Can natural irrigants replace sodium hypochlorite? A systematic review.

Area of Science:

• Endodontics
• Dental Materials
• Natural Products

Background:

• Sodium hypochlorite (NaOCl) is the standard endodontic irrigant but has toxicity and weakens dentin.
• Research is exploring natural product alternatives for endodontic irrigation.

Approach:

• A systematic review followed PRISMA 2020 guidelines.
• Included 10 in vivo studies (6 RCTs, 4 clinical) on 442 patients comparing natural irrigants with NaOCl.
• Searched PubMed, Cochrane, and SCOPUS; assessed risk of bias and certainty of evidence.

Key Points:

• Seven natural irrigants were evaluated.
• Antimicrobial efficacy was similar for castor oil, neem, garlic-lemon, noni, and papaine compared to NaOCl.
• Neem, papaine-chloramine, and neem-based combinations showed superior antimicrobial activity; propolis, miswak, and garlic were inferior. Neem reduced post-operative pain.

Conclusions:

• The reviewed natural irrigants are not more efficacious than NaOCl.
• Currently, natural irrigants cannot replace NaOCl for routine endodontic use.
• Natural irrigants may serve as substitutes in specific clinical situations.