Effectiveness of calcium hydroxide as an intracanal medicament in endodontic retreatment: A systematic review of clinical outcome
Bibliographic record
Abstract
Abstract Introduction: Endodontic retreatment cases are complicated by persistent biofilm-forming pathogens such as Enterococcus faecalis , as well as remnants of prior obturation material. Intracanal medicaments (ICMs), especially calcium hydroxide (Ca[OH] 2 ), play a vital role in improving treatment outcomes through effective disinfection. This systematic review aims to assess the efficacy of Ca(OH) 2 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) 2 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) 2 combined with chlorhexidine (CHX) or in nanoformulations yielded improved pain control and fewer flare-ups compared to Ca(OH) 2 alone. Four studies showed low RoB, while two had moderate risk. Conclusion: Ca(OH) 2 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.041 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.011 |
| Bibliometrics | 0.009 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".