Evidence map›Paper›PMID 40775318›Full record

SynthesisBMC oral health2025

Antibacterial efficacy of quaternary ammonium compounds (QACs) against Enterococcus faecalis in endodontic infections: a systematic review and meta-analysis.

Ranjeet Ajit Bapat, Sumaiya Zabin Eusufzai, Zohaib Akram, Tanay Chaubal, Khoo Suan Phaik, Liang Lin Seow, Umer Daood

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC oral health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Enterococcus faecalis and Endodontic Treatment Failure: A Qualitative Systematic Review of Its Role and Elimination Strategies.Australian endodontic journal : the journal of the Australian Society of Endodontology Inc · 2026
    Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Ranjeet Ajit BapatRestorative Dentistry Division, School of Dentistry, IMU University, Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, 57000, Malaysia.
Sumaiya Zabin EusufzaiDepartment of Pharmacology, Faculty of Medicine, University of Malaya, Wilayah Persekutuan Kuala Lumpur, 50603, Malaysia.
Zohaib AkramBachelor of Oral Health Program, Charles Sturt University, Melbourne, VIC, Australia.
Tanay ChaubalCollege of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, USA.
Khoo Suan PhaikDivision of Clinical Oral Health, School of Dentistry, IMU University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, 57000, Malaysia.
Liang Lin SeowRestorative Dentistry Division, School of Dentistry, IMU University, Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, 57000, Malaysia.
Umer DaoodRestorative Dentistry Division, School of Dentistry, IMU University, Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, 57000, Malaysia. umerdaood@imu.edu.my.

Funding

Fundamental Research Grant Scheme (FRGS) Malaysia FRGS/1/2020/SKK0/IMU/02/10
6 · The paper itself

Abstract

backgroundThis systematic review aims to assess the antibacterial efficacy of Quaternary Ammonium Compounds (QACs) against Enterococcus faecalis (E. faecalis) as a root canal irrigant for endodontic infections. MATERIALS AND

methodsA comprehensive literature search was conducted utilizing the databases PubMed, Scopus, Cochrane library and Google Scholar for papers from January 2000 up until January 2024. The research question was formulated using the PICO (Population, Intervention, Control and Outcomes) framework. This review focused on the efficacy of QACs (intervention) against E. faecalis (population) and compare it with NaOCl (comparator 1) and CHX (comparator 2) for antibacterial activity by using findings of colony forming unit (CFU) and confocal laser microscopy (CLSM) (outcomes). A methodological quality assessment was conducted using a scoring methodology provided by Quin tool to evaluate the studies, and the risk of bias was examined. A systematic screening of the selected publications was performed based on predefined inclusion criteria to identify studies eligible for meta-analysis.

resultsNine research studies papers included varied in their design and had a low to medium risk of bias. The findings demonstrated a decrease in the number of E. faecalis bacteria following the inclusion of QACs, leading to improved disinfection and efficacy in combating root canal infections. Furthermore, the meta-analysis findings indicated that there was no statistically significant distinction (p > 0.05) in the efficacy of QACs [Quaternary ammonium silane (K21) and Benzalkonium chloride (BAK)] when compared to commercially available NaOCl, however these QACs showed high efficacy against E. faecalis.

conclusionThis review found QACs to be promising alternatives to NaOCl and CHX for E. faecalis elimination, though no significant difference was observed in meta-analysis due to study heterogeneity. Standardized in vivo studies are needed for validation. PROSPERO REGISTRATION NO: CRD42023389258. CLINICAL TRIAL NUMBER: not applicable.

Indexed as

Anti-Bacterial AgentsEnterococcus faecalisGram-Positive Bacterial InfectionsQuaternary Ammonium CompoundsRoot Canal IrrigantsHumansAnti-Bacterial AgentsQuaternary Ammonium CompoundsRoot Canal IrrigantsAnd root canalAntibacterialDisinfectionEndodontic infectionEnterococcus faecalisInfectionIrrigantQuaternary ammonium compound

Identifiers

PMID40775318
PMCPMC12333173

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.