Comparative efficacy of two novel bioceramic root canal sealers in the treatment of chronic apical periodontitis

Chronic apical periodontitis (CAP) is a persistent periradicular inflammatory condition driven by intraradicular infection and remains a common indication for primary nonsurgical root canal therapy. This retrospective cohort study compared 2 calcium silicate-based bioceramic root canal sealers (C-Root SP vs iRoot SP) used during obturation in adults treated for CAP between January 2022 and December 2024. CAP was confirmed by compatible clinical findings and radiographic evidence of periapical radiolucency; cone-beam computed tomography (CBCT) was obtained when clinically indicated. The primary endpoint was a strict composite treatment success endpoint requiring both clinical resolution and radiographic healing at final follow-up. Secondary outcomes included pain severity measured by the visual analog scale (VAS) and treatment-related events. Among 227 eligible patients, 209 were included in the final analysis (C-Root SP, n = 101; iRoot SP, n = 108). Treatment success was higher with C-Root SP than with iRoot SP (86.1% vs 74.1%; χ2 = 4.73, P = .030), and radiographic healing was also more frequent (88.1% vs 76.9%; χ2 = 4.55, P = .033), whereas clinical resolution did not differ statistically (91.1% vs 83.3%; P = .095). After adjustment for age, sex, baseline lesion diameter, tooth location, diabetes mellitus, and baseline sinus tract, C-Root SP was associated with higher odds of treatment success (adjusted odds ratio [aOR] = 2.25, 95% confidence interval [CI]: 1.09-4.65; P = .028) and radiographic healing (aOR = 2.23, 95% CI: 1.04-4.79; P = .040), while the adjusted association with clinical resolution was not statistically significant (aOR = 2.12, 95% CI: 0.89-5.09; P = .091). VAS trajectories were similar overall, with a modest between-group difference at 1 month. Postoperative pain, acute exacerbations, sealer extrusion, and further endodontic interventions were infrequent and comparable between groups. In exploratory analysis, sealer extrusion was associated with treatment failure (OR = 4.91, P = .002). These observational findings indicate associations rather than causal treatment effects and require prospective confirmation.