{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T08:48:52Z","timestamp":1785746932813,"version":"3.56.0"},"reference-count":51,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: This study compared the antimicrobial effects of chitosan and sodium hypochlorite against Enterococcus faecalis (E. faecalis) at different irrigation solution concentrations. E. faecalis is a persistent pathogen frequently surviving root canal treatment, while sodium hypochlorite remains the current gold-standard irrigation material. Materials and Methods: A systematic review and meta-analysis of in vitro studies was conducted using Cochrane Library, EMBASE, and PubMed. Evidence certainty was assessed with GRADE. Two outcomes were analyzed: colony-forming units (CFU\/mL) and the inhibition rate (IR). Two reviewers independently screened studies and extracted data. Results: Of 889 identified records, 10 studies met the inclusion criteria. For CFU\/mL, the overall effect was \u22120.28 (95% CI: \u22121.54 to 0.97). For IR, chitosan concentrations &lt; 1% showed an effect of \u20137.35 (95% CI: \u221227.27 to 12.56), while concentrations \u2265 1% showed an effect of \u22120.90 (95% CI: \u221219.24 to 17.45). Conclusions: Chitosan demonstrated antimicrobial activity comparable to sodium hypochlorite in vitro, with concentrations above 1% showing enhanced antibacterial effects. However, methodological heterogeneity limits direct comparison, and clinical equivalence cannot be concluded.<\/jats:p>","DOI":"10.3390\/medicina62081491","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T08:04:59Z","timestamp":1785744299000},"page":"1491","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Antimicrobial Efficacy of Chitosan vs. Sodium Hypochlorite Against Enterococcus faecalis: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6244-0448","authenticated-orcid":false,"given":"Vir\u00e1g","family":"R\u00f3na","sequence":"first","affiliation":[{"name":"Department of Prosthodontics, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8965-6589","authenticated-orcid":false,"given":"Bulcs\u00fa","family":"Bencze","sequence":"additional","affiliation":[{"name":"Department of Prosthodontics, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2489-3790","authenticated-orcid":false,"given":"Gergely","family":"Ag\u00f3cs","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary"},{"name":"Department of Biophysics and Radiation Biology, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0969-5031","authenticated-orcid":false,"given":"P\u00e9ter","family":"Hegyi","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary"},{"name":"Institute of Pancreatic Diseases, Semmelweis University, 1083 Budapest, Hungary"},{"name":"Institute for Translational Medicine, Medical School, University of P\u00e9cs, 7624 P\u00e9cs, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5620-9481","authenticated-orcid":false,"given":"Kata","family":"Kelemen","sequence":"additional","affiliation":[{"name":"Department of Prosthodontics, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6440-4683","authenticated-orcid":false,"given":"Tam\u00e1s","family":"Heged\u00fcs","sequence":"additional","affiliation":[{"name":"Department of Prosthodontics, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5506-8198","authenticated-orcid":false,"given":"G\u00e1bor","family":"Varga","sequence":"additional","affiliation":[{"name":"Department of Oral Biology, Semmelweis University, 1089 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4000-9440","authenticated-orcid":false,"given":"Be\u00e1ta","family":"Ker\u00e9mi","sequence":"additional","affiliation":[{"name":"Department of Restorative Dentistry and Endodontics, Semmelweis University, 1088 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ad\u00e9l","family":"Galv\u00e1cs","sequence":"additional","affiliation":[{"name":"Department of Restorative Dentistry and Endodontics, Semmelweis University, 1088 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3799-9535","authenticated-orcid":false,"given":"Zolt\u00e1n","family":"G\u00e9czi","sequence":"additional","affiliation":[{"name":"Department of Prosthodontics, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"ref_1","first-page":"640509","article-title":"Comparison of the success rate of endodontic treatment and implant treatment","volume":"2011","author":"Elemam","year":"2011","journal-title":"ISRN Dent."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"37","DOI":"10.4103\/jcd.jcd_437_21","article-title":"The effectiveness of nano-chitosan high molecular 0.2% as irrigant agent against Enterococcus faecalis with passive ultrasonic irrigant","volume":"25","author":"Abidin","year":"2022","journal-title":"J. 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