Calcium Sealers: New Hope for Root Canals?

clinical-trial PMID: 34856212

Quick Summary: Researchers compared two methods for root canal treatments, one using a calcium-based sealer and the other a resin-based sealer. They found both methods worked about the same, with similar success rates and pain levels.

What The Research Found

This study looked at how well different sealers work in root canal treatments. The main findings were:

Similar Success: Both the calcium-based sealer and the resin-based sealer had similar success rates in healing the teeth.

Pain Levels: Patients in both groups reported similar levels of pain after the procedure.

Sealer Extrusion Matters: If the sealer went beyond the root, it lowered the chance of successful healing.

Study Details

Who was studied: 74 teeth needing root canal treatment.

How long: Patients were followed for an average of 17 months (between 6 months and almost 2.5 years).

What they took: One group received a root canal treatment using a calcium silicate sealer (Endoseal TCS). The other group received a root canal treatment using a resin-based sealer (AH Plus).

What This Means For You

If you need a root canal, this research suggests:

Choice of Sealer: The type of sealer used (calcium-based or resin-based) may not significantly affect the outcome.

Technique Matters: The dentist's skill in preventing the sealer from going beyond the root is important for a successful outcome.

Talk to Your Dentist: Discuss the best options for your specific situation with your dentist.

Study Limitations

Keep in mind:

Smaller Study: The study involved a relatively small number of teeth, so more research is needed.

Follow-Up Time: The follow-up time varied, which could affect the results.

Specific Sealers: The results apply only to the specific sealers used in the study (Endoseal TCS and AH Plus).

Not About Calcium Supplements: This study is about dental sealers, not calcium supplements for bone health.

Key Findings

This 2022 randomized clinical trial found that sealer-based obturation (SBO) using a calcium silicate sealer (Endoseal TCS) had comparable clinical efficacy to the continuous wave of condensation (CWC) technique with a resin-based sealer (AH Plus) in root canal treatments. Both groups showed similar postoperative pain levels (P = 0.973) and obturation quality. However, sealer extrusion significantly reduced success rates under "loose" healing criteria (P = 0.049), highlighting its negative impact on prognosis.

Study Design

Type: Randomized controlled clinical trial (RCT).
Methodology: 74 teeth requiring root canal treatment were randomly assigned to CWC (AH Plus sealer) or SBO (Endoseal TCS). Canals were prepared with rotary instruments and 2.5% sodium hypochlorite. Follow-up assessments occurred at 6–29 months (mean: 17 months).
Sample Size: 74 teeth (79% recall rate).
Duration: Mean follow-up of 17 months (range: 6–29 months).

Dosage & Administration

The study evaluated calcium silicate (Endoseal TCS) and resin-based (AH Plus) sealers applied via SBO or CWC techniques, respectively. Dosage was not applicable, as sealers were used as dental materials per manufacturer guidelines. Administration involved root canal obturation after biomechanical preparation with standardized protocols.

Results & Efficacy

Success Rates:
Loose criteria: 93.2% overall (CWC: 92.3%, SBO: 94.3%; P > 0.05).
Strict criteria: 60.8% overall (CWC: 51.3%, SBO: 71.4%; P > 0.05).
Sealer Extrusion: Teeth with extrusion had lower success rates under loose criteria (P = 0.049).
Postoperative Pain: No significant difference between groups (P = 0.973).
Obturation Quality: Similar void distribution and root-filling levels in both groups.

Limitations

Sample Size: Relatively small (n=74), limiting statistical power to detect subtle differences.
Follow-Up Variability: Duration ranged from 6–29 months, complicating long-term conclusions.
Blinding: Not explicitly addressed, risking performance or detection bias.
Demographics: No details on patient age, sex, or comorbidities affecting healing.
Single Sealer: Results apply only to Endoseal TCS and AH Plus; generalizability to other calcium silicate or resin sealers is uncertain.

Clinical Relevance

For dental practitioners, SBO with calcium silicate sealers (e.g., Endoseal TCS) may serve as a viable alternative to CWC with resin-based sealers (e.g., AH Plus) due to comparable success rates and pain outcomes. However, minimizing sealer extrusion is critical, as it reduced healing success under loose criteria. These findings support technique flexibility but emphasize procedural precision. Further research with larger cohorts and longer follow-ups is needed to confirm long-term equivalence and explore other calcium silicate formulations.

Note: This study focuses on dental calcium silicate sealers, not nutritional calcium supplements.