From the Desk of the Editor……the Endodontic Elixir.

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 therapy

In treating weeping canals with a lot of pus discharge

For direct and indirect pulp capping treatments

In pulpotomy treatments as a medicament

For apexification and apexogenesis cases

As a medicament in treatment of internal resorptions, external resorptions, and apical resorptions

As a medicament for treatment of horizontal root fractures

As a root canal sealer ingredient

As a medicament for perforation treatments

As 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.[45]

When used singly or in combination with other materials and irrigants, it performs very well without much harmful effects.[678] 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.