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

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% (I). 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 I 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 I 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.