Antibacterial Efficacy of Different Irrigants Used During Endodontic Surgery: A Comparative Study

Background: Endodontic surgery is often required in cases of persistent periapical infections where conventional root canal treatment fails. Effective irrigation plays a crucial role in bacterial elimination, thereby improving surgical outcomes. Various irrigants, including sodium hypochlorite (NaOCl), chlorhexidine (CHX), ethylenediaminetetraacetic acid (EDTA), and newer biocompatible agents, have been evaluated for their antibacterial efficacy. Objective: The present study aimed to compare the antibacterial efficacy of different irrigants used during endodontic surgery to determine the most effective solution for bacterial elimination in periapical infections. Methodology: Extracted human teeth with standardized periapical lesions were inoculated with Enterococcus faecalis and divided into groups based on the irrigation solution used: (1) 5.25% NaOCl, (2) 2% CHX, (3) 17% EDTA, (4) Herbal irrigants (e.g., propolis or neem), and (5) Sterile saline as a control. The samples underwent surgical endodontic procedures, followed by microbiological analysis using colony-forming unit (CFU) counts and confocal laser scanning microscopy to assess bacterial viability. Results: The findings suggested that NaOCl demonstrated the highest antibacterial efficacy, followed by CHX, while herbal irrigants showed promising results with fewer cytotoxic effects. EDTA exhibited limited direct antibacterial action but enhanced biofilm removal. The control group (saline) showed persistent bacterial growth. Conclusion: The study highlighted the importance of selecting an appropriate irrigant in surgical endodontics. While NaOCl remained the gold standard, alternative irrigants such as CHX and herbal solutions offered effective antibacterial properties with improved biocompatibility. Further research was recommended to assess their long-term clinical outcomes.