{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T07:02:17Z","timestamp":1782975737100,"version":"3.54.5"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Dent. Med."],"abstract":"\n Background<\/jats:title>\n Endodontically treated teeth are more prone to fracture due to structural loss during canal preparation and alterations in dentin biomechanics. Root canal sealers and obturation materials contribute not only to sealing ability but also to potential reinforcement of the remaining tooth structure. However, their influence on fracture resistance remains unclear due to variability in study designs and outcomes.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To systematically evaluate and synthesize the available evidence on the fracture resistance of endodontically treated teeth obturated with different root canal sealers and materials.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A comprehensive search was conducted across MEDLINE (via PubMed), Scopus, Web of Science, and the Cochrane Library, supplemented by grey literature from Google Scholar. A total of 549 records were identified, of which 24 studies met the eligibility criteria and were included in the qualitative synthesis. Among these, 22 were\n in vitro<\/jats:italic>\n studies, one was an\n in vivo<\/jats:italic>\n animal study, and one was an\n ex vivo<\/jats:italic>\n study. Two independent reviewers performed study selection and data extraction. Due to methodological heterogeneity, a qualitative synthesis was performed.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Obturation with root canal sealers generally improved fracture resistance compared with instrumented but unobturated controls, indicating a reinforcing effect. Epoxy resin-based and calcium silicate-based sealers demonstrated comparable performance, while zinc oxide eugenol-based sealers showed limited reinforcement. Considerable heterogeneity in tooth selection, loading conditions, and testing protocols limited direct comparisons.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Root canal sealers appear to enhance the mechanical strength of endodontically treated teeth; however, no specific sealer demonstrates clear superiority. Standardized experimental models and clinical studies are needed to determine their clinical significance.<\/jats:p>\n <\/jats:sec>\n \n Systematic Review Registration<\/jats:title>\n Unique Identifier, CRD420251163273.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fdmed.2026.1868502","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T05:34:28Z","timestamp":1782970468000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Fracture resistance of teeth obturated with different root canal sealers: a systematic review"],"prefix":"10.3389","volume":"7","author":[{"given":"Aditya","family":"Shetty","sequence":"first","affiliation":[{"name":"Department of Conservative Dentistry and Endodontics, A B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University)","place":["Mangalore, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lakshmi Nidhi","family":"Rao","sequence":"additional","affiliation":[{"name":"Department of Conservative Dentistry and Endodontics, A B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University)","place":["Mangalore, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aishwarya","family":"Nair","sequence":"additional","affiliation":[{"name":"Department of Conservative Dentistry and Endodontics, A B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University)","place":["Mangalore, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junaid","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Oral Medicine and Radiology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education","place":["Manipal, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vidya G.","family":"Doddawad","sequence":"additional","affiliation":[{"name":"Dept of Oral Pathology and Microbiology, JSS Dental College and Hospital, A Constituent College of JSS Academy of Higher Education and Research","place":["Mysore, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heeresh","family":"Shetty","sequence":"additional","affiliation":[{"name":"Dept of Conservative Dentistry, Nair Hospital Dental College","place":["Mumbai, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1016\/S0099-2399(06)80483-8","article-title":"Are endodontically treated teeth more brittle?","volume":"18","author":"Sedgley","year":"1992","journal-title":"J Endod"},{"key":"B2","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1016\/S0099-2399(89)80191-8","article-title":"Reduction in tooth stiffness as a result of endodontic and restorative procedures","volume":"15","author":"Reeh","year":"1989","journal-title":"J Endod"},{"key":"B3","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1016\/j.joen.2009.12.002","article-title":"Identifying and reducing risks for potential fractures in endodontically treated teeth","volume":"36","author":"Tang","year":"2010","journal-title":"J Endod"},{"key":"B4","first-page":"589","article-title":"Effect of sodium hypochlorite on dentin mechanical properties","volume":"33","author":"Marending","year":"2007","journal-title":"J Endod"},{"key":"B5","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1111\/j.1601-1546.2005.00197.x","article-title":"Materials used for root canal obturation: technical, biological and clinical testing","volume":"12","author":"\u00d8rstavik","year":"2005","journal-title":"Endod Topics"},{"key":"B6","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1016\/j.joen.2009.04.024","article-title":"Push-out bond strength of resilon\/epiphany and AH plus","volume":"35","author":"De-Deus","year":"2009","journal-title":"J Endod"},{"key":"B7","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1016\/j.joen.2014.06.007","article-title":"Sealers and warm gutta-percha obturation techniques","volume":"41","author":"Camilleri","year":"2015","journal-title":"J Endod"},{"key":"B8","first-page":"372","article-title":"Effect of root filling materials on fracture resistance","volume":"37","author":"Belli","year":"2011","journal-title":"J Endod"},{"key":"B9","first-page":"122","article-title":"Effect of different sealers on fracture resistance","volume":"114","author":"Sagsen","year":"2012","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"key":"B10","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1046\/j.1365-2591.2003.00705.x","article-title":"Solubility of root canal sealers","volume":"36","author":"Sch\u00e4fer","year":"2003","journal-title":"Int Endod J"},{"key":"B11","first-page":"123","article-title":"A review of factors influencing fracture resistance","volume":"23","author":"Iqbal","year":"2007","journal-title":"Dent Traumatol"},{"key":"B12","first-page":"119","article-title":"Flexural properties of endodontic materials","volume":"33","author":"Plotino","year":"2007","journal-title":"J Endod"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.1016\/j.prosdent.2022.05.019","article-title":"Development and validation of a risk-of-bias tool for assessing in vitro studies conducted in dentistry: the QUIN","volume":"131","author":"Sheth","year":"2024","journal-title":"J Prosthet Dent"},{"key":"B14","doi-asserted-by":"publisher","first-page":"326","DOI":"10.14744\/eej.2025.85866","article-title":"Evaluation of fracture resistance of roots obturated with three different sealers and three various obturation techniques","volume":"10","author":"Salim","year":"2025","journal-title":"Eur Endod J"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1567","DOI":"10.21608\/edj.2019.72581","article-title":"Fracture resistance of endodontically treated teeth obturated with different root canal sealers (in vitro study)","volume":"65","author":"Saba","year":"2019","journal-title":"Egypt Dent J"},{"key":"B16","doi-asserted-by":"crossref","first-page":"305","DOI":"10.4103\/0970-4388.108926","article-title":"Evaluation of resistance of teeth subjected to fracture after endodontic treatment using different root canal sealers: an: in vitro: study","volume":"30","author":"Bhat","year":"2012","journal-title":"J Indian Soc Pedod Prev Dent"},{"key":"B17","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1002\/jemt.22487","article-title":"Evaluation of the effect of different root canal obturation techniques using two root canal sealers on the fracture resistance of endodontically treated roots","volume":"78","author":"Ersoy","year":"2015","journal-title":"Microsc Res Tech"},{"key":"B18","doi-asserted-by":"publisher","first-page":"8022","DOI":"10.3390\/app11178022","article-title":"Influence of root canal sealers and obturation techniques on vertical root fracture resistance. An in vitro experiment","volume":"11","author":"Alkahtany","year":"2021","journal-title":"Appl Sci"},{"key":"B19","doi-asserted-by":"publisher","first-page":"7359","DOI":"10.1007\/s00784-023-05326-2","article-title":"The effect of sealer type and obturation technique on the fracture resistance of endodontically treated roots","volume":"27","author":"Al-Hiyasat","year":"2023","journal-title":"Clin Oral Investig"},{"key":"B20","doi-asserted-by":"publisher","first-page":"215","DOI":"10.15171\/joddd.2019.033","article-title":"Fracture resistance of roots enlarged with various rotary systems and obturated with different sealers","volume":"13","author":"Si","year":"2019","journal-title":"J Dent Res Dent Clin Dent Prospects"},{"key":"B21","doi-asserted-by":"publisher","first-page":"6","DOI":"10.26650\/eor.201989121662","article-title":"Evaluation of fracture resistance of roots-filled with various root canal sealers at different time periods","volume":"53","author":"\u00d6zy\u00fcrek","year":"2019","journal-title":"Eur Oral Res"},{"key":"B22","doi-asserted-by":"publisher","first-page":"382","DOI":"10.4103\/1735-3327.218558","article-title":"The effect of different root canal sealers on the fracture resistance of endodontically treated teeth-in vitro study","volume":"14","author":"Phukan","year":"2017","journal-title":"Dent Res J (Isfahan)"},{"key":"B23","doi-asserted-by":"publisher","first-page":"3217","DOI":"10.21608\/edj.2023.224252.2647","article-title":"Fracture resistance of roots obturated with bioceramic and epoxy resin-root canal sealers using different obturation techniques: an ex-vivo study","volume":"69","author":"Hassan","year":"2023","journal-title":"Egypt Dent J"},{"key":"B24","doi-asserted-by":"publisher","first-page":"134","DOI":"10.14744\/eej.2019.33042","article-title":"Fracture resistance of roots filled with bio-ceramic and epoxy resin-based sealers: in vitro study","volume":"5","author":"Almohaimede","year":"2020","journal-title":"Eur Endod J"},{"key":"B25","doi-asserted-by":"publisher","first-page":"25","DOI":"10.21608\/dsu.2023.122351.1111","article-title":"Effect of two calcium-silicate and one resin sealers on the fracture resistance of root dentin using different treatments in dog\u2019s teeth (an in vivo study)","volume":"4","author":"Ismail","year":"2023","journal-title":"Dental Science Updates"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e49426","DOI":"10.7759\/cureus.49426","article-title":"Comparison of the fracture resistance of root-canal-treated premolars obturated with dissimilar materials: an in vitro study","volume":"15","author":"Elnawawy","year":"2023","journal-title":"Cureus"},{"key":"B27","doi-asserted-by":"publisher","first-page":"50","DOI":"10.22037\/iej.2017.10","article-title":"Fracture resistance of roots after application of different sealers","volume":"12","author":"Dibaji","year":"2017","journal-title":"Iran Endod J"},{"key":"B28","first-page":"6","article-title":"Comparative evaluation of fracture resistance of endodontically treated teeth obturated with resin based adhesive sealers with conventional obturation technique: an in vitro study","volume":"7","author":"Langalia","year":"2015","journal-title":"J Int Oral Health"},{"key":"B29","doi-asserted-by":"publisher","first-page":"2420","DOI":"10.1080\/01694243.2016.1184403","article-title":"Fracture resistance of roots obturated with a novel calcium silicate-based endodontic sealer (BioRoot RCS)","volume":"30","author":"Guneser","year":"2016","journal-title":"J Adhes Sci Technol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.jds.2022.08.004","article-title":"Effect of a bioactive glass-based root canal sealer on root fracture resistance ability","volume":"18","author":"Huang","year":"2023","journal-title":"J Dent Sci"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1901","DOI":"10.21608\/edj.2024.257085.2841","article-title":"The effect of different obturation techniques on the fracture resistance of endodontically treated teeth obturated using bio-ceramic sealer","volume":"70","author":"El-Gamal","year":"2024","journal-title":"Egypt Dent J"},{"key":"B32","doi-asserted-by":"publisher","first-page":"793","DOI":"10.21608\/edj.2022.171754.2331","article-title":"Fracture resistance of two different sealers (in vitro study)","volume":"69","author":"Abdallah","year":"2023","journal-title":"Egypt Dent J"},{"key":"B33","doi-asserted-by":"publisher","first-page":"46","DOI":"10.4103\/IJDS.IJDS_45_18","article-title":"Relative assessment of fracture resistance of endodontically treated teeth with epoxy resin-based sealers, AH plus, MTA fillapex, and bioceramic sealer: an: in vitro: study","volume":"11","author":"Yendrembam","year":"2019","journal-title":"Indian J Dent Sci"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1253","DOI":"10.5005\/jp-journals-10024-2963","article-title":"Comparison of fracture resistance of two resin-based sealers to root canal walls: an in vitro study","volume":"21","author":"Issar","year":"2021","journal-title":"J Contemp Dent Pract"},{"key":"B35","doi-asserted-by":"publisher","first-page":"45","DOI":"10.4103\/denthyp.denthyp_29_22","article-title":"Comparison of fracture resistance of the endodontically treated roots with two sealer types: an in vitro study","volume":"13","author":"Hajihassani","year":"2022","journal-title":"Dent Hypotheses"},{"key":"B36","doi-asserted-by":"publisher","first-page":"175","DOI":"10.4103\/sjoralsci.sjoralsci_13_22","article-title":"Comparative evaluation of the fracture resistance of roots after the application of three different root canal sealers: AH plus, MTA fillapex, and BioRoot RCS: an in vitro study","volume":"9","author":"Muraleedhar","year":"2022","journal-title":"Saudi J Oral Sci"},{"key":"B37","doi-asserted-by":"publisher","first-page":"95","DOI":"10.32828\/mdj.v20i1.1044","article-title":"Fracture resistance of endodontically treated root obturated with AH plus, MTA fillapex, OneFill and NeoSealer (a comparative in vitro study)","volume":"20","author":"Shukri","year":"2024","journal-title":"Mustansiria Dent J"},{"key":"B38","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1016\/j.joen.2017.11.011","article-title":"Interfacial characteristics and cytocompatibility of hydraulic sealer cements","volume":"44","author":"Camilleri","year":"2018","journal-title":"J Endod"},{"key":"B39","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1111\/iej.13438","article-title":"The restoration of root filled teeth: a review of the clinical literature","volume":"54","author":"Bhuva","year":"2021","journal-title":"Int Endod J"}],"container-title":["Frontiers in Dental Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdmed.2026.1868502\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T05:34:30Z","timestamp":1782970470000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdmed.2026.1868502\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":39,"alternative-id":["10.3389\/fdmed.2026.1868502"],"URL":"https:\/\/doi.org\/10.3389\/fdmed.2026.1868502","relation":{},"ISSN":["2673-4915"],"issn-type":[{"value":"2673-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,2]]},"article-number":"1868502"}}