Removal Methods of Tricalcium Silicate Endodontic Sealer: Micro-CT Assessment Review

Objectives: Various studies have examined different approaches to removing gutta-percha and tricalcium silicate sealer in endodontic retreatment cases; however, preliminary literature research showed the absence of any systematic reviews regarding removal methods from the root dentin surface. The aim of this systematic review is to use Micro-CT to assess the different tricalcium silicate sealer removal techniques in endodontic retreatment.
Methods: Using the PubMed database, an electronic search was performed to locate studies that used Micro-CT to assess methods of tricalcium silicate endodontic sealer removal. Keywords included ‘remove, tricalcium silicate, sealer, and Micro-CT’ to access English-written, full-text online articles. Analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the review protocol was registered at PROSPERO (CRD469579). Two independent reviewers retrieved articles published between 2008 and 2023, and the third reviewer was consulted as needed.
Results: A total of 81 articles were reviewed, and 50 studies were excluded due to misclassification of material used; therefore, 31 studies were included. Twenty-nine studies were conducted in vitro using extracted human teeth, and two studies used artificial teeth. EndoSequence BC sealer (Brasseler, USA) was the commercial brand used the most frequently. In the 31 studies, rotary files were initially used to remove the gutta-percha and sealer. To remove the sealer from the root canal systems, the following techniques (number of the studies) were used: Passive Ultrasonic Irrigation (12), different retreatment rotary files (8), XP-Endo finisher R (7), conventional syringe-based irrigation (4), Shock Wave Enhanced Emission Photoacoustic Streaming (3), Photon-Induced Photoacoustic Streaming (2), commercial root canal brush (2), chemical solution (2), sonic activation (1), and agitation device (1).
Conclusions: Passive Ultrasonic Irrigation was the most (38.7%), sonic activation, and reciprocating agitation device were the least utilized (3.2%) among removal techniques of tricalcium silicate sealer in retreatment.