Effectiveness of calcium hydroxide as an intracanal medicament in endodontic retreatment: A systematic review of clinical outcome.

INTRODUCTION

Endodontic retreatment cases are complicated by persistent biofilm-forming pathogens such as , as well as remnants of prior obturation material. Intracanal medicaments (ICMs), especially calcium hydroxide (Ca[OH]), play a vital role in improving treatment outcomes through effective disinfection. This systematic review aims to assess the efficacy of Ca(OH) in reducing postoperative pain, microbial load, and flare-ups in retreatment cases.

MATERIALS AND METHODS

A comprehensive search strategy was conducted using four electronic databases (PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library) to identify clinical studies from January 2005 to August 2024. Inclusion criteria focused on randomized controlled trials evaluating Ca(OH) alone or in combination with other medicaments or adjuncts. Risk of bias (RoB) was assessed using the Cochrane RoB 2.0 tool.

RESULTS

Six studies involving 430 participants were included. Four assessed postoperative pain using various scales (VAS, Numeric Rating Scale, and Verbal Rating Scale), two evaluated flare-ups, one assessed bacterial reduction, and another measured inflammatory markers. Ca(OH) combined with chlorhexidine (CHX) or in nanoformulations yielded improved pain control and fewer flare-ups compared to Ca(OH) alone. Four studies showed low RoB, while two had moderate risk.

CONCLUSION

Ca(OH) remains a valuable ICM in endodontic retreatment. Its efficacy is enhanced when used with adjuncts such as CHX or in nanoformulations. However, the evidence is limited by heterogeneity in outcome measures and sample sizes. Further standardized, high-powered trials are warranted.