Functional and Bioactive Performance of Premixed Bioceramic Sealers with Warm Obturation: A Scoping Review

Premixed bioceramic sealers represent a recent advancement in endodontic obturation, combining bioactivity, moisture-induced mineralization and favorable handling properties. When used with warm gutta-percha techniques, these calcium silicate-based sealers are exposed to elevated temperatures that may influence their physicochemical behavior and interfacial performance. This review aimed to summarize current evidence on premixed bioceramic sealers used in conjunction with thermoplastic obturation techniques. A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science for studies published between January 2020 and July 2025 evaluating the physicochemical properties, bioactivity, sealing ability, fracture resistance, clinical outcomes and retreatability of premixed bioceramic sealers under warm obturation conditions. No meta-analysis was performed-this review provides a narrative synthesis of the available evidence within this scope. Twenty-five studies met the inclusion criteria. In vitro and ex vivo data indicate that premixed bioceramic sealers generally maintain chemical stability and bioactivity when exposed to clinically relevant heating protocols, with favorable dentinal tubule penetration, interfacial adaptation and the formation of calcium silicate hydrate, and hydroxyapatite at the sealer-dentin interface. These characteristics are associated with improved filling homogeneity, potential reinforcement of root dentin and high rates of periapical healing reported in limited short-term clinical studies. However, the evidence also highlights important challenges, including technique-sensitive retreatability, material remnants after re-instrumentation and concerns regarding overextension, and long-term dimensional stability. Within the limitations of predominantly in vitro and short-term clinical evidence, premixed bioceramic sealers used with warm gutta-percha techniques appear to be promising functional materials that combine mechanical sealing with bioactive and mineralizing potential. Standardized protocols and robust long-term clinical studies are needed to confirm their durability, retreatability and prognostic impact in routine endodontic practice.