Comparative efficacy of novel biomaterials versus traditional materials in the treatment of dental and pulpal diseases: a systematic review and meta-analysis

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 ( I 2 ). 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; I 2 = 22%) and improved apical sealing (SMD = −1.35, 95% CI: −1.78 to −0.92, p < 0.001; I 2 = 71%). However, they increased overfilling risk (OR = 1.85, 95% CI: 1.25–2.74, p = 0.002; I 2 = 18%) and retreatment difficulty (SMD = 0.88, 95% CI: 0.25–1.51, p = 0.006; I 2 = 45%). Mid-term clinical success rates showed no significant difference (OR = 1.12, 95% CI: 0.85–1.47, p = 0.41; I 2 = 15%). Conclusion Bioceramic sealers outperform AH Plus in reducing pain and enhancing sealing but carry higher overfilling and retreatment challenges. Mid-term success rates are comparable. Clinicians should prioritize bioceramics for cases demanding superior sealing and comfort while employing careful technique to mitigate risks. Long-term studies are needed to validate durability and retreatment protocols. Systematic review registration PROSPERO, identifier (CRD420261285302).