Antimicrobial Efficacy of Sodium Hypochlorite and Er, Cr: YSGG Laser against E Faecalis Biofilm - A Systematic Review

Abstract

Background: The complexity of the root canal system makes it difficult to completely disinfect is the leading cause for endodontic retreatment. Sodium hypochlorite (NaOCl) is the traditionally used irrigation solution and has improved its efficacy with various adjuncts. The use of lasers in disinfecting the canal system has come into prominence in recent years. Aim: To assess the efficacy of sodium hypochlorite and Er, Cr: YSGG laser against E faecalis biofilm. Methodology: A systematic search was conducted using a search strategy in PubMed and Google scholar for studies published between 1st January 2011 and 21st March 2022. Hand searching of relevant articles in Institutional library was also performed. Comparative in vitro studies in English language or articles in other languages which had a possibility of translation into English comparing sodium hypochlorite and Er, Cr: YSGG laser for irrigation against E faecalis biofilm were included in the review whereas, studies comparing efficacy against biofilm other than E faecalis, comparison with other laser activated intracanal irrigation, data reported through letter to editors, short communications and conference proceedings were excluded from the review. Results: A preliminary search yielded a total of 67 studies of which seven articles giving 11 estimates were included for qualitative synthesis. Data on colony forming units for both the groups (sodium hypochlorite and Er, Cr: YSGG laser) was extracted. Overall, four studies presented significant difference in the effectiveness of sodium hypochlorite and Er, Cr: YSGG laser whereas three studies presented with no difference among the two groups. Conclusion: Irrigation of root canal by sodium hypochlorite and Er, Cr: YSGG laser activation both prove to be effective in reducing the E faecalis colony forming units. However, it is difficult to provide a conclusive statement on the superiority of Er, Cr: YSGG laser activated irrigation over sodium hypochlorite solution as half of the studies gave contrasting results. Future studies with larger sample size on complex anatomical root structure are recommended.