# Patterns and Practices in the Use of Endodontic Materials: Insights from Romanian Dental Practices
## 4 Discussions
Vitapex possesses antibacterial properties and inhibits the reproduction of residual bacteria in the endodontic system. It promotes the healing of periapical lesions with a minimal inflammatory response in surrounding tissues [46; 47]. Regarding sealants used for endodontic filling, epoxy resin-based sealers are preferred by the dentists participating in the study because of their performance in root canal treatments (35.5%). Comparative trials have demonstrated that epoxy resin-based sealers exhibit superior sealing properties, leading to better clinical outcomes for patients with chronic apical periodontitis [48]. Epoxy sealers also demonstrate effective penetration into dental tubules, crucial for successful endodontic treatment [49]. Despite various sealants available on the market, epoxy resin sealers maintain their physical and bioactive properties, making them a preferred choice in endodontic procedures [50]. Calcium hydroxide-based sealants rank second in this study (23.5%). These sealers are widely used in root canal treatments due to their antimicrobial properties [51]. Resinous endodontic sealers containing calcium hydroxide have shown promising results in biocompatibility, antibacterial effects, and promotion of biomineralization and collagen maturation. They are effective against _Enterococcus faecalis_[52]. Furthermore, compared with biocercamic sealers, calcium hydroxide sealers have demonstrated superior pH, calcium ion release, and antibacterial effects against _E. faecalis_[52]. Zinc oxide eugenol sealers rank third among the preferences of doctors participating in the study (19.9%), approximately half as often as epoxy resin and nearly equal to calcium hydroxide-based sealers. Sealers utilizing zinc oxide eugenol (ZOE) have been widely and successfully used for many years. Various brands and formulations exist, with zinc oxide as the primary component. Originally, eugenol served as the liquid component in [PERSON]'s original composition, alongside sodium borate (anhydrous), bismuth subcarbonate, hydrogenated resin, zinc oxide, and barium sulfate [53; 54]. Even today, new zinc oxide eugenol sealers like EssenSeal have emerged, described by [PERSON] et al. as a reliable alternative for root canal sealing [55]. In many developed countries, biocercamic sealers have become standard in endodontics due to their superior properties that enhance the success of root canal treatments. These sealers are known for their biocompatibility, excellent sealing ability, and potential to improve root strength post-filling [56]. They also exhibit antibacterial properties, which are crucial in preventing reinfection of the root canal system [57]. Moreover, biocercamic sealers can augment the bioactivity of the dentin interface, facilitating hydroxyapatite production and enhancing the sealing and integration properties of the material [58]. Their use is also gaining momentum in developing regions, where improvements in dental technology and materials are becoming more accessible. However, cost and availability remain limiting factors in some areas. The global trend towards biocercamic sealers reflects a shift towards more predictable and efficient treatment outcomes in endodontics, with these materials being widely regarded as a key innovation in modern root canal therapy [13; 59; 60]. The use of biocercamic sealers in clinical practice varies among studies. This study shows that endodontic sealers are used on a much smaller scale than global trends, despite their proven advantages in improving treatment outcomes. Only 13.3% of participants preferred biocercamic sealers, ranking last. A survey in Bulgaria indicated that most dentists do not find biocercamic sealers necessary for endodontic treatments [61]. However, clinical studies have reported a high success rate of 99% when using biocercamic sealers with warm gutta-percha filling techniques [15]. An online questionnaire revealed that 51.70% of dentists use biocercamic sealers, citing improved properties as the primary reason [62].