An extensive search was conducted in PubMed, Scopus, Web of Science, Embase, and LILACS electronic databases until June 2022, and it was updated in September 2024. The grey literature was searched through OpenGrey, Google Scholar, and ProQuest. In vitro studies were selected according to eligibility criteria, participants, interventions, study appraisal, and synthesis methods. Two investigators extracted the data extraction and assessed the risk of bias independently. A random-effects model was used for the meta-analysis, evaluating sealer penetration considering root canal cervical, medium, and apical thirds.

Seven studies were included, and 5 were considered for the meta-analysis. One study was classified as a high risk of bias, and the others as a medium risk of bias. The meta-analysis that evaluated resin-based sealer penetration after passive ultrasonic activation showed no statistical differences (P >.05) between the groups in the cervical third (OR: −291.12; 95% CI: −853.26 to 271.03; P >.05). The middle third presented statistical differences between the groups (OR: −240.24; 95% CI: −352.05 to −128.42; P <.05) and the apical third did not (OR: −121.00; 95% CI: −462.60 to 220.60; P >.05). The meta-analysis that evaluated resin-based sealer penetration showed statistical differences between the groups in the cervical third (OR: −249.55; 95% CI: −315.00 to −184.11; P <.05) and the middle third (OR: −195.71; 95% CI: −369.53 to −21.88; P <.05), but not in the apical third (OR: −125.07; 95% CI: −300.58 to 50.45; P >.05).