From the Desk of the Editor: The New-Age Bioceramic Root Canal Sealers.

Dear Readers,

Bioceramics are the newest introduction to endodontics. They are highly biocompatible ceramic/metal oxides with antibacterial, antifungal, and excellent sealing properties. Bioceramics uses in dentistry are varied from filling up bony defects, root repair, apical filling, perforations sealing, as endodontic sealers, and in regeneration. They mainly include alumina, zirconia, bioactive glass, glass ceramics, hydroxyapatite, and calcium phosphates.

Their use in endodontics is justified by their high biocompatibility and dimensional stability coupled with them being nontoxic and bioinert. The osteoconductive activity has been compared to hydroxyapatite which is known to induce a regenerative response in the human body.

Sanz et al. concluded that the bioactivity of these materials could be studied using reverse transcriptase–polymerase chain reaction, alkaline phosphatase enzyme activity assays, and alizarin red staining to assess their mineralization potential.[1]

Root canal sealers are broadly classified as per their composition as zinc oxide-based, calcium hydroxide-based, silicone resin, and bioceramic-based sealers.[2]

Chemically, bioceramic sealers can be classified as:[3]

Mineral trioxide aggregate (MTA)-based sealers, namely Endo-CPM-Sealers, MTA Angelus, MTA Obtura, ProRoot Endo Sealer, and MTA Fillapex

Calcium silicate-based sealers, namely EndoSequence BC Sealer, iRoot SP, and iRoot BP

Phosphate-based bioceramic sealers, namely bio-aggregate

Calcium phosphate-based sealers, namely Sankin Apetite and Capseal.

The three B classification is as follows:[4]

Bioinert: Noninteractive with biological systems

Bioactive: Durable tissues that can undergo interfacial interactions with surrounding tissue

Biodegradable, soluble, or resorbable: Eventually replaced or incorporated into tissue.

Their cytotoxicity and genotoxicity being minimal on gingival fibroblasts make them a promising alternative to other sealers.[5] Their antibacterial activity has been well-documented, especially on Enterococcus faecalis.[6] Their low contact angle gives a better flow to penetrate lateral canals and anastomosis in the root canals. They also exhibit better dentinal tubules penetration and adaptation compared to resin sealers and are known to form chemical bonds with the dentin.[7] On the other hand, effective removal in retreatment cases is still a matter of debate.[8] With an ample setting time of 3–4 h, excellent radio-opacity, and minimal to no inflammation in case of an overfill, bioceramic sealers are highly preferred by endodontists now.

In conclusion, looking at the varied research documenting the advantages, bioceramic sealers have a promising future in endodontics.