Do different irrigating solutions affect the dislodgement resistance of bioceramic-based root canal sealers? A systematic review and meta-analysis

This review aimed to appraise and evaluate the effect of different irrigating solutions on the dislodgement resistance of bioceramic-based sealers to root dentine walls using a push-out bond strength test. Ten electronic databases (PubMed, Google Scholar, Web of Science, ScienceDirect, Cochrane, EMBASE, EBSCO, Open Gray, Library Genesis, LILACS) and five textbooks were searched for English-language articles published between January 1970 to March 2021. Only in-vitro, in-vivo or ex-vivo articles were included and assessed using the modified OHAT Risk of Bias assessment tool. Data were analyzed using the DerSimonian-Laird random-effect model. Eleven articles were included. All studies were in-vitro experiments, and they were classified as Tier 1 based on their risk of bias assessments. Single-arm meta-analysis revealed that the highest mean pooled bond strength was noted in samples irrigated with 2.5–3% NaOCl, followed by 17% EDTA, 2% CHX, MTAD, and lastly saline. Two-arm meta-analysis showed that 17% EDTA and 2% CHX increase the bond strength of bioceramic sealers by more than 2.5–3% NaOCl, but no significant differences were noted (p > 0.05). Moreover, no significant differences (p > 0.05) were also found when comparing 17% EDTA with 2% CHX and saline, respectively. Substantial heterogeneity was observed with the overall I2 ranging from 0% to 99.49%. Although using 2.5–3% NaOCl as irrigating solution yielded higher dislodgement resistance of bioceramic-based root canal sealers, other factors such as the type of bioceramic sealer used, presence of gutta-percha, sample thickness, and various methodological approaches significantly affected the push-out bond strength results.