Comparative Evaluation of Postoperative Pain Following Nonsurgical Endodontic Therapy with Calcium Silicate-Based Sealer and Traditional Sealers: A Systematic Review and Meta-Analysis

Objective: To systematically review and compare postoperative pain levels following NSET using calcium silicate-based sealers versus traditional sealers. Material and Methods: This systematic review adhered to PRISMA 2020 guidelines and was registered with PROSPERO (CRD42024607698). A comprehensive search of the PubMed, Scopus, and Web of Science databases was conducted to identify clinical trials comparing postoperative pain following obturation with calcium silicate-based versus traditional sealers. Studies including patients with symptomatic irreversible pulpitis or retreatment cases were selected. Pain outcomes were assessed using visual analog scales (VAS) or numeric rating scales (NRS) at 24 hours to 7 days postoperatively. Risk of bias was evaluated using RoB-2 for randomized trials and ROBINS-I for non-randomized trials. Meta-analysis was conducted where appropriate. Results: Five studies met the inclusion criteria. Meta-analysis indicated that calcium silicate-based sealers significantly reduced postoperative pain at 24 hours (SMD: -0.34; 95% CI: -0.63 to -0.04; p=0.02) but not at 48 hours (SMD: -0.26; 95% CI: -0.62 to 0.11; p=0.17). Overall, calcium silicate-based sealers demonstrated lower postoperative pain, especially within the first 24–72 hours. However, variability among study designs, patient conditions, and obturation techniques influenced outcomes. Conclusion: Calcium silicate-based sealers may offer short-term advantages in reducing postoperative pain after NSET. Nevertheless, findings were inconsistent across studies, and further high-quality randomized controlled trials are needed to confirm these results and establish long-term clinical relevance.