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Volume 62
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10.3390/medicina62081491
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Background:
Systematic Review

Antimicrobial Efficacy of Chitosan vs. Sodium Hypochlorite Against Enterococcus faecalis: A Systematic Review and Meta-Analysis

by
Virág Róna
1,
Bulcsú Bencze
1,
Gergely Agócs
2,3,
Péter Hegyi
2,4,5,
Kata Kelemen
1,
Tamás Hegedüs
1,
Gábor Varga
6,
Beáta Kerémi
7,
Adél Galvács
7 and
Zoltán Géczi
1,*
1
Department of Prosthodontics, Semmelweis University, 1085 Budapest, Hungary
2
Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
3
Department of Biophysics and Radiation Biology, Semmelweis University, 1085 Budapest, Hungary
4
Institute of Pancreatic Diseases, Semmelweis University, 1083 Budapest, Hungary
5
Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
6
Department of Oral Biology, Semmelweis University, 1089 Budapest, Hungary
7
Department of Restorative Dentistry and Endodontics, Semmelweis University, 1088 Budapest, Hungary
*
Author to whom correspondence should be addressed.
Medicina 2026, 62(8), 1491; https://doi.org/10.3390/medicina62081491
Submission received: 18 June 2026 / Revised: 26 July 2026 / Accepted: 28 July 2026 / Published: 3 August 2026
(This article belongs to the Special Issue Advances in Dental Prosthetics)
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Abstract

Background and Objectives: This study compared the antimicrobial effects of chitosan and sodium hypochlorite against Enterococcus faecalis (E. faecalis) at different irrigation solution concentrations. E. faecalis is a persistent pathogen frequently surviving root canal treatment, while sodium hypochlorite remains the current gold-standard irrigation material. Materials and Methods: A systematic review and meta-analysis of in vitro studies was conducted using Cochrane Library, EMBASE, and PubMed. Evidence certainty was assessed with GRADE. Two outcomes were analyzed: colony-forming units (CFU/mL) and the inhibition rate (IR). Two reviewers independently screened studies and extracted data. Results: Of 889 identified records, 10 studies met the inclusion criteria. For CFU/mL, the overall effect was −0.28 (95% CI: −1.54 to 0.97). For IR, chitosan concentrations < 1% showed an effect of –7.35 (95% CI: −27.27 to 12.56), while concentrations ≥ 1% showed an effect of −0.90 (95% CI: −19.24 to 17.45). Conclusions: Chitosan demonstrated antimicrobial activity comparable to sodium hypochlorite in vitro, with concentrations above 1% showing enhanced antibacterial effects. However, methodological heterogeneity limits direct comparison, and clinical equivalence cannot be concluded.
Keywords: chitosan; sodium hypochlorite; periapical; root canal; enterococcus faecalis; E. faecalis; irrigation chitosan; sodium hypochlorite; periapical; root canal; enterococcus faecalis; E. faecalis; irrigation
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MDPI and ACS Style

Róna, V.; Bencze, B.; Agócs, G.; Hegyi, P.; Kelemen, K.; Hegedüs, T.; Varga, G.; Kerémi, B.; Galvács, A.; Géczi, Z. Antimicrobial Efficacy of Chitosan vs. Sodium Hypochlorite Against Enterococcus faecalis: A Systematic Review and Meta-Analysis. Medicina 2026, 62, 1491. https://doi.org/10.3390/medicina62081491

AMA Style

Róna V, Bencze B, Agócs G, Hegyi P, Kelemen K, Hegedüs T, Varga G, Kerémi B, Galvács A, Géczi Z. Antimicrobial Efficacy of Chitosan vs. Sodium Hypochlorite Against Enterococcus faecalis: A Systematic Review and Meta-Analysis. Medicina. 2026; 62(8):1491. https://doi.org/10.3390/medicina62081491

Chicago/Turabian Style

Róna, Virág, Bulcsú Bencze, Gergely Agócs, Péter Hegyi, Kata Kelemen, Tamás Hegedüs, Gábor Varga, Beáta Kerémi, Adél Galvács, and Zoltán Géczi. 2026. "Antimicrobial Efficacy of Chitosan vs. Sodium Hypochlorite Against Enterococcus faecalis: A Systematic Review and Meta-Analysis" Medicina 62, no. 8: 1491. https://doi.org/10.3390/medicina62081491

APA Style

Róna, V., Bencze, B., Agócs, G., Hegyi, P., Kelemen, K., Hegedüs, T., Varga, G., Kerémi, B., Galvács, A., & Géczi, Z. (2026). Antimicrobial Efficacy of Chitosan vs. Sodium Hypochlorite Against Enterococcus faecalis: A Systematic Review and Meta-Analysis. Medicina, 62(8), 1491. https://doi.org/10.3390/medicina62081491

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