Infectious role of periapical abscesses and its influence on healing outcomes.

Background: Post-treatment apical periodontitis and postoperative pain remain critical challenges in endodontics, with success often relying on effective intracanal medications to control microbial infection, reduce inflammation, and promote tissue healing. Recent advances in medication formulations and techniques have expanded the options for managing these conditions, necessitating a systematic review of their efficacy. Thus, this review evaluated the effectiveness of various intracanal medications, including calcium hydroxide (CH), triple antibiotic paste with diclofenac potassium (TAPC), nano-based formulations, and Ledermix paste, in reducing microbial load, controlling inflammation, and alleviating postoperative pain in endodontic treatment. Method: Relevant studies were reviewed to assess the antimicrobial efficacy, pain management outcomes, and healing potential of different intracanal medications. The studies utilized various methodologies, including randomized controlled trials and retrospective analyses, with outcome measures such as bacterial reduction, levels of inflammatory mediators, pain scores, and imaging-based assessments of lesion healing. Results: CH demonstrated significant microbial reduction (up to 99.5%), decreased inflammatory mediators (IL-1β, TNF-α), and enhanced tissue healing, making it a reliable choice for managing apical periodontitis. TAPC showed superior pain relief compared to CH due to its dual antibacterial and anti-inflammatory action, significantly reducing pain within 48 hours. Nano-based formulations, including nano-silver and nano-CH, provided enhanced pain relief and effective microbial control while maintaining safety and reliability. Ledermix paste emerged as the most effective for rapid pain reduction in cases of acute apical periodontitis, highlighting the importance of corticosteroids and antibiotics. Advanced imaging modalities, such as cone-beam computed tomography (CBCT), facilitated accurate diagnosis and monitoring of periapical healing, demonstrating a high healing rate (76%) for large lesions treated nonsurgical. Conclusion: This review confirms the efficacy of traditional calcium hydroxide and highlights the advantages of innovative formulations such as TAPC, nanoparticles, and Ledermix paste in improving treatment outcomes. Rapid pain relief, effective microbial control, and enhanced healing underscore their potential for routine clinical use. The findings also emphasize the importance of advanced imaging and individualized treatment planning. Further research is warranted to optimize medication protocols and explore the long-term implications of emerging formulations.