INTRACANAL MEDICAMENTS: CURRENT EVIDENCE AND FUTURE DIRECTIONS

Successful endodontic therapy depends on the effective elimination of microorganisms from the root canal system. Despite advances in rotary instrumentation, irrigation solutions, and activation techniques, complete disinfection remains difficult due to the complex root canal anatomy, presence of dentinal tubules, and persistence of biofilm forming microorganisms such as Enterococcus faecalis. Intracanal medicaments,therefore,remain an essential adjunct to chemomechanical preparation by providing sustained antimicrobial activity between appointments,neutralizing bacterial endotoxins,and promoting periapical healing.This literature review critically analyzes current evidence related to intracanal medicaments, including conventional agents, emerging bioactive materials, novel drug delivery systems, and future therapeutic directions. Calcium hydroxide continues to be the most widely used intracanal medicament and the clinical gold standard because of its high alkalinityantimicrobial properties, and extensive clinical validation.However,its limitations,particularly reduced efficacy against resistant microorganisms, limited dentinal tubule penetration,and incomplete biofilm disruptionhave driven the search for alternative or adjunctive strategies. Chlorhexidine and antibiotic-based medicaments offer broader antimicrobial spectra but are associated with concerns related to cytotoxicity, discoloration, and the potential for antimicrobial resistance.