Advances in Root Canal Disinfection: A Review of Irrigants and Intracanal Medicaments

Abstract

The root canal therapy is greatly reliant on the ability to remove the microbial biofilms and stop the reinfection. The mechanical instrumentation is fundamental, although not sufficient and the addition of irrigants and intracanal medicaments are required. Sodium hypochlorite, chlorhexidine and EDTA are traditional irrigants that have been extensively used due to their antimicrobial effect and ability to remove the smear layer, but their drawbacks in terms of biocompatibility and biofilm eradication have led to the pursuit of a new option. Recent developments are characterised by application of herbal extracts, solutions containing nanoparticles, hypochlorous acid and ozone formulations, commonly combined with active methods of enhancement like ultrasonic, sonic and laser-aided irrigation, as means of enhancing disinfection performance. In a similar fashion, intracanal medicaments have transformed calcium hydroxide and phenolic-based medicaments to antibiotic-containing pastes, nanoparticle-enhanced medicaments, and bioactive natural medicaments and have been used both in conventional and regenerative endodontics. Alongside these developments, there are still problems such as cytotoxicity concerns, antimicrobial resistance, and failure to eliminate biofilms. The future directions are biofilm-specific treatment, intelligent drug delivery, and artificial intelligence (AI) to streamline disinfection procedures and optimize them, with strong clinical trials to promote evidence-based practices. This review is based on the synthesis of the existing advances in the field of root canal disinfection, focusing on its possible role on improving the treatment outcome without jeopardizing the safety and biocompatibility.