Bioceramic Endodontic Sealers: A Structured Narrative Review of Physicochemical Properties, Biological Behavior, Clinical Outcomes, and Limitations

Bioceramic endodontic sealers have become increasingly important in contemporary root canal obturation because of their hydraulic setting, hydrophilicity, alkaline pH, calcium ion release, bioactivity, and potential interaction with dentin and periapical tissues. The aim of this structured narrative literature review was to evaluate current evidence regarding bioceramic endodontic sealers, with emphasis on their composition, physicochemical properties, biological behavior, sealing ability, obturation techniques, clinical outcomes, postoperative pain, retreatability, and limitations. A literature search was performed using PubMed, PubMed Central, and Europe PMC, focusing on English-language full-text articles published between 2022 and 2026. The reviewed literature suggests that calcium silicate-based sealers demonstrate favorable laboratory properties, including dentinal tubule penetration, calcium ion release, high alkalinity, apatite-forming ability, and acceptable cytocompatibility. However, these properties vary between commercial products and should not be generalized to the entire material class. Clinical studies indicate that bioceramic sealers can achieve outcomes comparable to traditional epoxy resin- and zinc oxide-eugenol-based sealers, particularly when used with single-cone or sealer-based obturation techniques. Current evidence supports bioceramic sealers as clinically viable alternatives rather than universally superior replacements. Further long-term clinical studies are needed to clarify product-specific performance, retreatability, extrusion behavior, and long-term treatment outcomes.