Restor Dent Endod.  2022 Nov;47(4):e40. 10.5395/rde.2022.47.e40.

Influence of the root canal filling technique on the success rate of primary endodontic treatments: a systematic review

• Marconi DF
• Silva GSd
• Weissheimer T
• Silva IA
• Só GB
• Jahnke LT
• Skupien JA
• Só MVR
• Rosa RAd

• KMID: 2548144
• DOI: http://doi.org/10.5395/rde.2022.47.e40

Abstract

Objectives
This study aimed to investigate the influence of different obturation techniques compared to cold lateral compaction on the success rate of primary non-surgical endodontic treatments.
Materials and Methods
Systematic searches were performed for studies published up to May 17^th , 2022 in MEDLINE/PubMed, Cochrane Library, Web of Science, Scopus, EMBASE, and Grey Literature Reports. Randomized clinical trials and nonrandomized (nonrandomized clinical trials, prospective or retrospective) studies that evaluated the success rate of primary non-surgical endodontic treatments obturated with the cold lateral compaction (control) and other obturation techniques were included. The revised Cochrane risk of bias tools for randomized trials (RoB 2) and nonrandomized studies of interventions (ROBINS-I) were used to evaluate the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool was used to evaluate the certainty of evidence.
Results
Eleven studies (4 randomized clinical trials (RCTs), 4 prospective, and 3 retrospectives) were included. Two RCTs were classified as having some concerns risk of bias and 2 as a low risk of bias. Two nonrandomized studies were classified as having a critical risk of bias and 5 as having a moderate risk of bias. The GRADE analysis demonstrated a very low to moderate certainty of evidence.
Conclusions
This systematic review generally evidenced no differences in the success rate of primary non-surgical endodontic treatments when the cold lateral compaction technique and other obturation techniques are performed. Further well-designed studies are still necessary.

Keyword

Cold lateral compaction; Endodontics; Obturation techniques; Root canal filling; Success rate; Systematic review

Figure

• 

  Figure 1 PRISMA flow diagram depicting the systematic search process.

• 

  Figure 2 Quality assessment of the randomized clinical trials, according to the Cochrane Collaboration standard scheme for bias and RoB2 tool.

• 

  Figure 3 Quality assessment of the nonrandomized studies, according to the Cochrane Collaboration standard scheme for bias and ROBINS- I tool.

Reference

1. Olcay K, Ataoglu H, Belli S. evaluation of related factors in the failure of endodontically treated teeth: a cross-sectional study. J Endod. 2018; 44:38–45. PMID: 29246376.

2. Chugal NM, Clive JM, Spångberg LS. Endodontic infection: some biologic and treatment factors associated with outcome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003; 96:81–90. PMID: 12847449.

3. Kim S, Jung H, Kim S, Shin SJ, Kim E. The influence of an isthmus on the outcomes of surgically treated molars: a retrospective study. J Endod. 2016; 42:1029–1034. PMID: 27238415.

4. Chybowski EA, Glickman GN, Patel Y, Fleury A, Solomon E, He J. Clinical outcome of non-surgical root canal treatment using a single-cone technique with Endosequence Bioceramic Sealer: a retrospective analysis. J Endod. 2018; 44:941–945. PMID: 29606401.

5. Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K. Outcome of primary root canal treatment: systematic review of the literature -- Part 2. Influence of clinical factors. Int Endod J. 2008; 41:6–31. PMID: 17931388.

6. Torabinejad M, Corr R, Handysides R, Shabahang S. Outcomes of nonsurgical retreatment and endodontic surgery: a systematic review. J Endod. 2009; 35:930–937. PMID: 19567310.

7. Levitan ME, Himel VT, Luckey JB. The effect of insertion rates on fill length and adaptation of a thermoplasticized gutta-percha technique. J Endod. 2003; 29:505–508. PMID: 12929696.

8. Naseri M, Kangarlou A, Khavid A, Goodini M. Evaluation of the quality of four root canal obturation techniques using micro-computed tomography. Iran Endod J. 2013; 8:89–93. PMID: 23922567.

9. Keleş A, Alcin H, Kamalak A, Versiani MA. Micro-CT evaluation of root filling quality in oval-shaped canals. Int Endod J. 2014; 47:1177–1184. PMID: 24527697.

10. Li GH, Niu LN, Selem LC, Eid AA, Bergeron BE, Chen JH, Pashley DH, Tay FR. Quality of obturation achieved by an endodontic core-carrier system with crosslinked gutta-percha carrier in single-rooted canals. J Dent. 2014; 42:1124–1134. PMID: 24769108.

11. Nhata J, Machado R, Vansan LP, Batista A, Sidney G, Rosa TP, Leal Silva EJ. Micro-computed tomography and bond strength analysis of different root canal filling techniques. Indian J Dent Res. 2014; 25:698–701. PMID: 25728099.

12. Selem LC, Li GH, Niu LN, Bergeron BE, Bortoluzzi EA, Chen JH, Pashley DH, Tay FR. Quality of obturation achieved by a non-gutta-percha-based root filling system in single-rooted canals. J Endod. 2014; 40:2003–2008. PMID: 25262034.

13. Moinzadeh AT, Zerbst W, Boutsioukis C, Shemesh H, Zaslansky P. Porosity distribution in root canals filled with gutta percha and calcium silicate cement. Dent Mater. 2015; 31:1100–1108. PMID: 26205383.

14. Ho ES, Chang JW, Cheung GS. Quality of root canal fillings using three gutta-percha obturation techniques. Restor Dent Endod. 2016; 41:22–28. PMID: 26877987.

15. Jaworska M, Kierklo A. Use of microcomputed tomography for the evaluation of canal filling quality depending on the part of root canal. J Stomatol. 2016; 69:638–646.

16. Schilder H. Filling root canals in three dimensions. 1967. J Endod. 2006; 32:281–290. PMID: 16554195.

17. Zhang W, Liu H, Wang Z, Haapasalo M, Jiang Q, Shen Y. Long-term porosity and retreatability of oval-shaped canals obturated using two different methods with a novel tricalcium silicate sealer. Clin Oral Investig. 2022; 26:1045–1052.

18. De-Deus G, Reis C, Beznos D, de Abranches AM, Coutinho-Filho T, Paciornik S. Limited ability of three commonly used thermoplasticized gutta-percha techniques in filling oval-shaped canals. J Endod. 2008; 34:1401–1405. PMID: 18928857.

19. Peng L, Ye L, Tan H, Zhou X. Outcome of root canal obturation by warm gutta-percha versus cold lateral condensation: a meta-analysis. J Endod. 2007; 33:106–109. PMID: 17258624.

20. Whitworth J. Methods of filling root canals: principles and practices. Endod Topics. 2005; 12:2–24.

21. Pirani C, Camilleri J. Effectiveness of root canal filling materials and techniques for treatment of apical periodontitis: a systematic review. Int Endod J. 2022; Jun 23 [Epub]. DOI: 10.1111/iej.13787.

22. Aminosharie A, Johnson WT, Kulild JC, Tay F. Chapter 9: Cohen’s pathways of the pulp. 12th ed. St. Louis, MO: Mosby Elsevier;2020.

23. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann T, Mulrow CD, Shamseer L, Moher D. Mapping of reporting guidance for systematic reviews and meta-analyses generated a comprehensive item bank for future reporting guidelines. J Clin Epidemiol. 2020; 118:60–68. PMID: 31740319.

24. Maia LC, Antonio AG. Systematic reviews in dental research. A guideline. J Clin Pediatr Dent. 2012; 37:117–124. PMID: 23534316.

25. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA. PRISMA-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015; 4:1. PMID: 25554246.

26. Page MJ, Higgins JP, Sterne JA. Chapter 13: Assessing risk of bias due to missing results in a synthesis. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editors. Cochrane handbook for systematic reviews of interventions version 6.2. Chichester: John Wiley & Sons;2019.

27. Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng HY, Corbett MS, Eldridge SM, Emberson JR, Hernán MA, Hopewell S, Hróbjartsson A, Junqueira DR, Jüni P, Kirkham JJ, Lasserson T, Li T, McAleenan A, Reeves BC, Shepperd S, Shrier I, Stewart LA, Tilling K, White IR, Whiting PF, Higgins JP. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019; 366:l4898. PMID: 31462531.

28. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hróbjartsson A, Kirkham J, Jüni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schünemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016; 355:i4919. PMID: 27733354.

29. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, Norris S, Falck-Ytter Y, Glasziou P, DeBeer H, Jaeschke R, Rind D, Meerpohl J, Dahm P, Schünemann HJ. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011; 64:383–394. PMID: 21195583.

30. Peak JD, Hayes SJ, Bryant ST, Dummer PM. The outcome of root canal treatment. A retrospective study within the armed forces (Royal Air Force). Br Dent J. 2001; 190:140–144. PMID: 11236917.

31. Friedman S, Abitbol S, Lawrence HP. Treatment outcome in endodontics: the Toronto Study. Phase 1: initial treatment. J Endod. 2003; 29:787–793. PMID: 14686806.

32. Farzaneh M, Abitbol S, Lawrence HP, Friedman S. Toronto Study. Treatment outcome in endodontics-the Toronto Study. Phase II: initial treatment. J Endod. 2004; 30:302–309. PMID: 15107640.

33. Peters OA, Barbakow F, Peters CI. An analysis of endodontic treatment with three nickel-titanium rotary root canal preparation techniques. Int Endod J. 2004; 37:849–859. PMID: 15548276.

34. Chu CH, Lo EC, Cheung GS. Outcome of root canal treatment using Thermafil and cold lateral condensation filling techniques. Int Endod J. 2005; 38:179–185. PMID: 15743421.

35. Aqrabawi JA. Outcome of endodontic treatment of teeth filled using lateral condensation versus vertical compaction (Schilder’s technique). J Contemp Dent Pract. 2006; 7:17–24.

36. Marquis VL, Dao T, Farzaneh M, Abitbol S, Friedman S. Treatment outcome in endodontics: the Toronto Study. Phase III: initial treatment. J Endod. 2006; 32:299–306. PMID: 16554199.

37. de Chevigny C, Dao TT, Basrani BR, Marquis V, Farzaneh M, Abitbol S, Friedman S. Treatment outcome in endodontics: the Toronto study--phase 4: initial treatment. J Endod. 2008; 34:258–263. PMID: 18291271.

38. Özer SY, Aktener BO. Outcome of root canal treatment using Soft-Core and cold lateral compaction filling techniques: a randomized clinical trial. J Contemp Dent Pract. 2009; 10:74–81.

39. Mohan SM, Kaushik SK. Root canal treatment using thermoplasticized carrier condensation technique. Med J Armed Forces India. 2009; 65:336–341. PMID: 27408288.

40. Fleming CH, Litaker MS, Alley LW, Eleazer PD. Comparison of classic endodontic techniques versus contemporary techniques on endodontic treatment success. J Endod. 2010; 36:414–418. PMID: 20171354.

41. Prashanth MB, Tavane PN, Abraham S, Chacko L. Comparative evaluation of pain, tenderness and swelling followed by radiographic evaluation of periapical changes at various intervals of time following single and multiple visit endodontic therapy: an in vivo study. J Contemp Dent Pract. 2011; 12:187–191. PMID: 22186814.

42. Hale R, Gatti R, Glickman GN, Opperman LA. Comparative analysis of carrier-based obturation and lateral compaction: a retrospective clinical outcomes study. Int J Dent. 2012; 2012:954675. PMID: 22567010.

43. Krug R, Krastl G, Jahreis M. Technical quality of a matching-taper single-cone filling technique following rotary instrumentation compared with lateral compaction after manual preparation: a retrospective study. Clin Oral Investig. 2017; 21:643–652.

44. Kandemir Demirci G, Çalışkan MK. A prospective randomized comparative study of cold lateral condensation versus core/gutta-percha in teeth with periapical lesions. J Endod. 2016; 42:206–210. PMID: 26686053.

45. Sarin A, Gupta P, Sachdeva J, Gupta A, Sachdeva S, Nagpal R. Effect of different obturation techniques on the prognosis of endodontic therapy: a retrospective comparative analysis. J Contemp Dent Pract. 2016; 17:582–586. PMID: 27595726.

46. de Figueiredo FE, Lima LF, Oliveira LS, Ribeiro MA, Correa MB, Brito-Junior M, Faria-E-Silva AL. Effectiveness of a reciprocating single file, single cone endodontic treatment approach: a randomized controlled pragmatic clinical trial. Clin Oral Investig. 2020; 24:2247–2257.

47. Wang J, Du Y, Deng J, Wang X, He J. Efficacy of warm gutta-percha root canal filling in the treatment of dental pulpal and periapical diseases. Int J Clin Exp. 2019; 12:2738–2745.

48. de-Figueiredo FE, Lima LF, Lima GS, Oliveira LS, Ribeiro MA, Brito-Junior M, Correa MB, Sousa-Neto MD, Faria E Silva AL, Silva AL. Apical periodontitis healing and postoperative pain following endodontic treatment with a reciprocating single-file, single-cone approach: a randomized controlled pragmatic clinical trial. PLoS One. 2020; 15:e0227347. PMID: 32012166.

49. Swathi UB, Ramesh S, Antony DP. Comparative analysis of various obturation techniques in mandibular molars - a retrospective clinical outcome study. Int J Pharm Sci Res. 2020; 11(SPL3):172–178.

50. McGuinness LA, Higgins JP. Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods. 2021; 12:55–61. PMID: 32336025.

51. Young GR, Parashos P, Messer HH. The principles of techniques for cleaning root canals. Aust Dent J. 2007; 52(Suppl):S52–S63. PMID: 17546862.

52. Ricucci D, Siqueira JF Jr. Fate of the tissue in lateral canals and apical ramifications in response to pathologic conditions and treatment procedures. J Endod. 2010; 36:1–15. PMID: 20003929.

53. American Association of Endodontists. Guide to clinical endodontics. Chicago, IL: American Association of Endodontists;2013.

54. European Society of Endodontology. Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J. 2006; 39:921–930. PMID: 17180780.

55. Ørstavik D, Nordahl I, Tibballs JE. Dimensional change following setting of root canal sealer materials. Dent Mater. 2001; 17:512–519. PMID: 11567689.

56. Sjogren U, Hagglund B, Sundqvist G, Wing K. Factors affecting the long-term results of endodontic treatment. J Endod. 1990; 16:498–504. PMID: 2084204.

57. Azim AA, Griggs JA, Huang GT. The Tennessee study: factors affecting treatment outcome and healing time following nonsurgical root canal treatment. Int Endod J. 2016; 49:6–16. PMID: 25582870.

58. Friedman S, Mor C. The success of endodontic therapy--healing and functionality. J Calif Dent Assoc. 2004; 32:493–503. PMID: 15344440.

59. Orstavik D, Kerekes K, Eriksen HM. The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol. 1986; 2:20–34. PMID: 3457698.

60. Strindberg LZ. The dependence of the results of pulp therapy on certain factors—An analytical study based on radiographic and clinical follow-up examination. Acta Odontol Scand. 1956; 14:1–175.

61. Siqueira JF Jr, Rôças IN, Favieri A, Lima KC. Chemomechanical reduction of the bacterial population in the root canal after instrumentation and irrigation with 1%, 2.5%, and 5.25% sodium hypochlorite. J Endod. 2000; 26:331–334. PMID: 11199749.

62. Ulin C, Magunacelaya-Barria M, Dahlén G, Kvist T. Immediate clinical and microbiological evaluation of the effectiveness of 0.5% versus 3% sodium hypochlorite in root canal treatment: a quasi-randomized controlled trial. Int Endod J. 2020; 53:591–603. PMID: 31808947.

63. Gazzaneo I, Vieira GC, Pérez AR, Alves FR, Gonçalves LS, Mdala I, Siqueira JF Jr, Rôças IN. Root canal disinfection by single- and multiple-instrument systems: effects of sodium hypochlorite volume, concentration, and retention time. J Endod. 2019; 45:736–741. PMID: 30981431.

64. Petridis X, Busanello FH, So MV, Dijkstra RJ, Sharma PK, van der Sluis LW. Factors affecting the chemical efficacy of 2% sodium hypochlorite against oral steady-state dual-species biofilms: exposure time and volume application. Int Endod J. 2019; 52:1182–1195. PMID: 30807649.

65. Moreira MS, Anuar AS, Tedesco TK, Dos Santos M, Morimoto S. Endodontic treatment in single and multiple visits: an overview of systematic reviews. J Endod. 2017; 43:864–870. PMID: 28457639.

66. Skelly AC, Dettori JR, Brodt ED. Assessing bias: the importance of considering confounding. Evid Based Spine Care J. 2012; 3:9–12.

67. Guyatt GH, Oxman AD, Vist G, Kunz R, Brozek J, Alonso-Coello P, Montori V, Akl EA, Djulbegovic B, Falck-Ytter Y, Norris SL, Williams JW Jr, Atkins D, Meerpohl J, Schünemann HJ. GRADE guidelines: 4. Rating the quality of evidence--study limitations (risk of bias). J Clin Epidemiol. 2011; 64:407–415. PMID: 21247734.

68. Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, Alonso-Coello P, Glasziou P, Jaeschke R, Akl EA, Norris S, Vist G, Dahm P, Shukla VK, Higgins J, Falck-Ytter Y, Schünemann HJ. GRADE Working Group. GRADE guidelines: 7. Rating the quality of evidence--inconsistency. J Clin Epidemiol. 2011; 64:1294–1302. PMID: 21803546.

69. Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, Alonso-Coello P, Falck-Ytter Y, Jaeschke R, Vist G, Akl EA, Post PN, Norris S, Meerpohl J, Shukla VK, Nasser M, Schünemann HJ. GRADE Working Group. GRADE guidelines: 8. Rating the quality of evidence--indirectness. J Clin Epidemiol. 2011; 64:1303–1310. PMID: 21802903.

70. Murad MH, Mustafa RA, Schünemann HJ, Sultan S, Santesso N. Rating the certainty in evidence in the absence of a single estimate of effect. Evid Based Med. 2017; 22:85–87. PMID: 28320705.

71. Guyatt GH, Oxman AD, Sultan S, Glasziou P, Akl EA, Alonso-Coello P, Atkins D, Kunz R, Brozek J, Montori V, Jaeschke R, Rind D, Dahm P, Meerpohl J, Vist G, Berliner E, Norris S, Falck-Ytter Y, Murad MH, Schünemann HJ. GRADE Working Group. GRADE guidelines: 9. Rating up the quality of evidence. J Clin Epidemiol. 2011; 64:1311–1316. PMID: 21802902.

72. Ackley BJ, Swan BA, Ladwig G, Tucker S. Evidence-based nursing care guidelines: medical-surgical interventions. 1st ed. St. Louis, MO: Mosby Elsevier;2008. p. 7.