Antimicrobial and antibiofilm activity of peptides on multispecies endodontic pathogens: A systematic review

Abstract

Biofilms inside root canals pose a serious problem in the dental and medical fields because they consist of mixed communities of bacteria and fungi growing in sheltered, low-oxygen environments. Mechanical cleaning with hand or rotary tools fails to reach all spaces in the complex root canal, leaving some biofilm untouched. To address these challenges, several methods – such as using agitated irrigants, continuous chelating solutions, highly alkaline substances, antimicrobial nanoparticle, and antimicrobial peptides (AMPs) are being investigated for more thorough biofilm removal. The aim of this systematic review was to conduct a complete analysis of the literature on assessing the antimicrobial and antibiofilm activity of peptides on mixed colonization of multispecies endodontic pathogens. This systematic review paper evaluates the efficacy of AMP as a promising alternative to conventional antimicrobial agents. A thorough literature search was carried out using predefined Boolean keywords across electronic databases, Web of Science, Embase, Scielo, PubMed/MEDLINE, and Scopus. “MeSH” terms and/or keywords with respect to the subject were paired with the Boolean operators “AND” and “OR”. Studies assessing peptide efficacy against biofilms using both in vitro or in vivo models and published over the past 7–10 years were screened for inclusion. The review was conducted in two phases. In the first phase, screening for titles and abstracts was done, followed by the second phase wherein full-text papers and methodological quality with study outcomes were retrieved. Data extraction focused on types of peptides, concentration, assessment methods, bacterial strains, and outcomes. The quality of included studies was assessed based on experimental design, reproducibility, and statistical analysis. RevMan software was used to quantify data. Findings were synthesized to determine the efficacy of peptides in disrupting biofilms and enhancing antimicrobial activity. Ten studies were included in this review. The review identified several AMPs with varying efficacy against multispecies biofilms formed by endodontic pathogens. According to the risk assessment, there was a low risk of bias in 71.7% of the studies, an uncertain risk in 18.3%, and a high risk of bias in 10%. AMPs exhibit strong potential as antibacterial and antibiofilm agents against multispecies biofilms in endodontic infections. While some peptides demonstrate high efficacy, others may require modification or combination with existing treatments for improved results.