Bioceramic Sealer Research Articles

Treating apical fenestration in a previously endodontically treated tooth

Apical fenestration is a defect in the alveolar cortical plate, exposing the root without involving the alveolar bone margin, often linked to trauma, periodontal disease, and orthodontic treatment, leading to symptoms such as pain and abscesses from endodontic infections. This case report describes managing a mucosal fenestration in an endodontically treated tooth with nonsurgical root canal therapy and periodontal surgery. A 44-year-old male presented with mucosal fenestration and pain in the upper front jaw due to trauma and an inadequately treated root canal. Examination revealed an ill-fitting crown and an open apex with periapical radiolucency. Treatment included scaling, root planing, nonsurgical root canal therapy, apexification using Biodentine, and obturation with bioceramic sealer. Persistent fenestration necessitated periodontal surgery to remove extruded material and place an alloplastic graft. Apical fenestrations, although uncommon, require coordinated endodontic and periodontal treatment for successful outcomes.

Comparative Evaluation Of The Effect Of Different Chelating Agents On The Push-Out Bond Strength Of A Bioceramic Sealer: An In-Vitro Study

Aim: This study aimed to assess how the push out bond strength of a bioceramic sealer (Meta CeraSeal) is affected by three different chelating agents: 17% EDTA, 7% Maleic acid, and 5% Pentetic acid. Methodology: 60 mandibular premolars were shaped using Pro Taper Gold rotary file upto size F2. The canals were irrigated with 2ml of 5.25% sodium hypochlorite (NaOCl) between instrumentation and then the NaOCl was removed by rinsing with five milliliters of distilled water.. The 60 specimens were divided into 4 groups of 15 each, in a random manner, depending on the final irrigating solution: Group 1 (n=15): 17% EDTA,Group 2 (n=15): 7% Maleic acid,Group 3 (n=15): 5% Pentetic acid and Group 4 (n=15): 0.9% Saline. The canals were obturated with Meta CeraSeal coated gutta percha using single cone technique. Access to cavities were sealed and the specimens were sectioned to obtain three horizontal sections at distances of 12, 6, and 2 mm from the apex (coronal, middle, and apical root sections, respectively). A universal testing machine was used to apply the push-out test. Results: The push out bond strength was significantly higher for 5% Pentetic acid as compared to 17% EDTA and 7% Maleic acid (p<0.05). Also, the apical third exhibited the lowest push out bond strength value in all the groups. Conclusion: Within the limitations of the study, it can be concluded that, in comparison to the other tested groups, 5% pentetic acid has higher potential to facilitate the bonding of the bioceramic sealer Meta CeraSeal to root dentin

Nonsurgical root canal treatment of an Oehlers type IIIa maxillary central incisor with dens invaginatus: a case report

Dens invaginatus has a complex anatomy, making endodontic treatment challenging. We report the case of a 11-year-old girl who presented with radiolucency at the apex of the maxillary central incisor; she was diagnosed with symptomatic apical periodontitis. Cone-beam computed tomography (CBCT) revealed dens invaginatus. The invagination and root canal were observed using a dental operating microscope, and nonsurgical root canal treatment was performed. The invagination was connected to the periodontal tissue, and the tooth was classified as Oehlers type IIIa. Root canal preparations were performed using NiTi files and an ultrasonic device. A calcium hydroxide paste was used as an intracanal dressing. The root canal was filled using a single-cone hydraulic condensation technique with a highly fluid calcium silicate-based sealer. At the 2-year follow-up, no clinical symptoms were observed, and CBCT images revealed no radiographic lesions. Nonsurgical endodontic treatment using CBCT imaging, dental microscope, effective cleaning systems, and a highly fluid sealer facilitated the successful treatment of apical periodontitis attributed to dens invaginatus. The single-cone hydraulic condensation technique using a bio-ceramic sealer is considered effective even in cases with a complex morphology and open apex.

Effect of bioceramic-based and resin-based sealers on postoperative discomfort following root canal therapy: a systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to furnish evidence-based recommendations for the utilization of bioceramic-based and resin-based sealers in clinical endodontics, with a focus on reducing postoperative discomfort. The investigation's methodology was registered on the International Prospective Database of Systematic Reviews (PROSPERO: CRD42022355506) and executed using the 2020 PRISMA protocol. Articles were selected utilizing the PICO technique and applying specific inclusion and exclusion criteria. Articles published between January 2000 and August 2022, PubMed, MEDLINE, and DOAJ were utilized as primary data sources. After the identification of studies, two autonomous reviewers evaluated the titles and abstracts, and data from qualifying studies were extracted. Nine published studies were included in this analysis. The findings indicate that there were no significant differences in the Visual Analog Scale (VAS) scores between resin-based and bioceramic root canal sealers at intervals of 6 hours, 12 hours, 24 hours, and 48 hours after treatment. The findings of this systematic review and meta-analysis suggest that after the utilization of bioceramic sealers during root canal therapy, the pain and discomfort levels were not significantly different from those experienced pain after the use of resin-based sealers.

Sealing Ability of Bioceramic Sealer after Ultrasonic Activation of Different Root Canal Irrigating Solutions

Aim To evaluate and compare the sealing ability of bio ceramic root canal sealer after ultrasonic activation of root canal irrigation solutions 3% NaOCl , 40% Citric acid & Neem leaf extract .  Materials and Methods In this study, 42 mandibular premolar teeth with single roots and canals were divided into three groups for irrigation: 3% NaOCl, 40% citric acid, and Neem leaf extract. After access preparation and glide path creation with a #10 K-file (0.02 taper), the canals were instrumented using a crown-down technique to an ISO size of 30, with saline as the irrigant. Ultrasonically activated irrigation was used, followed by saline in all groups. The canals were obturated with Dentsply Gutta- percha and Bio C sealer, 1mm short of the working length, and sealed with temporary restorations. Teeth were incubated at 37°C for 3 days, and horizontal sections at 3mm from the apex were taken. Confocal laser scanning microscopy measured sealer penetration, and statistical analysis was conducted to compare results between groups.  Results The results suggest that 40% citric acid is the most effective irrigant for enhancing sealer penetration into dentinal tubules at the apical third, both in terms of percentage and depth of penetration, compared to 3% NaOCl and neem leaf extract. This indicates that citric acid may improve the sealing ability of root canal treatments more effectively than the other tested irrigants.  Conclusion The results suggest that 40% citric acid is the most effective irrigant for enhancing sealer penetration into dentinal tubules at the apical third, both in terms of percentage and depth of penetration, compared to 3% NaOCl and neem leaf extract. This indicates that citric acid may improve the sealing ability of root canal treatments more effectively than the other tested irrigants.

Comparison of Retreatability of AH Plus Sealer and Bioceramic Sealer with Solvent, Retreatment Files and Diode Laser: A CBCT and SEM Analysis

ABSTRACT Aim: The present study evaluated the retreatability of canals obturated using AH Plus sealer and Bioceramic (BC) sealers, employing Cone beam computed tomography (CBCT) and Scanning Electron Microscope (SEM). Methodology: A group of 90 extracted premolars was classified into two main categories based on whether they were sealed with AH Plus or BC Sealer. Each of these categories was then divided into two subcategories according to the retreatment technique applied. CBCT and SEM were used to assess the residual filling material within the canals. Results: The findings showed that there was no marked statistical variation in the retreatment success of canals sealed with BC and AH Plus sealers. Conclusion: The diode laser was the most effective modality for eliminating root canal filling materials in the least amount of time. None of the retreatment modalities used removed the obturating material completely.

Clinical outcomes of nonsurgical root canal treatment using NeoSealer Flo and Endosequence BC Sealer: A retrospective analysis with short-term follow-up.

Sealers are an important component in root canal obturation to provide the seal of the root canal system. In recent years, there has been an increase in the use of hydraulic silicate sealers, commonly referred to as bioceramic sealers, due to their many advantageous properties. NeoSealer Flo (NS; Avalon Biomed USA, Houston TX) is a recently introduced premixed bioceramic sealer. There is limited evidence on its properties and clinical performance. Therefore, the purpose of this study was to evaluate the outcome of root canal treatment using NS in a sealer-based obturation technique. The records of patients in a private practice between 2017 and 2022 were analyzed to identify both initial and retreatment cases obturated with either EndoSequence BC sealer or NS using sealer-based obturation with a minimum of one-year follow-up. Treatment outcome between NS and BC was compared with chi-square test. Logistic regression was used to identify additional prognostic factors. Six hundred and eighty-seven teeth met the inclusion criteria for the study. The success rate of cases obturated with BC was 94.9% and 96.5% for the cases obturated with NS.No statistically significant differences were found between the two sealer types. Presence of a periapical radiolucency or periapical radiolucency > 5.00mm were statistically significant prognostic factors. Endodontic treatment using BC or NS with sealer-based obturation method is a viable treatment option. Root canal obturation with bioceramic sealers, such as NeoSealer Flo and Endosequence BC sealer, provide favorable clinical outcomes.

Immediate and delayed shear bond strength evaluation between root canal sealers and restorative materials: an experimental study

BackgroundSeveral calcium silicate-based sealers have recently emerged in endodontics. This study aimed to compare the immediate and delayed shear bond strength between the bioceramic and calcium hydroxide-based sealers and different resin-based restorative materials.MethodsOne hundred and twenty specimens with a 3-mm depth and a 3-mm diameter were prepared. They were evenly divided into two groups, the bioceramic sealer and calcium hydroxide-based sealer groups. Each primary group was subdivided into two subgroups based on the restorative material used; i.e., the flowable resin composite and resin-modified glass ionomer subgroups. Moreover, each subgroup was further divided into the restoration process’s timing: either immediately post-sealing or delayed after setting the sealers for seven days. The mode of failure was assessed by stereomicroscopic examination.ResultsThe highest shear bond strength was found when the bioceramic sealer was used and restored with the flowable resin composite. The strengths were 8.45 (1.17) and 6.67 (1.60) megapascals (MPa) in the immediate and delayed restoration groups, respectively. In contrast, the lowest strength, 2.91 (1.22) MPa, was recorded when calcium hydroxide-based sealer was employed and restored after allowing the sealer to set completely with resin-modified glass ionomer. Notably, there were no cohesive fractures within the tested restorative materials. All observed fractures occurred within the sealer materials, at the interface of the sealer and restorative material, or in combination. Moreover, the most common failure was a mixed failure.ConclusionsWhen flowable resin composite was used immediately before complete setting, bioceramic sealers showed a higher bond strength than calcium hydroxide-based sealers.

Comparison of Different Obturation Techniques in the Dentinal Tubule Penetration of EndoSequence® Bioceramic Sealer HiFlow™: An In-Vitro Study.

Background This study aimed to assess the dentinal tubule penetration of bioceramic sealer(DTPB) using EndoSequence® Bioceramic Sealer HiFlow™ (BCHF). Three obturation techniques were compared, namely, single cone (SC), cold lateral condensation (CLC), and warm vertical compaction (WVC) using scanning electron microscopy (SEM). Methodology A total of 45 intact mandibular premolars were decoronated, instrumented, and irrigated with uniform procedures. Subsequently, they were randomly assigned into the following three groups according to the gutta-percha and BCHF obturation technique: Group 1 (n = 15) with the SC technique, Group 2 (n = 15) with the CLC technique, and Group 3 (n = 15) with the WVC technique. Afterward, the roots were sectioned at three levels (coronal, middle, apical) from the apex and examined using SEM to determine the maximum distance of DTPB in µm. The collected data were analyzed using SPSS software (IBM Corp., Armonk, NY, USA) using the one-way analysis of variance test and Bonferroni tests. The level of significance was set at α of 0.05. Results Significant differences were observed in the maximum distances of DTPB values among the three levels across groups (p < 0.05). Both the WVC and CLC groups exhibited higher values compared to the SC group (p < 0.05). Specifically, the DTPB maximum distance at the apical third was significantly higher in the CLC group than in the WVC and SC groups (p < 0.05). Additionally, the coronal third in each group demonstrated significant DTPB maximum distance (p < 0.05) compared to the other groups. Conclusions BCHF with the WVC and CLC obturation technique showed the best performance in DTPB maximum distance values at the three levels.

Comparative evaluation of the effect of three different obturation techniques on push-out bond strength of AH Plus Bioceramic and EndoCeramic sealers: An in vitro study

Abstract Context: Effect of three different obturation techniques on bond strength of bioceramic sealers. Aim: This study aimed to investigate the effect of cold lateral compaction, thermafil, and thermoplasticized obturation techniques on the push-out bond strength of AH Plus Bioceramic and EndoCeramic sealers. Settings and Design: The design of the study was an in vitro study. Materials and Methods: Forty-two extracted teeth that were single-rooted and had fully developed apices were chosen, decoronated, and biomechanically prepared using rotary nickel–titanium (NiTi) instruments. Samples were divided into two groups of n = 21. Group 1: AH Plus Bioceramic sealer, Group 2: EndoCeramic sealer. Then, based on the obturation technique employed, each group was divided into three subgroups (n = 7): subgroups 1a, 2a: Cold lateral compaction; Subgroups 1b, 2b: Thermafil; and Subgroups 1c, 2c: Thermoplasticized (obtura). Using universal testing machine, slices from the middle third of the sample’s root were analyzed to determine the push-out bond strength values. Results: Compared to other groups push-out bond strength was noticeably higher for the cold lateral compaction technique with EndoCeramic sealer (Subgroup 2a), followed by the Thermafil technique with EndoCeramic sealer (Subgroup 2b). Conclusions: In the present study, compared to heat-based obturation techniques, cold lateral compaction showed better push-out bond strength values for both sealers. EndoCeramic sealer resulted in greater push-out bond strength values than AH Plus Bioceramic sealer.

Retrievability of bio-ceramic sealers from root canals obturated using two different techniques

Retrievability of bio-ceramic sealers from root canals obturated using two different techniques

Assessment of sealer penetration of Bioceramic sealer with different activation techniques using Confocal Laser Microscopy (An In-vitro study)

Assessment of sealer penetration of Bioceramic sealer with different activation techniques using Confocal Laser Microscopy (An In-vitro study)

Impact of different disinfection protocols on the bond strength of NeoMTA 2 bioceramic sealer used as a root canal apical plug (in vitro study)

IntroductionTreatment of an immature permanent tooth required a special disinfection protocol due to the presence of thin radicular walls, which are prone to fracture. Mineral Trioxide Aggregate (MTA) has been proposed as a root repair material for root canal treatment. The aim of this in vitro study was to compare the push-out bond strength of conventional White MTA cements and second generation NeoMTA 2 in imitated immature roots treated with different disinfection protocols, which are 5.25% sodium hypochlorite (NaOCl), followed by 17% ethylenediaminetetraacetic acid (EDTA), and NaOCl, followed by 20% etidronic acid (HEBP).MethodsThe root canals of freshly extracted single-root teeth were manually prepared until 90 K-file to imitate immature roots. Roots were randomly divided into four groups (G) according to the disinfection protocol (n = 15 per group). where G1 (NaOCl + EDTA + White MTA) and G2 (NaOCl + EDTA + NeoMTA 2) While G3 (NaOCl + HEBP + White MTA) and G4 (NaOCl + HEBP + NeoMTA 2) All groups were activated with manual agitation. All specimens were incubated for 48 h. The apical third of each root was perpendicularly sectioned to attain a slice of 3 mm thickness. Push-out bond strength values were assessed using a two-way ANOVA and a Student’s t test.ResultsG3 and G4 that were treated with HEPB showed higher significant push-out bond strength mean values than G1 and G2 treated with an EDTA chelating agent. Irrespective of the chelating agent used, it was found that both NeoMTA 2 and White MTA had no significant influence on push-out bond strength mean values (p ≤ 0.05).ConclusionThe combined use of 5.25% NaOCl and 20% HEBP increased the push-out strength values of both NeoMTA 2 and White MTA, rendering them suitable to be used as an alternative chelating agent to EDTA.

Comparative In Vitro Analysis of Push-Out Bond Strength of Different Root Canal Sealers to Root Dentin

ABSTRACT Aim: The study’s objective is to assess the bond strengths of four different endodontic sealers to root dentin using a push-out test technique. Material and Method: Sixty single-rooted teeth were selected and decoronated. Canal instrumentation was done using rotary files and divided into four groups (n = 15) based on the sealer used. Group 1: zinc oxide eugenol (ZOE)-based, Group 2: epoxy resin-based, Group 3: methacrylate-based, and Group 4: bioceramic. Following obturation with Gutta Percha, each tooth was prepared with root portions that were 2 mm thick at the apical and middle 1/3 so that universal testing equipment could measure the push-out bond strength. Tukey’s post hoc tests and one-way ANOVA were used to examine the data. Result: According to the results, group 4 had the strongest push-out relationship, followed by groups 3, 2, and 1, respectively. It can be concluded that the bioceramic sealers have superior bond strengths. Conclusion: Bioceramic sealers demonstrated the highest bond strengths to root dentin, outperforming methacrylate, epoxy resin, and zinc oxide eugenol sealers in the push-out test.

The Push-Out Bond Strength, Surface Roughness, and Antimicrobial Properties of Endodontic Bioceramic Sealers Supplemented with Silver Nanoparticles.

This study evaluated push-out bond test (POBT), surface roughness, and antimicrobial properties against Enterococcus faecalis of bioceramic sealers supplemented with silver nanoparticles (AgNPs). The sealers tested were CeraSeal®, EndoSequence® BC SealerTM, and Bio-C® Sealer. The POBT was measured with a Universal Testing Machine, and the type of failure was evaluated with a stereomicroscope. The roughness average (Sa) and peak-valley height (Sy) values were evaluated by atomic force microscopy. The bacterial growth inhibition was evaluated using a disk diffusion test, and antimicrobial activity was determined with the plate microdilution method. The POBT showed no significant difference between sealers with and those without NPs in cervical and apical thirds (p > 0.05). In the middle third, the adhesion force was significant for Endosequence BC Sealer® (p < 0.05). The results showed that the Sa and Sy parameters, when AgNPs were added, did not show a statistically significant difference compared to the groups without nanoparticles (p > 0.05). All tested sealers showed bacterial growth inhibition, but no significant difference was found. Their efficacy, in descending order of antibacterial activity when AgNPs were added, is as follows: EndoSequence® BC SealerTM > Bio-C® Sealer > CeraSeal®. The incorporation of AgNPs into bioceramics improves antimicrobial activity without affecting mechanical properties.

Comparison between AH plus sealer and total fill bioceramic sealer performance in previously untreated and retreatment cases of maxillary incisors with large-sized periapical lesion: a randomized controlled trial

ObjectiveThis study aims to assess the efficacy of bioceramic (BC) sealer when applied using the single cone technique (SCT), in comparison to AH Plus sealer applied with the cold lateral condensation technique (LCT), concerning their impact on the healing of large-sized periapical lesions in both untreated and retreatment cases.Materials and methodsA randomized controlled trial was conducted on 41 patients who had 60 permanent teeth in the maxillary incisors that were accompanied by large-sized periapical lesions. The included teeth were radiographed with cone beam computed tomography (CBCT) images and divided equally into two groups according to the endodontic treatment statute (30 untreated previous cases and 30 retreated cases). Subsequently, teeth received uniform preparation, irrigation, and dressing procedures. Then each group was divided equally according to the used sealer (15 teeth obturated using AH plus sealer with LCT and 15 teeth obturated using BC sealer with SCT). All cases were followed up after 6 and 12 months with CBCT images. Subsequently, the change in periapical lesion diameter (PLD) was observed as an indicator to determine the treatment outcome score. One-way ANOVA and Mann–Whitney U test were used to analyze the PLD changing and scoring the treatment outcome during the follow-up periods. The significance level was set at α = 0.05.ResultsThere were no statistically significant differences between untreated and retreatment cases neither using AH plus sealer with LCT nor BC sealer with SCT regarding changes in PLD in the follow-up periods. Moreover, there were no significant differences between groups regarding treatment outcome scores in the follow-up periods. All groups showed a high success rate.ConclusionsSuccessful treatment was achieved for untreated or retreatment maxillary incisor cases accompanied by large-sized periapical lesions using either BC sealer with the SCT or AH Plus sealer with LCT with a similar high success rate up to 12 months follow-up period.

The Efficiency of Different Supplementary Irrigation Techniques After Nickel-Titanium Rotary System in Endodontic Retreatment

Objective: To assess the efficiency of XP-Endo Finisher file (XPFF), EDDY, and diode laser as supplementary irrigation activation techniques following nickel-titanium rotary files in the endodontic retreatment. Methods: 48 mandibular premolars were collected. Each root canal was shaped and filled with EndoSequence BC sealer and gutta percha. After 14 days, endodontic retreatment was performed using D-Race instruments. Then, 48 samples were assigned into 4 groups (n=12) as control, diode laser, EDDY, and XPFF according to the supplementary irrigation methods. After the irrigation procedure, all samples were visualized under a stereomicroscope. The remaining root filling material was scored and compared statistically using Kruskal-Wallis and Post-hoc pairwise comparison tests. Results: In all thirds, there was a significant difference between the diode laser and control groups. The amount of remaining filling material in the diode laser group was significantly lower than in the control group. When the other groups were compared, a significant difference was observed only between the diode laser and XPFF groups in the coronal third. Conclusion: No supplemental method could eliminate the root obturation material. The diode laser can be used in addition to nickel-titanium rotary retreatment systems to improve the removal of gutta percha and bioceramic sealer.

A Comparison of Two Fluorescent Stains for the Evaluation of Bioceramic Sealer Penetration into the Tubular Dentine Using Confocal Microscopy

This study aimed to compare the percentage of bioceramic sealer penetration and maximum penetration sealer depending on the fluorescent staining method when evaluated with confocal laser scanning microscopy (CLSM). In total, 42 single-rooted premolars were instrumented. Two groups of 20 teeth each were filled using the single cone technique. TotalFill BC Sealer® mixed with Rhodamine B was used for the first group and TotalFill BC Sealer® mixed with Fluo-3 for the second group. Two teeth made up the control group. All teeth were sectioned at 3 and 6 mm from the apex and were analyzed with CLSM. The canal perimeter where the tubular penetration happened and the maximum penetration of each sample were calculated. There were no significant differences between the two groups in either the apical or medial sections. In terms of maximum penetration, Rhodamine B had greater tubular penetration in the apical sections, and it had similar results to Fluo-3 in the medial sections. TotalFill BC Sealer® has a higher tubular penetration in the medial slices than in the apical slices regardless of the fluorescent stain used. Rhodamine B has higher results than Fluo-3 in terms of the percentage of sealer penetration and maximum penetration.

Clinical outcome of non-surgical root canal treatment using different sealers and techniques of obturation in 237 patients: A retrospective study

ObjectivesThe aim of this retrospective study was to compare the clinical results of two root canal sealers and three obturation techniques used for non-surgical root canal treatment.Materials and methodsA total of two hundred eighty-three root canal treated teeth in two hundred thirty-seven patients with minimum a 6-month follow-up was included for this study. The canals were filled with three different modes: 1) cold lateral condensation (CLC) and AH Plus Sealer; 2) continuous wave condensation technique (CWC) and AH Plus Sealer, and 3) sealer-based obturation technique (SBO) and AH Plus Bioceramic Sealer. The treatment outcome was analysed based on clinical signs and symptoms, and periapical radiograph (periapical index, PAI).ResultsThere were no significant differences in treatment outcome between various sealers and filling techniques applied. The sealer extrusion was found most frequently in the CWC group (60.67%), followed by SBO (59.21%) and CLC (21.19%) with statistically significant differences (p < .05). The initial diagnosis, previous treatment and sealer extrusion (p < .05) were prognostic factors that affected treatment outcome.ConclusionsBased on the findings of this study, neither the sealer type nor the filling technique affected the treatment success while preoperative diagnosis, previous treatment and sealer extrusion had significant effect on the outcome.Clinical relevanceA bioceramic sealant applied along with the single-cone technique might be considered as an alternative method in root canal obturation.

Non-surgical endodontic treatment of a type III dens invaginatus with large perirradicular radiolucency using bioceramic materials: Case report

Dens invaginatus (DI), also known as dens in dente, is an uncommon dental anomaly in humans, characterized by irregular morphological development during odontogenesis, which can manifest in various coronal and radicular anatomies. Endodontic treatment of teeth with this variation demands anatomical knowledge, detailed planning, and the use of specialized techniques and materials. The objective of this research is to detail, through a case report, the non-surgical endodontic treatment of type III dens invaginatus in the upper lateral incisor with extensive periapical lesion, using bioceramic materials. An 18-year-old female patient was referred to the referral center by an orthodontist after radiographic examination revealed an extensive periapical lesion on tooth 12. Consequently, cone beam computed tomography was requested to assess the lesion and internal/external anatomy. The endodontic treatment was performed entirely under operative microscopy, utilizing mechanized instrumentation and thermoplasticized obturation. Disinfection was enhanced through activated irrigation technique and intracanal placement of bioceramic medication, with periapical repair achieved using bioceramic sealer cement. Long-term follow-up demonstrated that conservative endodontic treatment, employing modern techniques alongside bioceramic materials, proved effective in resolving complex cases.