{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T19:49:54Z","timestamp":1790884194136,"version":"4.1.0"},"reference-count":58,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Materials"],"abstract":"<jats:p>This systematic review aims to compare the efficacy of sodium hypochlorite (NaOCl) and chlorhexidine digluconate (CHX) in decontaminating gutta-percha (GP) cones against endodontic pathogens\u2014Enterococcus faecalis (E. faecalis), Staphylococcus aureus (S. aureus), and Candida albicans (C. albicans)\u2014within 0\u201310 min. A systematic search was conducted in six databases (PubMed, Web of Science, Cochrane Library, SCIELO, Scopus, and LILACS), supplemented by manual searches performed independently by three reviewers. No publication year restrictions were applied, and only English-language studies were included. This review followed the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The risk of bias was assessed using six parameters with a modified Cochrane risk of bias tool. Out of 309 potentially eligible studies, 216 were screened by title and abstract, 32 were selected for full-text assessments, and 7 were included. All studies had a moderate or high risk of bias. The majority of the included studies showed that higher NaOCl concentrations effectively eliminate E. faecalis and S. aureus within 1\u20135 min. However, data on CHX\u2019s antimicrobial effect on C. albicans were limited. The qualitative analysis suggests that NaOCl remains the most effective agent for GP decontamination, while CHX with additives shows potential against fungal species.<\/jats:p>","DOI":"10.3390\/ma18071539","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T02:50:16Z","timestamp":1743389416000},"page":"1539","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Antimicrobial Efficacy of Sodium Hypochlorite and Chlorhexidine in Gutta-Percha Cone Decontamination: A Systematic Review"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8473-8050","authenticated-orcid":false,"given":"Ruta","family":"Aucinaite","sequence":"first","affiliation":[{"name":"Institute of Dentistry, Faculty of Medicine, Vilnius University, Zalgirio 115, 08217 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4889-2023","authenticated-orcid":false,"given":"Egle","family":"Nedzinskiene","sequence":"additional","affiliation":[{"name":"Institute of Dentistry, Faculty of Medicine, Vilnius University, Zalgirio 115, 08217 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vytaute","family":"Peciuliene","sequence":"additional","affiliation":[{"name":"Institute of Dentistry, Faculty of Medicine, Vilnius University, Zalgirio 115, 08217 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9930-325X","authenticated-orcid":false,"given":"Irma","family":"Dumbryte","sequence":"additional","affiliation":[{"name":"Institute of Dentistry, Faculty of Medicine, Vilnius University, Zalgirio 115, 08217 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1046\/j.1365-2591.1997.00092.x","article-title":"Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis","volume":"30","author":"Figdor","year":"1997","journal-title":"Int. Endod. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1046\/j.1365-2591.2001.00396.x","article-title":"Aetiology of root canal treatment failure: Why well-treated teeth can fail","volume":"34","author":"Siqueira","year":"2001","journal-title":"Int. Endod. J."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Kowalski, J., Rygas, J., Homa, K., Dobrzy\u0144ski, W., Wiglusz, R.J., Matys, J., and Dobrzy\u0144ski, M. (2024). Antibacterial Activity of Endodontic Gutta-Percha\u2014A Systematic Review. Appl. Sci., 14.","DOI":"10.3390\/app14010388"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"27","DOI":"10.17096\/jiufd.92774","article-title":"Antimicrobial and structural effects of different irrigation solutions on gutta-percha cones","volume":"49","author":"Turker","year":"2015","journal-title":"J. Istanb. Univ. Fac. Dent."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1111\/iej.13787","article-title":"Effectiveness of root canal filling materials and techniques for treatment of apical periodontitis: A systematic review","volume":"56","author":"Pirani","year":"2023","journal-title":"Int. Endod. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1097\/01.don.0000158012.01520.e5","article-title":"Structural effects of sodium hypochlorite solutions on gutta-percha cones: Atomic force microscopy study","volume":"31","author":"Valois","year":"2005","journal-title":"J. Endod."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Wieczorkiewicz, K., Jarz\u0105bek, A., Bakinowska, E., Kie\u0142bowski, K., and Pawlik, A. (2025). Microbial Dynamics in Endodontic Pathology\u2014From Bacterial Infection to Therapeutic Interventions\u2014A Narrative Review. Pathogens, 14.","DOI":"10.3390\/pathogens14010012"},{"key":"ref_8","first-page":"100021","article-title":"Evaluation of the risk of Enterococcus faecalis cross-contamination of gutta-percha cartridges","volume":"2","author":"Smith","year":"2023","journal-title":"JADA Found. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Dioguardi, M., Gioia, G.D., Illuzzi, G., Arena, C., Caponio, V.C.A., Caloro, G.A., Zhurakivska, K., Adipietro, I., Troiano, G., and Muzio, L.L. (2019). Inspection of the Microbiota in Endodontic Lesions. Dent. J., 7.","DOI":"10.3390\/dj7020047"},{"key":"ref_10","first-page":"733","article-title":"Evaluation of antimicrobial and antifungal effects of iodoform-integrating gutta-percha","volume":"72","author":"Bodrumlu","year":"2006","journal-title":"J. Can. Dent. Assoc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"103283","DOI":"10.1016\/j.jdent.2020.103283","article-title":"Antimicrobial and ultrastructural properties of root canal filling materials exposed to bacterial challenge","volume":"93","author":"Long","year":"2020","journal-title":"J. Dent."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.tripleo.2005.10.073","article-title":"Antimicrobial effect, in vitro, of gutta-percha points containing root canal medications against yeasts and Enterococcus faecalis","volume":"102","author":"Oztan","year":"2006","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1097\/00004770-200206000-00002","article-title":"In situ antimicrobial effectiveness of chlorhexidine and calcium hydroxide: Gel and paste versus gutta-percha points","volume":"28","author":"Barthel","year":"2002","journal-title":"J. Endod."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1080\/08927014.2021.1993836","article-title":"Coexistence of Candida albicans and Enterococcus faecalis increases biofilm virulence and periapical lesions in rats","volume":"37","author":"Du","year":"2021","journal-title":"Biofouling"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Teles, A.M., Pina, C., Cardoso, I.L., Tramontana, A., Cardoso, M., Duarte, A.S., Bartolomeu, M., and Noites, R. (2024). Degree of Contamination of Gutta-Percha Points by Staphylococcus aureus (MRSA\/MSSA) Strains. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25168566"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Thomas, C., Minty, M., Vinel, A., Canceill, T., Loubi\u00e8res, P., Burcelin, R., Kaddech, M., Blasco-Baque, V., and Laurencin-Dalicieux, S. (2021). Oral Microbiota: A Major Player in the Diagnosis of Systemic Diseases. Diagnostics, 11.","DOI":"10.3390\/diagnostics11081376"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1111\/j.1747-4477.2010.00256.x","article-title":"Effectiveness of different chemical agents for disinfection of gutta-percha cones","volume":"37","author":"Nabeshima","year":"2011","journal-title":"Aust. Endod. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1016\/j.tripleo.2004.10.002","article-title":"Disinfection of gutta-percha cones with chlorhexidine and sodium hypochlorite","volume":"100","author":"Gomes","year":"2005","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"45","DOI":"10.54589\/aol.33\/1\/045","article-title":"Decontamination of Gutta-percha Cones employed in Endodontics","volume":"33","author":"Carvalho","year":"2020","journal-title":"Acta Odontol\u00f3gica Latinoam."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1016\/j.joen.2013.06.022","article-title":"Efficacy of Peracetic Acid in Rapid Disinfection of Resilon and Gutta-percha Cones Compared with Sodium Hypochlorite, Chlorhexidine, and Povidone-iodine","volume":"39","author":"Subha","year":"2013","journal-title":"J. Endod."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1590\/S1517-83822000000100016","article-title":"Effectiveness of different chemical agents in rapid decontamination of gutta-percha cones","volume":"31","author":"Cardoso","year":"2000","journal-title":"Braz. J. Microbiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"221","DOI":"10.4103\/ijdr.IJDR_233_20","article-title":"Antimicrobial Efficacy of Acacia Nilotica (Babul) Extract and its Effectiveness in Disinfecting Gutta Percha Cones\u2014An In Vitro Study","volume":"32","author":"Jagyasi","year":"2021","journal-title":"Indian J. Dent. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"47","DOI":"10.5005\/jp-journals-10024-1009","article-title":"Evaluation of residual antimicrobial effects and surface changes of gutta-percha disinfected with different solutions","volume":"12","author":"Sahinkesen","year":"2011","journal-title":"J. Contemp. Dent. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Hoffmann, S., Walter, S., Blume, A.-K., Fuchs, S., Schmidt, C., Scholz, A., and Gerlach, R.G. (2018). High-Throughput Quantification of Bacterial-Cell Interactions Using Virtual Colony Counts. Front. Cell. Infect. Microbiol., 8.","DOI":"10.3389\/fcimb.2018.00043"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Perez-Gavilan, A., de Castro, J.V., Arana, A., Merino, S., Retolaza, A., Alves, S.A., Francone, A., Kehagias, N., Sotomayor-Torres, C.M., and Cocina, D. (2021). Antibacterial activity testing methods for hydrophobic patterned surfaces. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-85995-9"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.3390\/microbiolres14040119","article-title":"Exploring the Variability in Antibacterial Testing of Resin Dental Composites among Investigators: A Narrative Review","volume":"14","author":"Pal","year":"2023","journal-title":"Microbiol. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.joen.2005.09.014","article-title":"Root canal irrigants","volume":"32","author":"Zehnder","year":"2006","journal-title":"J. Endod."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1590\/0103-6440201302188","article-title":"Chlorhexidine in endodontics","volume":"24","author":"Gomes","year":"2013","journal-title":"Braz. Dent. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1046\/j.1365-2591.2001.00412.x","article-title":"Efficacy of chemical sterilization and storage conditions of gutta-percha cones","volume":"34","author":"Maltos","year":"2001","journal-title":"Int. Endod. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1111\/j.1875-595X.2008.tb00354.x","article-title":"Sodium hypochlorite in endodontics: An update review","volume":"58","author":"Mohammadi","year":"2008","journal-title":"Int. Dent. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1590\/S0103-64402002000200007","article-title":"Mechanism of action of sodium hypochlorite","volume":"13","author":"Estrela","year":"2002","journal-title":"Braz. Dent. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"571","DOI":"10.4103\/0972-0707.144607","article-title":"Disinfection of gutta-percha cones using three reagents and their residual effects","volume":"17","author":"Chandrappa","year":"2014","journal-title":"J. Conserv. Dent. JCD"},{"key":"ref_33","unstructured":"Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., and Welch, V.A. (2024). Cochrane Handbook for Systematic Reviews of Interventions Version 6.5, Cochrane. Available online: www.training.cochrane.org\/handbook."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_35","first-page":"3","article-title":"Immediate and Delay Antimicrobial Activity of Three Disinfection Solutions on Gutta-Percha Cones as Routine Chair-Side Procedure","volume":"28","author":"Mahdee","year":"2021","journal-title":"Int. Med. J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"14","DOI":"10.29252\/jrdms.5.2.14","article-title":"Low-Pressure Radiofrequency Cold Plasma for Disinfection of Gutta-Percha Cones","volume":"5","author":"Asnaashari","year":"2020","journal-title":"J. Res. Dent. Maxillofac. Sci."},{"key":"ref_37","first-page":"9","article-title":"Antibacterial activity of a plant extract and its potential for disinfecting gutta-percha cones","volume":"25","author":"Nobre","year":"2012","journal-title":"Acta Odontol. Latinoam. AOL"},{"key":"ref_38","first-page":"ZC40","article-title":"Comparing the Efficacy of Berberine against Sodium Hypochlorite and Chlorhexidine Cetrimide as a Chairside Disinfectant of Gutta Percha Cones","volume":"13","author":"Rai","year":"2019","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_39","first-page":"993","article-title":"Rapid Decontamination of Gutta-Percha Points- An in Vitro Comparative Study between Different Auxiliary Chemical Substances","volume":"14","author":"Banka","year":"2024","journal-title":"J. Chem. Health Risks"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1007\/s42770-024-01255-8","article-title":"Efficacy of calcium hypochlorite in disinfection of gutta-percha cones contaminated with Candida albicans","volume":"55","author":"Pauletto","year":"2024","journal-title":"Braz. J. Microbiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e364","DOI":"10.4317\/medoral.22907","article-title":"Influence of microbiology on endodontic failure. Literature review","volume":"24","author":"Prada","year":"2019","journal-title":"Med. Oral Patol. Oral Cir. Bucal"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1111\/j.1601-1546.2003.00041.x","article-title":"Persistent, recurrent, and acquired infection of the root canal system post-treatment","volume":"6","author":"Haapasalo","year":"2003","journal-title":"Endod. Top."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.joen.2005.10.049","article-title":"Enterococcus faecalis: Its Role in Root Canal Treatment Failure and Current Concepts in Retreatment","volume":"32","author":"Stuart","year":"2006","journal-title":"J. Endod."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/j.joen.2007.01.012","article-title":"Detection and eradication of microorganisms in root-filled teeth associated with periradicular lesions: An in vivo study","volume":"33","author":"Schirrmeister","year":"2007","journal-title":"J. Endod."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"106337","DOI":"10.1016\/j.micpath.2023.106337","article-title":"Enterococcus faecalis in secondary apical periodontitis: Mechanisms of bacterial survival and disease persistence","volume":"183","author":"Elashiry","year":"2023","journal-title":"Microb. Pathog."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/0030-4220(87)90237-4","article-title":"The significance of environmental contamination of sealer and gutta-percha before endodontic obturation","volume":"63","author":"Klager","year":"1987","journal-title":"Oral Surg. Oral Med. Oral Pathol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/j.tripleo.2003.12.022","article-title":"Fungi in endodontic infections","volume":"97","author":"Siqueira","year":"2004","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol."},{"key":"ref_48","first-page":"24","article-title":"Presence of Candida Albicans in Root Canal System of Teeth Requiring Endodontic Retreatment with and without Periapical Lesions","volume":"2","author":"Ashraf","year":"2007","journal-title":"Iran. Endod. J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1111\/j.1365-2591.1987.tb00616.x","article-title":"Efficiency of different chemical agents in decontamination of gutta-percha cones","volume":"20","author":"Stabholz","year":"1987","journal-title":"Int. Endod. J."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"391","DOI":"10.4103\/0970-9290.57353","article-title":"Antimicrobial effect of MTAD, Tetraclean, Cloreximid, and sodium hypochlorite on three common endodontic pathogens","volume":"20","author":"Giardino","year":"2009","journal-title":"Indian J. Dent. Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.joen.2007.01.015","article-title":"An in vitro comparison of the antimicrobial effects of various endodontic medicaments on Enterococcus faecalis","volume":"33","author":"Davis","year":"2007","journal-title":"J. Endod."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1590\/S1517-83822007000400013","article-title":"Disinfection of Gutta-percha cones with chlorhexidine","volume":"38","author":"Redmerski","year":"2007","journal-title":"Braz. J. Microbiol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.joen.2009.10.013","article-title":"Eradication of Enterococcus faecalis biofilms by cetrimide and chlorhexidine","volume":"36","author":"Valderrama","year":"2010","journal-title":"J. Endod."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1111\/j.1601-1546.2003.00040.x","article-title":"Enterococcus faecalis\u2013 the root canal survivor and \u2018star\u2019 in post-treatment disease","volume":"6","author":"Portenier","year":"2003","journal-title":"Endod. Top."},{"key":"ref_55","first-page":"ZC20","article-title":"Comparative Evaluation of Antimicrobial Activity of QMiX, 2.5% Sodium Hypochlorite, 2% Chlorhexidine, Guava Leaf Extract and Aloevera Extract Against Enterococcus faecalis and Candida albicans\u2014An In-Vitro Study","volume":"10","author":"Jose","year":"2016","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1111\/iej.13677","article-title":"Present status and future directions: Microbiology of endodontic infections","volume":"55","author":"Siqueira","year":"2022","journal-title":"Int. Endod. J."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1034\/j.1601-0825.2001.70103.x","article-title":"Adjunctive use of chlorhexidine in oral candidoses: A review","volume":"7","author":"Ellepola","year":"2001","journal-title":"Oral Dis."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s11046-012-9520-4","article-title":"Susceptibilities of Candida albicans Mouth Isolates to Antifungal Agents, Essentials Oils and Mouth Rinses","volume":"174","author":"Carvalhinho","year":"2012","journal-title":"Mycopathologia"}],"container-title":["Materials"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1996-1944\/18\/7\/1539\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:04:50Z","timestamp":1760029490000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1996-1944\/18\/7\/1539"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,28]]},"references-count":58,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["ma18071539"],"URL":"https:\/\/doi.org\/10.3390\/ma18071539","relation":{},"ISSN":["1996-1944"],"issn-type":[{"value":"1996-1944","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,28]]}}}