Nestor Rios-Osorio, Javier Caviedes-Bucheli, Rafael Fernandez-Grisales, Lauren Barahona Pascua, Juan Pablo Hurtado, Melissa Cabezas Rodriguez, Jesus Montenegro Cuello, Jenny Muñoz Simbaqueva, Maria Rivera Valencia, Linette Rodriguez Cuellar, Valentina Serna Correa, Karl Seidel Barrera, Monica Toro Cruz, Hernan Dario Muñoz-alvear
European Endodontic Journal - 2026;11(3):129-139
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 (kappa = 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.
