Influence of Final Irrigation on Calcium Silicate-Based Sealer Dentinal Tubular Penetration: A Systematic Review

The aim of this systematic review was to assess the influence of different final irrigation protocols and activation methods on the dentinal tubular penetration of calcium silicate-based sealers (CSSs). The review followed the PRISMA 2020 guidelines, and the protocol was registered in the Open Science Framework (OSF; DOI: 10.17605/OSF.IO/5HTVN). A PICOS-based research question was formulated, and a comprehensive literature search was conducted in MEDLINE, Scopus, Embase, Web of Science, and SciELO up to October 2025. After study selection, a qualitative synthesis of methodologies and outcomes was performed, and methodological quality was assessed using the QUIN tool. Twenty-one in vitro studies were included, all of which used single-rooted teeth or single roots. The available evidence suggests that final irrigation protocols may influence CSS penetration, although the magnitude and consistency of this effect varied substantially across studies. Sodium hypochlorite (NaOCl) and 17% EDTA were the most frequently investigated irrigants and were generally associated with improved penetration, but no irrigation protocol or activation technique can currently be considered superior. Current research trends include the evaluation of chelating agents, continuous chelation protocols, and irrigant activation systems such as passive ultrasonic irrigation, sonic activation, laser activation, and XP-Endo Finisher. Future studies should standardize irrigation protocols, activation methods, sealer types, obturation techniques, microscopy-based assessment procedures, and penetration outcome measures, while also including larger samples and more anatomically complex root canal systems.