Effects of Different Root Canal Sealers and Irrigation Agitation Methods on Postoperative Pain in the Treatment of Teeth with Chronic Apical Periodontitis: A Randomized Clinical Trial.

Introduction: This study aimed to explore how different combinations of root canal sealers and irrigation activation techniques affect postoperative pain in single-rooted teeth with chronic apical periodontitis.

Methods: Eighty teeth with single root and chronic apical periodontitis were randomly assigned into four groups according to the sealer and irrigation activation used: AH Plus sealer+Manuel dynamic irrigation (MDI), AH Plus sealer+Passive ultrasonic irrigation (PUI), NeoSealer Flo+MDI, NeoSealer Flo+PUI. The canals were prepared using Reciproc (R25 and R40) files. Root canals were obturated with gutta-percha cones corresponding in size and taper to the final instrument used. Ah Plus was used in the first and second groups, and NeoSealer Flo was used in the third and fourth groups as the root canal sealer. The 17% Ethylenediaminetetraacetic acid used in the final irrigation was activated using two different agitation methods (MDI, PUI). Postoperative pain was assessed at multiple time points up to 7 days using the Visual Analogue Scale.

Results: Pain intensity generally peaked between 6 and 24 hours after treatment. Among the groups, the AH Plus + MDI combination resulted in the lowest pain scores, while the NeoSealer Flo + PUI group showed higher pain levels. A significant difference was noted between early pain levels and the consumption of analgesics (p < 0.001). There were no statistically significant differences observed in terms of demographic characteristics (p > 0.05).

Conclusions: The combination of MDI with the AH Plus showed lower levels of pain in the early postoperative period.