Bioceramic Materials in Endodontics: Properties, Clinical Applications, and Current Evidence (2020–2026): A Narrative Review

Abstract

Background: Bioceramic materials have become central to contemporary endodontic practice since the introduction of mineral trioxide aggregate (MTA), owing to their biocompatibility, sealing ability, and capacity to induce mineralised tissue formation. The past six years have seen rapid diversification of these materials, including premixed bioceramic sealers, resin-modified calcium silicates, and nanoparticle-enhanced formulations, alongside a growing body of clinical evidence. This narrative review synthesises the literature published between 2020 and 2026 on the composition, physicochemical and antimicrobial properties, and clinical applications of bioceramic materials in endodontics, and evaluates the strength of current clinical evidence. Methods: A structured search of PubMed, Scopus, Web of Science, and Google Scholar was conducted for articles published from January 2020 to August 2026 using combinations of the keywords "bioceramic," "calcium silicate," "MTA," "Biodentine," "bioceramic sealer," "vital pulp therapy," "regenerative endodontics," and "root canal sealer." In-vitro studies, randomised controlled trials, cohort studies, systematic reviews, and meta-analyses in English were included. Case reports without outcome data and non-peer-reviewed sources were excluded. Results: Bioceramics are used across the full spectrum of endodontic treatment, including vital pulp therapy, root canal obturation, apexification, regenerative endodontic procedures, perforation repair, and root-end filling. Recent randomised trials and meta-analyses indicate that bioceramic sealers and calcium silicate cements generally achieve treatment outcomes, postoperative pain profiles, and healing rates comparable to or better than conventional materials such as resin-based sealers and calcium hydroxide, although mechanical limitations, handling difficulty, discoloration, and variable solubility persist. Nanoparticle modification and resin-modified formulations have emerged as strategies to improve antimicrobial activity and handling properties. Conclusion: Current evidence supports bioceramic materials as a reliable and increasingly evidence-based option across most endodontic procedures. However, heterogeneity in study design, short follow-up periods, and a relative scarcity of long-term randomised trials indicate a continued need for standardised outcome reporting and well-designed clinical research.

Keywords: Bioceramics; calcium silicate cements; mineral trioxide aggregate; endodontic sealers; vital pulp therapy; regenerative endodontics