Retreatment Challenges and Removal Strategies for Hydraulic Calcium Silicate–Based Root Canal Sealers: A Review
Keywords:
bioceramic sealers, hydraulic calcium silicate sealers, laser-assisted photoacoustic streaming, NiTi instruments, retreatment, solvents, supplemental irrigationAbstract
Hydraulic calcium silicate sealers (HCSs) are increasingly used in endodontics for their bioactivity, alkaline pH, calcium release, dentin bonding, and biocompatibility. While beneficial in primary treatment, these properties complicate nonsurgical retreatment, where effective removal of filling materials is required for disinfection and healing. HCSs become progressively harder and strongly bonded to dentin, and no reliable solvents exist for their dissolution. Nickel–titanium (NiTi) rotary and reciprocating instruments remain the primary tools. Heat-treated rotary files and reciprocating systems, such as Reciproc Blue and WaveOne Gold, improve efficiency but cannot fully eliminate remnants, especially in the apical third. Solvents such as chloroform, formic acid, hydrochloric acid, and citric acid have demonstrated variable efficacy, accompanied by concerns regarding dentin erosion and inconsistent clinical outcomes. Adjunctive methods enhance removal. Passive ultrasonic irrigation, sonic devices, and advanced ultrasonics improve irrigant dynamics. Shape-memory instruments (XP Finisher) and laser-assisted photoacoustic streaming (PIPS, SWEEPS) achieve superior cleaning in complex morphologies but still leave residual material. Complete removal of HCSs remains unachievable, with apical remnants the main limitation. Integration of mechanical, chemical, and supplemental techniques maximizes removal and supports periapical healing.
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