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Antimicrobial additives in resin-based endodontic sealers enhance antibacterial activity against Enterococcus faecalisAdditives help fight bacteria in root canal infection treatments

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Key Takeaway
Note that antimicrobial additives in endodontic sealers enhance antibacterial activity while maintaining material integrity.

This scoping review analyzed 33 studies to evaluate the antimicrobial efficacy, physicochemical properties, and cytotoxicity of resin-based endodontic sealers containing various additives, including nanoparticles, chlorhexidine, quaternary ammonium compounds, herbal extracts, and chemical agents. The primary objective was to determine if these additions improved outcomes for root canal infections.

The authors synthesized evidence showing that these additives enhanced antibacterial activity against Enterococcus faecalis. Some formulations demonstrated reduced biofilm formation and sustained antimicrobial effects over time. Additionally, the physicochemical properties, including flow, solubility, and setting time, were generally maintained within acceptable limits. Cytotoxicity was reported as reduced or unchanged in most combinations.

Limitations noted by the authors include a lack of data on long-term biological performance and clinical effectiveness. While these additives show promise for improving sealers, further studies are required to confirm their durability and safety in clinical practice. The results suggest that incorporating such additives may improve efficacy without compromising material integrity or cell viability.

How this fits prior evidence

This scoping review addresses a gap regarding the efficacy of antimicrobial additives in endodontic sealers. While prior coverage noted that chlorhexidine gluconate carries a higher risk for UTIs compared to povidone iodine, this study focuses on its application as an additive in resin-based sealers. The findings suggest these additions may improve antibacterial activity against Enterococcus faecalis without compromising physicochemical properties.

When a tooth is infected, doctors use special sealers to fill the area. These sealers need to stay strong and keep bacteria away so the infection does not return. A review of 33 studies looked at what happens when these sealers are mixed with extra ingredients like chlorhexidine or herbal extracts.

The research found that these additives help fight off specific bacteria, such as Enterococcus faecalis, more effectively. Some combinations even helped stop the buildup of bacterial layers over time. Importantly, adding these substances did not seem to ruin the physical properties of the sealer, like how it flows or sets, and they were generally safe for cells.

While these results are promising for treating root canal infections, there is still a catch. Because this was a review of existing data rather than a new clinical trial, we do not yet know how these materials perform over many years in the human body. More research is needed to confirm their long-term safety and success in real patients.

What this means for you:
Adding antimicrobial agents can improve how well sealers fight bacteria without hurting the material's quality.

Common questions

Do these added ingredients make the dental sealer safer?

The study found that adding antimicrobial agents, such as nanoparticles or herbal extracts, generally resulted in reduced or unchanged levels of cell damage. This means the materials remained compatible with cells while still fighting infection.

How do these additives affect the physical properties of the sealant?

The research showed that adding antimicrobial agents did not significantly change important qualities like flow, solubility, or setting time. These properties stayed within acceptable limits for dental use.

Are these treatments proven to work long-term in patients?

While the study shows these additives can fight bacteria and reduce biofilm formation, more research is still needed to confirm how they perform over a long period of time in clinical settings.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
Root canal sealers based on polymeric resins have incorporated nanostructured and antimicrobial ingredients to enhance antimicrobial activity and prevent root canal reinfection. This scoping review aimed to evaluate antimicrobial additives incorporated into resin-based endodontic sealers and their effects on antibacterial efficacy, physicochemical properties, and cytotoxicity. Electronic searches were conducted in Cochrane Library, PubMed, MEDLINE, Scopus, and Web of Science using text keywords related to resin-based endodontic sealers, antibacterial additives, physicochemical properties, and cytotoxic effects. From 1,473 records retrieved, 63 articles were eligible for full-text screening and 33 studies were included. The included studies evaluated various antibacterial additives, including nanoparticles, chlorhexidine, quaternary ammonium compounds, herbal extracts, and several chemical agents incorporated into resin-based endodontic sealers. Many studies reported enhanced antibacterial activity against Enterococcus faecalis, with some demonstrating reduced biofilm formation and sustained antimicrobial effects over time. The physicochemical properties, including flow, solubility, and setting time, were generally maintained within acceptable limits. Cytotoxicity outcomes were either reduced or unchanged in most combinations, indicating favorable biocompatibility. In conclusion, incorporating antimicrobial additives into resin-based endodontic sealers may enhance antibacterial efficacy without significantly compromising physicochemical properties or cytocompatibility. However, further studies are required to confirm long-term biological performance and clinical effectiveness. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261388075, identifier CRD420261388075
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