Non-Cochrane · intervention · PM42291285
Antimicrobial effectiveness of intracanal medicaments against Enterococcus faecalis in endodontics: a systematic review with structured domain-based interpretative synthesis and exploratory meta-analysis.
Ardila Carlos M, Pineda-Vélez Eliana, Vivares-Builes Anny Marcela · Frontiers in oral health · 2026 · PubMed · doi:10.3389/froh.2026.1854046
Findings
Population Extracted human teeth with E. faecalis infection (ex vivo dentin cylinders and in vitro root dentin model)
1 finding
| Triple antibiotic paste (TAP) | Calcium hydroxide | E. faecalis bacterial load (CFU/mL; log10 CFU/mg at 400 um dentinal depth) After 7 days of medicament application (reinoculation for Afkhami; 400 um depth for Ahangari) | SMD (Hedges' g) 4.76 [-5.43, 14.96] GRADE not reported 2 studies |
Included primary studies 16
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Afkhami 2022 Residual antibacterial effects of a mixture of silver nanoparticles/calcium hydroxide and other root canal medicaments against… DOI:10.1016/j.jds.2021.11.013 | 2022 | this review only | E. faecalis bacterial load (CFU/mL; log10 CFU/mg at 400 um dentinal depth) | not extracted yet |
| Afkhami 2022 Residual antibacterial effects of a mixture of silver nanoparticles/calcium hydroxide and other root canal medicaments against… PMID:35784127 | 2022 | this review only | E. faecalis bacterial load (CFU/mL; log10 CFU/mg at 400 um dentinal depth) | not extracted yet |
| Ahangari 2026 Antimicrobial effects of Propolis, calcium Hydroxide, triple antibiotic paste, and modified triple antibiotic paste on tubular dentin… DOI:10.1186/s12903-026-07901-x | 2026 | this review only | E. faecalis bacterial load (CFU/mL; log10 CFU/mg at 400 um dentinal depth) | not extracted yet |
| Ahangari 2026 Antimicrobial effects of Propolis, calcium Hydroxide, triple antibiotic paste, and modified triple antibiotic paste on tubular dentin… PMID:41699568 | 2026 | this review only | E. faecalis bacterial load (CFU/mL; log10 CFU/mg at 400 um dentinal depth) | not extracted yet |
| Babu 2024 Omeprazole with Calcium Hydroxide's Effectiveness as an Intracanal Medication against Enterococcus faecalis. PMID:39926745 | 2024 | this review only | not stated | not extracted yet |
| Bhupal 2025 Comparative antimicrobial efficacy of triple antibiotic paste, 2% chlorhexidine gel, and bromelain paste against Enterococcus faecalis in… PMID:40860383 | 2025 | this review only | not stated | not extracted yet |
| Halkai 2018 Antibacterial Efficacy of Biosynthesized Silver Nanoparticles against Enterococcus faecalis Biofilm: An in vitro Study. PMID:29875567 | 2018 | this review only | not stated | not extracted yet |
| Harshitha 2022 Antibacterial efficacy of nisin, calcium hydroxide, and triple antibiotic paste in combination with chitosan as an intracanal medicament… PMID:36506622 | 2022 | this review only | not stated | not extracted yet |
| Mandal 2020 A Comparative Evaluation of the Influence of Three Different Vehicles on the Antimicrobial Efficacy of Triple Antibiotic Paste against… PMID:33110328 | 2020 | this review only | not stated | not extracted yet |
| Mekala 2024 Antimicrobial Efficacy of Ampicillin With Ceftriaxone in Comparison With Diclofenac Sodium, Modified Triple Antibiotic Paste, and Calcium… PMID:39845253 | 2024 | this review only | not stated | not extracted yet |
| Nikhade 2023 Efficacy of Triple Antibiotic Paste and Bromelain Paste As Intracanal Medicament Against Enterococcus faecalis: An In-Vivo Study. PMID:38046769 | 2023 | this review only | not stated | not extracted yet |
| Punathil 2020 Comparison of Antibacterial Effect of Calcium Hydroxide Combined With Chlorhexidine and Povidone-Iodine Against Enterococcus faecalis in… PMID:33149504 | 2020 | this review only | not stated | not extracted yet |
| Sidiqa 2025 Antimicrobial Efficacy of Calcium Hydroxide Nanoparticles Combined with Nisin Against Enterococcus Faecalis in Root Canal Infections – an… DOI:10.14744/eej.2025.50455 | 2025 | this review only | not stated | not extracted yet |
| Sidiqa 2025 Antimicrobial Efficacy of Calcium Hydroxide Nanoparticles Combined with Nisin Against Enterococcus Faecalis in Root Canal Infections ���… PMID:41685841 | 2025 | this review only | not stated | not extracted yet |
| Valan 2024 Comparison of Antibacterial Efficacy of Triple Antibiotic-Loaded Hydrogel Versus Modified Triple Antibiotic-Loaded Hydrogel as Intracanal… DOI:10.14744/eej.2023.06977 | 2024 | this review only | not stated | not extracted yet |
| Valan 2024 Comparison of Antibacterial Efficacy of Triple Antibiotic-Loaded Hydrogel Versus Modified Triple Antibiotic-Loaded Hydrogel as Intracanal… PMID:38456465 | 2024 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Studies evaluating E. faecalis as the primary microorganism in endodontic infection models (dentin, biofilm or clinical root canal systems) | E. faecalis infected extracted human teeth, dentin blocks, root segments (10 laboratory studies) and infected root canals in patients (2 clinical studies) (n=12 studies) |
| Intervention | Intracanal medicaments: calcium hydroxide, chlorhexidine used as medicament, triple antibiotic paste, modified TAP, nanoparticle-based systems, other alternative antimicrobial formulations | Calcium hydroxide, triple antibiotic paste and modified TAP, chlorhexidine, nanoparticles, bromelain, nisin, propolis, omeprazole and other agents |
| Comparison | Other intracanal medicaments, untreated controls or vehicle controls | Other medicaments, calcium hydroxide, no-medicament or vehicle controls |
| Outcomes | CFU, log reduction, MIC, MBC; indicators of persistence, resistance or tolerance | CFU counts (CFU/mL, CFU/mg), log10 CFU, MIC, MBC, FIC, inhibition zones, microscopy |
| Study designs | In vitro, ex vivo and clinical studies reporting quantitative antimicrobial outcomes | In vitro (n=8), ex vivo (n=2), in vivo clinical (n=2) |
| Timing | Not specified | Exposure from 24 h to 21 days; clinical studies 7 days |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Partial Yes | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: No · NRSI: No | NRSI: N/A · RCT: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |