Abstract
Background Radiopacity is a critical property for root canal sealers as it allows for the assessment of the material's placement and quality within the root canal system on radiographic images. The study aimed to evaluate the radiopacity of calcium silicate-based and resin-based materials using direct digital radiography, employing an aluminium step wedge according to American National Standards Institute/International Organization for Standardization (ANSI/ISO) standard protocols for testing the radiopacity of root canal sealers. This study seeks to determine the effectiveness of these materials in meeting the required standards for clinical use. Methodology The materials tested were AH Plus, Apexit Plus, Biodentine and MTA Fillapex in circular disc form and radiographed alongside the aluminium step wedge using direct digital radiography to determine the radiopacity using grey-pixel values. All the materials, viz., AH Plus, Apexit Plus, Biodentine and MTA Fillapex were found satisfactorily radiopaque and met the minimum radiopacity standard, that is, minimum 3mm of aluminium recommended by ANSI/American Dental Association (ADA) Specification No. 57. Results AH Plus exhibited the highest radiopacity with values of 222.54 mm Al Eq (isodensity) and 220.88 mm Al Eq (densitometric), significantly surpassing Apexit Plus, Fillapex and Biodentine (p < 0.001). Apexit Plus and Fillapex showed no significant difference between them (p = 0.238), but both were significantly higher than Biodentine (p < 0.001). Biodentine had the lowest radiopacity among all the sealers tested. Conclusion All the tested materials met the ANSI/ADA minimum radiopacity standard, demonstrating their suitability for clinical use. The materials varied in their levels of radiopacity, demonstrating that they are adequately visible on radiographic images for effective assessment in root canal treatments.