Correspondence Address:
Dr. Shishir Singh
Department of Conservative Dentistry and Endodontics, Terna Dental College, Nerul, Navi Mumbai, Maharashtra
India

Full Text

The Science of Endodontics has progressed rapidly bringing to us a variety of choices as far as treatment choices go. One of the main objectives of endodontic treatment is the elimination of microorganisms, for which an array of medicaments and antibacterials have been proposed.[1] Strangely, so the endodontic textbooks and literature are replete with a long list of endodontic medicaments, but there is just one that has stood the test of time which is calcium hydroxide. This white alkaline powder with a pH of 12 was introduced to dentistry by B.W. Hermann a century ago in 1920 and till date is the most preferred medicament by endodontists worldwide.

Its indications and uses are many:[2]

As a root canal medicament in endodontic therapyIn treating weeping canals with a lot of pus dischargeFor direct and indirect pulp capping treatmentsIn pulpotomy treatments as a medicamentFor apexification and apexogenesis casesAs a medicament in treatment of internal resorptions, external resorptions, and apical resorptionsAs a medicament for treatment of horizontal root fracturesAs a root canal sealer ingredientAs a medicament for perforation treatmentsAs a cavity liner.

Calcium hydroxide forms a physical barrier preventing bacterial ingress and destroys the remaining bacteria. Its antibacterial action is due to a high pH and leaching action on necrotic pulp tissue.[3] This antibacterial activity is due to its ability to damage the bacterial cytoplasmic membrane and cause protein denaturation and DNA damage. Ability to induce hard tissue formation, good tissue-dissolving properties, minimal side effects, and a high healing potential makes it a preferred medicament. Interestingly, it has been proven that, when used for a prolonged period in treating necrotic pulps and apical periodontitis, there is a high healing rate.[4],[5]

When used singly or in combination with other materials and irrigants, it performs very well without much harmful effects.[6],[7],[8] On the other hand, a lot of evidence exists with materials showing similar or even better properties in the endodontic literature.[9] On a concluding note, one must weigh each individual case treatment modalities properly, the pros and cons associated with the use of a specific material, its costs, patient affordability, and finally prognosis and outcomes.

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