SYSTEMATIC REVIEW article
Front. Med.
Sec. Precision Medicine
Comparative efficacy of novel biomaterials versus traditional materials in the treatment of dental and pulpal diseases: a systematic review and meta-analysis
Provisionally accepted
Qing Sheng1Guangwei Fan1Weiqing Lu2Linran Yao1Bochong Li1Yijun Qian1Danping Zheng1Shi Zhang1
Ruyi Zhu1*Yanyan Hu3*- 1Department of Endodontics, Dental & Ophthalmic Clinic of Putuo District, Shangha, Shanghai, China
- 2Department of Periodontist, Dental & Ophthalmic Clinic of Putuo District, Shangha, Shanghai, China
- 3Department of Prosthodontics, Dental & Ophthalmic Clinic of Putuo District, Shangha, Shanghai, China
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Aim: This systematic review and meta-analysis aimed to compare the efficacy of novel bioceramic sealers versus traditional epoxy resin-based sealers (AH Plus) used with the single-cone technique in root canal treatment, focusing on postoperative pain, apical sealing, overfilling, retreatment difficulty, and clinical success. Methods: Following PRISMA guidelines, a comprehensive search was conducted across PubMed, Embase, Cochrane CENTRAL, Web of Science, CNKI, and Wanfang databases from January 2014 to December 2024. Randomized controlled trials (RCTs) and cohort studies comparing bioceramic sealers (e.g., iRoot SP, Bio-C Sealer) to AH Plus were included. Two reviewers independently extracted data and assessed quality using Cochrane RoB 2.0 and Newcastle-Ottawa tools. Meta-analyses were performed using RevMan 5.4, employing fixed-or random-effects models based on heterogeneity (I²). Results: Fifteen studies (11 RCTs, 4 cohorts; 1,528 teeth) were included. Bioceramic sealers significantly reduced postoperative pain (OR = 0.48, 95% CI: 0.35–0.66, P < 0.001; I² = 22%) and improved apical sealing (SMD = -1.35, 95% CI: -1.78 to -0.92, P < 0.001; I² = 71%). However, they increased overfilling risk (OR = 1.85, 95% CI: 1.25– 2.74, P = 0.002; I² = 18%) and retreatment difficulty (SMD = 0.88, 95% CI: 0.25–1.51, P = 0.006; I² = 45%). Mid-term clinical success rates showed no significant difference (OR = 1.12, 95% CI: 0.85–1.47, P = 0.41; I² = 15%). Conclusion: Bioceramic sealers outperform AH Plus in reducing pain and enhancing
Keywords: Apical sealing, Bioceramic sealer, Meta-analysis, Postoperative pain, Root canal treatment, Single-cone technique
Received: 08 Dec 2025; Accepted: 23 Jan 2026.
Copyright: © 2026 Sheng, Fan, Lu, Yao, Li, Qian, Zheng, Zhang, Zhu and Hu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Ruyi Zhu
Yanyan Hu
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.