The goal of endodontic treatment is the prevention and control of pulpal and periradicular infections. Calcium hydroxide ($Ca(OH)_2$) has been widely used in endodontics as an intracanal medicament to eliminate the remaining microorganisms after chemomechanical preparation. The purpose of this article is to review the antimicrobial properties of $Ca(OH)_2$ as an intracanal medicament in root canal treatment. The first part of this review details the characteristics of $Ca(OH)_2$ and summarizes the results of in vitro studies related to its antimicrobial effect. The antimicrobial effect of $Ca(OH)_2$ results from the release of hydroxyl ions when it comes into contact with aqueous fluids. $Ca(OH)_2$ has a wide range of antimicrobial effects against common endodontic pathogens, but is less effective against Enterococcus faecalis and Candida albicans. The addition of vehicles or other agents might contribute to the antimicrobial effect of $Ca(OH)_2$.