Clinical assessment of polyhexanide as an endodontic irrigant in the management of chronic apical periodontitis

INTRODUCTION. Chronic forms of apical periodontitis remain a relevant challenge in endodontic practice. The effectiveness of treatment largely depends on the quality of root canal irrigation. Polyhexamethylene guanidine (polyhexanide) is considered a promising alternative to sodium hypochlorite, offering antimicrobial activity with low cytotoxicity. MATERIALS AND METHODS. The study included 49 patients with chronic apical periodontitis, divided into two groups. In the first group, a 0.2% polyhexanide solution was used as the primary irrigant, while the second group received a standard protocol with 3% sodium hypochlorite (NaOCl) and 17% EDTA. Treatment efficacy was evaluated based on clinical symptoms and radiographic changes at 6 and 12 months. The Mann–Whitney U test and Pearson’s chi-squared (χ²) test were used for statistical analysis. RESULTS. The treatment success rate was 98% in the polyhexanide group and 93.6% in the control group. After 12 months, patients in the experimental group showed a lower incidence of persistent periapical lesions. Although the differences did not reach statistical significance (p > 0.05), there was a trend toward a more favorable healing process with polyhexanide use. CONCLUSIONS. The use of a 0.2% polyhexanide solution as an irrigant demonstrated clinical efficacy comparable to the traditional protocol, with a potential reduction in the risk of adverse effects on hard tissues and surrounding structures. Further studies with larger sample sizes and longer follow-up periods are needed to definitively assess the advantages of this approach. © Generalova Yu.A., Umarov A.Yu., Wehbe A., Dashtieva M.Yu., Bagdasarova I.V., 2025.