Can natural irrigants replace sodium hypochlorite? A systematic review

source extracted confidence: high 2026-04-09
#humans #sodium-hypochlorite #chloramines #root-canal-irrigants #anti-infective-agents

Can natural irrigants replace sodium hypochlorite? A systematic review

Susila et al., 2023 | Clin Oral Investig | Systematic Review

Citation

Susila Anand Venkatraman, Sai Shamini, ... Nivedhitha Sureshbabu. Can natural irrigants replace sodium hypochlorite? A systematic review. Clin Oral Investig. 2023-May;27(5):1831-1849. doi:10.1007/s00784-023-04913-7

Abstract

CONTEXT: Sodium hypochlorite, a gold standard for irrigation in endodontics, has disadvantages like toxicity and root dentin weakening. Alternatives derived from natural products are being explored. AIMS: This systematic review was done to understand the clinical benefits of natural irrigants when compared with a standard irrigant, sodium hypochlorite. SETTINGS AND DESIGN REGISTRATION: This systematic review was registered with PROSPERO (2018 CRD42018112837) METHODS AND MATERIAL: This review was done in conformation to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA 2020) statement. In vivo studies using at least one natural irrigant and sodium hypochlorite (NaOCl) were included. Studies using them as medicaments were excluded. PubMed, Cochrane and SCOPUS were searched. RevMan tool for Risk of Bias 2 (RoB 2) and risk-of-bias tool to assess non-randomized studies of interventions (ROBINS-I) were used. GRADEpro was used to assess certainty of evidence. RESULTS: Ten articles (6 RCTs and 4 clinical studies) on approximately 442 patients were included. Seven natural irrigants were evaluated clinically. Due to the heterogeneity, meta-analysis could not be conducted. Antimicrobial efficacy was found to be similar for castor oil, neem, garlic-lemon, noni, papaine and NaOCl. Neem, papaine-chloramine, neem-NaOCl and neem-CHX were superior, while propolis, miswak and garlic were inferior to NaOCl. Post-operative pain was less for neem. There was no significant difference between papaine-chloramine, garlic extract and sodium hypochlorite in clinical/radiographic success. CONCLUSIONS: The studied natural irrigants are not more efficacious than NaOCl. At the moment, they cannot replace NaOCl routinely and may only substitute in select cases.

Key Findings

Ten articles (6 RCTs and 4 clinical studies) on approximately 442 patients were included. Seven natural irrigants were evaluated clinically. Due to the heterogeneity, meta-analysis could not be conducted. Antimicrobial efficacy was found to be similar for castor oil, neem, garlic-lemon, noni, papaine and NaOCl. Neem, papaine-chloramine, neem-NaOCl and neem-CHX were superior, while propolis, miswak and garlic were inferior to NaOCl. Post-operative pain was less for neem. There was no significant

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 442
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Sodium Hypochlorite
  • Chloramines
  • Root Canal Irrigants
  • Anti-Infective Agents
  • Dental Pulp Cavity

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Systematic Review, Journal Article
  • Vertical: garlic

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09