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Article

Comparison of Apical Microleakage in Bioceramic and Resin-Based Endodontic Sealers with Conventional and Bioceramic Surface-Impregnated Gutta-Percha Points

by
Lucia Somolová
1,2,*,
Yuliya Morozova
1,2,
Iva Voborná
1,2,
Matej Rosa
1,2,
Barbora Novotná
1,2,
Pavel Holík
1,2 and
Kateřina Langová
3
1
Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacký University, Palackého 12, 77200 Olomouc, Czech Republic
2
Olomouc University Hospital, Zdravotníků 248/7, 77900 Olomouc, Czech Republic
3
Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacký University, Hněvotínská 3, 77515 Olomouc, Czech Republic
*
Author to whom correspondence should be addressed.
Ceramics 2025, 8(2), 65; https://doi.org/10.3390/ceramics8020065
Submission received: 16 March 2025 / Revised: 3 May 2025 / Accepted: 15 May 2025 / Published: 26 May 2025
Browse Figures
Versions Notes

Abstract

The aim of this study is to evaluate the apical sealing ability of novel bioceramic-based (BCB) and widely used resin-based (RB) root canal sealers in combination with traditional or bioceramic-coated gutta-percha points. A total of 92 human single-root extracted teeth were endodontically treated and divided into three groups (A, B, and C) of 30 samples based on the endodontic sealer/type of gutta-percha points/obturation method used. One tooth sample was used for the negative and positive controls (each). Group A: BCB sealer BioRoot RCS (Septodont, Saint-Maur-des-Fossés, France)/bioceramic-impregnated gutta-percha TotalFill BC points (FKG Dentaire, La Chaux-de-Fonds, Switzerland)/cold hydraulic single-cone. Group B: BioRoot RCS (Septodont, France)/traditional Protaper Gold Gutta-Percha Points (Dentsply Sirona, Charlotte, NC, USA)/cold hydraulic single-cone. Group C: RB sealer AdSeal (Meta Biomed, Cheongju, Republic of Korea)/traditional Protaper Gold Gutta-Percha Points (Dentsply Sirona, USA)/warm vertical condensation. A dye penetration method was applied, and the length of apicocoronal penetration was measured using a surgical microscope. The data were statistically analyzed to evaluate differences at the 0.05 significance level. A significant difference was found between groups A and C, p = 0.0003, and groups B and C, p = 0.003. The data analysis proved that the BCB sealer using the cold hydraulic single-cone method ensured a substantially better seal than the RB sealer using the warm vertical condensation method. The choice of the type of gutta-percha points (bioceramic-coated or regular) appeared to be unimportant. No statistical significance was found between groups A and B, which indicates that using bioceramic-coated gutta-percha points does not bring any considerable benefit in view of a no-gap root canal obturation.

Graphical Abstract

1. Introduction

Biomaterials represent an indispensable element in modern medicine and dentistry [1]. The use of biomaterials has penetrated the field of dentistry, led by materials based on bioceramics. They became applicable in various clinical endodontic situations, including root-end filling, vital pulp therapy, root canal therapy, apexification, regenerative treatment, perforation repair, and root defect repair [2].
The field of endodontics is no longer considered a means of pain management only. It has a strong impact on infection control and can affect risk factors for systemic complications [3]. In some conditions, dental disease can be clinically completely asymptomatic. These asymptomatic cases can remain unnoticed for a long time and may have a negative effect on a patient’s general health [4]. Due to endodontic disease, there is an increased risk of bacteremia—microbes from the root canal translocating into the systemic environment—triggering an immune response and potentially negatively affecting other organs and tissues [5]. Inflammation of the apical periodontal area of the tooth can be correlated with various systemic diseases [6].
Apart from the infected dental pulp being the primary cause of apical periodontal disease, previous poorly performed root canal treatment can be the source of a problem as well [7]. A quality endodontic treatment is primarily obtained by the optimal hermetic coronal and apical seal of the root canal [8].
The absence of an apical seal, known as apical leakage, has been reported as the most common cause of endodontic treatment failure [7]. Marginal leakage at a micron level can be investigated using various methods [9] that investigate this phenomenon from different angles; therefore, their outcomes are incomparable with their own limitations [10]. The dye penetration method is a well-documented and commonly used method for the evaluation of sealing capacity [11]. Sample standardization regarding the root canal wall, the materials used, and the techniques would be favorable to make the most accurate evaluations [12]. Human teeth, as biological tissue, are not standardized in their nature and always have their anatomical individual characteristics. In the future, genetic engineering shall provide the opportunity to study standardized human tissue artificially created in the laboratory [13,14]. For now, we can only select samples of a similar type and standardize the materials and methods used.
The aim of this experiment was to evaluate the apical sealing ability of biocompatible and bioactive bioceramic-based (BCB) root canal sealer using different types of gutta-percha points (points coated with bioceramic nanoparticles versus traditional points) and compare it with the widely-used epoxy-resin-based (RB) root canal sealer in combination with non-coated gutta-percha points. The outcome of this investigation should propose the preferred choice of obturation material and technique to ensure the best apical seal of the tooth and, therefore, eliminate the possibility of focal infection.
Even though the BCB sealer presents more modern, reliable, and biocompatible technology [15,16], RB sealers are still more commonly used for the purpose of root canal obturation, mainly due to their cost and availability on the market [17].
The single-cone hydraulic cold obturation method is recommended for BCB root canal sealers [2,18,19,20]. It is an easy-to-perform and time-saving method of root canal treatment, with sealer as the primary material and gutta-percha as an auxiliary [2,18]. With the adequate selection of the main gutta-percha point, which corresponds exactly to the apical dimension after the root canal has been instrumented, reliable sealing can be achieved when a sealer is applied as a filler in larger quantities [18,20].
Current evidence shows that the single-cone obturation method using BCB sealers has achieved good clinical results and has great operability [18,19]. Despite that, it is not widely accepted by most clinical practitioners at this time due to insufficient standardized clinical guidelines and high dependence on the properties of root canal sealers [2]. Thus, the physicochemical properties of the BCB sealers play a key role in the success of treatment [2]. Additionally, it is necessary to pay attention to the precise composition of the materials identified as bioceramics on the market. The diverse chemical composition of these materials may undoubtedly affect their clinical performance [21]. BCB sealers have generally good biocompatibility, excellent fluidity, and chemical stability. When used with the cold single-cone obturation method, BCB sealers have demonstrated adequate short-term clinical results [2,22].
In the meta-analysis by Rekha et al. [23] of 24 studies published between the years 2014 and 2021, no significant difference was measured between the sealing ability of RB and BCB sealers. When using the dye penetration method, microleakage tests showed comparable sealing ability of RB and BCB sealers. Variable methods of outcome observation were used, such as scanning electron microscopy, stereo-microscopy, confocal laser scanning microscopy, fluid filtration, spectrophotometry, bacterial penetration, and microtomography. In 2024, Huth et al. conducted a study on glucose penetration and confocal laser scanning microscopy evaluation, in which both BCB and conventional sealers performed similarly; therefore, BCB sealers could be a clinical alternative to conventional sealers, especially in particularly challenging cases [24]. Moreover, in 2020, Asawaworarit et al. published a study using fluid filtration and electron scanning microscopy, where BCB sealer provided significantly better sealing ability and lower apical microleakage than RB sealer [25]. A comparison of RB and BCB sealers has been the subject of some studies; however, an evaluation of the importance of using bioceramic-coated gutta-percha points, considering a gap-free seal, is not widely investigated. It is clear that this issue demands further research, and the use of multiple methods in standardized conditions could collectively bring a well-founded outcome in the future [26,27]. This study contributes to the results of previously conducted experiments.
For this study, the cold hydraulic single-cone method for the BCB sealer and the warm vertical condensation method for the RB sealer were used. The two methods are the most commonly used for root canal obturation and can appear to be unalike when looked at from the big picture. However, taking into account that this study focuses on the apical 3–5 mm of the root filling only, the two methods display a similar situation at that apical location when compared. Hot plugger reaches the apical part of the root canal at a distance of 3–5 mm from the apical foramen [28]. Due to that fact, the investigated apical part of the root canal filling is obtained by the equivalent calibrated gutta-percha point placement procedure, and therefore, from a strictly apical point of view, the two methods act correspondingly. When using an RB sealer, a single-cone method is perceived as obsolete and unreliable; therefore, the warm vertical condensation method became accepted as the method of choice among dental practitioners [29]. This claim does not apply to the use of BCB sealers due to their physicochemical properties, which are listed below. On the other hand, BCB sealers are recommended for the cold hydraulic single-cone method [18]. Since bioceramic surface-impregnated gutta-percha points became available on the market, the question of their necessity and efficacy arose. This experiment compares the results of obturation with the two types of gutta-percha points using the same sealer and filling method to point out whether the specialized bioceramic-coated gutta-percha points are worth their cost.
The conclusion of this study should present the preferred choice of obturation technique along with the best option of the filling material, considering these two most commonly used endodontic sealers.

2. Materials and Methods

2.1. Bioceramic Material Bioactive Management

In our in vitro study, BioRoot RCS (Septodont, Saint-Maur-des-Fossés, France) was used in experimental groups A and B. It is a two-component calcium silicate-based root canal sealer that consists of liquid and powder. The powder contains tricalcium silicate, zirconium oxide (radiopaque filler), and povidone, which increases adhesion to hard dental tissues. The liquid is an aqueous solution of calcium chloride (setting modifier) and polycarboxylate [30]. The setting aspects of this material are presented by the following chemical equation, where tricalcium silicate reacts with water and forms a calcium silicate hydrate gel and calcium hydroxide, which is also responsible for its antibacterial activity [16].
3CaO·SiO2 + H2O → C–S–H + Ca(OH)2
Porosity and solubility introduce a major challenge to the sealing ability of a root canal sealer. In general, BCB sealer tends to show higher porosity and solubility than RB sealer [31,32,33,34]. The voids in the material using BCB sealer, however, should not have a negative impact on the sealing quality of the root canal filling [32]. On the contrary, increased solubility may support the bioactivity of the sealer due to its dynamic character in the human body [19]. After 14 to 28 days, the process of biomineralization occurs, and the deposition of hydroxyapatite precipitates on the dentinal surface begins [19,35]. These structures have the ability to fill the voids created by the increased solubility of the sealer [30]. The following chemical reaction of precipitation shows the reaction of calcium cations originating from calcium hydroxide formed during the primary hydration phase with phosphate anions occurring in dentin; this results in a specific intermediate layer formed by apatite structures similar to hydroxyapatite [36]. This intermediate layer ensures a chemical bond between the material and the dentin and, thus, creates a better seal against other materials in similar indications [16,37]. This process of biomineralization (production of mineral substances by a living organism) is closely related to the ability to seal the filled space in the root system [19,38].
7Ca(OH)2 + 3Ca(H2PO4)2 → Ca10(PO4)6(OH)2 + 12H2O

2.2. Tooth Specimens

This in vitro experimental study was conducted on 92 human single-root teeth extracted for orthodontic or periodontal reasons. Informed consent was obtained from all patients involved in the study.
Initially, the number of extracted teeth specimens was higher, but due to the reasons mentioned below, a few samples needed to be excluded from the main study. The criteria for exclusion were the following: teeth with an already filled or otherwise damaged root system, teeth affected by a carious lesion or other root integrity defect within a minimum range of 10 mm from the anatomical apex of the tooth; teeth with an irregularly shaped root canal (such as apical ramifications or multiple root canals present in one root). All specimen preparations, obturations, and evaluations were performed by a single operator, the main author of this publication.
A total of 92 freshly extracted human single-root and single-canal teeth with completed root development were disinfected after extraction and stored in a 0.5% chloramine T solution in a dark glass container at 4 °C. If necessary, the surface of the root was gently cleaned with an ultrasonic tip and cooling to remove possible incrustations of tartar and soft tissues without violating the integrity of the root surface.
After that, the anatomical crown of the teeth was separated from the root through a cross-section using a high-speed micromotor with a cylindrical diamond bur with cooling. This resulted in root samples approximately 10–15 mm long, depending on the anatomy of the tooth, with an intact surface and access to the root canal, suitable for root canal treatment.
For individual samples, an initial probing of the root canal was performed, and then the working length was determined.
The canals were processed using a sequence of Protaper Gold Rotary Files (Dentsply Sirona, Charlotte, NC, USA), ending with F3 tools or F4 tools (according to the initial size of the root canal), which corresponded to the apical dimensions of ISO 30 or 40. During the entire treatment, the standard irrigation protocol was followed, i.e., rinsing with 2.5% sodium hypochlorite (NaClO) for 30 min and applying 17% ethylenediaminetetraacetic acid (EDTA) for 1 min after the final treatment.
Then, the canals were dried with paper pins of the appropriate size.

2.3. Placement of Root Canal Obturation

Subsequently, the samples were randomly divided into three groups (A, B, and C) containing 30 samples each and one sample for the negative control (N) and positive control (P) each, as follows:
(A)
The first group was filled with BCB root canal sealer BioRoot RCS (Septodont, France) in combination with a gutta-percha point impregnated with bioceramic particles, TotalFill BC Points (FKG Dentaire, La Chaux-de-Fonds, Switzerland), using a cold hydraulic obturation technique. The BioRoot RCS material was mixed according to the manufacturer’s instructions (1 scoop of powder/5 drops of liquid) and repeatedly applied in large quantities to the canal on a selected gutta-percha point corresponding to the final instrumentation (ISO 30–40, taper 6%). After the final insertion, the point was shortened 1–2 mm below the level of the entrance to the canal with an ultrasonic tip without cooling and gently condensed with a cold plugger.
(B)
The second group was filled with a BCB root canal sealer, BioRoot RCS (Septodont, France), in combination with a calibrated gutta-percha point without surface treatment, Protaper Gold Conform Fit Gutta-Percha Points F3–F4 (Dentsply Sirona, USA), using a cold hydraulic obturation technique. The BioRoot RCS material was mixed according to the manufacturer’s instructions (1 scoop of powder/5 drops of liquid) and repeatedly applied in larger quantities to the canal on a selected gutta-percha point of the appropriate size. After the final insertion, the point was shortened 1–2 mm below the level of the entrance to the canal with an ultrasonic tip without cooling and gently condensed with a cold plugger.
(C)
The third group was filled with a poly-epoxide RB root canal sealer, AdSeal (Meta Biomed, Cheongju, Republic of Korea), in combination with a calibrated gutta-percha point without surface treatment, Protaper Gold Conform Fit Gutta-Percha Points F3-F4 (Dentsply Sirona, USA), using the warm vertical condensation technique. The AdSeal material was mixed according to the manufacturer’s instructions and introduced into the root canal in a very small amount on a gutta-percha point of the appropriate size. Using a hot plugger, the point was shortened approximately 5 mm from the apical stop and vertically condensed. After that, the remaining space of the canal was filled with an injection of heated gutta-percha and then condensed with a plugger in the vertical direction. The root canal filling was finished 1–2 mm below the level of the canal entrance.
(P), (N): The positive and negative control samples were left unfilled. The chemical composition, manufacturer, and mixing procedures of the tested sealers are presented in Table 1.

2.4. Dye Penetration

The coronal entrance of the root canal was adhesively closed in all groups by applying the Single Bond Universal (3M, Maplewood, MN, USA) material and a flow-type composite material, Filtek Flow Supreme Restorative (3M, USA).
To isolate the root surface of the samples from external influences, heated laboratory soft modelling wax was used. In groups A, B, C, and P, the wax was applied to cover the entire surface of the sample, with the exception of the apical part within 1–2 mm from the anatomical apex, to ensure the accessibility of the root filling to the effects of the dye. For sample (N), the wax was applied to cover the entire surface of the sample, including the apical part.
By mixing a sterile saline solution of NaCl 0.9% (B.Braun, Melsungen, Germany) and caries detector dye, Caries Detector (Kuraray, Tokyo, Japan), at a ratio of 3:1, a dye solution was created. This dye solution was poured into the six closed containers.
The groups of samples (A, B, C, P, N) were each submerged into one of the six containers and labeled accordingly. They were left in a laboratory incubator at a temperature of 37 °C for 48 h.
Then, the samples were removed from the solution, gently rinsed with distilled water for 10 s, and delicately dried with an air stream from the dental air gun.

2.5. Assessment of Dye Leakage

To evaluate the level of dye penetration, the samples were longitudinally cut at the level of the root filling using a cylindrical diamond bur in the high-speed micromotor with cooling.
Under visual inspection using a surgical microscope, Zeiss Extaro 300 (Carl Zeiss AG, Oberkochen, Germany), the samples were measured for possible penetration of the dye in the apicocoronal direction (Figure 1) with the help of an electronic digital caliper. The point of the longest penetration of the dye in the given sample was considered determinative. Lengths of dye penetration were measured in millimeters to a precision of 2 decimal places. The measurement of the values of the penetration length of each sample group was blinded to eliminate bias. The order of the measurement of each sample within the group was irrelevant. The data were recorded and analyzed using statistical software, IBM SPSS Statistics for Windows, Version 23.0, IBM Corp (Armonk, NY, USA). The best result was a situation where there was no penetration of the dye into the root canal system.

2.6. Evaluation of the Data Outcomes

The main outcome of this study is expressed as a statistical difference between the groups for A versus C and B versus C, showing the clinical importance of the choice of the main sealing obturation material, with no emphasis on the type of gutta-percha points placed.
The secondary outcome of the study shows the importance of choosing the gutta-percha point surfaces, which can be seen when comparing groups A and B, which use the same obturation material as the sealer.

2.7. Statistical Analysis

Quantitative data (length of the dye penetration) were collected and represented as means, minimum values, maximum values, and standard deviations (SD). Shapiro–Wilk tests were applied to show data uniformity distribution. The quantitative data were analyzed for significant differences using a Kruskal–Wallis test. Afterward, post-hoc analysis was realized using a Mann–Whitney U test with Bonferroni correction to evaluate significant differences. Statistical analysis was performed using IBM SPSS Statistics for Windows, software Version 23.0, IBM Corp. (Armonk, NY, USA). All tests were performed at a statistical significance of p ≤ 0.05.

3. Results

  • The Kruskal–Wallis comparison of the mean values, minimum values, maximum values, means, and standard deviations (SDs) is shown in Table 2. This method demonstrated a significant difference between individual groups in dye penetration length, p = 0.00003 ***. The percentage of the no dye penetration value (concurrently, also the minimum value) is 90% in group A, 83.3% in group B, and 40% in group C.
  • Post-hoc Mann–Whitney U tests with Bonferroni correction were performed to compare each group’s specimen values. A p-value that is less than 0.05 is considered statistically significant and is marked red in the table; the results are shown in Table 3. According to the post-hoc Mann–Whitney U test, a statistically significant difference between groups A (BioRoot RCS/TotalFill BC Points) and C (AdSeal/ProtaperGold Points) was proven; p = 0.0003. Groups B and C also presented a statistically significant difference; p = 0.003.
  • The Shapiro–Wilk test demonstrated that the quantitative data do not have a normal distribution. The distribution of the quantitative values is shown using a box graph (Figure 2).

4. Discussion

Available retrospective studies by Chybowski et al. and Albakhakh et al. demonstrate a high success rate (91%) using BCB sealer with the single-cone method, with an 89% success rate for initial treatment, and a 64% success rate for retreatment [30,31]. In prospective studies by Bardini et al. and Zavattini et al., the BCB sealer used with the single-cone obturation method has reached a one-year success rate of 90–97%, which is similar to the 89–93% success rate of warm vertical condensation of gutta-percha points using RB sealers [32,33]. A randomized clinical trial of RB and BCB sealers using a single-cone technique exhibited no significant differences in post-operative sensitivity or healing process [34]. Even though the BCB sealers have a higher tendency to extrude more into the periodontium than RB sealers, this may not be associated with increased post-operative pain [35]. The results of a recent study by Jurič et al. showed a significant decrease in the success rate of treatment when RB sealers were used compared to a novel BCB sealer [36]; this can be linked to the physicochemical properties of the BCB sealer [37]. According to Hamdy et al., BCB sealer can be used as a prospective alternative to RB sealer, thanks to its advantageous properties [38]. BCB sealers, moreover, tend to show higher push-out bond strength and fewer voids than RB sealers, according to a new study by Nouroloyouni et al. [39]. In the case of using the single-cone obturation method, BCB sealers should be preferred to RB sealers [39]. However, in the new randomized clinical trial by Hu et al. using the warm vertical compaction method, the success rates of the two groups of sealers (BCB and RB) did not differ significantly. The two groups showed similar clinical performance and success rates in root canal treatment during a two-year follow-up [40]. A meta-analysis including 24 studies [23] showed no significant difference between the sealing ability of BCB sealer and RB sealer evaluated using the microleakage tests. They both exhibited comparable sealing ability. On the other hand, a recent study by Asawaworarit et al. using a fluid filtration method and scanning electron microscopy demonstrated a better sealing ability and BCB sealer penetration level than the RB sealer, even though the best results were achieved using different types of obturation method (multiple wave condensation technique) [25]. Another study by Roizenblit et al. [41], using micro-computed tomography analysis, demonstrated similar obturation quality outcomes for two filling methods: the single-cone technique with a BCB sealer and the continuous wave technique with an RB sealer. There was no significant difference in terms of the filling volume, voids, and gaps, although no sealer was able to fill the root canal space completely. Therefore, we can see that the choice of a suitable obturation method deserves the same degree of attention as the choice of the filling material. In summary, these studies provide a comparison of the sealing capacity and success rate of the two investigated materials: BCB and RB sealer. In most cases, modern BCB sealers had better results in terms of sealing ability, which correlates with the results of our study.
The main goal of our experiment was to investigate whether root canal obturation using BCB sealer in combination with gutta-percha points of any choice (groups A and B) shows a better result than obturation using the widely used RB sealer together with ordinary, standardized gutta-percha points (group C). The statistical analysis of the results shows a statistically significant difference between group A (BioRoot RCS/TotalFill BC Points) and group C (AdSeal/ProtaperGold Points), p = 0.0003, and also a difference between group B (BioRoot RCS/ProtaperGold Points) and group C, p = 0.003. There was no statistically significant difference between groups A and B. Thus, the data analysis shows that BCB endodontic sealer ensures a substantially better seal than RB sealer when taking into account the fact that the type of gutta-percha points used is not particularly important. It can be deduced that the single-cone obturation method using the BCB sealer with either bioceramic-coated or regular gutta-percha points provides a superior obturation outcome than the vertical warm compaction method using RB sealer with a regular gutta-percha point.
Due to the favorable fluidity and physicochemical properties of BCB sealers, they presumably are able to fill the anatomical irregularities of the root canal or iatrogenic defects [20]. Our experimental study has unintentionally proven this hypothesis as well, even though it was not the primary purpose. Specimens of the teeth that were excluded from the main study due to root canal irregularities presented the possible capacity of the BCB root canal sealer to compensate for these issues and, therefore, hermetically seal the root canal system, preventing the dye from infiltrating the root canal system (Figure 3).
On the contrary, specimens possessing similar anatomical inconsistencies obturated with RB sealer did not have the same good results as the BCB sealer obturated specimens. Dye penetration levels in the latter group were significantly higher (Figure 4). These samples (Figure 3 and Figure 4) were excluded from the main study due to irregularities in the root canal system (irregularly shaped root canal, apical ramifications, or multiple root canals present in one root) and, therefore, were not included in the statistical analysis and results of the study. Their presentation only suggests a discrepancy in the tendency of the fluidity of the different root canal sealers. This matter needs further research in standardized conditions.
Yu et al. investigated the filling of irregular spaces in root canals (type IV isthmus) in a recently published study. The single-cone obturation method, compared to continuous wave of condensation, did not appear to provide the best result; nevertheless, it demonstrated the better filling quality of the single-cone method using BCB sealer in comparison with other types of sealer [42]. Canderio et al. focused on the penetration capacity of two endodontic sealers (BCB and RB) into artificial lateral canals using the single-cone technique. In this study, no significant difference was observed in this regard [43]. According to Manjila et al., BCB sealers can also be useful for hermetically sealing root canals containing broken rotary instruments, which present one of the most common endodontic treatment complications [44]. Liu et al. and Wisawawatin et al. showed that the BCB sealers may also be suitable for filling irregular root canal shapes, such as C-shaped canals. Hydraulic obturation in combination with BCB sealer appeared to yield the best results [45,46].
With certain limitations, BCB sealers may supposedly compensate in some way for the complexity of the root canal anatomy and fill the anatomical abnormalities and irregular spaces. This phenomenon is difficult to investigate in vivo due to the anatomical uniqueness of the root canal space of each individual based on individual genetic traits.
A secondary goal of our study was to point out the importance of choosing the type of gutta-percha points and whether the specially modified points (coated with bioceramic nanoparticles) have a significant impact on the final outcome of the sealing quality. The use of standardized gutta-percha points is considered the gold standard of root canal obturation in combination with a selected type of sealer. However, gutta-percha points are not able to bond to dentin and have poor flexibility [47]. Unlike traditional points, bioceramic-coated points, such as Totalfill BC Points, are subjected to a patented process of impregnating and coating each point with bioceramic nanoparticles. Bioceramic particles on the surface of the gutta-percha points allow for a chemical bond with bioceramic particles found in the BCB sealer and, therefore, ensure a true gap-free seal [47,48].
Quaresma et al. proved that the filling of the root canal system with BCB sealer should be associated with bioceramic-coated gutta-percha points to provide the best treatment outcome [49]. On the contrary, Eltair et al. showed that there is no advantage in using the bioceramic-impregnated gutta-percha points in relation to a gap-free seal [50].
In our experimental study, a statistical analysis of the results has shown no statistically significant difference between groups A (BioRoot RCS/TotalFill BC Points) and B (BioRoot RCS/ProtaperGold Points). In this case, the data analysis does not indicate that using bioceramic-coated points brings any considerable benefit to the quality of the obturation. Further clinical trials investigating this issue should be performed to deliver the most relevant outcomes. Multiple evidence-based outcomes could present a guideline for the choice of the best obturation material and method for dental practitioners to use. Nowadays, due to the rapid development of technologies and materials, it will be a challenging task to accomplish.
The limits of this study lie, foremost, in the limited number of studied specimens, the different root canal sizes and shapes, and, thus, the different amounts of sealer used. In spite of a selection of single-rooted, single-canal teeth, there could be some variations regarding the anatomical abnormalities and individual characteristics of the root canal space of the selected teeth.

5. Conclusions

Based on the results of this study, a BCB sealer showed significantly better results as a high-quality biomaterial for root canal obturation than an RB sealer. The BCB sealer applied using the single-cone obturation method demonstrated superior apical sealing ability compared to the RB sealer applied using the warm vertical condensation method.
Along with the BCB sealer, the results of this experiment show that the use of special bioceramic surface-impregnated gutta-percha points did not bring any significant benefit to root canal obturation quality compared to the use of traditional gutta-percha points.

Author Contributions

Conceptualization, L.S. and Y.M.; methodology, L.S. and Y.M.; software, K.L.; validation, I.V. and P.H.; formal analysis, B.N.; investigation, L.S. and M.R.; resources, Y.M. and I.V.; data curation, M.R.; writing—original draft preparation, L.S.; writing—review and editing, L.S. and Y.M.; visualization, L.S.; supervision, Y.M. and I.V.; project administration, Y.M. and L.S.; funding acquisition, Y.M. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by Palacký University Olomouc.

Institutional Review Board Statement

The study was approved by the Ethics Committee of the University Hospital and the Faculty Medicine, Palacky University in Olomouc (61/21; 12 April 2021).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.

Conflicts of Interest

The authors declare no conflict of interest. The funders had no role in the design of the study, in collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

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Figure 1. Illustration of dye penetration into the apical area of the tooth specimens under a stereomicroscope. (a) Tooth specimen from group A; (b) tooth specimen from group B; (c,d) teeth specimens from group C.
Figure 1. Illustration of dye penetration into the apical area of the tooth specimens under a stereomicroscope. (a) Tooth specimen from group A; (b) tooth specimen from group B; (c,d) teeth specimens from group C.
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Figure 2. Distribution of dye penetration length in millimeters of each group.
Figure 2. Distribution of dye penetration length in millimeters of each group.
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Figure 3. Teeth specimens excluded from the main study due to anatomical root canal irregularities. (a–d) Various irregular root canal spaces filled by a bioceramic-based (BCB) sealer with no or an insignificant amount of dye penetration into the root canal system.
Figure 3. Teeth specimens excluded from the main study due to anatomical root canal irregularities. (a–d) Various irregular root canal spaces filled by a bioceramic-based (BCB) sealer with no or an insignificant amount of dye penetration into the root canal system.
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Figure 4. Teeth specimens excluded from the main study due to anatomical root canal irregularities. (a–d) Various irregular root canal spaces filled by a resin-based (RB) sealer with an increased amount of dye penetration into the root canal system.
Figure 4. Teeth specimens excluded from the main study due to anatomical root canal irregularities. (a–d) Various irregular root canal spaces filled by a resin-based (RB) sealer with an increased amount of dye penetration into the root canal system.
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Table 1. Chemical composition, manufacturer, and mixing procedures of the tested root canal sealers.
Table 1. Chemical composition, manufacturer, and mixing procedures of the tested root canal sealers.
MaterialsManufacturerMixingChemical Composition
BioRoot RCSSeptodont
Saint-Maur-des-Fossés, France		manual mixing with spatula on a mixing plate:
5 drops of liquid with 1 scoop of powder		powder:
tricalcium silicate, zirconium dioxide, povidone
liquid:
water, calcium chloride, polycarboxylate
AdSealMetaBiomed
Cheongju, Republic of Korea		manual mixing with spatula on a mixing plate:
dual syringe: 9 g of base and 4.5 g of catalyst paste		base paste:
epoxy resin oligomer, hydroxyethyl salicylate, bismuth III carbonate
catalyst paste:
poly-butanediol amino benzoate, calcium phosphate, bismuth III carbonate
Table 2. Kruskal–Wallis comparison of the mean values of the dye penetration (in millimeters) in the specimens with the negative control group.
Table 2. Kruskal–Wallis comparison of the mean values of the dye penetration (in millimeters) in the specimens with the negative control group.
GroupNMeanMedianMinimumMaximumSDp
A300.160.000.003.600.680.00003 ***
B0.140.000.001.200.34
C0.660.400.004.200.92
*** p < 0.001.
Table 3. Comparison of the values of dye penetration of the groups’ specimen values using post-hoc Mann–Whitney U tests with Bonferroni correction.
Table 3. Comparison of the values of dye penetration of the groups’ specimen values using post-hoc Mann–Whitney U tests with Bonferroni correction.
Group Comparisonsp
A versus B1.000
B versus C0.003 **
A versus C0.0003 ***
** p < 0.01; *** p < 0.001.
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MDPI and ACS Style

Somolová, L.; Morozova, Y.; Voborná, I.; Rosa, M.; Novotná, B.; Holík, P.; Langová, K. Comparison of Apical Microleakage in Bioceramic and Resin-Based Endodontic Sealers with Conventional and Bioceramic Surface-Impregnated Gutta-Percha Points. Ceramics 2025, 8, 65. https://doi.org/10.3390/ceramics8020065

AMA Style

Somolová L, Morozova Y, Voborná I, Rosa M, Novotná B, Holík P, Langová K. Comparison of Apical Microleakage in Bioceramic and Resin-Based Endodontic Sealers with Conventional and Bioceramic Surface-Impregnated Gutta-Percha Points. Ceramics. 2025; 8(2):65. https://doi.org/10.3390/ceramics8020065

Chicago/Turabian Style

Somolová, Lucia, Yuliya Morozova, Iva Voborná, Matej Rosa, Barbora Novotná, Pavel Holík, and Kateřina Langová. 2025. "Comparison of Apical Microleakage in Bioceramic and Resin-Based Endodontic Sealers with Conventional and Bioceramic Surface-Impregnated Gutta-Percha Points" Ceramics 8, no. 2: 65. https://doi.org/10.3390/ceramics8020065

APA Style

Somolová, L., Morozova, Y., Voborná, I., Rosa, M., Novotná, B., Holík, P., & Langová, K. (2025). Comparison of Apical Microleakage in Bioceramic and Resin-Based Endodontic Sealers with Conventional and Bioceramic Surface-Impregnated Gutta-Percha Points. Ceramics, 8(2), 65. https://doi.org/10.3390/ceramics8020065

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