Evaluation of antimicrobial efficacy of mineral trioxide aggregate with and without silver nanoparticles: A systematic review and meta-analysis

Mineral trioxide aggregate (MTA) is widely utilized in endodontics due to its excellent sealing properties and biocompatibility. However, its limited antibacterial efficacy, particularly against resistant microorganisms such as Enterococcus faecalis, highlights the need for enhancements in its antimicrobial performance. Recent research has focused on the incorporation of silver nanoparticles (AgNPs) into MTA to improve its antibacterial activity without compromising its physical and biological characteristics. This systematic review evaluates the antibacterial efficacy of AgNP-modified MTA in comparison to conventional MTA. The review protocol was registered in the PROSPERO database (CRD42024555867). A comprehensive literature search was conducted across PubMed, MEDLINE, the Cochrane Library, and Directory of Open Access Journals for the articles published until July 2024. Search strategies employed the PICO framework and Boolean operators, with MeSH terms including MTA, AgNPs, antibacterial activity, and E. faecalis. Two reviewers independently extracted the data, and the quality of the included in vitro studies was assessed using the QUIN tool. Of the 635 records initially identified, seven studies met the inclusion criteria. These studies utilized the various concentrations of AgNPs and employed different methods for antibacterial evaluation. Overall, AgNP-modified MTA demonstrated superior antibacterial activity in a dose-dependent manner, particularly against E. faecalis. The findings support the clinical potential of AgNP-enhanced MTA in improving microbial control during endodontic procedures.