Antibacterial efficacy of quaternary ammonium compounds (QACs) against Enterococcus faecalis in endodontic infections: a systematic review and meta-analysis
Abstract Background This systematic review aims to assess the antibacterial efficacy of Quaternary Ammonium Compounds (QACs) against Enterococcus faecalis (E. faecalis) as a root canal irrigant for endodontic infections. Materials and methods A comprehensive literature search was conducted utilizing...
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BMC
2025-08-01
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| Series: | BMC Oral Health |
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| Online Access: | https://doi.org/10.1186/s12903-025-06573-3 |
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| author | Ranjeet Ajit Bapat Sumaiya Zabin Eusufzai Zohaib Akram Tanay Chaubal Khoo Suan Phaik Liang Lin Seow Umer Daood |
| author_facet | Ranjeet Ajit Bapat Sumaiya Zabin Eusufzai Zohaib Akram Tanay Chaubal Khoo Suan Phaik Liang Lin Seow Umer Daood |
| author_sort | Ranjeet Ajit Bapat |
| collection | DOAJ |
| description | Abstract Background This systematic review aims to assess the antibacterial efficacy of Quaternary Ammonium Compounds (QACs) against Enterococcus faecalis (E. faecalis) as a root canal irrigant for endodontic infections. Materials and methods A comprehensive literature search was conducted utilizing the databases PubMed, Scopus, Cochrane library and Google Scholar for papers from January 2000 up until January 2024. The research question was formulated using the PICO (Population, Intervention, Control and Outcomes) framework. This review focused on the efficacy of QACs (intervention) against E. faecalis (population) and compare it with NaOCl (comparator 1) and CHX (comparator 2) for antibacterial activity by using findings of colony forming unit (CFU) and confocal laser microscopy (CLSM) (outcomes). A methodological quality assessment was conducted using a scoring methodology provided by Quin tool to evaluate the studies, and the risk of bias was examined. A systematic screening of the selected publications was performed based on predefined inclusion criteria to identify studies eligible for meta-analysis. Results Nine research studies papers included varied in their design and had a low to medium risk of bias. The findings demonstrated a decrease in the number of E. faecalis bacteria following the inclusion of QACs, leading to improved disinfection and efficacy in combating root canal infections. Furthermore, the meta-analysis findings indicated that there was no statistically significant distinction (p > 0.05) in the efficacy of QACs [Quaternary ammonium silane (K21) and Benzalkonium chloride (BAK)] when compared to commercially available NaOCl, however these QACs showed high efficacy against E. faecalis. Conclusion This review found QACs to be promising alternatives to NaOCl and CHX for E. faecalis elimination, though no significant difference was observed in meta-analysis due to study heterogeneity. Standardized in vivo studies are needed for validation. Prospero registration no CRD42023389258. Clinical trial number not applicable. |
| format | Article |
| id | doaj-art-5bea97f9010e462e996ea2e7cdbce2cf |
| institution | Kabale University |
| issn | 1472-6831 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Oral Health |
| spelling | doaj-art-5bea97f9010e462e996ea2e7cdbce2cf2025-08-20T04:02:49ZengBMCBMC Oral Health1472-68312025-08-0125112010.1186/s12903-025-06573-3Antibacterial efficacy of quaternary ammonium compounds (QACs) against Enterococcus faecalis in endodontic infections: a systematic review and meta-analysisRanjeet Ajit Bapat0Sumaiya Zabin Eusufzai1Zohaib Akram2Tanay Chaubal3Khoo Suan Phaik4Liang Lin Seow5Umer Daood6Restorative Dentistry Division, School of Dentistry, IMU University, Kuala LumpurDepartment of Pharmacology, Faculty of Medicine, University of MalayaBachelor of Oral Health Program, Charles Sturt UniversityCollege of Dentistry, University of Oklahoma Health Sciences CenterDivision of Clinical Oral Health, School of Dentistry, IMU University Kuala LumpurRestorative Dentistry Division, School of Dentistry, IMU University, Kuala LumpurRestorative Dentistry Division, School of Dentistry, IMU University, Kuala LumpurAbstract Background This systematic review aims to assess the antibacterial efficacy of Quaternary Ammonium Compounds (QACs) against Enterococcus faecalis (E. faecalis) as a root canal irrigant for endodontic infections. Materials and methods A comprehensive literature search was conducted utilizing the databases PubMed, Scopus, Cochrane library and Google Scholar for papers from January 2000 up until January 2024. The research question was formulated using the PICO (Population, Intervention, Control and Outcomes) framework. This review focused on the efficacy of QACs (intervention) against E. faecalis (population) and compare it with NaOCl (comparator 1) and CHX (comparator 2) for antibacterial activity by using findings of colony forming unit (CFU) and confocal laser microscopy (CLSM) (outcomes). A methodological quality assessment was conducted using a scoring methodology provided by Quin tool to evaluate the studies, and the risk of bias was examined. A systematic screening of the selected publications was performed based on predefined inclusion criteria to identify studies eligible for meta-analysis. Results Nine research studies papers included varied in their design and had a low to medium risk of bias. The findings demonstrated a decrease in the number of E. faecalis bacteria following the inclusion of QACs, leading to improved disinfection and efficacy in combating root canal infections. Furthermore, the meta-analysis findings indicated that there was no statistically significant distinction (p > 0.05) in the efficacy of QACs [Quaternary ammonium silane (K21) and Benzalkonium chloride (BAK)] when compared to commercially available NaOCl, however these QACs showed high efficacy against E. faecalis. Conclusion This review found QACs to be promising alternatives to NaOCl and CHX for E. faecalis elimination, though no significant difference was observed in meta-analysis due to study heterogeneity. Standardized in vivo studies are needed for validation. Prospero registration no CRD42023389258. Clinical trial number not applicable.https://doi.org/10.1186/s12903-025-06573-3AntibacterialDisinfectionEndodontic infectionEnterococcus faecalisInfectionIrrigant |
| spellingShingle | Ranjeet Ajit Bapat Sumaiya Zabin Eusufzai Zohaib Akram Tanay Chaubal Khoo Suan Phaik Liang Lin Seow Umer Daood Antibacterial efficacy of quaternary ammonium compounds (QACs) against Enterococcus faecalis in endodontic infections: a systematic review and meta-analysis BMC Oral Health Antibacterial Disinfection Endodontic infection Enterococcus faecalis Infection Irrigant |
| title | Antibacterial efficacy of quaternary ammonium compounds (QACs) against Enterococcus faecalis in endodontic infections: a systematic review and meta-analysis |
| title_full | Antibacterial efficacy of quaternary ammonium compounds (QACs) against Enterococcus faecalis in endodontic infections: a systematic review and meta-analysis |
| title_fullStr | Antibacterial efficacy of quaternary ammonium compounds (QACs) against Enterococcus faecalis in endodontic infections: a systematic review and meta-analysis |
| title_full_unstemmed | Antibacterial efficacy of quaternary ammonium compounds (QACs) against Enterococcus faecalis in endodontic infections: a systematic review and meta-analysis |
| title_short | Antibacterial efficacy of quaternary ammonium compounds (QACs) against Enterococcus faecalis in endodontic infections: a systematic review and meta-analysis |
| title_sort | antibacterial efficacy of quaternary ammonium compounds qacs against enterococcus faecalis in endodontic infections a systematic review and meta analysis |
| topic | Antibacterial Disinfection Endodontic infection Enterococcus faecalis Infection Irrigant |
| url | https://doi.org/10.1186/s12903-025-06573-3 |
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