AH Plus vs BC Sealer: how do their properties and clinical outcomes compare?

Introduction

Bioceramic sealers, such as EndoSequence BC Sealer (Brasseler, USA), have been introduced as alternatives. These calcium silicate–based materials exhibit bioactivity, antibacterial effects, and lower cytotoxicity compared with epoxy resin sealers, and are capable of forming hydroxyapatite bonds with dentin [17–20]. The literature remains inconsistent regarding the influence of endodontic sealers on post-obturation pain, partly because many studies fail to isolate the obturation phase from other treatment-related variables. Therefore, the aim of this study was to compare the occurrence and intensity of postoperative pain following obturation with EndoSequence BC Sealer versus AH Plus in asymptomatic molars up to 3 days after obturation. The null hypothesis was that the type of sealer would not influence postoperative pain.

Postoperative pain and quality of life after the use of different endodontic sealers in asymptomatic molars: a randomized clinical trial. © The Author(s) 2026. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

Results

Table 3 shows that most participants did not report pain after obturation with either sealer, and no statistically significant differences were found between groups regarding the absolute frequency or risk of postoperative pain. Regarding bite sensitivity, assessed using a latex device, no significant differences were observed between groups or across time intervals (Table 4). With respect to analgesic intake, 24 patients in the AH Plus group and 11 in the BC Sealer group reported taking pain medication, mostly within the first 24 h, resulting in a statistically significant difference in analgesic consumption between groups (p = 0.02). The mean number of tablets taken for pain relief was 2.46 ± 1.9 in the AH Plus group and 2.5 ± 3.3 in the BC Sealer group. Sealer extrusion, as visualized on radiographs, occurred in three cases in the AH Plus group and one case in the BC Sealer group. In all cases, visible extrusion did not exceed 1 mm (Fig. 3).

Postoperative pain and quality of life after the use of different endodontic sealers in asymptomatic molars: a randomized clinical trial. © The Author(s) 2026. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

3.7. Microleakage

While more stable in neutral conditions, calcium phosphate-based materials demonstrate increased solubility under acidic conditions and often show porosity or dissolution-related issues during the setting phase [118,121]. However, the mechanisms of degradation for calcium phosphate-based sealers remain comparatively understudied. Endosequence BC Sealer is an endodontic material containing calcium silicates and calcium phosphates, and it has been shown to have more apical and coronal leakage than AH Plus, especially when used with the single cone technique (ref). Studies suggest that AH Plus forms a stronger bond due to its covalent interaction with dentin, resulting in less leakage.

Bioceramics in Endodontics: Limitations and Future Innovations—A Review. © 2025 by the authors. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

Results

1. Composition Table 1 shows the manufacturer and composition of calcium silicate based sealers. 2. Physicochemical properties -Radioopacity Radioopacity, a well-known characteristic of endodontic sealers, should exist in any root canal filling materials with a certain degree in order to evaluate the quality of root filling function (34). Two methods of standard discs and tissue simulator were used to evaluate radio opacity in one study which indicated that it was higher in AH Plus than MTA Fillapex and Endo CPM (34). Radioopacity of Endo CPM sealer was 6 mmAl (35). Also, radiopacity of MTA Fillapex and AH-Plus were 3.9 and 18.4 mmAl respectively (36). Xuereb (37), found the value of 10.8 and 4.3 for radioopacity of Endosequence BC and MTA Fillapex sealers. However, another study demonstrated the radioopacity of Endosequence BC sealer and AH Plus to be 3.84 and 6.90 mm Al respectively (38). The radiopacity of Endoseal was lower than AH Plus (9). -Setting time

Composition and physicochemical properties of calcium silicate based sealers: A review article. Copyright: © 2017 Medicina Oral S.L. Creative Commons Attribution 2.5 International (https://creativecommons.org/licenses/by/2.5/).

Results

-Flowability, film thickness and dimensional stability Flow determines the ability of sealers for filling the irregularities, and it is the viscosity that determines the flow characteristics (58). According to ISO 6786/2001, a root canal sealer should have a flow rate of not less than 20mm (12). MTA Fillapex had flowability higher than 20 mm and a film thickness lower than 50 µm (51). MTA Fillapex was significantly more flowable than AH Plus by the results of Zhou H et al. (42) and Silva EJ et al. (56). Others stated similar flow, film thickness and inferior compressive strength of MTA Fillapex when compared to AH Plus sealers (45). Flow of Endoseal was higher than AH Plus (9). Also, they were a similarity between MTA Fillapex and Endosequence BC sealers (42). Film thickness of MTA Fillapex is higher than both AH Plus and Endosequence BC sealer (42). Endosequence BC Sealer (38) showed flow according to ISO 6876/2001 recommendations. The flow test revealed that BC Sealer and AH Plus presented flow of 26.96 mm and 21.17 mm respectively (38). 3. An Introduction to X-Ray Diffraction, Elemental microanalysis, and micromorphology techniques

Composition and physicochemical properties of calcium silicate based sealers: A review article. Copyright: © 2017 Medicina Oral S.L. Creative Commons Attribution 2.5 International (https://creativecommons.org/licenses/by/2.5/).