Hydrogel-Based Intracanal Medicaments in Endodontics: A Systematic Review of Development and Antibacterial Efficacy

Background and Aim: Endodontic treatment necessitates the elimination of infectious pulp tissue and the disinfection of the root canal system to prevent reinfection and periradicular inflammation. Traditional intracanal medicaments, such as calcium hydroxide (Ca(OH)2), have limitations including limited drug diffusion, short retention time, and potential tooth discoloration. Hydrogels, due to their unique properties such as controlled drug release and biocompatibility, have emerged as promising carriers for intracanal medicaments. This systematic review aims to evaluate the development, antimicrobial efficacy, and clinical applications of hydrogelbased intracanal medicaments in endodontics. The primary objective is to assess the effectiveness of these medicaments compared to traditional in vitro intracanal medicament models or other drug delivery systems. The secondary objective is to evaluate the properties and characteristics of different hydrogel formulations used in endodontics. Materials and Methods: This systematic review was registered in PROSPERO (registration number: CRD42024525186). Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, experimental studies investigating hydrogel-based intracanal medicaments in simulated endodontic conditions were included. Eligibility criteria encompassed in vitro models, hydrogel-based interventions, and outcomes related to antimicrobial properties, drug release profiles, and other relevant in vitro outcomes. Data extraction and quality assessment were conducted by two independent reviewers. Results: Fourteen studies were included, that used various hydrogel formulations such as methylcellulose, GelMA, poloxamer gel, alginate, chitosan-based hydrogel, and HPMC. Enterococcus aecalis was the most commonly evaluated microorganism. Evaluation methods included agar diffusion assay, colony count, and SEM. Most hydrogels demonstrated significant antimicrobial efficacy, controlled drug release, and favorable biocompatibility. Material characterization varied, with some studies evaluating mechanical properties, swelling behavior, and degradation rates. Conclusion: Hydrogel-based intracanal medicaments with active antimicrobial agents demonstrate promising potential in the improvement of endodontic treatment with their sustainability in the antimicrobial activity and enhanced biocompatibility. The interaction between the hydrogel carriers and their active ingredients thus represents a critical factor toward optimal therapeutic outcomes. However, the study has limitations, including a limited number of in vivo studies and variability in the formulations and evaluation methods across included studies. Further investigation into material properties and specific active agents is thus necessary to fully realize the benefits of these medicaments in endodontic therapy.