Intracanal Medicaments and Root Canal Sealers in Contemporary Endodontics: From Ideal Requirements to Evidence-Based Selection – A Comprehensive Narrative Review

Author

Dr. Althaaf Khan


Abstract

 Background: Successful root canal treatment depends on elimination of intraradicular infection and on a durable three-dimensional seal. Intracanal medicaments (ICMs) and root canal sealers are two adjuncts whose selection remains inconsistent in practice. 

Objective: To review the properties, mechanisms, clinical performance and limitations of commonly used ICMs (calcium hydroxide, Ledermix and related agents) and obturation sealers (zinc oxide–eugenol, epoxy resin and calcium silicate/bioceramic), and to rank them against ideal requirements. 

Methods: A narrative review of laboratory, animal and clinical literature, with emphasis on systematic reviews and randomised or prospective clinical studies, was performed. 

Results: Calcium hydroxide remains the reference ICM because of its availability, biocompatibility and alkaline antimicrobial action, yet culture-based syntheses show it does not reliably render canals bacteria-free. Ledermix, a corticosteroid–tetracycline paste, is valuable for controlling inflammation, pain and inflammatory resorption, but is not a long-term antimicrobial dressing and carries a risk of discolouration. Among sealers, epoxy resin (AH Plus) retains its status as the benchmark for physicochemical stability, whereas premixed bioceramic sealers offer bioactivity, hydrophilicity and simplified single-cone protocols, with clinical outcomes that are broadly comparable to resin sealers and possibly less postoperative pain. 

Conclusions: No ICM or sealer is ideal. Selection should be guided by the clinical scenario, the diagnosis and the available evidence, with disinfection quality and coronal restoration remaining the principal determinants of outcome.



Keywords

intracanal medicament; calcium hydroxide; Ledermix; root canal sealer; bioceramic sealer; obturation



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References


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