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The Fate of Apically Extruded Sealers: Radiographical Disappearance or Biological Integration? A Narrative Review
Fausto Zamparini1, Andrea Spinelli1, Stefano Palma1
1Endodontic Clinical Section, Dental School, University of Bologna, Via san vitale 59, Bologna, Italy.
European Endodontic Journal
|May 13, 2026
Summary
Accidental extrusion of endodontic sealers into apical tissues can cause varied tissue responses. Bioactive sealers, like bioceramics, may show dynamic radiographical changes, unlike bioinert materials.
Area of Science:
- Endodontics
- Biomaterials Science
- Regenerative Dentistry
Background:
- Novel bioactive and biointeractive endodontic materials have been developed.
- Limited consensus exists on the biological consequences of apical sealer extrusion, especially with premixed bioceramic sealers.
Purpose of the Study:
- To analyze immediate and long-term effects of apical extrusion of new bioactive root canal sealers.
- To compare these effects with traditional bioinert obturation materials.
Main Methods:
- Comprehensive literature search across Scopus, PubMed, and Embase.
- Inclusion of clinical reports, in vivo animal studies, and in vitro experiments.
- Evaluation of clinical outcomes, apical healing, pain, extrusion occurrence, tissue responses, inflammation, and sealer resorption.
Main Results:
- Biological behavior varies significantly with sealer formulation and periapical tissue interaction.
- Apical extrusion of bioactive sealers (e.g., premixed bioceramics) can lead to dynamic radiographical modifications.
- Minor percentages of zinc oxide and calcium hydroxide sealers showed similar modifications, while epoxy resin-based sealers did not.
Conclusions:
- Extrusion of any endodontic material poses risks, especially with existing periapical pathologies.
- Understanding sealer properties and composition is crucial for clinicians.
- Further long-term clinical trials and standardized terminology are needed to clarify the impact of sealer extrusion and radiographical disappearance.
