Comparative Evaluation of Postoperative Pain Following Unintentional Periapical Extrusion of Three Root Canal Sealers: A Prospective Clinical Study

Background: Unintentional apical extrusion of root canal sealers is a common occurrence and may result in postoperative pain of varying intensity.

Aim: To compare the intensity of postoperative pain following radiographically confirmed sealer extrusion using zinc oxide-eugenol (ZOE), AH Plus, and RoekoSeal sealers.

Materials & Methods: Ninety single-rooted teeth with unintentional sealer extrusion visible on postoperative radiographs were prospectively included and divided into three groups (n=30 each) according to the sealer used: Group 1 – ZOE, Group 2 – AH Plus, Group 3 – RoekoSeal. Pain intensity was recorded using a 100-mm Visual Analogue Scale (VAS) at 0–6 h, 6–12 h, and 12–24 h postoperatively.

Results: Mean VAS scores were highest in the ZOE group at all time intervals, followed by AH Plus and RoekoSeal. Statistically significant differences were observed between ZOE and the other two sealers at all time points (p < 0.05, Kruskal-Wallis test).

Conclusion: Within the limitations of this prospective clinical study, RoekoSeal was associated with the least postoperative pain, while ZOE-based sealer caused the most intense discomfort when extruded periapically.