Non-Cochrane · intervention · PM42654388
Antimicrobial Efficacy of Chitosan vs. Sodium Hypochlorite Against Enterococcus faecalis: A Systematic Review and Meta-Analysis.
Róna Virág, Bencze Bulcsú, Agócs Gergely, et al. · Medicina (Kaunas, Lithuania) · 2026 · PubMed · doi:10.3390/medicina62081491
Findings
Population Enterococcus faecalis (standardized strains; in vitro root canal, biofilm and agar models)
4 findings
| Chitosan-based irrigant (0.1% to 2%) | Sodium hypochlorite (2% to 5.2%) | Inhibition rate (inhibition zone diameter, mm) in vitro (laboratory) | MD -4.12 [-12.25, 4.01] -4.12 [-12.25, 4.01] MD in mm High 5 studies · 120 participants |
| Chitosan-based irrigant (0.1% to 2%) | Sodium hypochlorite (2% to 5.2%) | Number of E. faecalis (colony-forming units, CFU/mL) in vitro (laboratory) | MD -0.28 [-1.54, 0.97] -0.28 [-1.54, 0.97] MD in CFU/mL High 6 studies · 188 participants |
| Chitosan-based irrigant, concentration below 1% | Sodium hypochlorite (2% to 5.2%) | Inhibition rate (inhibition zone diameter, mm) in vitro (laboratory) · Chitosan concentration <1% | MD -7.35 [-27.27, 12.56] GRADE not reported 3 studies · 70 participants |
| Chitosan-based irrigant, concentration 1% or higher | Sodium hypochlorite (2% to 5.2%) | Inhibition rate (inhibition zone diameter, mm) in vitro (laboratory) · Chitosan concentration >=1% | MD -0.90 [-19.24, 17.45] GRADE not reported 3 studies · 50 participants |
Included primary studies 13
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Bhullar 2020 matched by author and year (probable) | NR | this review only | Number of E. faecalis (colony-forming units, CFU/mL) | not extracted yet |
| Bhullar 2021 matched by author and year (probable) | NR | this review only | Number of E. faecalis (colony-forming units, CFU/mL) | not extracted yet |
| Camacho-Alonso 2017 Bactericidal Efficacy of Photodynamic Therapy and Chitosan in Root Canals Experimentally Infected with <i>Enterococcus faecalis</i> : An… DOI:10.1089/pho.2016.4148 | 2017 | this review only | Number of E. faecalis (colony-forming units, CFU/mL) | not extracted yet |
| Camacho-Alonso 2017 Bactericidal Efficacy of Photodynamic Therapy and Chitosan in Root Canals Experimentally Infected with Enterococcus faecalis: An In Vitro… PMID:28068186 | 2017 | this review only | Number of E. faecalis (colony-forming units, CFU/mL) | not extracted yet |
| Geethapriya 2016 Effect of chitosan-ethylenediamine tetraacetic acid on Enterococcus faecalis dentinal biofilm and smear layer removal. PMID:27656070 | 2016 | this review only | Inhibition rate (inhibition zone diameter, mm) | not extracted yet |
| Goel 2022 An In Vitro Study Comparing the Antimicrobial Efficacy of 0.2% Chitosan, 3% Sodium Hypochlorite, 2% Chlorhexidine against Enterococcus… PMID:35528502 | 2022 | this review only | Number of E. faecalis (colony-forming units, CFU/mL) | not extracted yet |
| Jaiswal 2017 Evaluation of antibacterial efficacy of Chitosan, Chlorhexidine, Propolis and Sodium hypochlorite on Enterococcus faecalis biofilm : An in… PMID:29075407 | 2017 | this review only | Number of E. faecalis (colony-forming units, CFU/mL) | not extracted yet |
| Janavathi 2022 matched by author and year (probable) | NR | this review only | Inhibition rate (inhibition zone diameter, mm) | not extracted yet |
| Janawathi 2022 matched by author and year (probable) | NR | this review only | Inhibition rate (inhibition zone diameter, mm) | not extracted yet |
| Pillai 2018 Comparative Evaluation of Antimicrobial Efficacy of Chlorhexidine, MTAD and Chitosan as Root Canal Irrigant against Enterococcus faecalis DOI:10.7860/jcdr/2018/36191.12368 | 2018 | this review only | Inhibition rate (inhibition zone diameter, mm) | not extracted yet |
| Shenoi 2016 In vitro evaluation of the antimicrobial efficacy of chitosan and other endodontic irrigants against Enterococcus faecalis. PMID:27599284 | 2016 | this review only | Inhibition rate (inhibition zone diameter, mm) | not extracted yet |
| Wang 2020 Antibacterial effect of chitosan and its derivative on Enterococcus faecalis associated with endodontic infection. PMID:32346445 | 2020 | this review only | Number of E. faecalis (colony-forming units, CFU/mL) | not extracted yet |
| Yadav 2017 Evaluation of Antimicrobial and Antifungal efficacy of Chitosan as endodontic irrigant against Enterococcus Faecalis and Candida Albicans… PMID:28298975 | 2017 | this review only | Number of E. faecalis (colony-forming units, CFU/mL); Inhibition rate (inhibition zone diameter, mm) | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Controlled in vitro studies using standardized E. faecalis strains | In vitro E. faecalis models (n=10 studies) |
| Intervention | Chitosan-based irrigants | Chitosan solutions, nanoparticles, HTCC derivative, chitosan-EDTA, chitosan-CHX, PDT or laser combinations at 0.1% to 2% |
| Comparison | Sodium hypochlorite | Sodium hypochlorite 2% to 5.2% |
| Outcomes | Colony-forming units (CFU/mL) or inhibition rate (IR) | CFU/mL (6 studies); inhibition rate in mm (5 studies) |
| Study designs | Controlled in vitro studies | In vitro studies (n=10) |
| Timing | Not specified | Exposure from 3 min to 24 h; agar readings at 24, 48, 72 h |
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 | No | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Partial Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: No · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | Yes | no |
| 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 |