This review aims to evaluate the antimicrobial efficacy of calcium hydroxide against endodontic pathogens when used for 7 days or longer. A systematic electronic literature search was performed in the PubMed, Embase and EBSCO Dentistry & Oral Sciences Source databases using appropriate key words to identify investigations written in the English language that examined the association between the contact time of intracanal calcium hydroxide dressing and its antimicrobial properties. There were no exclusions based on study design. The search yielded 6993 publications. After duplicate removal, 5913 publications were identified and 11 studies met the inclusion criteria. Results showed that the antimicrobial effect of calcium hydroxide for contact times ranging between seven and 45 days is comparable. Two studies demonstrated contradictory findings when exposure was extended to more than 45 days. Future studies are warranted to investigate and optimise calcium hydroxide application for longer periods and identify the potential benefits of its use in clinical settings.