Calcium Silicate-Based Root Canal Sealers: A Narrative Review and Clinical Perspectives

Abstract

Over the last two decades, calcium silicate-based materials have grown in popularity. As root canal sealers, these formulations have been extensively investigated and compared with conventional sealers, such as zinc oxide–eugenol and epoxy resin-based sealers, in in vitro studies that showed their promising properties, especially their biocompatibility, antimicrobial properties, and certain bioactivity. However, the consequence of their higher solubility is a matter of debate and still needs to be clarified, because it may affect their long-term sealing ability. Unlike conventional sealers, those sealers are hydraulic, and their setting is conditioned by the presence of humidity. Current evidence reveals that the properties of calcium silicate-based sealers vary depending on their formulation. To date, only a few short-term investigations addressed the clinical outcome of calcium silicate-based root canal sealers. Their use has been showed to be mainly based on practitioners’ clinical habits rather than manufacturers’ recommendations or available evidence. However, their particular behavior implies modifications of the clinical protocol used for conventional sealers. This narrative review aimed to discuss the properties of calcium silicate-based sealers and their clinical implications, and to propose rational indications for these sealers based on the current knowledge.

In vitro physicochemical characterization of five root canal sealers and their influence on an ex vivo oral multi‐species biofilm community

“…Additionally, some sealers can solubilize when challenged by aqueous environments, such as at the interface between foramen and periapical tissues. High sealer solubilization will form voids in the obturation (Sfeir et al, 2021; Urban et al, 2018), which can compromise the isolation of the root canal space—and of the bacteria and their by‐products contained within—from the tissues surrounding the tooth. Importantly, some level of solubilization might be essential for the antimicrobial activity of some biomaterials, as it contributes to the release of bioactive antimicrobial molecules (Muñoz‐Bonilla & Fernández‐García, 2012).…”

The Effect of Ultrasonic Agitation on the Porosity Distribution in Apically Perforated Root Canals Filled with Different Bioceramic Materials and Techniques: A Micro-CT Assessment

“…Sealing apical root perforations with BioRoot RCS, together with a modified SC obturation technique, was proposed mainly due to the simplicity and effectiveness previously reported in in vitro and in vivo studies [ 16 , 17 , 19 ]. The concept of the SC obturation technique refers to the desirable physico-chemical properties of BioRoot RCS [ 14 , 15 ], which was designed as a biological filler [ 45 ], and to the tapered gutta-percha cone, acting as a piston on the flowable sealer [ 46 ]. As reported previously, the insertion of the tapered gutta-percha cone creates hydraulic pressure, which improves the material distribution throughout the root canal [ 47 ].…”

“…BioRoot RCS possesses all the necessary antibacterial, biocompatible and bioactive properties, which promote the regeneration of periapical tissues and contribute to the recruitment of osteo-odontogenic stem cells within the apical environment [ 14 ]. Moreover, this material has the desirable dimensional stability and low solubility and provides high clinical success rates when used in conjunction with a single gutta-percha cone (SC) obturation technique [ 15 , 16 , 17 ]. In contrast to cold lateral compaction or various thermoplastic methods, the BioRoot RCS/single gutta-percha cone (BR/SC) obturation technique is clinically appealing due to its simplicity, as no superior clinical skills or any additional armamentarium and devices are needed [ 18 ].…”

A critical analysis of research methods and experimental models to study root canal fillings

“…Unlike conventional sealers, CSS are hydraulic and hygroscopic with a particular setting process, and exhibit biocompatibility, antimicrobial, and bioactivity properties. Overall, in vitro results for CSS mostly display characteristics comparable to the gold standard epoxy‐resin‐based sealers; however, reports on dimensional stability and solubility usually do not comply with international standards (Donnermeyer et al, 2019; Jafari & Jafari, 2017; Lim et al, 2020; Sfeir et al, 2021; Silva Almeida et al, 2017; Silva et al, 2021a). Actually, bioactive materials such as CSS are only able to induce their expected biological effect because of their surface reactivity and strong interaction with adjacent tissues related to the high flux of calcium hydroxide ions through the medium during the hydration process, the output phenomenon of the material solubility (Fridland & Rosado, 2003).…”