Comparative Effectiveness of Bioceramic and Resin-Based Sealers in Root Canal Therapy: A Meta-Analysis

Abstract

Background: Successful root canal therapy depends on effective disinfection, three-dimensional obturation, and durable sealing of the root canal system to prevent reinfection and support periapical healing. Resin-based sealers have long been used as reference materials because of their handling characteristics, dimensional stability, and established sealing performance. Bioceramic sealers have gained increasing clinical interest because of their hydrophilicity, bioactivity, biocompatibility, alkaline pH, calcium ion release, and ability to interact with dentinal tissues. However, evidence comparing their clinical and laboratory performance with resin-based sealers remains variable. Objective: This systematic review and meta-analysis aimed to compare the effectiveness of bioceramic and resin-based sealers in root canal therapy, focusing on clinical success, postoperative pain, periapical healing, sealing ability, dentinal tubule penetration, and long-term treatment stability. Methods: Electronic searches were conducted in PubMed, Scopus, Web of Science, ScienceDirect, the Cochrane Library, and Google Scholar for studies published between 2005 and 2025. Eligible studies directly compared bioceramic or calcium silicate-based sealers with resin-based or epoxy resin sealers in human root canal treatment or extracted human-tooth models. Data were extracted on study design, sample size, sealer type, obturation technique, follow-up duration, and reported outcomes. Clinical and laboratory outcomes were synthesized separately using a random-effects approach, and heterogeneity was assessed using the I² statistic. Results: Twenty-six studies involving 2,134 treated teeth or specimens were included. Bioceramic sealers showed a clinical success rate of 91.4% compared with 88.7% for resin-based sealers. Postoperative pain was lower with bioceramic sealers, occurring in 12.6% of cases compared with 18.3% for resin-based sealers. Periapical healing was 89.2% with bioceramic sealers and 85.6% with resin-based sealers. Overall heterogeneity was moderate (I² = 32%). Laboratory findings indicated high sealing ability in both groups, with greater dentinal tubule penetration and stronger biological interaction reported for bioceramic materials. Conclusion: Both bioceramic and resin-based sealers are effective for root canal obturation. Bioceramic sealers demonstrated modest advantages in postoperative comfort, periapical healing, and dentinal interaction, while resin-based sealers remained reliable and clinically established materials.