Table 3.

Characteristics of the included studies.

Study Id	Place of Study	Age of Participants	Sample Size I1/I2/C	Type of Tooth	Type of Pulpal Disease	Pulp Sensibility Test	Method of Root Canal Preparation	Final Irrigant Used	Obturation Technique I/C	Sealer Used I1/I2/C	Medicament Prescribed	Visit for RCT	Outcome Assessed	Method of Outcome Assessment	Time of Evaluation	Authors’ Conclusion
Tan, H.S., et al. 2021 [36]	Singapore	21 and above	80/-/83	Maxillary and mandibular anterior and posterior teeth	Vital, non-vital and previously root-filled teeth	-	Nickel– titanium rotary files in crown-down approach	1.25% NaOCl 17% EDTA	Totalfill® BC point/non-standardised GP cones	Totalfill BC/-/AH plus	Ibuprofen if necessary	Single and Multiple	Post-obturation pain	Likert scale	1, 3 and 7 days	There was no significant difference in pain experience between teeth filled using AH Plus or Totalfill BC sealer 1, 3 and 7 days after obturation.
Aslan., T, et al. 2020 [28]	Turkey	18–60	28/30/26	Mandibular first and second molar	Asymptomatic irreversible pulpitis	Thermal and electric pulp test	Nickel–titanium file system Reciproc with a VDW	3 mL of 17% EDTA, 3 mL of 5% NaOCl, 2 mL of distilled water	Single tapered gutta-percha cone	Endoseal MTA/Endosequence BC/AH Plus	Ibuprofen 400 mg only when they encountered severe pain	Single	Pain, frequency of analgesic drug intake	VAS	6, 12, 24 and 48 h and on 3rd, 4th, 5th, 6th and 7th day	Endoseal MTA, Endosequence BC Sealer and AH Plus were not significantly different in terms of the severity of postoperative pain after single-visit root canal treatment.
Ferreira, N., 2020 [27]	Brazil	18 and above	20/20/20	Single rooted anterior teeth and premolars	Pulp necrosis	Cold test Absence of bleeding on access opening	-	5 mL 2.5% NaOCl 5 mL 17% EDTA	Single-cone and vertical compaction technique	EndoFill/MTA Fillapex/ AH Plus	-	Min. 2 visits	Postoperative pain intensity	Level of pain	24 h, 48 h and 7 days	Root canal filling using AH Plus, MTA Fillapex and EndoFill resulted in the same postoperative pain occurrence and intensity and need for analgesic intake.
Ved, R.P., 2020 [37]	India	20–40	10/-/10	Upper central or lateral incisor	Asymptomatic apical periodontitis	-	Rotary Protaper (F3) files	3% NaOCl (2 mL) 17% aqueous EDTA	Syringe method/ cold lateral condensation	Smart seal/-/AH plus sealer	-	Min. 2 visits	Resolution of the lesion	Change in area of the periapical lesion using radiographs	3, 6 and 12 months	Smart seal group showed better healing of the lesion as compared to gutta percha and AH Plus group at both 6 and 12 months following root canal treatment.
Zavattini, A., 2020 [38]	Russia	NR	53/-/51	-	Irreversible pulpitis Necrotic pulp	-	Protaper rotary instruments in a crown-down approach	2% sodium hypochlorite 15% EDTA	Single-cone technique/warm vertical condensation	BioRootTM/-/AH plus	-	Two	Success rate	CBCT images, periapical radiographs	12 months	BioRootTM RCS in combination with single cone resulted in a comparable success rate of cases compared to that of warm vertical condensation and AH plus.
Fonseca, B., 2019 [26]	Brazil	25–55	32/-/32	Single- rooted anterior maxillary teeth	Necrotic pulps	Cold and electric pulp test	VDW Silver motor	17% EDTA 2.5% NaOCl	Single-cone technique	Sealer Plus BC/-/AH Plus	600 mg Ibuprofen every 6 h if they experienced any pain	Single	Postoperative pain intensity	VAS	24, 48, 72 h and 1 week	BG sealer presented significantly more extrusion than RG sealer, which was not associated with pain.
Ates, A.A., 2018 [39]	Turkey	18–65	39/-/39	Mandibular premolar or molar	Devitalised teeth	Electric pulp tester	One Shape system and VDW Silver motor	5 mL 2.5% NaOCl, 5 mL 17% EDTA, and 5 mL sterile saline	Carrier-based obturation system- Hero fill™ Soft-Core obturators	iRoot SP/-/AH Plus	200 mg ibuprofen	Single	Preoperative and postoperative pain rating, frequency of analgesic drug intake	Huskisson 10 cm VAS	6, 12, 24 and 72 h.	iRoot SP sealer was associated with lower analgesic intake than AH Plus sealer.
Graunaite, I., 2018 [23]	Lithuania	35–65	61/-/61	Single-rooted teeth	Asymptomatic apical periodontitis	-	Protaper Gold system driven by an X-Smart endodontic motor	Ultrasonic activation for 30 s with 2.0 mL NaOCl, 2.0 mL 17% EDTA	Warm vertical condensation technique using the Calamus Dual System	Total Fill/-/AH Plus	-	Single	Postoperative pain	VAS	24, 48, 72 h and 7 days	AH Plus and Total Fill perform similarly in terms of the occurrence and intensity of postoperative pain in teeth with AAP with no material extrusion beyond the apex.
Nagar, N., 2018 [25]	India	15–47	16/16/16	Maxillary anterior teeth	Apical periodontitis, small periapical lesion, Root resorption	-	-	2 mL of 2.5% NaOCl and 2 mL of sterile saline followed by 10 mL 17% EDTA	-	Bioceramic sealer/MTA-based sealer/AH Plus	-	-	Pain, tenderness on percussion, sinus tract, swelling and mobility	VAS, radiovisiography measurement scale	1, 3 and 6 months	Bioceramic Sealer was found to be of greatest efficiency followed by MTA, AH PLUS and Zinc Oxide Eugenol for all the evaluated parameters.
Paz, A., et al. 2018 [40]	Portugal	NR	10/10 and 10	Maxillary and mandibular anterior and posterior teeth	Asymptomatic irreversible pulpitis, pulp necrosis or disease that needed retreatment	-	Protaper Next engine driven rotary nickel-titanium files	2.5% NaOCl 10% Citric acid	Single-cone technique -/cold lateral condensation and continuous wave of condensation	BioRoot RCS/AH Plus	Ibuprofen 600 mg if needed	Single and Multiple	Postoperative pain	Modified VAS	24, 48, 72, 96, 120, 144 and 168 h	Single cone + Bioceramic and Continuous wave + resin sealer presented the highest percentage of moderate and the lowest levels of postoperative pain intensity felt, respectively, during the 7 day evaluation period
Atteia, M.H., 2017 [10]	Egypt	20–35	15/-/15	Mandibular first molars	Chronic apical periodontitis	Electronic apex locator	Protaper-NEXT NiTi rotary files	3% NaOCl 2 mL of 17% EDTA	Lateral compaction technique of gutta-percha	Totalfill sealer/-/AH Plus	-	Single	Apical healing, sealer resorption and extruded sealer	Periapical radiographs, digital radiography	12 months	Totalfill recorded higher observations of complete apical healing, compared to AH-Plus.
Thakur, S., 2013 [41]	India	18–50	15/-/15	Single rooted tooth	Apical radiolucency and periapical index Score 2 or more Diagnosis	-	Protaper rotary system	2.5% NaOCl, EDTA and normal saline	Lateral compaction technique	ProRoot MTA/-/AH Plus	-	Multiple	Pain evaluation Periapical status Area measurement	VAS, periapical Index, VixWin Pro digital image analysis software	1 week and 6 months	MTA could be used as a root canal sealer with equal effectiveness compared with epoxy resin- or zinc oxide eugenol-based sealers.

AAP: Asymptomatic apical periodontitis, C: Comparative group, EDTA: Ethylenediaminetetraacetic acid, h: hour, I₁: Intervention group, I₂: Intervention group, NaOCl: Sodium Hypochlorite, VAS: Visual analogue scale. NR: Not recorded.