Postoperative pain following warm and cold obturation techniques with sealer injection in teeth with asymptomatic apical periodontitis: a randomized controlled trial

Objective: To assess how different obturation techniques influence postoperative pain when used combined with a sealer injection approach.

Materials and Methods: In this single-blinded randomized controlled trial, 63 patients diagnosed with asymptomatic apical periodontitis requiring non-surgical root canal treatment were randomly allocated into three treatment groups according to the obturation technique employed: cold lateral compaction (CLC) Group, single cone (SC) Group, and continuous wave compaction (CWC) Group. In all groups, the sealer was delivered using an injectable technique. Postoperative pain was assessed using the Visual Analogue Scale at 8, 12, 24, 48, and 72 hours and 1 week after obturation. Wilcoxon signed rank test, Kruskal–Wallis test, and Dunn’s post-hoc test with Bonferroni correction were used for statistical analysis (α=0.05).

Results: At 8 hours, the CLC group showed a mean pain score of 7.00 ± 1.15, which was significantly higher than the SC (2.78 ± 0.85) and CWC (2.78 ± 0.91) groups (p = 0.001). At 12 hours, pain remained higher in the CLC group (5.21 ± 1.02) compared with SC (2.34 ± 0.82) and CWC (2.41 ± 0.80) (p = 0.001). Pairwise comparisons confirmed significantly higher pain in the CLC group at all evaluated intervals, whereas no significant differences were observed between SC and CWC (p > 0.05). By 72 hours, pain scores had markedly decreased in all groups (CLC: 0.74 ± 0.40; SC: 0.31 ± 0.28; CWC: 0.36 ± 0.25), and no patient reported pain at the one‑week follow‑up.

Conclusion: Obturation performed using SC and CWC techniques resulted in significantly lower postoperative pain compared with the CLC technique when an injectable bioceramic sealer was used. Both techniques demonstrated comparable postoperative pain outcomes.