Outcome Of Endodontic Treatment Research Articles

The immune landscape in apical periodontitis: From mechanism to therapy.

Apical periodontitis (AP) is featured by a persistent inflammatory response and alveolar bone resorption initiated by microorganisms, posing risks to both dental and systemic health. Nonsurgical endodontic treatment is the recommended treatment plan for AP with a high success rate, but in some cases, periapical lesions may persist despite standard endodontic treatment. Better comprehension of the AP inflammatory microenvironment can help develop adjunct therapies to improve the outcome of endodontic treatment. This review presents an overview of the immune landscape in AP, elucidating how microbial invasion triggers host immune activation and shapes the inflammatory microenvironment, ultimately impacting bone homeostasis. The destructive effect of excessive immune activation on periapical tissues is emphasized. This review aimed to systematically discuss the immunological basis of AP, the inflammatory bone resorption and the immune cell network in AP, thereby providing insights into potential immunotherapeutic strategies such as targeted therapy, antioxidant therapy, adoptive cell therapy and cytokine therapy to mitigate AP-associated tissue destruction.

CBCT based investigation of frequency of Middle Mesial Canal in Mandibular First Molars of Saudi Sub-population.

One key factor in determining endodontic treatment outcome is the clinicians' comprehension of tooth anatomy, as missed canals may harbor bacteria ultimately leading to apical periodontitis. The study aimed to investigate the prevalence of middle mesial canal (MMC) in Mandibular first molars (MFMs) of Saudi subpopulation. The cross-sectional retrospective study was conducted at Qassim University Dental College from June to August 2023. Overall, 302 CBCT images with 604 bilateral lower first molars were examined by two calibrated assessors. The existence of MMC was noted. The data were coded, and analysis was done in SPPS-24. The reliability of inter-evaluator and intra-evaluator agreement for detecting MMC were estimated using Cohen's kappa. The patients' average age was 30.95±11.61years. The sample's female to male ratio was 1:1.75. The overall frequency of MMC was 14.2%. The differences in the frequency of MMC on the basis of gender, quadrants and age groups were found to be insignificant. Inter-evaluator and intra-evaluator reliability was noted to be 0.78 and 0.74, depicting acceptable reliability. The MMC is an uncommon occurrence with rare bilateral presentation in MFMs of Saudi population. Endodontists performing endodontic treatment in such subjects should mindfully investigate inter mesiobuccal- mesiolingual canals area for locating, negotiating, and managing any present MMC's.

Endodontic Treatment Outcomes in Cone Beam Computed Tomography Images-Assessment of the Diagnostic Accuracy of AI.

Background/Objectives: The aim of this study was to assess the diagnostic accuracy of the AI-driven platform Diagnocat for evaluating endodontic treatment outcomes using cone beam computed tomography (CBCT) images. Methods: A total of 55 consecutive patients (15 males and 40 females, aged 12-70 years) referred for CBCT imaging were included. CBCT images were analyzed using Diagnocat's AI platform, which assessed parameters such as the probability of filling, adequate obturation, adequate density, overfilling, voids in filling, short filling, and root canal number. The images were also evaluated by two experienced human readers. Diagnostic accuracy metrics (accuracy, precision, recall, and F1 score) were assessed and compared to the readers' consensus, which served as the reference standard. Results: The AI platform demonstrated high diagnostic accuracy for most parameters, with perfect scores for the probability of filling (accuracy, precision, recall, F1 = 100%). Adequate obturation showed moderate performance (accuracy = 84.1%, precision = 66.7%, recall = 92.3%, and F1 = 77.4%). Adequate density (accuracy = 95.5%, precision, recall, and F1 = 97.2%), overfilling (accuracy = 95.5%, precision = 86.7%, recall = 100%, and F1 = 92.9%), and short fillings (accuracy = 95.5%, precision = 100%, recall = 86.7%, and F1 = 92.9%) also exhibited strong performance. The performance of AI for voids in filling detection (accuracy = 88.6%, precision = 88.9%, recall = 66.7%, and F1 = 76.2%) highlighted areas for improvement. Conclusions: The AI platform Diagnocat showed high diagnostic accuracy in evaluating endodontic treatment outcomes using CBCT images, indicating its potential as a valuable tool in dental radiology.

Outcomes of nonsurgical endodontic treatment under general anesthesia in special health care needs: An observational study

Background and aimThe alarming rise in the number of people with special health care needs (SHCNs) necessitates a paradigm shift in how to approach their oral health needs. General anesthesia (GA) is a valuable technique for facilitating dental procedures in patients with SHCNs who may not be able to tolerate treatment without it. The aim was to assess nonsurgical endodontic treatment and outcomes in patients with SHCNs performed under GA.MethodSeventy-eight permanent teeth in 33 patients who received nonsurgical endodontic treatment under GA were included between 2018 and 2022 in SHCNs hospital clinics. The demographic data, types of SHCNs, pulpal and periapical diagnosis, type of treatment, and material used were analyzed. All patients were recalled for clinical and radiographic examinations. Pre-treatment and recall periapical radiographs were evaluated and scored using the Periapical Index (PAI).ResultsAutism and Attention deficit hyperactivity disorder were 39.4% of patients treated. Most treatments delivered were primary nonsurgical root canal treatment (95%). Warm vertical compaction of gutta-percha for obturation accounted for 88% of cases treated. Single cone obturation technique was used in 9 cases (12%) utilizing tricalcium silicate sealer. At the recall visits, 98.7% of teeth treated had survived. Twelve teeth have pre-treatment periapical lesions, and all healed except one. Female patients were found to have higher scores of PAI compared to male patients (23.7% vs 7.5%), yet insignificant. Only 10 patients with nonsurgical root canal treatment reported recurrent caries.ConclusionThis study demonstrates a high survival rate for nonsurgical endodontic treatment performed under GA in a cohort of patients with SHCNs. Interestingly, patients with social and communication disorders received the highest proportion of treatments under GA. These findings highlight the potential of GA-facilitated endodontics for this population. However, further research is warranted to explore additional methods for optimizing oral health outcomes in SHCNs.

Factors Influencing Non-Surgical Root Canal Treatment Outcomes in Mandibular Second Molars: A Retrospective Cone-Beam Computed Tomography Analysis.

Background/Objectives: This study aimed to investigate the influence of the root canal morphology and various treatment variables on the outcomes of root canal treatments (RCTs) in mandibular second molars, assessed through cone-beam computed tomography (CBCT) imaging. Methods: A total of 150 CBCT images were examined, comprising 100 cases of persistent endodontic infections and 50 of previously treated root canals with normal apices in the mandibular second molars. CBCT was utilized to evaluate the root canal configuration, the radiographic quality of coronal restorations and treated canal systems, and the presence of periapical lesions. Statistical analyses were performed to explore the correlations between these factors. Results: The presence of a C-shaped root canal configuration did not demonstrate a significant correlation with periapical lesions (p = 0.05). Factors influencing endodontic treatment outcomes included missing canals (p = 0.018), underfilling or overfilling (p = 0.045), and inadequate coronal restoration (p = 0.006). Missing a canal was identified as the variable most significantly associated with periapical lesions (OR = 3.103). Inhomogeneous root canal obturation was more commonly observed in C-shaped root canals (p < 0.001). Conclusions: Regardless of the root canal morphology of mandibular second molars, successful RCT depends on thorough disinfection to eliminate any untreated canals, precise three-dimensional filling of the canals at the correct working length, and a securely sealed coronal restoration to prevent leakage.

Morphology and classification of the second mesiobuccal canal in maxillary first molars: a cone-beam computed tomography analysis in a Chinese population

BackgroundUnderstanding the tooth anatomy is crucial for ensuring effective endodontic treatment. This study investigated the root canal morphology of the second mesiobuccal (MB2) canal in maxillary first molars (MFMs) in a Chinese population using cone-beam computed tomography (CBCT).MethodsThis study evaluated 486 MFMs with MB2 canals from 285 participants undergoing CBCT examination and determined the Vertucci’s classification and position of the MB2 canal orifice. The prevalence of the MB2 canal was correlated with the sex, age, and tooth side. The correlations between the prevalence of the MB2 canal and sex and tooth side were assessed using the Fisher's exact test. The chi-square test was used for evaluating the correlation between the prevalence of the MB2 canal and age.ResultsThe number of type II, III, IV, V, VI, VII, and other root canals in the MFMs was 30.9%, 0.6%, 65.0%, 1.2%, 1.2%, 0.4%, and 0.6%, respectively. Among the 201 cases with bilateral inclusion, 87.6% showed consistent canal configuration. Results of the first clear apparent position (FCAP) of the MB2 canals showed that 434, 44, and 3 teeth had FCAP at the upper, middle, and bottom one-third of the root, respectively. The FCAPs of the MB2 canal in the MFMs with types II, IV, and VI, as well as types III and V canals showed significant differences (p<0.05). The horizontal distance between the MB1 and MB2 canal orifices in the type II canals of MFMs was significantly lesser than those in the type IV canals of MFMs (p < 0.01). The longitudinal distance between the pulp chamber floor plane and MB2 canal orifice significantly correlated with age (p < 0.05).ConclusionsThe morphology of the mesiobuccal root canal in the MFMs is complex. Complete understanding of the anatomical morphology of the root canal combined with the CBCT and dental operating microscope is necessary for the accurate detection of the MB2 canal and consequently improved success rate of root canal treatment. Our study findings can help endodontists improve endodontic treatment outcomes.

Clinical, Radiographic, and Histologic Outcomes of Regenerative Endodontic Treatment in Human Immature Teeth Using Different Biological Scaffolds: A Systematic Review and Meta-analysis.

Biological scaffolds such as blood clot (BC), platelet-rich plasma (PRP), platelet- rich fibrin (PRF), and platelet pellet (PP) are used in regenerative endodontic treatments (RETs). To systematically and quantitatively evaluate clinical, radiographic, and histologic outcomes of RET studies using different biological scaffolds. MEDLINE, Scopus, Cochrane library, and Embase were searched to identify studies on RET procedures with any scaffold type performed on immature non-vital human teeth, employing any type of biological scaffold. Clinical, radiographic, and histologic outcomes were extracted. Cochrane collaboration risk of bias tool and Newcastle-Ottawa scale were used for quality assessment. Random and fixed model meta-analysis was carried out with 95% confidence interval. Thirty-two studies were included in the qualitative analysis from the primarily retrieved 1895 studies. Only one study had high risk of bias and 71.8% of the studies had high quality. None of the studies reported any histologic findings. Thirty studies were included in meta-analysis. Clinical success rate of RET using either BC, PRP, or PRF was >99%. Furthermore, 32%, 23%, and 27% of BC, PRP, and PRF cases regained vitality, respectively. Periapical healing was seen in 67%, 75%, and 100% of BC, PRP, and PRF cases, respectively. There was no statistical difference between BC, PRP, or PRF regarding clinical success or any radiographic outcomes. There was no significant difference between BC, PRP, and PRF in terms of clinical and radiographic outcomes. When it is difficult or dangerous to induce bleeding in root canals, PRP and PRF may be employed instead.

Endodontic management of a maxillary first molar with three roots and six root canals

Variations in the root canal anatomy of a maxillary first molar are often challenging to diagnose and treat; thus, clinicians must have a thorough knowledge of the same. This case report highlights the successful nonsurgical endodontic management of a maxillary first molar with an unusual morphology of three roots and six root canals. A total of six root canals (mesiobuccal [MB] 1, MB2, MB3, distobuccal [DB] 1, DB2, and palatal) were detected after initiating root canal therapy and access cavity preparation. Conventional root canal treatment was completed, and postoperative cone-beam computed tomography scanning was done to verify the total number of canals and ensure the adequacy of root canal fillings. Managing such cases with rare variations in the root canal systems could be arduous and thus, clinicians should be well-versed in the methods to identify and manage such complexities to facilitate the successful outcomes of endodontic treatment.

OBTURATION AND DIFFERENT OBTURATION TECHNIQUES- A REVIEW

The crucial stage of obturation completes the endodontics triad. Achieving a fluid tight seal and performing an obturation correctly and appropriately are critical to the outcome of endodontic treatment. Among the several obturation procedures available, selecting a specific technique depends on the anatomy of the root canal and attaining case-specific goals. Warm vertical compaction and lateral condensation are the two fundamental obturation techniques. Modern tools and methods have emerged, like those that use vibration and heat to cause the obturating material to condense and compact. These innovations have fundamentally changed the field of endodontics and increased the predictability of obturation success.

Incidence of Postoperative Flare-Up After Single-Visit and Multi-visit Endodontic Therapy.

The aim of the survey was to obtain data from the studied patients on the frequency and the type of postoperative pain after treatment of chronic apical periodontitis, as well as whether there is a relation between gender, age, and postoperative pain. A visual analog scale was used to study the intensity of postoperative pain in the treatment of teeth diagnosed with CPP, which are treated by one of two methods - single-visit ormulti-visit method. The total number of surveyed patients is 71. The patients were examined and treated at the Dental Clinic "Imperial" in Varna, Bulgaria, in 2020.Thirty-one of them were treated by the single-visit method, and the remaining 40 by the multi-visitmethod with placement of a temporary dressing or sterile swab. A relatively large proportion (70%) of patients reported mild pain immediately after the root canal filling. A relatively large proportion (90.3%) of patients did not report pain one week after the root canal filling. The more frequent symptoms were observed in cases treated by the multi-visitmethod, after the application of a temporary dressing. Patients who reported taking analgesics were treated in the multi-visitmethod. More frequent pain symptoms with both methods of treatment were observed in men aged 36-60 years. Although exacerbation has been shown to have no significant effect on the outcome of endodontic treatment, it is highly undesirable. In the short term, the postoperative pain in patients treated by the multi-visitmethod through the use of intracanal medication is more pronounced. Patients receiving the single-visit treatment reported less postoperative pain.

Outcomes of Regenerative Endodontic Treatment Performed Using Different Magnification Devices: A Systematic Review.

In this systematic review, we assessed whether the effects of the usage of various devices help with magnification in endodontics and whether they resulted in any significant changes in the clinical result of treatment. An exhaustive search was performed across MEDLINE and Cochrane Registers for various clinical studies, which were focused on comparing regenerative endodontic treatment based on the usage of magnification devices. Various terms were used to search these clinical trials such as microscope, regenerative endodontic surgery, apicoectomy, endoscope, and loupes. After scrutinizing the studies, around three clinical trials based on magnification in endodontic surgeries were included in the present review. It was observed that no statistically noteworthy betterment of treatment outcome was seen in patients treated with either of the magnification devices such as loupes and microscope. It was evident that these magnification devices can alter the effectiveness of regenerative endodontic treatment in a very minimal way. However, we believe that more randomized clinical studies should be conducted in this area.

Endodontic management of type I maxillary first molar with two palatal roots using cone-beam computed tomography

Background: Understanding the anatomical variations in the root canal system is vital for the successful outcome of endodontic treatment. Anatomical variation with respect to palatal roots is rare compared with other roots of maxillary molars. Purpose: This case report describes a rare case of cone-beam computed tomography (CBCT)-guided endodontic treatment of a maxillary first molar with two palatal roots. Case: A 35-year-old Saudi woman complained of continuous pain in the right maxillary first molar. Past dental history revealed root canal treatment of the same tooth four weeks prior. Master cone radiographs recovered from her general dentist revealed a missing second palatal canal. Case Management: A CBCT image was taken to confirm if there were any aberrations in root canal morphology. Clinical exploration presented four distinct orifices: two palatal and two buccal. All the root canals were prepared and irrigated with 2.5% NaOCl and normal saline during instrumentation. All the canals were obturated with gutta-percha and AH 26 sealer using the continuous wave obturation technique. Conclusion: Clinical exploration of the pulpal floor, along with multiple angled radiographs, is needed to confirm any anatomic aberration.

Radiographic outcome of endodontic treatment and retreatment of teeth with apical periodontitis using two different root canal irrigants. A prospective cohort study.

The aim of this prospective cohort study was to compare the radiographic outcome of endodontic treatment and retreatment of teeth with apical periodontitis using either 1% sodium hypochlorite (NaOCl) or 2% chlorhexidine digluconate (CHX) for root canal irrigation. In the years from 2013 to 2015 standard irrigation varied by semester between NaOCl and CHX at the Department of Endodontics at the Faculty of Dentistry. During that time, 912 teeth received treatment for apical periodontitis in 744 patients, of whom 532 responded to the request for a 1-year follow-up. Only one tooth per person (the most distally located) were included; 285 teeth treated with NaOCl and 247 with CHX. One hundred cases were then randomly sampled from each irrigation group and analysed for outcome by periapical index (PAI) scoring using criteria for success, uncertain and failure. Clinical and other radiographic parameters were scored or recorded and analysed for associations with radiographic outcome using chi-square, ANOVA and regression analyses. Success rates (PAI score 1 or 2 at control) were nearly identical for the two irrigation liquids. The use of irrigating solution also did not significantly influence the outcome in chi-square analyses of subgroups of teeth or regression analyses with other variables included. Ordinal regression analysis established that preoperative lesion size or preoperative PAI score were significantly associated with outcome, and teeth in the mandible had significantly better outcomes than in the maxilla. No significant differences in the radiographic outcome using either 1% NaOCl or 2% CHX as irrigants were found. The outcome was better for teeth with small lesions or lower PAI scores at completion of treatment and for mandibular teeth.

Endodontic management of maxillary first molar with two palatal canals - A case report

An awareness and understanding of unusual root canal morphology is essential as it deter-mines the successful outcome of endodontic treatment. Aberrations in root canal anatomy are commonly occurring phenomena. I report a clinical case of a maxillary left first molar with two palatal root canals. The morphology is atypical because it has two palatal canals with separated orifices, running parallelly but joined at the apex. Modifications to the usual access opening and examination of the pulpal floor for additional canals are essential in such atypical cases for the success of endodontic treatment

A 1 year follow-up of a molar root canal treatment using periapical radiographs and CBCT

CBCT offers many significant advantages in dentistry, while the periapical radiographs provide a cheaper technique and a lower radiation compared to CT scan. The aim of this clinical case was to compare the outcome 1 year after root canal treatment, using digital periapical radiographs versus CBCT. Tooth 46 with necrotic pulp and periapical periodontitis was rotary prepared and filled using continuous wave condensation and AH Plus. X-rays and CBCT scans were made both before and after the treatment, at 1 year recall. On x-ray the lesion appeared to be healed, while on CBCT one can still see a smaller lesion, so the tooth is healing. The increased accuracy of CBCT offers the most relevant information for the outcome of endodontic treatment.

Ergonomic interventions and endodontic treatment outcomes: An analysis of dentist working posture and error rates

PurposeDentists spend a long time the day in the position. It is possible that this leads to discomfort that may translate to procedural errors during treatment, such as root canal treatment. This study aims to investigate the relationship of working posture and procedural errors in endodontic manipulations. Materials and Methods32 dentists (17 men, 53.13%, and 15 women, 46.88%) from the University Dental Polyclinic of Uzhhorod National University (Uzhhorod, Ukraine) were included in the study. REBA, RULA, frequency of procedural errors were analysed using regression. ResultsThis study revealed a surprising trend where a decrease in errors during endodontic treatment was associated with higher RULA and REBA scores, contrary to the expected increase in errors with higher ergonomic stress. Additionally, the research highlighted the significant impact of a dentist's handedness and tooth position in the dental arch on treatment ergonomics and efficiency, as observed and analyzed through ergonomic assessments and statistical methods. ConclusionsThe study conclusively demonstrated that optimal positioning and alignment during dental procedures significantly contribute to a reduction in procedural errors, underscoring the importance of ergonomics in clinical dentistry.

A Cone Beam Computed Tomography-Based Investigation of the Frequency and Pattern of Radix Entomolaris in the Saudi Arabian Population.

Background and Objectives: An understanding of the anatomical complexity of teeth is a significant factor for a successful endodontic treatment outcome. The aim of this study was to explore the frequency and pattern of distribution of radix entomolaris (RE) in mandibular first molars (MFMs) of a Saudi Arabian subpopulation using CBCT scans. Materials and Methods: This study was conducted at dental clinics of Qassim University from February to May 2023 by evaluating CBCT scans that were previously obtained for diagnostic purposes. Scans of Saudi national patients with bilaterally present MFMs and fully formed root apices were included. Conversely, scans with one/or two missing MFMs, MFMs with incomplete root apices, full- or partial-coverage prosthesis, endodontic treatment, and associated radicular resorption were excluded from study. A total of 303 CBCT scans with 606 bilateral MFMs were analyzed by two calibrated evaluators for the presence of, and type according to Song's typolgy of RE. The data were analyzed using SPPS-24. The descriptive variables were documented as frequencies and percentages. The chi-square test was used to determine the association between the prevalence of RE with the gender, jaw side and age group. Both inter-rater and intra-rater agreements were estimated for detecting and classifying RE using Cohen's kappa test. Results: The sample had 63.7% males and 36.3% females. The prevalence of RE was 6.6%, with Song's type III (57.5%) as the most common variant. Absolute agreement was noted between the raters about the presence of RE and very strong agreement was noted for the classification of the RE. Conclusions: RE is an uncommon finding among the mandibular first molars of the Saudi population without any gender and quadrant predilection. The clinicians' knowledge of the presence and Song's type of RE may contribute towards the enhancement of endodontic treatment outcomes.

The Effect of Tooth Location on the Success and Failure of Endodontic Treatment: A Systematic Review

Endodontic treatment is preferred to save the inside of the tooth, which is being infected by bacteria. There are many factors that can influence the outcome of an endodontic treatment. One of the most challenging factors is the anatomy of the tooth itself on which the endodontic treatment is planned. The location and type of tooth and structure of the root canal influence the anatomy of the tooth. This study aims to determine the effect of tooth location on the success rate of an endodontic treatment from the existing literature. Eight studies were included in this review with a total sample size of 6,056 patients who underwent endodontic treatment. All studies showed the outcome of endodontic treatment in the context of tooth type. Studies were consistent with the fact that the overall success rate of endodontic treatment is higher in anterior incisors as compared to premolars and molars owing to the number of canals per tooth and the comparative operational difficulty between incisors and molars while performing an endodontic treatment. Therefore, the findings in this review suggest that tooth location is a significant factor that can influence the outcome of endodontic treatment.

Clinical diagnostic approach in the treatment of chronic periodontitis in mandibular molars: Clinical cases

Background. Inflammatory process in periapical tissues causes tooth extraction in more than 50% of cases. The development of chronic apical periodontitis can be triggered by an intracanal infection in undetected/missed root canal of the mandibular molars. The morphology of mandibular molars is distinguished by additional canals in the mesial root in some cases. Different studies reveal the middle mesial canal in 4.5% to 26% of cases with quite high incidence in youth. The dental therapy has been searching for effective approaches to diagnosis and treatment of chronic periodontitis, enabling the focus of chronic inflammation to be eliminated and the tooth to be saved. Case descriptions. The paper presents clinical cases of patients with destructive changes in bone tissues in the periapical region of the mesial root in mandibular molars. The developing of this pathology is associated with missed anatomy in the mesial root during primary endodontic treatment. The patients underwent clinical examination consisting of basic methods (interview, examination) and additional techniques (intraoral radiography). An additional middle mesial canal in the root of the mandibular molar was identified taking into account the complex morphology of the root system of the tooth and verified by its careful analysis and radiography. The final clinical diagnosis, chronic apical periodontitis (K04.5), was made following the obtained diagnostic results and the ICD-10 classification. Diagnostic examination and endodontic retreatment were performed using a dental operating microscope. Conclusion. An operating dental microscope provides visualization of microscopic anatomotopographical details, promoting the efficiency of diagnosis and treatment of chronic apical periodontitis in mandibular molars. Using dental microscope facilitates systematization of the data obtained during the examination, making a final clinical diagnosis, and development of a reasonable personalized treatment plan focused on detecting an additional middle canal in the mesio-buccal canal of the mandibular molar. Due to the suggested approach, the long-term outcomes of endodontic treatment can be an objective assessed in dynamics, thereby improving the quality of treatment for chronic apical periodontitis in patients.

Influence of sealer type on treatment outcome of teeth with apical periodontitis: a systematic review.

The purpose of this article was to Evaluate the influence of sealer on the outcome of non-surgical endodontic treatment or retreatment of permanent teeth with apical periodontitis (PROSPERO registration: CRD42020205951). A systematic review of original clinical studies was carried out following PRISMA guidelines to answer whether the type of sealer used in endodontic treatment or retreatment influences the repair of apical periodontitis determined by clinical and radiographic parameters. Electronic searches were performed in PubMed, Embase, Web of Science, Scopus, and the Cochrane Library database, until May 2023. Gray literature and a hand search of reference lists were also performed. The risk of bias was assessed using Cochrane RoB2 for randomized trials and the Newcastle-Ottawa Scale (NOS) for prospective and retrospective cohort and case-control studies. Among 1046 studies, a total of 819 were selected by title and abstract, resulting in 23 for full-text review. In total, 11 studies met the inclusion criteria (1467 patients/teeth with apical periodontitis). The quality assessment using RoB2 included five randomized control trials, of which four had medium risk and one had a low risk of bias. According to the NOS scale, five studies were classified as low risk and one study was considered as medium risk of bias. The sealer type and obturation techniques varied, and the mean follow-up time was 3.7 years. Most studies used two-dimensional radiographic criteria to assess the treatment outcome sealers and not cements. Eight studies did not find significant differences when comparing cements. The healing rates ranged from 56.7% to 90%. The results of this review support that the current endodontic sealers do not seem to influence the treatment outcome of permanent teeth with apical periodontitis. Although the studies had medium and low risk of bias, the results should be interpreted with caution. More randomized studies of long-term outcomes comparing filling materials are needed to strengthen this claim and allow for a meta-analysis.