Clinical implications of apically extruded resin-based sealers: A long-term observation

Apical extrusion of resin-based sealers is a common yet concerning event in root canal therapy, with uncertain effects on long-term periapical healing. This case series evaluates the clinical and radiographic outcomes of four cases with unintentional sealer extrusion, treated nonsurgically by a single operator using standardized protocols. All cases showed extrusion of resin-based sealer without gutta-percha overextension. Patients were followed for up to 3 years with periodic assessments. Despite the presence of extruded material, all cases exhibited favorable healing or healed status based on Strindberg's criteria, with no clinical symptoms reported. Although the volume of sealer appeared reduced over time, complete resorption was not observed. These findings suggest that apically extruded resin-based sealers may remain inert and do not necessarily compromise periapical healing. Further studies with larger sample sizes and advanced imaging modalities are recommended to validate these observations and explore outcomes with different sealer types.