Endodontic Sealers and Innovations to Enhance Their Properties: A Current Review

Endodontic sealers are crucial for achieving an effective root canal obturation, preventing reinfection and promoting long-term treatment success. This review categorizes sealers by chemical composition, including traditional types such as zinc oxide-eugenol, glass ionomer, silicone, methacrylate and epoxy resins, calcium hydroxide, and the latest bioceramic formulations. Each type is evaluated for its physicochemical properties, biocompatibility, sealing ability, antimicrobial activity, and clinical limitations. A significant focus is placed on recent research into modifications of these materials with antimicrobial agents, aimed at improving antibacterial properties, bioactivity, and sealing performance. Among these, chitosan emerges as the most promising additive due to its broad antimicrobial spectrum, low cytotoxicity, and enhancement of sealing capacity. While bioceramic sealers represent a notable advancement due to their bioactivity and favorable interaction with moist environments, concerns regarding potential neurotoxicity and retreatability remain. The article presents recent advancements in the enhancement of endodontic sealers through the incorporation of organic and inorganic additives. It further delineates key research priorities, particularly the integration of bioactive materials, nanotechnology, and naturally derived compounds, with an emphasis on their potential applications in pediatric endodontics. Overall, while contemporary sealers offer a wide range of benefits, continued innovation is needed to optimize their biological safety, mechanical performance, and clinical usability.