold standard in endodontics. This study aimed to compare postoperative pain and sealer extrusion between these two materials in a large-scale clinical setting. Methods In this multicenter randomized clinical trial, 564 root canal-treated teeth were obturated with either NeoSealerFlo (n = 305) or AH Plus (n = 259). Patients were categorized based on pulpal diagnosis (asymptomatic irreversible pulpitis, pulp necrosis, and previously treated cases) with no or asymptomatic apical periodontitis. Postoperative pain was assessed using the visual analog scale at 24, 48, and 72 hours. Statistical analyses included chi-square tests, the Friedman test, analysis of variance, general linear model analysis, and logistic regression to evaluate the effects of sealer type, sealer extrusion, and apical periodontitis on pain outcomes. Results A total of 305 cases were obturated using NeoSealerFlo and 259 with AH Plus. At 24 hours, the incidence of postoperative pain was significantly higher in the AH Plus group (46.7%) than in the NeoSealerFlo group (38.4%) (P < .05). Pain levels were also higher for AH Plus (4.83 ± 2.01) than NeoSealerFlo (4.05 ± 2.30) (P < .001). Pain decreased in both groups at 48 hours and 72 hours, with no significant differences. Sealer extrusion occurred in 44.1% of cases, more frequently with NeoSealerFlo (50.2%) than AH Plus (37.1%); however, it was associated with higher pain in the AH Plus group. Cases of pulp necrosis exhibited the highest pain levels, while previously treated cases had the lowest pain. General linear model and logistic regression confirmed AH Plus use, sealer extrusion, and apical periodontitis as significant predictors of postoperative pain. Conclusions NeoSealerFlo was associated with lower postoperative pain at 24 hours despite a higher extrusion rate. Sealer differences diminished over time, indicating that both materials provide comparable long-term clinical pain outcomes.