Antimicrobial Activity of Natural Intracanal Medicaments in Endodontic Management of Permanent Teeth: A Systematic Review of In-vivo Studies

Background: Endodontic therapy has long been recognized as the modality for the elimination of microbial infections from the root canal system. Traditionally, calcium hydroxide has been prevalent in the history of intracanal medicaments because of their inherent antimicrobial activity. However, interest in recent years has been in the area of endodontic therapy incorporating natural intracanal medicaments from plant extracts into their protocols. The biocompatibility of these agents, its reduced cytotoxic potential, and other therapeutic properties such as anti-inflammatory and tissue regenerative have all been promising. But the clinical effectiveness of these natural agents is yet to be clearly established, especially in permanent teeth.

Objective: This systematic review aims at assessing the effectiveness of natural intracanal medicaments in the endodontic treatment of permanent teeth by pooling evidence from in vivo studies regarding their antimicrobial activity, as compared to traditional synthetic agents.

Methodology: Electronical databases, such as Google Scholar, Web of Science, PubMed, and Scopus were searched for articles published between 2014 and 2021. Rayyan software was used in the screening and management of all articles and, during the study selection, title and abstract screening were done independently by two reviewers. Meta-analysis assessed the pooled effect size of such agents.

Results: Of nearly 2500 articles, only 6 qualified for inclusion. The natural agents Neem, Curcumin, and Propolis demonstrated high antimicrobial activity compared to conventional agents such as calcium hydroxide and chlorhexidine. Neem had the highest antibacterial activity, and Curcumin demonstrated anti-inflammatory effects superior to all else. While results from these natural medicaments demonstrated a broad efficacy, significant heterogeneity was found among the studies at 96% (I² =).

Conclusion: Natural intracanal medicaments are a promising future of efficacy: as good as or even better than traditional synthetic agents applied in endodontic therapy. Some of them are Aloe vera, Curcumin, Neem, and Propolis, which have been shown to exhibit not only good antimicrobial efficacy but also some degree of anti-inflammatory and tissue-regenerating properties. However, more standardized clinical trials should be designed and well executed to validate their effectiveness, thus defining clear clinical guidelines for permanent teeth use.