I. Core Composition & Curing Mechanisms Category Bioceramic Filling Materials (e.g., MTA, iRoot) VS Traditional Root Canal Fillers (e.g., Gutta-percha + Sealers) 1. Main Components Bioceramic Filling Materials - Inorganic minerals (calcium silicate, calcium phosphate, zirconium oxide) - Contain bioactive ions (Ca²+, PO₄³-, etc.) Traditional Root Canal Fillers - Gutta-percha: Natural gutta-percha (20%–25%) + zinc oxide, barium sulfate, etc. - Sealers: Zinc oxide-eugenol (ZOE), calcium hydroxide, etc. 2. Curing Method Bioceramic Filling Materials - Hydration curing: Solidifies via chemical reaction when exposed to tissue fluid or blood - Curing time: 1–3 hours (e.g., MTA) to immediate (e.g., iRoot BP) Traditional Root Canal Fillers - Gutta-percha: Softens with heat for mechanical compaction - Sealers: Physical solidification or chemical polymerization (e.g., resin-based sealers) 3. Bioactivity Bioceramic Filling Materials - Releases calcium and phosphate ions to promote hard tissue regeneration - Induces cementum/bone-like tissue formation in periapical areas Traditional Root Canal Fillers - Most lack bioactivity; some sealers (e.g., calcium hydroxide) have antibacterial properties but no hard tissue induction ability II. Physicochemical Properties Property Bioceramic Filling Materials VS Traditional Root Canal Fillers 1. Sealability Bioceramic Filling Materials - Low microleakage: Forms chemical bonds with root canal walls - Ideal for apical retrofilling and perforation repair Traditional Root Canal Fillers - Gutta-percha relies on sealers for sealing, prone to microleakage due to temperature changes or aging 2. Strength & Stability Bioceramic Filling Materials - High hardness (similar to dentin) after curing, resistant to body fluid erosion - Long-term stability, non-resorbable Traditional Root Canal Fillers - Gutta-percha has low strength; sealers may dissolve in tissue fluid (e.g., ZOE sealers) Radiopacity - Highly radiopaque, facilitating radiographic assessment - Gutta-percha requires barium sulfate for radiopacity; some sealers have insufficient radiopacity Antibacterial Activity - Alkaline environment (pH 10–12) inhibits bacterial growth - Released Ca²+ disrupts bacterial cell membranes - Some sealers (e.g., chlorhexidine-based) show short-term antibacterial effects but lack sustained action III. Clinical Applications Application Scenario Advantages of Bioceramic Materials Limitations of Traditional Fillers Apical Induction (young permanent teeth) - Induces apical closure and hard tissue barrier formation - Suitable for teeth with immature apices - Cannot promote periapical mineralization, may lead to open apex or infection Apical Retrofilling (apical surgery) - Excellent bone compatibility, can directly contact periapical tissue - Relies on chemical sealing rather than mechanical retention - Gutta-percha cannot achieve tight seal in retrofilling; sealers may resorb and cause leakage Root Canal Perforation Repair - Quickly seals perforations and promotes tissue repair - Suited for complex cases (e.g., furcal or root perforations) - Traditional materials (e.g., amalgam) have poor biocompatibility and may irritate tissues Routine Root Canal Filling - Higher operation difficulty (requires wet environment for curing), higher cost - Used in complex cases (e.g., periapical periodontitis, calcified canals) - Gutta-percha + sealer remains the gold standard for routine fillings, with simple operation and low cost Primary Teeth Root Canal Treatment - Replaces calcium hydroxide sealers, reducing risk of root fracture from sealer resorption - During physiological root resorption, traditional sealers may accelerate root resorption IV. Biocompatibility & Tissue Response Bioceramic Filling Materials: Non-cytotoxic, induces osteoblast differentiation and periapical healing; Case: MTA used in pulp capping promotes reparative dentin formation. Traditional Root Canal Fillers: Gutta-percha has good biocompatibility, but sealers may cause irritation (e.g., ZOE sealers irritate pulp); Resin-based sealers may release monomers, leading to allergic reactions. V. Operational Features & Cost Dimension Bioceramic Filling Materials Traditional Root Canal Fillers Operational Difficulty - Strict moisture control required (some need a wet environment for curing) - Fine particles require specialized delivery instruments - Gutta-percha can be filled via thermoplastic injection or cold lateral condensation, with mature techniques Treatment Time - Longer curing time (e.g., MTA takes 24 hours for full curing), may require staged treatment - Immediate filling suitable for one-visit root canal therapy Cost - Higher material cost (e.g., MTA is 10–20 times more expensive than gutta-percha), limiting routine use - Low cost, suitable for large-scale clinical application VI. Summary: How to Choose? Opt for bioceramic materials in: Apical induction for young permanent teeth; Apical retrofilling or perforation repair in apical surgery; Complex cases requiring hard tissue regeneration (e.g., refractory periapical periodontitis). Choose traditional fillers in: Routine root canal filling for mature permanent teeth; Primary teeth root canal treatment (short-term use of sealers); Cases with cost sensitivity or high demand for operational simplicity. Bioceramic materials represent the cutting-edge trend in endodontics, but their high cost and technical complexity limit them to challenging cases. Traditional materials still dominate basic endodontic treatments, and clinical decisions should balance case complexity, patient needs, and economic factors.