Etidronic Acid as a Root Canal Irrigant: A Systematic Review of its Efficacy in Disinfection and Potential to Enhance Endodontic Treatment Outcomes

Abstract

Aim: This systematic review aims to critically evaluate the efficacy of 1-hydroxyethylidene-1,1-bisphosphonate (HEBP) as an antimicrobial irrigant in root canal disinfection protocols.
Materials and Methods: A comprehensive literature search was conducted across PubMed, Google Scholar, and ScienceDirect databases, encompassing studies from the past 15 years. The inclusion criteria were strictly limited to studies utilizing HEBP on extracted human teeth, while animal studies and non-English publications were excluded. The systematic review adhered to PRISMA guidelines, and the methodological quality of included studies was assessed using Cochrane risk of bias tools. Quality assessment parameters included sample size adequacy, presence of control groups, procedural standardization, robustness of statistical analyses, and overall risk of bias. This rigorous approach aimed to provide an evidence-based analysis of HEBP's effectiveness in root canal disinfection.
Results: The initial search yielded 141 studies, of which 126 were excluded following duplicate removal and full-text analysis. Fifteen studies met the stringent inclusion criteria and were subjected to detailed review. The systematic analysis revealed that HEBP, when used as a sole irrigant, did not demonstrate superiority over conventional irrigants such as sodium hypochlorite or ethylenediaminetetraacetic acid (EDTA). However, the combination of HEBP with sodium hypochlorite exhibited synergistic effects, resulting in enhanced antimicrobial efficacy.
Conclusion: The findings of this systematic review indicate that while HEBP as a standalone irrigant does not surpass the antimicrobial efficacy of established agents like sodium hypochlorite or EDTA, it demonstrates comparable disinfection capabilities. Notably, the synergistic potential of HEBP when combined with sodium hypochlorite warrants further investigation for potential clinical applications in root canal disinfection protocols.