Five-Year Outcomes of Root Canal Treatment Comparing Sealer-Based Obturation With Calcium Silicate-Based Sealer to Continuous Wave of Condensation: A Randomized Controlled Trial

Abstract

Introduction: While sealer-based obturation (SBO) with calcium silicate-based sealers has shown promise in short-term studies, including a previous randomized controlled trial comparing it to the continuous wave of condensation (CWC) technique, long-term evidence on its clinical performance remains limited. This study addresses this critical gap by following the same patient cohort for 5 years to evaluate the long-term clinical and radiographic outcomes of both techniques and investigate factors influencing long-term success. Methods: Patients were initially randomized at the time of obturation into 2 treatment groups, based on the obturation protocol: CWC with AH Plus sealer and SBO with Endoseal TCS (TriCalcium Silicate). Postobturation pain was assessed using a numerical rating scale. Root canal obturation quality was evaluated for sealer extrusion, filling voids, and root filling level. Five-year follow-up examinations assessed healing based on periapical index score reduction and symptom resolution. Statistical analysis included chi-square or Fisher's exact tests and multivariate logistic regression. Results: Of the initial 93 teeth, 60(64.5% recall rate) were available for analysis after 5 years (mean follow-up: 62 months). Four teeth were extracted for nonendodontic reasons, leaving 56 teeth (CWC: 33; SBO: 23) for evaluation. Success rates showed no significant differences between groups under both loose (overall: 83.9%; CWC: 81.8%; SBO: 87.0%) and strict criteria (overall: 76.8%; CWC: 75.8%; SBO: 78.3%). No analyzed factors significantly correlated with long-term success. Conclusion: The SBO technique with Endoseal TCS demonstrated comparable 5-year outcomes to the CWC technique, supporting its potential as a less technique-sensitive and clinically viable alternative for root canal obturation. (J Endod 2025;51:538-546.)