PhD Scientific Days 2026

Poster Session 1.O - Dental Research

Comparing the void formation in root canal fillings - A Systematic Review and Meta-analysis

Name of the presenter

Komora, Péter

Institute/workplace of the presenter

Department of Restorative Dentistry and Endodontics, Semmelweis University, Budapest, Hungary

Authors

Péter Komora¹, Orsolya Vámos², Gergely Agócs³, Boglárka Lilla Szentes³, Péter Hegyi³, Eszter Ágnes Szalai¹, Alexander Schulze Wenning³, Gábor Varga³, János Vág¹, Beáta Kerémi¹
1: Department of Restorative Dentistry and Endodontics, Semmelweis University, Budapest, Hungary
2: Department of Prosthodontics, Semmelweis University, Budapest, Hungary
3: Centre for Translational Medicine, Semmelweis University, Budapest, Hungary

Text of the abstract

Introduction:
A hermetic seal of the root canal system is critical for ensuring long-term endodontic success.Epoxy resin–based sealers (ERBSs),especially AH Plus,are widely regarded as the gold standard.In contrast, calcium silicate–based sealers (CSBSs) have become increasingly popular due to their bioactivity and simplified clinical application.Nevertheless,the evidence comparing their respective filling quality remains inconclusive.
Aims:
This study aims to compare the quality of root canal fillings using CSBSs and AH Plus with respect to void formation and to evaluate the impact of various obturation techniques.
Methods:
A systematic review and meta-analysis of in vitro studies was conducted according to PRISMA guidelines and registered in PROSPERO (CRD42024559126).Electronic searches were performed in MEDLINE,EMBASE,Cochrane Library and Web of Science up to July 2025.Randomized in vitro studies comparing CSBSs and AH Plus in permanent mature extracted or artificial teeth were included.Outcomes were percentage volume and area of voids. Random-effects meta-analyses and multilevel meta-regression models were applied.Risk of bias was assessed using the QUIN tool and certainty of evidence was evaluated with GRADE.
Results:
Twenty-one studies were included,with 18 contributing to quantitative synthesis.No statistically significant differences were found between CSBSs and AH Plus in total void volume or regional void distribution (apical,middle,coronal) across obturation techniques.Similarly,no significant differences were observed between single-cone,warm vertical compaction or lateral compaction techniques. AH Plus with warm vertical compaction showed numerically lower void values;however,these differences were not statistically significant.Artificial teeth demonstrated lower void values than extracted teeth in regional analyses (p < 0.001),although data were limited.Overall certainty of evidence was moderate.
Conclusions:
CSBSs and AH Plus demonstrate comparable root canal filling quality with respect to void formation under in vitro conditions,regardless of obturation technique. These findings suggest that multiple obturation approaches may be clinically acceptable;however,further well-designed studies,particularly clinical trials,are needed to confirm these results.
Funding:
Supported by the Semmelweis University Research,Development and Innovation Fund.