# Antibacterialativity of Endodontic Gutta-Percha--A Systematic Review
## 4 Discussion
\begin{table}
\begin{tabular}{c c c c c c c c} \hline \hline  & **Group Size at** & **Control** & **Sample Size** & \begin{tabular}{c} **Detailed** \\ **Description of** \\ **Procedure** \\ \end{tabular} & \
\begin{tabular}{c} **Bacterial Test** \\ **Quality: Molecular** \\ **Test (1) or Culture (0)** \\ \end{tabular} &
\begin{tabular}{c} **Study with (1)** \\ **or without (0)** \\ **Teeth** \\ \end{tabular} & **Risk of Bias** \\ \hline [PERSON] et al. [26] & 0 & 1 & 0 & 1 & 0 & 0 & 2 & High \\ [PERSON] et al. [6] & 1 & 1 & 0 & 1 & 0 & 1 & 4 & Moderate \\ [PERSON] et al. [7] & 0 & 1 & 0 & 1 & 0 & 1 & 3 & Moderate \\ [PERSON] et al. [20] & 1 & 0 & 0 & 0 & 0 & 1 & High \\ [PERSON] et al. [8] & 0 & 1 & 0 & 1 & 0 & 2 & High \\ [PERSON] et al. [27] & 0 & 1 & 0 & 1 & 0 & 2 & High \\ [PERSON] et al. [21] & 0 & 1 & 0 & 1 & 0 & 2 & High \\ [PERSON] et al. [18] & 1 & 1 & 0 & 1 & 0 & 3 & Moderate \\ [PERSON] et al. [18] & 1 & 1 & 0 & 1 & 0 & 3 & Moderate \\ [PERSON] et al. [15] & 1 & 1 & 1 & 1 & 1 & 6 & Low \\ [PERSON] et al. [16] & 0 & 1 & 0 & 1 & 0 & 2 & High \\ [PERSON] et al. [17] & 1 & 1 & 0 & 1 & 0 & 1 & 4 & Moderate \\ [PERSON] et al. [29] & 1 & 1 & 1 & 1 & 1 & 1 & 6 & Low \\ \hline \hline \end{tabular}
\end{table} 
Table 3: _Cont._indicated that chlorhexidine is effective against _Enterococcus faecalis_, a notion supported by numerous other studies demonstrating both the in vitro and in vivo effectiveness of this aspect [40; 41; 42; 43; 44; 45; 46; 47]. Furthermore, chlorhexidine exhibits biocidal activity against Gram-positive bacteria, and, if the minimum inhibitory concentration (MIC) is maintained, it can also inhibit Gram-negative bacteria. Additionally, chlorhexidine remains active against DNA and RNA viruses and yeast, including _Candida albicans_[48; 49; 50; 51; 52; 53]. The primary limitation of this systematic review is that the considered studies were based on both in vitro and in vivo examinations of the samples. Consequently, prior to examination, the materials underwent varied and non-uniform conditions, even within the scope of each group. Materials tested in vivo were intracanal, placed after canal instrumentation and disinfection. The canal system irrigation varied across studies and included the use of MTAD, EDTA 17% or 20%, NaOCl 3% or 5, 25%, 0.9% NaCl, or saline of unknown concentration. The selection of different root canal rinsing agents undoubtedly impacts the post-preparation microflora of the endodontium [54; 55; 56; 57] and the quality of obturation. Moreover, not only does the type of irrigant affect overall root canal treatment efficacy, but also its volume and the duration of rinsing. The choice of the preparation technique and the tooth type are also crucial factors. Another limitation pertained to the duration of bacterial culture incubation on the material's surface in in vitro conditions, ranging from a minimum of 1 h [30] to a maximum of 21 days [20]. Bacterial growth does not follow a consistent vector over time, leading to different periods of incubation yielding diverse, non-uniform, and non-comparable counts of microorganisms. In future studies, it is imperative for researchers to standardize laboratory conditions and root canal system preparation before obturation. Additionally, each study should prioritize assessing material activity specifically against _Enterococcus faecalis_, considering this bacterium as the primary pathogen associated with root canal treatment [58; 59; 60; 61; 62; 63].