Saatchi M, Shokraneh A, Navaei H, Maracy MR, Shojaei H. Antibacterial effect of calcium hydroxide combined with chlorhexidine on Enterococcus faecalis: a systematic review and meta-analysis.
J Appl Oral Sci 2015;
22:356-65. [PMID:
25466470 PMCID:
PMC4245746 DOI:
10.1590/1678-775720140032]
[Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 05/15/2014] [Indexed: 11/22/2022] Open
Abstract
Objective
Enterococcus faecalis (E. faecalis) is the most
frequently isolated strain in failed endodontic therapy cases since it is
resistant to calcium hydroxide (CH). Whether a combination of CH and chlorhexidine
(CHX) is more effective than CH alone against E. faecalis is a matter of
controversy. Thus, the aim of this study was to conduct a systematic review and
meta-analysis of the literature.
Material and Methods
A comprehensive search in PubMed, EMbase, EBSCOhost, The Cochrane Library, SciELO,
and BBO databases, Clinical trials registers, Open Grey, and conference
proceedings from the earliest available date to February 1, 2013 was carried out
and the relevant articles were identified by two independent reviewers. Backward
and forward search was performed and then inclusion and exclusion criteria were
applied. The included studies were divided into "comparisons" according to the
depth of sampling and dressing period of each medicament. Meta-analysis was
performed using Stata software 10.0. The level of significance was set at
0.05.
Results
Eighty-five studies were retrieved from databases and backward/forward searches.
Fortyfive studies were considered as relevant (5 in vivo, 18
in vitro, 18 ex vivo, and 4 review articles).
Nine studies were included for meta-analysis. Inter-observer agreement (Cohen
kappa) was 0.93. The included studies were divided into 21 comparisons for
meta-analysis. Chi-square test showed the comparisons were heterogeneous
(p<0.001). Random effect model demonstrated no significant difference between
CH/CHX mixture and CH alone in their effect on E. faecalis
(p=0.115).
Conclusions
According to the evidence available now, mixing CH with CHX does not significantly
increase the antimicrobial activity of CH against E. faecalis. It
appears that mixing CH with CHX does not improve its ex vivo
antibacterial property as an intracanal medicament against E.
faecalis. Further in vivo studies are necessary to
confirm and correlate the findings of this study with the clinical outcomes.
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