Abu Hasna Amjad, Khoury Rayana Duarte, Mendes Gabriela Vieira, Carvalho Cláudio Antonio Talge, Bresciani Eduardo, Valera Marcia Carneiro
Department of Restorative Dentistry, Endodontics Division, Institute of Science and Technology (UNESP), São Paulo State University, São José Dos Campos, Brazil.
School of Dentistry, Universidad Espíritu Santo, Samborondón, Ecuador.
Odontology. 2025 Feb 2. doi: 10.1007/s10266-025-01063-y.
Effective root canal disinfection is crucial for the success of endodontic treatment. N-acetylcysteine (NAC), known for its antimicrobial properties, has recently been investigated as a potential endodontic irrigant or intracanal medication. This systematic review aims to assess the antimicrobial efficacy of NAC in comparison to sodium hypochlorite, chlorhexidine, and calcium hydroxide against endodontic pathogens. A comprehensive search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, and LILACS databases up to April 2024, without language or date restrictions. The PICO strategy for this review were as follows: population-teeth requiring endodontic treatment; intervention-NAC used as an endodontic irrigant or intracanal medication; comparison-sodium hypochlorite, chlorhexidine, and calcium hydroxide; Outcomes: reduction in microbial load, encompassing clinical and in vitro studies. Risks of bias assessment and data extraction were conducted with two reviewers independently selecting studies, extracting data, and assessing risk of bias. A general meta-analysis was performed across all included studies, with additional meta-analyses evaluating different exposure times, NAC concentrations, control groups and evaluation methods. After removing duplicates, 9170 studies were initially identified, and seven in vitro studies were included in the systematic review, of which five were included in the meta-analysis. Data were compared using standardized mean differences within a random-effects model. No clinical studies using NAC as an antimicrobial agent were identified. The overall meta-analysis demonstrated that NAC effectively reduced Enterococcus faecalis. Further meta-analyses revealed that exposure time, NAC concentration and choice of control group significantly influenced NAC's effectiveness. NAC effectively reduced Enterococcus faecalis, showing comparable antimicrobial activity to CHX and NaOCl, especially at concentrations of 25-50 mg/mL over a 7-day exposure. Despite significant heterogeneity across studies, NAC demonstrated satisfactory antimicrobial effects in vitro. This suggests that NAC merits reconsideration as an effective intracanal medication for clinical use.
有效的根管消毒对于牙髓治疗的成功至关重要。N-乙酰半胱氨酸（NAC）以其抗菌特性而闻名，最近被作为一种潜在的牙髓冲洗剂或根管内用药进行研究。本系统评价旨在评估NAC与次氯酸钠、氯己定和氢氧化钙相比，对牙髓病原体的抗菌效果。截至2024年4月，在PubMed、Scopus、Web of Science、Cochrane图书馆和LILACS数据库中进行了全面检索，无语言或日期限制。本评价的PICO策略如下：人群——需要牙髓治疗的牙齿；干预——NAC用作牙髓冲洗剂或根管内用药；对照——次氯酸钠、氯己定和氢氧化钙；结局：微生物负荷的降低，包括临床和体外研究。由两名评价者独立选择研究、提取数据并评估偏倚风险，进行偏倚风险评估和数据提取。对所有纳入研究进行一般荟萃分析，并进行额外的荟萃分析以评估不同的暴露时间、NAC浓度、对照组和评估方法。去除重复项后，最初识别出9170项研究，系统评价纳入了7项体外研究，其中5项纳入荟萃分析。在随机效应模型中使用标准化均数差比较数据。未识别出使用NAC作为抗菌剂的临床研究。总体荟萃分析表明，NAC能有效降低粪肠球菌。进一步的荟萃分析显示，暴露时间、NAC浓度和对照组的选择显著影响NAC的有效性。NAC能有效降低粪肠球菌，显示出与CHX和NaOCl相当的抗菌活性，尤其是在25 - 50 mg/mL浓度下暴露7天时。尽管各研究间存在显著异质性，但NAC在体外显示出令人满意的抗菌效果。这表明NAC作为一种有效的根管内用药用于临床值得重新考虑。
