Antimicrobial Polymeric Nanoparticles in Endodontics: A Systematic Review

Abstract

Background: The efficacy of endodontic treatments, essential for managing infections and injuries in dental pulp, heavily relies on completely eradicating microorganisms from the root canal system. Traditional methods often fail to achieve thorough disinfection, prompting the exploration of polymeric nanoparticles for their potential to enhance cleanliness.Objectives: This systematic review aims to evaluate the use and effectiveness of polymeric nanoparticles in endodontic treatments, with a specific focus on their antimicrobial properties.Methods: Studies eligible for inclusion involved inoculated root canals, dentine, or endodontic medicaments containing relevant microbial species. The interventions examined included the application of polymeric nanoparticles that contain antimicrobial agents, sometimes enhanced by ultrasound or photodynamic therapy, compared against control groups without treatment. The primary outcome was the reduction in bacterial load. Systematic searches were conducted in databases such as PubMed, Web of Science, Scopus, and Google Scholar and completed by January 31, 2024. The risk of bias was assessed using a modified Cochrane tool, and results were synthesized descriptively due to heterogeneity in methodologies and reporting across the studies.Results: Nine studies met the inclusion criteria, primarily focusing on bacterial strains like Enterococcus faecalis and Staphylococcus aureus. Results indicated that nanoparticles exhibited significant antimicrobial activity, especially those made of chitosan and poly (lactic-co-glycolic acid) (PLGA). This suggests a potential to revolutionize root canal disinfection processes. However, clinical translation faces challenges such as ensuring nanoparticle stability, biocompatibility, and cost-effective manufacturing processes.Discussion: The evidence was limited by variability in study designs and microbial strains, the absence of clinical trials, and inconsistent reporting precluded a meta-analysis. Despite promising in vitro results, several barriers hinder the clinical implementation of nanoparticle-based therapies. Long-term safety data are sparse, and the potential for adverse effects like inflammatory responses and antimicrobial resistance remains a concern. Additionally, achieving optimal delivery within the intricate anatomy of the root canal system requires further innovation. Addressing these challenges is critical for transitioning from experimental to practical applications.