Antimicrobial Effects of Formulations of Various Nanoparticles and Calcium Hydroxide as Intra-canal Medications Against Enterococcus faecalis: A Systematic Review

Abstract

The combination of calcium hydroxide (Ca(OH)₂) and nanoparticles (NPs) offers a promising approach to improving the efficacy of intra-canal treatments. Their synergistic effects can enhance antimicrobial action, improve penetration, and promote better healing outcomes in endodontic therapy. This review article examines the antimicrobial efficacy of various nanoparticles combined with Ca(OH)₂ against Enterococcus faecalis ( E. faecalis ) compared to Ca(OH)₂ alone as an intra-canal medicament. The analysis is based on in vitro studies involving bacterial inoculation on human-extracted teeth. Publications from 2013 to 2024 were retrieved from databases such as PubMed, Scopus, the Cochrane Library, and EBSCOhost and were screened according to specific inclusion criteria. Ultimately, 11 studies met these criteria for inclusion in the systematic review. A meta-analysis was not conducted due to the heterogeneity of the studies regarding the duration of medicament application, analytical methods, and result interpretations. The results indicate that NPs combined with calcium hydroxide exhibit superior bactericidal effects compared to Ca(OH)₂ alone, suggesting their potential as effective intra-canal medicaments. Thus, a systematic review concluded that nanoparticle-based Ca(OH)₂ intra-canal medicaments exhibit superior antibacterial/antimicrobial capabilities against E. faecalis when compared to Ca(OH)₂individually.