Root canal sealer plays a crucial marginal sealing role in root canal obturation because of its excellent ffuidity and adhesion. However, due to the complex anatomical structure of the root canal system, sealers inevitably extrude into the periapical tissues during clinical operations. Currently used sealers mostly have a certain degree of cytotoxicity and tissue irritation, which may induce inffammatory reactions in surrounding tissues, delay healing, or even lead to bone resorption. In addition, root canal sealers may also affect the ffnal aesthetic performance of teeth. Therefore, the biocompatibility and aesthetic performance of root canal sealers have become important considerations in clinical selection. This paper focuses on bioceramic root canal sealers and systematically reviews the research progress in their biocompatibility and aesthetic performance, aiming to provide references for the development of new types of sealers.