The calcium silicate-based sealers currently available on the market have different compositions and formulations, which is why their physical and chemical properties may vary. (1) The aim of the study was to measure the physico-chemical properties of calcium silicate-based sealers and their push-out bond strength to root dentine, comparing two push-out testing protocols. (2) Standardized specimens of EndoSequence BC, BioRoot RCS, MTA Fillapex, and AH Plus (control) were subjected to pH measurements over 28 days. Radiopacity was measured using a CCD sensor, and flexural strength was assessed using a three-point bending setup. Push-out bond strength was measured in coronal, middle, and apical sections of 40 single-root teeth (conventional method), and cylindrical cavities were prepared for all sealers on the same root dentine disks in 11 third molars (disk method). (3) EndoSequence BC exhibited a higher pH than MTA Fillapex and the highest radiopacity (p < 0.05). The highest flexural and push-out bond strengths were found for AH Plus. The push-out bond strength of EndoSequence BC and BioRoot RCS was higher than MTA Fillapex (p < 0.05). The conventional and disk methods exhibited similar push-out bond strength results, but the data were more homogeneously distributed in the disk method. (4) All calcium silicate-based sealers exhibited a higher pH than AH Plus. MTA Fillapex did not meet the ISO standard. Calcium silicate-based sealers showed weaker performance in terms of physical properties compared to AH Plus.

Although biocompatible calcium silicate cements (CSCs) and calcium aluminate cements (CACs) may induce local and systemic adverse effects. This study aimed to evaluate the subchronic and chronic effects of experimental CAC and CSC mixtures on rat liver, kidney, brain, and spleen tissue. Two experimental mixtures, CAC with added ZrO₂ (ECCA + ZrO₂) and CSC with added ZrO₂ (ECCS + ZrO₂), and mineral trioxide aggregate (MTA), were implanted intraalveolary in 36 male Wistar rats. Histomorphometry was conducted after 30 and 180 days on liver, kidney, brain, and spleen. Consistent results were observed in all material groups. Liver tissue inflammation ranged from none to minimal for all three materials. In kidney, ECCA + ZrO₂ displayed a slightly better result than other two materials. In brain, after 180 days, both ECCA + ZrO₂ and MTA showed a statistically significant reduction in perineural vacuolation (p < 0.05), and MTA showed a reduction in the percentage of intravascular congestion (p < 0.05). In spleen, a larger lymphoid follicle diameter was observed for ECCS + ZrO₂ chronic group compared to other two materials (p < 0.05). ECCA + ZrO₂, ECCS + ZrO₂, and MTA caused none to minimal changes in liver, kidney, brain, and spleen following subchronic and chronic exposure.