Bioceramic Sealers: Do They Truly Improve Success Rates

In endodontics, success still depends upon quality obturation, microbial control, and a solid coronal seal. Sealers have undergone tremendous evolution, and today bioceramic sealers are in trend.  

But do they really boost treatment success? 

Clinical studies evaluating the efficacy of bioceramic (BC) sealers and resin-based (RB) sealers found that BC sealers achieve very high success rates (97.5–100%) in both initial and retreatment cases with overall outcomes comparable to RB sealers ^1,2. They offer several advantages such as  

• Bioactivity (promoting mineralization),  

• Biocompatibility 

• Dimensional stability,  

• Chemical bonding to dentin and gutta-percha, and  

• Better adaptability to complex canals.  

However, solely sealers are not responsible for success; it depends upon  

• Complete canal cleaning;  

• Proper obturation technique,  

• Lesion size, 

• Quality restoration, and 

• Clinician skill. 

Quick Comparison Table: Bioceramic vs Resin-Based Sealers 

Factors Contributing to High Success with Bioceramic Sealers^3,4 

• Bioactivity: Bioceramic sealers releases calcium ions and forms hydroxyapatite. This promotes tissue repair and micromechanical bonding with dentin. 

• Dimensional Stability & Low Solubility: Bioceramic sealers slightly expand on setting and do not shrink or reabsorb; thus, ensuring a tight and lasting seal. 

• Excellent Sealing Ability: They chemically bond with dentin and gutta-percha; thereby reducing microleakage. 

• Potential to Promote Periapical Healing: They aid in the regeneration of periapical tissues and faster resolution of the lesion. 

• Biocompatibility: Studies have reported that they are well-tolerated by nearby tissues; thus, reducing the chances of rejection and irritation. 

• Antibacterial Action: Bioceramic sealers have an initial pH of ~12.8. This high pH facilitates antibacterial effect during the first 24 hours. 

• Hydrophilic Setting: Being hydrophilic in nature, bioceramic sealers cures in moist environments; thus, reducing the occurrence of issues like sensitivity to canal dryness. 

Key Clinical Findings and Highlights 

• Fewer Post-Treatment Complications like pain⁵ 

• Follow-up imaging revealed fewer gaps in obturation indicating more consistent sealing³ 

• Effective in complex canal anatomy^3,4,5 

Limitations of Bioceramic Sealers 

Certain limitations that need to be considered⁶: 

• Traditional biochemicals like MTA delay the treatment because it takes long setting time 

• In anterior teeth, tooth discoloration can occur 

• Some variants have low compressive strength 

• Initially, high PH can irritate the tissue 

• Premium bioceramic formulations are expensive affecting accessibility 

Final Takeaway 

Bioceramic sealers are highly effective, and the success rates are comparable to resin-based sealers. Studies have found evidence that application of bioceramic sealers contributes to better healing, lesser complications, and long-term durability of the treatment.  

However, they are not a magical solution. Bioceramic sealers in synergy with proper canal cleaning, obturation, lesion management, and clinician skills can improve the success rate significantly.   

References 

1. Pontoriero DI, Ferrari Cagidiaco E, Maccagnola V, Manfredini D, Ferrari M. Outcomes of endodontic-treated teeth obturated with bioceramic sealers in combination with warm gutta-percha obturation techniques: a prospective clinical study. Journal of clinical medicine. 2023 Apr 14;12(8):2867.  

2. Bani-Younes HA, Methqal KA, Madarati AA, Daud A. Clinical and radiographic outcome of a bioceramic sealer compared to a resin-based sealer: a retrospective study. Scientific Reports. 2025 May 14;15(1):16680. 

3. Amza O, Funieru C, Gheorghe G, Iosif L, Dimitriu B. Endodontic bioceramic sealers: evolution and future directions. Acta Scientific Medical Sciences. 2025 Jan 28;9(1):2021. doi:10.31080/ASMS.2025.09.2021. 

4. Tomer AK, Kumari S, Rastogi D, Cecilia LL, Singh S, Tyagi A. Bioceramics in Endodontics-A Review. Int J Appl Dent Sci. 2020;6(3):588-94. 

5. Shankar S, Vivek R, Chaubey N, Rao V, Hiwale S, Nandhita SK. Effect of bioceramic sealers in enhancing root canal healing. Bioinformation. 2025;21(4):866-9. 

6. Prasad Kumara PA, Cooper PR, Cathro P, Gould M, Dias G, Ratnayake J. Bioceramics in Endodontics: Limitations and Future Innovations—A Review. Dentistry journal. 2025 Apr 1;13(4):157.