Diagnostic Challenges: Radiographic Artifact Expression of Hydraulic Calcium Silicate-Based Root Canal Sealers: A Comparative Analysis

Objective: This study aimed to compare the artifact expression of different hydraulic calcium silicate-based root canal sealers using standardized cone-beam computed tomography (CBCT) imaging parameters.Methods: A polymethylmethacrylate (PMMA) model with a standardized cylindrical cavity (0.5 × 0.5 cm) was used. The cavity was filled with AH Plus, AH Plus Bioceramic, NeoSealer Flo, Bio-C Sealer, MTA Cem S, or Bioserra, following manufacturers’ instructions. After setting, each material within the PMMA phantom was scanned using CBCT (Planmeca ProMax 3D Classic; Planmeca, Finland) at 90 kVp, 3.6 mA, 0.2 mm voxel size, and 8×8 cm FOV. The empty phantom served as the control. Each group was scanned three times. Around each material, eight regions of interest (ROIs) were defined. The standard deviation (SD) of gray values within the ROIs was calculated to assess artifact presence. Statistical analysis was performed using the Kruskal–Wallis test with post hoc Bonferroni correction (p = .05).Results: The control group showed significantly lower SD values than all sealer groups (p < .001). AH Plus Bioceramic, NeoSealer Flo, Bio-C Sealer, and MTA Cem S had similar SD values to AH Plus. However, Bioserra exhibited significantly higher SD values compared to AH Plus, AH Plus Bioceramic, and Bio-C Sealer (p < .001).Conclusions: All bioceramic sealers generated artifacts on CBCT. Among them, Bioserra resulted in more pronounced artifacts. These findings suggest that bioceramic sealers may complicate CBCT interpretation, emphasizing the importance of material selection in clinical imaging.