Comparison of antibacterial effectiveness between Sealapex and AH-plus sealer against Enterococcus faecalis: a systematic review of in vitro studies

Aim: To summarize the outcome of in vitro studies comparing the antibacterial effectiveness of Sealapex and AH-plus sealer against E. faecalis. Methodology: The research question was developed using the PICO methodology and studies were identified from three electronic databases in Medline, Scopus, and EBSCOhost (Dentistry; Oral Sciences Source) since inception up to November 2019. The title and abstract of the selected articles were independently reviewed by two reviewers based on the specified inclusion and exclusion criteria and extracted the data using the data extraction form. The quality of selected in vitro studies was appraised using revised Cochrane Risk of Bias tool.Results: Sixteen studies satisfied the inclusion criteria and were included in this systematic review. Due to the lack of homogeneity in the data, meta-analysis could not be conducted. The quality of the evidence was "low", since every study had at least three questions related to high risk of bias. Different laboratory tests and protocols were used, their results were contradicting even for studies using the same laboratory tests and quality of evidence was found to be low. No study provided strong evidence, twelve studies provided moderate evidence, three studies provided limited evidence and one study provided conflicting evidence. The research question could not be meaningfully addressed. Conclusions: No difference was observed in the antimicrobial efficacy of Sealapex and AH-plus root canal sealers against Enterococcus faecalis. There was an identification of poor quality relevant studies with contradicting results that indicates the need for development of standardized protocols for future in vitro studies.