Six-month 3-dimensional Cone-Beam Computed Tomography Assessment of Periapical Healing After Conventional Endodontic Treatment with 3 Different Endodontic Sealers: A Comparative Prospective Clinical Trial.

OBJECTIVE: To evaluate periapical healing at a 6-month follow-up after single-visit endodontic treatment using 3 commonly employed sealers-zinc oxide-eugenol (C-Gross), epoxy resin-based (AH Plus), and calcium silicate-based (Bio-C Sealer)-assessed through 3-dimensional cone-beam computed tomography (CBCT) volumetric analysis.

METHODS: A comparative, parallel, non-randomised, double-blinded clinical design was used. Seventy-five patients with pulp necrosis and chronic apical periodontitis were enrolled; 70 completed follow-up (AH Plus:n=25; Bio-C: n=23; C-Gross: n=22). Treatments were performed by 10 supervised postgraduate operators following a standardised protocol. Preoperative and 6-month CBCT scans were segmented by 2 calibrated, blinded radiologists (κ = 0.90). Lesion volumes were obtained using manual boundary tracing and automated 3D reconstruction. Intragroup and intergroup comparisons were evaluated using non-parametric statistics.

RESULTS: All 3 sealers showed significant intragroup reductions in lesion volume over 6 months (P < .001). Median volumes decreased from 81.0 to 15.0 mm3 (AH Plus), 63.0 to 12.0 mm3 (Bio-C), and 36.0 to 4.5 mm3 (C-Gross). Percentage reductions were similarly high across groups (median 79.7%-84.9%). No significant differences were observed among sealers for absolute volumetric change (P=.096) or percentage reduction (P=.912).

CONCLUSIONS: Periapical healing was comparable across AH Plus: n=25; Bio-C: n=23; C-Gross: n=22. When disinfection, 3-dimensional obturation, and coronal sealing are optimally achieved, sealer composition has minimal influence on tissue repair. Healing appears primarily host-driven, governed by inflammatory resolution and bone remodelling rather than sealer-derived bioactivity.