CARBOHYDRATE-DERIVED FULVIC ACID (CHD-FA) AS A ROOT CANAL IRRIGANT: A SYSTEMATIC REVIEW

Abstract

Background: Root canal irrigation plays a pivotal role in achieving successful endodontic treatment by eliminating microorganisms, dissolving organic debris, and removing the smear layer. Although sodium hypochlorite (NaOCl) and ethylene diamine tetra acetic acid (EDTA) remain the most commonly used irrigants, their limitations, including cytotoxicity and adverse effects on dentin, have prompted the search for safer and equally effective alternatives. Carbohydrate-Derived Fulvic Acid (CHD-FA), a naturally derived compound with antimicrobial, anti-inflammatory, immunomodulatory and chelating properties, has gained attention as a potential root canal irrigant. Objective: To systematically evaluate the available evidence on the efficacy and safety of CHD-FA as a root canal irrigant by assessing its antimicrobial effectiveness, smear layer removal capability, biocompatibility, and effects on dentin in comparison with conventional irrigants. Methods: A systematic review was conducted following PRISMA 2020 guidelines. Electronic databases were searched to identify eligible in vitro, ex vivo, and clinical studies evaluating CHD-FA as an endodontic irrigant. Studies meeting predefined inclusion criteria were screened, and data regarding study design, irrigation protocols, comparator agents, and reported outcomes were extracted and qualitatively synthesized. Results: The included studies consistently demonstrated that CHD-FA possesses broad-spectrum antimicrobial activity and effective smear layer removal while exhibiting favorable biocompatibility and lower cytotoxicity than conventional irrigants. However, heterogeneity in experimental methods, concentrations, irrigation protocols, and outcome measures limited direct comparisons and precluded quantitative meta-analysis. Conclusions: Current evidence suggests that CHD-FA is a promising root canal irrigant with the potential to provide effective canal disinfection and smear layer removal while improving biocompatibility. Nevertheless, the existing evidence is predominantly laboratory based. Well-designed randomized clinical trials with standardized protocols are needed to validate its clinical effectiveness and support its routine use in endodontic practice.