Dislodgment Resistance of Bioceramic and Epoxy Sealers: A Systematic Review and Meta-analysis.

ABSTRACT

OBJECTIVES: The aim of the present systematic review was to evaluate if epoxy resin-based root canal sealers present superior push-out bond strength compared to calcium silicate-based root canal sealers. METHODS: The inclusion criteria consisted of in vitro studies that compared the push-out bond strength of epoxy resin-based and calcium silicate-based sealers. A systematic search was performed in the following databases for articles published until February 2018 PubMed, ScienceDirect, Scopus, Web of Science, and OpenGrey. The quality assessment and data extraction of the selected articles were performed. A meta-analysis of the pooled data and the subgroups according to the root thirds was carried out using the RevMan software (P < .05). RESULTS: The search resulted in 2292 studies. After the duplicate studies were removed and the title and abstract were read, 20 studies were selected and 17 were considered as having a low risk of bias. The pooled meta-analysis comparing epoxy resin-based (n = 467) and paste-to-paste calcium silicate-based root canal sealers (n = 467) demonstrated higher mean push-out bond strength values (P < .001) for the epoxy resin-based root canal sealers; the heterogeneity among studies was 85% (I2). The comparisons between epoxy resin-based (n = 358) and premixed ready-to-use calcium silicate-based root canal sealers (n = 358) also demonstrated a significant difference between the sealers (P < .05), with an I2 of 95%. The subgroup analysis showed that only in the middle third, were increased bond strength values for epoxy resin-based sealer observed (P < .001), with an I2 of 94%. CONCLUSIONS: The epoxy resin-based sealer demonstratedhigher push-out bond strength than paste-to-paste calcium silicate-based root canal sealer regardless of the root third assessed. In addition, the epoxy resin-based sealer exhibited increased push-out bond strength in comparison with premixed ready-to-use calcium silicate-based root canal sealer when evaluating the middle third.