An In Vitro Study Comparing the Antimicrobial Efficacy of 0.2% Chitosan, 3% Sodium Hypochlorite, 2% Chlorhexidine against Enterococcus faecalis, Alone and in Conjunction with Diode Laser

Smear layer removal and antimicrobial efficacy of chitosan as a root canal irrigant: a systematic review of in-vitro studies

This systematic review was designed to answer the following question: Does chitosan provide better smear layer removal and antimicrobial efficacy than other root canal irrigants? A literature search was done using electronic databases PubMed, Scopus, Web of Science, Cochrane Library, EBSCO host, Grey Literature Report, and Open Grey from inception to June 18, 2024. The reference lists of included articles were also hand-searched. Two reviewers independently assessed the studies' eligibility based on the inclusion and exclusion criteria and performed data extraction. Two reviewers independently evaluated the risk of bias in the selected studies. The search retrieved 2330 studies. After analysis, 36 studies fulfilled the eligibility criteria and were included, with 19 involving smear layer removal, 16 involving antibacterial efficacy, and 1 involving both. The overall risk of bias of the included studies was medium. Chitosan removed the smear layer more effectively than citric acid and acetic acid, similar to MTAD and Qmix, with conflicting results against EDTA. In addition, chitosan demonstrated comparable antibacterial efficacy to chlorhexidine, propolis, and photodynamic therapy but was less effective than sodium hypochlorite. Based on available evidence, it was found that chitosan provided better smear layer removal and antimicrobial efficacy than most root canal irrigants compared in this systematic review. There was substantial heterogeneity in the methodology of included studies. As a result, this review highly recommends further research using standardized methods to assess the effectiveness of chitosan as a root canal irrigant in in-vitro studies to validate its clinical use.

Antimicrobial efficacy of chitosan versus sodium hypochlorite: A systematic review and meta-analysis

AIM

This meta-analysis aimed to compare the antibacterial efficacy of chitosan/chitosan nanoparticles (Ch/Ch-NPs) versus sodium hypochlorite/chlorhexidine (NaOCl/CHX).

MATERIALS AND METHODS

A search was performed in four electronic databases until December 08, 2023. Studies with missing, unclear, and insufficient data sets were excluded. The included studies were assessed by two independent reviewers using the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies. The meta-analysis of standardized mean difference was performed using a random effects model. Additionally, funnel plots as well as Egger's regression intercept test were used to evaluate potential publication bias.

RESULTS

A total of 426 samples were used in nine included studies. There was no difference in antibacterial efficacy between Ch/Ch-NPs-NaOCl (SMD: 0.005; 95% CI: -0.844-0.854; p = 0.990). However, the antibacterial efficacy of NaOCl was statistically more effective than Ch/Ch-NPs (SMD: 0.807; 95% CI: 0.015-1.599; p = 0.046) using the bacterial culture method, and Ch/Ch-NPs was statistically higher than NaOCl (SMD: -1.827; 95% CI: -2.720, -0.934; p < 0.000) using confocal laser scanning microscopy.

CONCLUSIONS

Ch/Ch-NPs may be an alternative to NaOCl against Enterococcus faecalis. The methods used in the in vitro studies evaluating the antibacterial efficacy of irrigation solutions against E. faecalis may have had an impact on the results.