Root canal obturation plays a critical role in endodontic treatment by entombing remaining microorganisms, preventing reinfection and facilitating periapical healing [1]. Currently, a variety of endodontic sealers are available to ensure effective root canal sealing. Among these, epoxy resin-based sealers are widely considered the gold standard due to their physicochemical and biological properties [2,3]. More recently, calcium silicate-based sealers have gained popularity as viable alternatives. Their excellent biocompatibility, dimensional stability, bioactivity, and superior flowability make them promising options for root canal obturation [[4], [5], [6]].

Optimal outcomes are typically achieved when endodontic materials remain confined within the root canal system [1,7]. However, unintentional sealer extrusion may occur in some cases, often resulting from deficient apical seal and/or improper root canal preparation [8,9]. Different types of sealers exhibit varying extrusion rates and elicit distinct biological responses upon extrusion [2,[10], [11], [12], [13]]. Therefore, concerns have been raised regarding the potential adverse effects of sealer extrusion beyond the apex [[14], [15], [16], [17]]. The impact of sealer extrusion on treatment outcome remains a subject of ongoing debate. Several studies have suggested that sealer extrusion negatively impacts endodontic outcomes [11,14,15], while others have found no significant effect [8,13,18,19]. Additionally, to the best of our knowledge, no studies have investigated the outcomes in cases involving unintentional sealer extrusion, likely due to the very limited sample size available. Therefore, this retrospective cohort study aims to evaluate the treatment outcome and sealer dissolution of endodontically treated teeth with unintentional root canal sealer extrusion and identify the prognostic factors that may influence these outcomes.