Antibacterial efficacy of antibiotic pastes versus calcium hydroxide intracanal dressing: A systematic review and meta-analysis of studies.

BACKGROUND

Conflicting findings on the potency of antibiotic pastes versus calcium hydroxide (CH) have been evident in the literature.

AIMS

To compare the antibacterial efficacy of single antibiotic paste (SAP), double antibiotic paste (DAP), triple antibiotic paste (TAP), and modified TAP (mTAP) with CH on bacterial biofilms.

METHODS

PubMed, Scopus, and Embase were comprehensively searched until August 23, 2021. The study protocol was registered in the PROSPERO. studies performed on or polymicrobial biofilms incubated on human/bovine dentin were selected. The quality of the studies was assessed using a customized quality assessment tool. Standardized mean difference (SMD) with a 95% confidence interval (CI) was calculated for the meta-analysis. Meta-regression models were used to identify the sources of heterogeneity and to compare the efficacy of pastes.

RESULTS

The qualitative and quantitative synthesis included 40 and 23 papers, respectively, out of 1421 search results. TAP (SMD = -3.82; CI, -5.44 to -2.21; < 0.001) and SAPs (SMD = -2.38; CI, -2.81 to - 1.94; < 0.001) had significantly higher antibacterial efficacy compared to the CH on biofilm. However, no significant difference was found between the efficacy of DAP (SMD = -2.74; CI, -5.56-0.07; = 0.06) or mTAP (SMD = -0.28; CI, -0.82-0.26; = 0.31) and CH. Meta-regression model on showed that SAPs have similar efficacy compared to TAP and significantly better efficacy than DAP. On dual-species (SMD = 0.15; CI, -1.00-1.29; = 0.80) or multi-species (SMD = 0.23; CI, -0.08-0.55; = 0.15) biofilms, DAP and CH had similar efficacy.

CONCLUSIONS

evidence showed that antibiotic pastes were either superior or equal to CH. The studied SAPs had considerably higher or similar antibacterial effectiveness compared to DAP, CH, and TAP. Hence, combined antibiotic therapy was not necessarily required for root canal disinfection .