# Antibacterialativity of Endodontic Gutta-Percha--A Systematic Review
## 3 Results
### Main Study Outcomes  
The objective of this study was to assess the antimicrobial properties generated by gutta-percha and to determine which substances, when mixed with gutta-percha, enhanced these properties. The findings across studies revealed diverse and sometimes contradictory outcomes. Various techniques were employed to measure the impact of gutta-percha on bacterial strains. Most studies did not explicitly state whether gutta-percha alone functioned as an inhibitor of bacterial development. This ambiguity arose from the common practice of comparing regular, classic gutta-percha cones with those enriched with additional substances. These studies focused on describing the improved properties of gutta-percha, while often overlooking a crucial piece of information--the antimicrobial properties of clean gutta-percha. Nevertheless, six papers [1; 3; 15; 18; 20; 23] provided a clear answer, affirming that clean gutta-percha, without any additional substances, did indeed exhibit antimicrobial properties. Among these, five studies [1; 3; 15; 20; 23] demonstrated antibacterial efficacy specifically against _Enterococcus faecalis_. It was established that gutta-percha inhibited every _Enterococcal_ virulence factor except the fsr virulence factor, which did not exhibit significant differences upon contact with the material [15]. Additionally, gutta-percha was found to inhibit the growth of _Candida albicans_. Furthermore, [PERSON] et al. [18] reported that gutta-percha alone actively combated the species of _Actinomyces israeli_ and _Actinomyces naselundii_. [PERSON] et al. [23] suggested that gutta-percha inhibited several endodontic species; however, the study did not specify which ones. However, six studies asserted that gutta-percha lacked antibacterial and antifungal properties [5; 9; 10; 12; 14; 26] against the microbial species used in the experiments. [PERSON] et al. [27] extended these conclusions further, indicating that, in a study using glass capillaries to simulate root canals, gutta-percha containing zinc oxide, when used to fill the capillaries, led to a 177% increase in the growth of _Enterococcus faecalis_ compared to the empty infected samples. Interestingly, different results emerged in studies comparing gutta-percha and Resilon. Some studies [1; 15; 18] asserted that gutta-percha exhibited superior antibacterial properties compared to Resilon. However, a study by [PERSON] et al. [10] demonstrated that both gutta-percha and Resilon did not exhibit any antimicrobial effect. The results from five studies [3; 13; 25; 26; 27] consistently demonstrated the superiority of chlorheximide over the addition of calcium hydroxide to gutta-percha. In a singular study [16], contrasting findings were reported. The efficacy of chlorheximide against _Enterococcus faecalis_ was consistently confirmed in four studies [3; 13; 25; 27]. The addition of calcium hydroxide to gutta-percha exhibited activity against this specific strain of bacteria in two studies [16; 27]. Notably, in one study, calcium hydroxide paste exhibited superior antibacterial properties compared to gutta-percha with chlorheximide [7]. [PERSON] et al. [6] investigated chlorheximide and calcium hydroxide individually, determining that each possessed better antibacterial properties alone than when mixed with gutta-percha. [PERSON] et al. [21] presented a case in which a combination of both chlorheximide and calcium hydroxide with gutta-percha demonstrated better performance than a mix of each of these materials with gutta-percha. Unfortunately, none of the examined combinations in the study were effective against _Enterococcus faecalis_. The addition of iodoform to gutta-percha consistently resulted in an enhancement of the material's properties [5; 18; 22]. However, [PERSON] et al. [22] asserted that medicated gutta-percha (MGP) remains inactive against _E. faecalis_, _E. aeruginosa_, and _E. coli_. Tetracycline gutta-percha cones (TGP) [14; 18] also improved the cones' antibacterial properties and demonstrated effectiveness against _E. faecalis_.