Propolis-based intracanal medicaments in endodontics – A systematic review and meta-analysis

Aim: This systematic review and meta-analysis aimed to evaluate the antimicrobial efficacy of propolis-based intracanal medicaments. Methods: An electronic search was conducted in PubMed (MEDLINE), Wiley Online Library, ScienceDirect, and Google Scholar for English-language publications from 2010 to 2024, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Included studies were in vitro models using extracted human permanent teeth to assess the antimicrobial activity of propolis-based intracanal medicaments against Candida albicans, Enterococcus faecalis , or both, compared with other chemical or natural agents. Animal studies, in vivo or ex vivo i nvestigations, randomized controlled trials, clinical trials, non-English articles, and duplicates were excluded. Risk of bias in the final 12 included studies was assessed using the Quality Assessment of In vitro Studies (QUIN) tool. This review was registered with the International Prospective Register of Systematic Reviews (CRD42020206446). Results: Of 356 articles initially identified, 16 duplicates were excluded. After screening titles and abstracts of 340 records, 318 were removed. Full-text evaluation of 22 studies led to the inclusion of 12 studies, of which 3 were eligible for meta-analysis. Pooled analysis demonstrated that propolis exhibited significantly greater antimicrobial efficacy than calcium hydroxide against E. faecalis on day 5 (standardized mean difference = −1.81; 95% confidence Interval = −2.33 to −−1.28; P < 0.00001). Conclusion: Propolis showed superior antimicrobial activity against C. albicans and E. faecalis compared to other natural medicaments and outperformed calcium hydroxide against E. faecalis . Given its biocompatibility and promising in vitro performance, propolis represents a potential alternative intracanal medicament. Further well-designed in vivo and long-term clinical studies are needed to confirm its clinical effectiveness.