Radiographic Intraradicular Reduction of a Calcium Silicate–Based Sealer: Case Reports

AIM: To document radiographically observable intraradicular reduction of AH Plus Bioceramic, a premixed calcium silicate-based sealer (CSBS), during clinical follow-up after nonsurgical root canal retreatment. SUMMARY: Four cases of nonsurgical root canal retreatment performed with a premixed CSBS using a single-cone obturation technique are reported. Post-operative periapical radiographs confirmed satisfactory canal filling in all cases. Follow-up evaluation with periapical radiographs and cone-beam computed tomography at 7-24 months revealed partial intraradicular sealer reduction in all four cases. Two cases showed radiographic findings compatible with periapical healing and remained asymptomatic; two exhibited persistent or recurrent periapical pathology despite comparable radiographic sealer reduction. Outcome assessment was based on qualitative clinical and radiographic criteria; no quantitative volumetric or scoring-based assessment was performed. KEY LEARNING POINTS: (1) Radiographically detectable intraradicular reduction of a CSBS (AH Plus Bioceramic) can occur under routine clinical conditions following nonsurgical root canal retreatment. (2) This radiographic finding is not consistently associated with clinical outcome, suggesting uncertain prognostic significance. (3) Systematic long-term investigations using standardized CBCT-based volumetric analysis are required to determine whether intraradicular sealer reduction represents a biologically neutral remodelling process or a potential contributor to late treatment failure.