Comparison of apical microleakage between CEM cement and cold ceramic as root-end filling materials, an in vitro study

Public attitudes toward oral health have shifted toward preserving natural tooth structure. Achieving an effective apical seal is critical to prevent bacterial microleakage. This in vitro study aimed to compare apical microleakage between Calcium-Enriched Mixture (CEM) Cement and Cold Ceramic as root-end filling materials. Sixty extracted single-rooted human teeth with closed apices were used. After decoronation and root canal preparation, a 3-mm apical resection was performed, and 3-mm retrograde cavities were prepared using an ultrasonic device under magnification. Teeth were randomly assigned to two experimental groups ( n = 25 each) receiving either CEM Cement (BioniqueDent) or Cold Ceramic (SANIN), plus positive and negative controls ( n = 5 each). Bacterial leakage was assessed using a dual-chamber model with Enterococcus faecalis over 90 days. Statistical analysis included Fisher’s exact test, Mann–Whitney U test, and Kaplan–Meier survival analysis. Apical microleakage occurred in 72% of the CEM Cement group and 92% of the Cold Ceramic group. The difference was not statistically significant ( p = 0.138). Mean time to leakage was 13.83 days (median 11.5 days) for CEM Cement and 12.70 days (median 10 days) for Cold Ceramic ( p = 0.793). Kaplan–Meier analysis showed no significant difference in time to leakage (log-rank p = 0.07). This in vitro study found no statistically significant difference in apical microleakage between CEM Cement and Cold Ceramic. Further long-term clinical studies are warranted.