The Antimicrobial Efficacy of Sodium Hypochlorite and Chlorhexidine in Gutta-Percha Cone Decontamination: A Systematic Review

Abstract

This systematic review aims to compare the efficacy of sodium hypochlorite (NaOCl) and chlorhexidine digluconate (CHX) in decontaminating gutta-percha (GP) cones against endodontic pathogens—Enterococcus faecalis (E. faecalis), Staphylococcus aureus (S. aureus), and Candida albicans (C. albicans)—within 0–10 min. A systematic search was conducted in six databases (PubMed, Web of Science, Cochrane Library, SCIELO, Scopus, and LILACS), supplemented by manual searches performed independently by three reviewers. No publication year restrictions were applied, and only English-language studies were included. This review followed the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The risk of bias was assessed using six parameters with a modified Cochrane risk of bias tool. Out of 309 potentially eligible studies, 216 were screened by title and abstract, 32 were selected for full-text assessments, and 7 were included. All studies had a moderate or high risk of bias. The majority of the included studies showed that higher NaOCl concentrations effectively eliminate E. faecalis and S. aureus within 1–5 min. However, data on CHX’s antimicrobial effect on C. albicans were limited. The qualitative analysis suggests that NaOCl remains the most effective agent for GP decontamination, while CHX with additives shows potential against fungal species.