Endodontic treatment outcomes in apical periodontitis cases by the lateral condensation versus warm vertical compaction techniques: a one-year follow-up study

OBJECTIVE: To compare the effects of different sealers (epoxy resin-based AH Plus [AHP] and calcium silicate-based AH Plus Bioceramic Sealer [AHPbcs]) and obturation techniques (cold lateral condensation [CLC] and warm vertical compaction [WVC]) on radiological healing, sealer extrusion rates, pain, and postoperative treatment success in the treatment of teeth with periapical lesions. MATERIALS AND METHODS: 168 patients having single-rooted teeth with apical periodontitis were randomized into four groups: AHP-CLC, AHP-WVC, AHPbcs-CLC, and AHPbcs-WVC. Clinical and radiological evaluations (PAI score, periapical lesion size, periapical healing, sealer extrusion, and treatment success) were performed preoperatively and again at the end of a 1-year follow-up. Post-obturation pain levels and analgesic use were recorded at 6, 24, 72 h, and up to 1-week post-treatment. RESULTS: At the 1-year follow-up, the periapical healing score in the AHPbcs-WVC group was statistically significantly higher compared to that of the AHP-CLC group (p < 0.05). Postoperative pain, albeit relatively, was observed most frequently in the AHPbcs-WVC group (60%) at 6 h. Although the success rates showed relative differences between the groups, they were not statistically significant (p = 0.175). CONCLUSIONS: Although no significant difference was observed in overall success rates between the groups, the AHPbcs-WVC combination showed more favorable results in terms of periapical healing and lesion size reduction. Sealer extrusion was significantly associated with both sealer type and obturation technique and occurred more frequently with AHPbcs-WVC. CLINICAL RELEVANCE: AHPbcs even with an increased risk of extrusion when used with the WVC technique, offer better potential for periapical healing and treatment success. However, patients must be supported by pain management. These results emphasize that the choice of material and technique affects both the long-term success and patient comfort regarding pain in endodontic treatment. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT07106307, retrospectively registered on 07/12/2025, https://clinicaltrials.gov/study/NCT07106307.