Clinical and Radiographic Failure of Nonsurgical Endodontic Treatment and Retreatment Using Single-cone Technique With Calcium Silicate-based Sealers: A Systematic Review and Meta-analysis

This systematic review and meta-analysis aimed to evaluate the clinical and radiographic failure of non-surgical endodontic treatment and retreatment for mature permanent teeth with or without apical periodontitis using the single-cone (SC) obturation technique with calcium silicate-based bio-ceramic (CSBC) sealers and to compare these failure rates to other sealer materials and obturation techniques.A comprehensive search was conducted using MEDLINE (PubMed), Embase, Cochrane Library, Scopus, Web of Science, and gray literature up to March 2023. Two reviewers assessed the eligibility of the included studies. Eligible studies were critically appraised for risk of bias and quality of evidence. Subsequently, a meta-analysis of pooled data was conducted utilizing the RevMan software (P< 0.05) to evaluate the failure rate of non-surgical root canal therapy using CSBC sealers and SC obturation procedures. Separately, another analysis was conducted to compare those results with the outcome of non-surgical root canal therapy using alternative obturation materials and methods.5 studies were included. The pooled failure rate for non-surgical endodontic treatment and retreatment combined using CSBC sealers and SC obturation technique was 6.8% [95% confidence interval (CI)= (3%-12%), I2 = 46%]. A second analysis was conducted on the three included clinical trials to compare the outcomes of the intervention (CSBC sealers and SC obturation technique) and control groups (other sealers and other obturation techniques). This analysis found no significant difference between the two groups regarding clinical and radiographic failure of endodontic treatment and retreatment [Risk ratio=0.71, 95% CI = (0.33,1.51), I2 = 0]. This difference was also not statistically significant when the failure rate of primary root canal treatment and retreatment were separately analyzed [Combined Risk ratio of primary root canal treatment=0.94, 95% CI = (0.46,1.93), I2= 0%; Combined Risk ratio of retreatment=0.21, 95% CI = (0.001, 75.46), I2= 0%].The overall results of this systematic review and meta-analysis demonstrate that the SC obturation technique with CSBC sealer provides similar results compared to other obturation materials and techniques in facilitating the healing of apical periodontitis.