Hydraulic calcium silicate–based sealers exhibit Favorable Long-Term Outcomes in Apical Periodontitis: Study

A new retrospective study published in the journal of Clinical Oral Investigations found that hydraulic calcium silicate–based sealers (CSBSs) in root canal therapy show reliable and favorable long-term outcomes when used with cold hydraulic condensation (CHC) in teeth with apical periodontitis. The severity of the lesion before treatment is the most important prognostic factor influencing periapical healing over time, while demographic and procedural variables appear to have minimal impact on long-term success.

This research analyzed outcomes from 637 teeth diagnosed with symptomatic apical periodontitis, all treated by a single experienced clinician using a premixed CSBS and the CHC technique. The cases included both primary root canal treatments and retreatments, which offers a holistic perspective on real-world performance. Data were compiled from clinical records and radiographic archives, by tracking patients over a 5-year period.

Under strict success criteria like the complete absence of symptoms and full radiographic healing, the success rates increased steadily from 80.2% at one year to 87.67% at 5 years. When evaluated using more lenient criteria, which also counted partial healing without symptoms, success rates were even higher, starting at 99.2% in the first year and stabilizing at 87.67% by year five.

Teeth with higher baseline periapical index (PAI) scores which indicates more extensive infection, had significantly lower odds of achieving strict success at multiple follow-up points. This reinforces the idea that early intervention remains crucial in endodontic care.

The variables such as patient age, sex, tooth type, whether the procedure was a primary treatment or retreatment, sealer extrusion, and even the type of final restoration did not significantly affect long-term results. Thus, the material and technique themselves may provide a level of consistency that reduces variability tied to these factors.

The use of a single operator, while limiting generalizability, ensured procedural consistency across all cases. This strengthens the internal validity of the findings, though further dedicated multi-center studies would be required to confirm broader applicability.

Overall, the results support the reliability of CSBSs when used with the CHC technique for treating apical periodontitis. While advanced materials like CSBSs offer strong long-term performance, the condition of the tooth at the time of treatment remains the most critical predictor of healing. Early diagnosis and timely intervention continue to be central to successful endodontic outcomes.

Source:

Cardinali, F., Malvicini, G., Sauro, S., Cernera, M., Pontoriero, D. I. K., Grandini, S., & Gaeta, C. (2026). Five-year clinical outcomes of root canal treatment using a calcium silicate-based sealer in teeth with apical periodontitis: a retrospective cohort study. Clinical Oral Investigations, 30(5). https://doi.org/10.1007/s00784-026-06884-x