This review explores the field of retreatment strategies for cases filled with calcium silicate-based root canal sealers. Since the introduction of calcium silicate-based materials in dentistry, calcium silicate-based root canal sealers have become popular among dentists because of their biocompatibility, bioactivity, and sealing ability. Therefore, effective retreatment strategies are indispensable. This article aims to identify the challenges associated with the removal of calcium silicate-based sealers themselves and removal of gutta-percha with the sealers during retreatment, evaluate current techniques and materials, and provide future directions for research in this field. Regarding the strategies of removal of root canal sealers, calcium silicate-based sealers are still relatively new materials for clinicians compared with traditional sealers such as epoxy- or eugenol-based sealers. First, no clinically established solvents have been reported. Second, calcium silicate-based sealers are currently utilized by clinicians in either the cold sealer-based technique or the warm vertical condensation technique. Third, the setting process of calcium silicate-based sealers generates byproducts, primarily calcium hydroxide and secondarily hydroxyapatite, that could interact with dentine. Lastly, there is a lack of clinical studies evaluating the efficacy of retreatment protocols for teeth filled with calcium silicate-based sealers. Therefore, it is important to investigate the chemo-mechanical properties of calcium silicate-based sealers themselves and their reactions to solvents and/or mechanical instruments and identify the interfacial properties of calcium silicate-based sealers with respect to dentine and gutta-percha. In addition, researchers in the clinical field need to actively gather and report data on retreatments of teeth filled with calcium silicate-based sealers.

This review explores the field of retreatment strategies for the cases filled with calcium silicate-based root canal sealers. Since the introduction of calcium silicate-based materials in dentistry, calcium silicate-based root canal sealers have become popular among dentists because of their biocom- patibility, bioactivity, and sealing ability. Therefore, effective retreatment strategies are indispensable. This article aims to identify the challenges associated with the removal of calcium silicate-based sealers itself and gutta-percha with the sealers during retreatment, evaluate current techniques and materials, and provide future directions for research in this field. Regarding the strategies of removal of root canal sealers, calcium silicate-based sealers are still relatively new materials for clinicians compared with the traditional sealers such as epoxy- or eugenol-based sealers. First, no clinically established solvents have been reported. Second, calcium silicate-based sealers are currently utilized by clinicians in either cold sealer-based technique or warm vertical condensation technique. Third, the setting process of calcium silicate-based sealers generates byproducts primarily calcium hydroxide and secondarily hydroxyapatite, which could interact with dentine. Lastly, there is a lack of clinical studies evaluating the efficacy of retreatment protocols for teeth filled with calcium silicate-based sealers. Therefore, it is important to investigate chemo-mechanical properties of calcium silicate- based sealers itself and their reactions to solvents and/or mechanical instruments, and identify the interfacial properties of calcium silicate-based sealers in respect to dentine and gutta-percha. In addition, researchers in clinical field need to actively gather and report data on retreatments of teeth filled with calcium silicate-based sealers.

Background/Objectives: Apical periodontitis is a prevalent dental condition associated with systemic inflammation. C-reactive protein (CRP) is a sensitive biomarker of inflammatory status. While previous studies have examined CRP changes after endodontic treatment, limited evidence exists on short-term systemic effects following clinically indicated endodontic therapy in healthy individuals. This prospective observational cohort study aimed to evaluate the impact of endodontic treatment or retreatment on serum CRP levels in patients with symptomatic and asymptomatic apical periodontitis and assess demographic influences. No control group was included. Methods: A prospective observational cohort study was conducted in a private endodontic clinic in Jeddah, Saudi Arabia (2021–2023). Three hundred ASA I patients were enrolled and categorized into symptomatic apical periodontitis (SAP) and asymptomatic apical periodontitis (AAP) groups. Blood samples were collected before treatment and two weeks post-treatment. CRP levels were measured using a high-sensitivity assay. Statistical analyses included paired t-tests, Mann–Whitney U tests, and multiple regression. Laboratory personnel were blinded to patient grouping. Results: CRP levels significantly decreased after treatment in both groups (SAP: 6.99 to 2.01 mg/L; AAP: 5.40 to 1.64 mg/L; p < 0.001). Reduction was greater in SAP (mean difference = 4.98 mg/L) than AAP (3.76 mg/L; p < 0.001). Paired t-test showed a very large effect size (Cohen’s d = 3.51). Age and sex were not significant predictors of CRP changes (R² < 0.02). Conclusions: Endodontic treatment or retreatment significantly reduces systemic inflammation in patients with apical periodontitis. These findings reinforce the oral–systemic health link and highlight the clinical relevance of managing apical infections. Longer-term studies and inclusion of additional biomarkers are recommended.