Volume - 15 | Issue - 06 | June - 2025 | PRINT ISSN No. 2249 - 555X | DOI : 10.

36106/ijar
Original Research Paper
Endodontics

BIOCERAMIC SEALERS IN ENDODONTICS: A NEW ERA OF

SEALING SUCCESS

Dr. Rashmi Misra Professor

Dr. Nikita Toprani Lecturer
Dr. Sumita
Professor
Bhagwat
Dr. Sakshi
Post Graduate Student *Corresponding Author
Knadalkar* 91966
Dr. Aastha Dureja Lecturer 2025-06-04 10:50:16
--------------------------------------------
Dr. Shreya Gupta Post Graduate Student
replace with Kandalkar
ABSTRACT Root canal therapy (RCT) is a widely used treatment to eliminate infection and preserve teeth with compromised pulp.
The success of RCT depends on achieving a hermetic seal, which is facilitated by root canal sealers. Traditional sealers,
such as zinc oxide-eugenol and resin-based materials, have limitations, including cytotoxicity, shrinkage, solubility, and weak bonding with
dentin. Bioceramic-based sealers have emerged as an alternative due to their biocompatibility, bioactivity, and superior sealing ability. These
sealers chemically bond with dentin, promote hydroxyapatite formation, and enhance periapical healing. Their alkaline pH provides
antimicrobial properties, and they exhibit low solubility and slight expansion upon setting, ensuring long-term stability. However, their
strong adhesion to dentin poses challenges during retreatment, making their removal more difficult than conventional sealers. Additionally,
their response to heat varies, with some formulations exhibiting changes in flow and setting time. This review explores the composition,
properties, advantages, and limitations of bioceramic-based sealers compared to traditional sealers, analyzing their role and retreatment
challenges. While they present certain limitations, ongoing research aims to improve their removability and handling characteristics,
positioning them as a promising material for modern endodontic practice.
KEYWORDS : bioceramic, root canal sealers, zinc oxide eugenol.
INTRODUCTION  Powder-Liquid Sealers – Require manual mixing (e.g., BioRoot
Root canal therapy (RCT) is the preferred treatment for managing RCS)(6).
pulpal infections while preserving natural teeth. The success of RCT
depends on the quality of root canal filling, which is influenced by Properties Of Bioceramic Sealers
the properties of the sealer(1). Sealers act as an interface between Mechanical Properties:
gutta- percha and dentinal walls, ensuring an airtight seal to prevent 1. Sealing Ability And Adhesion
reinfection(2). Bioceramic sealers chemically bond to dentin by penetrating the
dentinal tubules and forming a mineral infiltration zone. This
Traditional sealers, such as zinc oxide-eugenol, resin-based, and interaction strengthens the mechanical interlocking of the sealer with
calcium hydroxide-based materials, have been widely used but the dentin, significantly reducing the risk of microleakage—a
present drawbacks like cytotoxicity, shrinkage, solubility, and weak common cause of RCT failure[3].
adhesion(3). To overcome these limitations, bioceramic-based
sealers were introduced, offering superior bioactivity, 2. Solubility And Dimensional Stability
biocompatibility, and chemical bonding with dentin(3). Solubility is a critical factor in determining the longevity of a sealer.
Excessive solubility can lead to void formation, compromising the
Bioceramic materials have been studied for decades. In 1969, L.L. seal. Most bioceramic sealers have demonstrated low solubility and
Hench introduced Bio Glass, highlighting the potential of ceramics excellent dimensional stability, making them reliable choices for long-
to bond with bone(4). Later, LeGeros et al. developed calcium term root canal sealing. However, some bioceramic sealers, such as
phosphate-based bioceramic dental cement. In root canal applications, TotalFill BC Sealer, exhibit slightly higher solubility than others[5].
Krell and Wefel compared experimental calcium phosphate cement
with Grossman's sealer, finding no significant differences in adhesion, 3. Radiopacity And Flowability
tubule penetration, or apical seal(5). Radiopacity is essential for the radiographic evaluation of the root
canal filling. Studies indicate that AH Plus, a resin-based sealer, has
Classification Of Bioceramic Root Canal Sealer: higher radiopacity than most bioceramic sealers. However, certain
1. By Composition bioceramic formulations, like Dia-Root Bio Sealer, exhibit sufficient
 Calcium Silicate-Based - e.g., BioRoot RCS, EndoSequence radiopacity for clinical use [5].
BC Sealer– Most common, promotes hydroxyapatite
formation(6). Flowability is another key property, influencing how well a sealer
 Calcium Phosphate-Based – Enhances biocompatibility and spreads within the root canal system. TotalFill BC Sealer and MTA
osseointegration e.g., iRoot SP, and MTA Fillapex. (2). Fillapex have demonstrated superior flowability, allowing them to
 Calcium Aluminate-Based – Offers chemical stability and low penetrate lateral and accessory canals more effectively [5].
solubility. e.g., Sure-Seal Root, and Bio-C Sealer. (6)
Biological Properties:
2. By Setting Mechanism 1. Biocompatibility And Bioactivity
 Hydraulic Sealers – Set with dentinal moisture (e.g., Any root canal sealer must be biocompatible because the root filling
EndoSequence BC Sealer)(6). material acts as a real implant that will come into direct touch with
 Non-Hydraulic Sealers – Require external mixing e.g., MTA the essential tissue at the root's lateral and apical foramina, or
Fillapex, and Bio-C Sealer. (6). indirectly through surface repair [7].

3. By Application One of the major advantages of bioceramic sealers is their

 Pre-Mixed Sealers – Ready-to-use, consistent (e.g., Bio-C biocompatibility, meaning they do not provoke adverse immune
Sealer)(6).
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 Volume - 15 | Issue - 06 | June - 2025 | PRINT ISSN No. 2249 - 555X | DOI : 10.36106/ijar
reactions. These sealers enhance periapical healing by forming a apical
chemical bond with dentin and promoting the deposition of
hydroxyapatite, which facilitates natural tissue integration [2].

Another crucial property of bioceramic sealers is their alkaline pH

(typically ranging between 10 and 12), which contributes to their
antibacterial effects. The high pH environment helps neutralize
residual bacteria in the root canal system, thereby reducing the
chances of reinfection [2].

2. Dentinal Tubule Pe ne tr ati on And Anti mi c r obi al

Effectiveness:
Bioceramic sealers enhance dentinal tubule penetration due to their
nanoparticle size, hydrophilicity, and bioactivity. Their excellent flow
allows deeper penetration, especially when the smear layer is
removed with EDTA. They release calcium and hydroxyl ions,
promoting hydroxyapatite formation and improving the sealer-dentin
bond. Their alkaline pH (~12) enhances antimicrobial properties, and
slight setting expansion ensures a better seal. Compared to resin-
based sealers, bioceramic sealers penetrate deeper, reducing
microleakage and improving long-term endodontic outcomes. [8]

3. Bond Strength and Adhesive Interface Quality:

Premixed bioceramic sealers achieve strong adhesion through
chemical bonding, hydroxyapatite formation, and slight setting
expansion. Their deep tubule penetration and nano leakage
resistance enhance seal quality, while their hydrophilicity ensures
optimal performance in moist conditions. With bond strength
comparable to or exceeding resin-based sealers, they provide a
durable and reliable root canal seal [9].

Clinical Implications:
1. Role Of Bioceramic Sealer In Complex Crown-root
Fractures:
Bioceramic sealers play a vital role in managing complex crown-
root fractures by providing strong bonding, sealing, and
bioactive properties [10]. They chemically bond with dentin,
expand slightly to enhance adaptation, and prevent microleakage.
Their bioactivity promotes hydroxyapatite formation, aiding
periapical and periodontal healing, while their alkaline pH offers
antimicrobial effects [11]. Bioceramic sealers are also moisture-
compatible, making them effective in moist environments like
fractured roots [10]. Their low solubility ensures long-term
stability, making them ideal for sealing fractures, aiding fragment
reattachment. However, their strong adhesion complicates
retreatment, requiring specialized removal techniques [12].

2. Role Of Bioceramic Sealer In Inflammatory Internal

Root Resorption:
Bioceramic sealers play a crucial role in managing inflammatory
internal root resorption (IIRR) due to their bioactivity, sealing
ability, and antimicrobial properties. Their alkaline pH creates an
unfavourable environment for osteoclastic activity, helping to halt
resorption [13]. Bioceramic sealers chemically bond with dentin,
ensuring a hermetic seal that prevents bacterial infiltration and
promotes tissue regeneration by stimulating hydroxyapatite formation
[13][14]. Their moisture compatibility makes them ideal for
irregular resorptive defects, enhancing adaptation and long-term
stability. Additionally, their biocompatibility reduces inflammatory
responses, promoting periapical healing [14]. Overall, bioceramic
sealers provide an effective solution for arresting and managing IIRR
while supporting dentin repair [15].

3. Post Operative Pain With Bioceramic Sealer:

Bioceramic sealers generally cause minimal post-operative pain due
to their biocompatibility, bioactivity, and sealing ability [16].
Their alkaline pH creates an antibacterial environment,
reducing inflammation and microbial irritation [17]. Unlike resin-
based or zinc oxide-eugenol sealers, bioceramic sealers do not
shrink or release toxic byproducts, minimizing periapical
irritation [18]. However, factors like overextension, extrusion
beyond the apex, or improper adaptation can lead to temporary
discomfort [16]. Studies suggest that patients treated with
bioceramic sealers experience lower post- operative pain
compared to traditional sealers, making them a preferred choice
for endodontic treatment.

4. Role Of Bioceramic Sealer In Open Apex Management:

Bioceramic sealers are effective in managing teeth with an open
apex, commonly found in immature permanent teeth or cases of
2 INDIAN JOURNAL OF APPLIED RESEARCH
resorption [19]. Their bioactivity stimulates hydroxyapatite Role of QMix in Bioceramic Sealer-Based RCT
formation, promoting apical barrier development and aiding in 1. Smear Layer Removal – QMix effectively eliminates the
apexification [20]. With superior flowability, they penetrate smear layer, exposing dentinal tubules and facilitating better
irregular apical anatomy, ensuring an optimal seal and preventing adhesion of bioceramic sealers[7].
bacterial microleakage. Their high pH creates an antimicrobial
environment, reducing reinfection risk [19]. Unlike traditional
materials like calcium hydroxide, bioceramic sealers offer
enhanced biocompatibility, exhibit low solubility, and maintain
long-term stability without requiring multiple applications. Their
moisture tolerance makes them particularly effective in open apex
cases, providing a predictable and durable treatment approach
[21].

5. Role of Bioceramic Sealer as a Repair Material for

Perforation:
Bioceramic sealers are highly effective in perforation repair. Their
bioactive properties enhance mineralization, strengthening dentin
and ensuring long-term stability. With a premixed formulation and
excellent flow, they offer easy application and uniform coverage
[22]. Their high alkalinity provides antimicrobial benefits,
reducing reinfection risks. Clinically, they are widely used for root,
furcation, and lateral perforations, making them an essential
material in modern endodontic therapy [21].

6. Thermal Effects Of Obturating Techniques On Bioceramic

Sealer:
The characteristics and clinical performance of endodontic
bioceramic sealers may be considerably impacted by heating. High
temperatures have the potential to cause the thermal deterioration
of organic substances that can change the film thickness,
flowability, and setting time of the sealer [24,25]. Furthermore, the
solubility of bioceramic sealers can be affected by heat; calcium
silicate-based sealers show greater solubility when exposed to high
temperatures, thus impairing their capacity to keep the root canal
intact [26].

Warm vertical compaction techniques are commonly used in

endodontics, but heating can affect the flow, setting time, and
chemical composition of bioceramic sealers. Some formulations,
like BioRoot RCS, exhibited reduced flowability after heat
exposure, whereas others, such as EndoSequence BC Sealer,
remained stable [24].

Irrigation Protocol Before Using Bioceramic Sealer:

A proper irrigation protocol is essential for optimizing the
performance of bioceramic sealers in root canal treatments. The
following sequence is recommended:
1. Sodium Hypochlorite (NaOCl) (2.5%–5.25%): Utilize
throughout instrumentation to dissolve organic tissue and
disinfect the canal [27].
2. Ethylenediaminetetraacetic Acid (EDTA) (17%): Apply as a
final rinse to effectively remove the smear layer, enhancing
sealer adhesion.[27][28].
3. Chlorhexidine (CHX) (2%) (Optional): Offers additional
antimicrobial benefits; however, avoid mixing with NaOCl to
prevent precipitate formation.[29].
4. Saline or Distilled Water: Use for a final rinse to eliminate
any residual irrigants, ensuring they do not interfere with the
sealer's properties.[27]

It's crucial to leave the canal walls slightly moist before applying
the bioceramic sealer, as these materials require moisture to set
properly. Over-drying with paper points should be avoided to
maintain the necessary humidity for optimal sealer performance.
[28]

Implementing this protocol enhances the bonding and sealing

capabilities of bioceramic sealers, contributing to the success of
endodontic treatments.

QMix And Bioceramic Sealer In Root Canal Treatment:

QMix is a dual-action endodontic irrigant containing
chlorhexidine (CHX), EDTA, and a detergent. It is designed to
effectively remove the smear layer, kill residual bacteria, and
enhance dentin permeability before obturation. When used in
conjunction with bioceramic sealers, it can improve sealer
penetration and bonding, ultimately enhancing the success of root
canal treatment (RCT) [7].
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Volume - 15 | -Issue
15 | Issue
- 06 | -June
06 | June
- 2025- 2025 | PRINT
| PRINT ISSNISSN No. 2249
No. 2249 - 555X
- 555X | DOI| DOI : 10.36106/ijar
: 10.36106/ijar
2. Antimicrobial Action – The combination of CHX and EDTA symptoms often subside over time.[34]
helps in eradicating residual bacteria, reducing the risk of 5. Radiographic Appearance: Extruded bioceramic sealer appears
reinfection [7][8]. radiopaque and may remain visible on radiographs for an
3. Enhancing Sealer Penetration – Bioceramic sealers are extended period without necessarily causing clinical symptoms.
hydrophilic and require an open dentinal structure for maximum [33]
adaptation; QMix ensures better tubule penetration [8].
4. pH Compatibility – QMix does not interfere with the alkaline Research And Innovation:
nature of bioceramic sealers, preserving their bioactivity and The future of bioceramic sealers lies in the development of
antimicrobial properties [8]. formulations that enhance retreatability without compromising
adhesion. Current research is also exploring the incorporation of
Clinical Considerations nanoparticles to improve antimicrobial properties, sealing ability,
 QMix should be used as a final irrigant after sodium and flow characteristics [1].
hypochlorite (NaOCl) to maximize its effects [7].
 Avoid simultaneous use with NaOCl to prevent precipitation CONCLUSION:
of chlorhexidine by-products [7]. Bioceramic-based root canal sealers have transformed endodontics
 Ensure proper drying before applying the bioceramic sealer, as by offering superior biocompatibility, bioactivity, and sealing
excessive moisture can affect its setting [8]. properties. Their ability to form a chemical bond with dentin
enhances treatment longevity, while their alkaline pH provides
The combination of QMix and bioceramic sealers enhances root antimicrobial benefits. Despite challenges in retreatment and the
canal disinfection, sealer adaptation, and long-term success of the effects of heating, bioceramic sealers remain one of the most
treatment. promising advancements in root canal therapy.
Use Of Bioceramic Sealer In Single-sitting Root Canal Treatment: For clinicians, selecting the right sealer depends on the clinical case,
Bioceramic sealers have transformed single-sitting root canal retreatment considerations, and desired biological interactions. As
treatment (RCT) due to their superior biocompatibility, enhanced research continues, bioceramic sealers are expected to evolve
sealing ability, and bioactivity. Their hydrophilic nature allows them further, refining their application in endodontic therapy [2].
to set in the presence of moisture, ensuring an optimal seal in a
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