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Title Bioceramic Sealers Have Similar Success Rates to Nonbioceramic Sealers for Endodontic Cases treated with Nonsurgical Root Canal Therapy
Clinical Question For patients presenting with irreversible pulpitis or pulpal necrosis, does nonsurgical root canal therapy (NS-RCT) performed with bioceramic sealer have long-term successful outcomes compared to NS-RCT using nonbioceramic sealer?
Clinical Bottom Line Non-surgical root canal therapy (NS-RCT) performed with bioceramic sealer has long-term successful outcomes comparable to NS-RCT using nonbioceramic sealer. This is supported by a nonrandomized clinical trial of 150 teeth in which NS-RCT completed with bioceramic sealer had a similar (not significantly different) success rate compared to NS-RCT completed with nonbioceramic sealer. Unlike other root canal sealers, bioceramic sealers promote osteoblastic differentiation and mineralization that may aid in improved healing and successful outcomes for root canal therapy. However, additional clinical evidence, especially randomized clinical trials with long-term recalls, are needed to validate the use of bioceramic sealers over other root canal sealers on the market.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 32183124Zavattini/2020150 teeth undergoing NS-RCT using either bioceramic sealer or AH Plus (nonbioceramic Sealer)Nonrandomized clinical trial
Key resultsBioceramic sealer used with a single cone obturation has a success rate (84%-90%) that is similar/comparable to epoxy resin-based sealer (AH Plus Sealer) and warm vertical condensation (80-89%). The difference between the two groups was not found to be statistically significant (P=0.6099).
#2) 29606401Chybowski/2018307 teeth undergoing NS-RCT using bioceramic sealerRetrospective cohort study
Key resultsThe overall success rate of BC Sealer was 90.9%.
Evidence Search ((NS-RCT[Title/Abstract]) OR (Non-Surgical Root Canal Treatment[Title/Abstract])) AND ((bioceramic sealer[Title/Abstract]) OR (Calcium Silicate[Title/Abstract]))
Comments on
The Evidence
Validity: Chybowski et al. completed NS-RCT on 307 teeth and had an average follow up time of 30.1 months (+/- 18.7 months). Healing was assessed by clinical and radiograph examination (periapical radiography). There was no control group within this study. Zavatinni et al. completed NS-RCT on 150 teeth total. Treatment was either completed with BC sealer or AH Plus. Healing was assessed by non-blinded examiners via clinical and radiographic examination that included CBCT and periapical radiography. Perspective: The clinical study by Zavattini compared the outcomes of NS-RCT using bioceramic (calcium silicate) sealer to AH Plus, a nonbioceramic sealer viewed as a “gold standard” for sealers due to several ideal properties as well as a documented history of success. The authors used a different obturation technique for each sealer (single cone obturation with bioceramic sealer; warm vertical condensation for AH Plus) and found no difference in success/outcomes. While warm vertical condensation may be seen as technique sensitive and time consuming for some practitioners, using a single gutta percha cone with BC sealer is less technique sensitive and can save chair time without compromising clinical outcomes. Chybowski et al. demonstrated a similar level of success (90.9%) using single cone obturation and bioceramic sealer during NS-RCT. Thus, the use of BC sealer at this time can be viewed as clinician preference, as it does not provide a significant increase in successful outcomes when compared to AH Plus.
Applicability Although BC sealer offers several favorable benefits not demonstrated with AH plus or other commercially available root canal sealers, the cost of this product is much higher compared to non bioceramic sealers. Thus, without offering significant improvements/increase in the success rate of NS-RCT, it is hard to rationalize increasing office overhead to purchase BC sealer. However, the time saved using a single cone gutta percha technique with BC sealer may offset the additional cost of the sealer if it is saving the clinician patient chair time. Additional studies with longer follow up/improved outcomes are needed before the endodontic community is able to accept BC Sealer as the “gold standard” for root canal sealers.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords NS-RCT, Bioceramic sealers, Calcium Silicate Sealers, Success
ID# 3456
Date of submission: 11/30/2020spacer
E-mail raoufr@livemail.uthscsa.edu
Author Ryan Raouf
Co-author(s) Gautam Shirodkar
Co-author(s) e-mail shirodkar@uthscsa.edu
Faculty mentor/Co-author Dr. Anibal Diogenes
Faculty mentor/Co-author e-mail diogenes@uthscsa.edu
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