Sealing Ability of Root Canal Sealers in Warm Obturation Techniques Compared to Cold Obturation Techniques: A Systematic Review

Abstract

Introduction: Obturation is a critical step in root canal treatment of the teeth that significantly contributes to its success. Various techniques are used for obturation of root canals. Aim: To compare the sealing efficiency of sealers under warm and cold obturation techniques across parameters such as Microleakage (ML), Push-out Bond Strength (PBS), and dentinal tubule penetration, which help evaluate the sealer-dentin interface in root canal systems. Materials and Methods: The research question was designed in the Population, Intervention, Comparison, Outcome (PICO) format, and the databases searched were Medical Literature Analysis and Retrieval System Online (MEDLINE), Cochrane, and Scopus following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Inclusion criteria included in-vitro studies between January 2011 and June 2021 in the English language, comparing the influence of both cold and warm obturation techniques on root canal sealers. Key parameters considered for evaluating the sealing ability of endodontic sealers were marginal adaptation, ML, and Dentinal Tubule Penetration (DTP). Two independent reviewers assessed studies for eligibility against the inclusion and exclusion criteria and conducted data extraction. Risk of bias assessment was performed using the Cochrane risk of bias assessment tool, Review Manager (v5.4). Results: A total of 19 articles were finalised for review, and methodological assessment for all parameters involved in the study was conducted using the Cochrane risk of bias assessment tool. Out of the total, five studies showed a moderate risk of bias, while the remaining 14 studies showed a low risk of bias. Conclusion: Warm and cold obturation techniques perform similarly in producing a good apical seal when used in root canal treatment with different endodontic sealer materials. Warm obturation techniques perform better than cold obturation techniques in producing homogeneous root canal fillings, while cold obturation techniques enhance push-out bond strength at the sealer-dentin interface.

Keywords

• bond strength
• microleakage
• sealing
• thermoplasticised