Retreatment Strategies for Root Canals Obturated with Calcium Silicate-Based Sealers: A Comprehensive Review

Abstract

Calcium silicate-based sealers (CSBS) have gained widespread acceptance in endodontics due to their superior biocompatibility, bioactivity, and excellent sealing properties. However, their removal during endodontic retreatment presents unique challenges due to their chemical bonding to dentin, high radiopacity, and resistance to conventional solvents. This comprehensive review evaluates the efficacy of current retreatment strategies for root canals obturated with CSBS, including mechanical (rotary and reciprocating file systems, ultrasonic activation), chemical (solvents such as EDTA, chloroform, and citric acid), and combined approaches.

Key findings indicate that mechanical methods alone are insufficient for complete sealer removal, often leaving residual debris in the apical third. Chemical solvents, particularly 17% EDTA, demonstrate improved efficacy due to their calcium-chelating properties, while passive ultrasonic irrigation (PUI) significantly enhances debridement in complex anatomies. Emerging adjunctive technologies, such as laser-assisted retreatment (Er:YAG, Nd:YAG) and XP-endo Finisher systems, show promise but require further clinical validation.

This review also discusses clinical considerations, including case selection, sealer composition, and anatomical challenges, while providing evidence-based recommendations for optimizing retreatment outcomes. Future research directions focus on advanced disinfection protocols and bioceramic solvent formulations to improve retreatment predictability.

Keywords:

Calcium silicate-based sealers, endodontic retreatment, bioceramic sealers, retreatment techniques, root canal therapy

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