Bioactive Root Canal Sealers: A Review of Material Science and Clinical Outcomes

Abstract

Root canal sealers have evolved in transitioning away of inert obturation materials with active bioactive formulations that are actively involved in the healing process. Traditional sealers, though efficient in the provision of a seal, are sometimes not biologically integrated and stable enough as time goes by, thus coming the calcium silicate based and bioceramic sealers. These bioactive sealers demonstrate the ability to release calcium and hydroxyl ions, trigger the formation of hydroxyapatite and improve the formation of the biological seal at the dentin-sealer interface, which improves clinical outcomes. Their position is also complemented by the developments in material science and the endodontic adjuncts such as imaging and irrigation systems, which have refined diagnostic accuracy and treatment predictability. Evidence supports their favorable biological interactions, particularly in vital pulp therapy and regenerative procedures, where bioactive sealers foster tissue healing and hard tissue deposition. Comparative studies on root canal filling systems highlight their superior sealing ability, mechanical strength, and contribution to tooth survival, even under functional stresses. Besides, as artificial intelligence is becoming more and more part of endodontic diagnostics, the prospect of bioactive materials harmonizing with digital workflows has become an exciting prospect. Although the clinical outcomes are promising, it has difficulties in managing characteristics and cost. Long-term randomized trials are also required; however, bioactive root canal sealers represent a paradigm shift in endodontics, offering not only physical sealing but also biological activity that aligns with the principles of tissue preservation and regeneration.