Systematic Review and Meta-Analysis on Antimicrobial Effectiveness of Herbal-Modified Glass Ionomer Cements

This systematic review with meta-analysis was registered in PROSPERO (CRD42024522010) and conducted according to PRISMA guidelines. Searches were performed in PubMed/MEDLINE, Scopus, and Web of Science. In vitro studies comparing conventional and phytotherapeutic-modified glass ionomer cements were included. Antimicrobial activity was assessed mainly using agar diffusion and minimum inhibitory concentration assays against cariogenic and opportunistic microorganisms. Of 34 records identified, eight studies met the eligibility criteria for qualitative synthesis, and two provided sufficiently comparable inhibition zone data against Streptococcus mutans for meta-analysis. Herbal-modified glass ionomer cements demonstrated increased antimicrobial activity against Streptococcus mutans, Candida albicans, and Staphylococcus aureus under laboratory conditions. The exploratory meta-analysis showed a statistically significant increase in inhibition zone diameter favoring herbal-modified cements (mean difference = 6.08 mm; 95% CI: 0.50 to 11.67; p = 0.03), with substantial heterogeneity (I² = 98%). Several studies also evaluated mechanical and physicochemical properties, including compressive strength, microhardness, and fluoride release, which were generally comparable to those of conventional glass ionomer cements.