Evaluation of Postoperative Pain and Apical Outcomes Following Three Distinct Obturation Techniques: A Randomized Controlled Trial

Background and aim Postoperative pain following root canal treatment (RCT) can be influenced by the obturation technique, as variations in apical sealing and material extrusion may affect periapical tissue response. The aim of this study was to evaluate postoperative pain and apical outcomes following three different obturation techniques in patients diagnosed with symptomatic irreversible pulpitis, with or without apical periodontitis. Methods Seventy-five single-rooted teeth requiring RCT were randomly allocated into three groups based on the obturation technique used: cold lateral condensation, warm vertical compaction, and carrier-based obturation (CBO). Baseline pain was recorded using a Visual Analogue Scale (VAS). All procedures were performed by a single experienced endodontist in two visits. Postoperative pain levels were recorded using the VAS at six, 24, 48, and 72 hours. The incidence of apical sealing of lateral canals and ramifications, as well as obturation material extrusion, was evaluated radiographically. Results Intergroup comparison of postoperative pain scores using the Kruskal-Wallis H test showed no statistically significant difference among the three obturation techniques at any of the evaluated time intervals (p > 0.05). The CBO group demonstrated a higher incidence of sealing of apical ramifications and lateral canals; however, the overall difference among groups was not statistically significant (p = 0.056). A significantly higher incidence of obturation material extrusion was observed in the CBO group (p = 0.020). Conclusions The obturation technique did not significantly affect postoperative pain. The CBO method demonstrated a higher incidence of apical sealing but was associated with increased material extrusion. The selection of the obturation technique should balance sealing efficacy with the risk of extrusion.