MTA AND ITS USES

1. Mahmoud Torabinejad, DMD, MSD, PhD, and Noah Chivian, DDS, FICD,
FAC
LITERATURE
REVIEW

2. Vital Pulp
Therapy
• Because MTA has been shown to prevent dye
and bacterial leakage and has a high level of
biocompatibility (9),
• it was used as a pulp-capping material
• The results of this study showed that MTA
stimulates dentin bridge formation adjacent to
the dental pulp

3. Pulpal
reactions
• MTA used for pulp capping or partial pulpotomy
stimulates reparative dentine formation.
• MTA-capped pulps showed complete bridge
formation with no signs of inflammation
• This hard tissue bridge formed over the pulp
was documented after using (ProRoot MTA
&MTA Angelus) and both (grey &white Portland
cement)
• The incidence of dentine bridge formation was
higher with MTA than with calcium hydroxide.

4. INDICATIONS
• Pulp capping and pulpotomies are indicated only in teeth with immature apexes
when the dental pulps are exposed.
• These procedures are contraindicated in teeth with signs and symptoms of
irreversible pulpitis.

5. Apical MTA Plug
• MTA was used as an apical plug in immature premolars of
dogs that had been purposely infected and then disinfected
with calcium hydroxide.
• The results of these investigations showed that MTA induced
apical hard tissue formation more often, and its use was
associated with less inflammation than the other test
materials (Fig. 3).
• Based on these results, it seems that MTA can be used as an
apical barrier in teeth with immature apexes.

6. INDICATIONS
• Teeth with necrotic pulps and open apexes.
• 3 to 5 mm apical plug is needed to prevent
coronal leakage and extrusion of obturation
material into the periapical tissues.

7. CLINICAL
PROCEDURES
• After obtaining anesthesia, application of a rubber
dam, and preparing an adequate access
preparation, the root canal should be cleaned using
NaOCI irrigation.
• To disinfect the root canal, a calcium hydroxide paste
should be placed in the root canal for 1 wk.
• Mix the MTA powder with sterile water and carry the
mixture with a large amalgam carrier to the canal.
• Condense the MTA mix to the apical end of the root
with pluggers or paper points.
• Create a 3 to 4 mm apical plug of MTA and check its
extension radiographically.

8. • If creation of an ideal plug fails in the first attempt, rinse out the MTA with sterile
water and repeat the procedure.
• Place a moist cotton pellet in the canal and close the access cavity preparation
with a temporary restoration material for at least 3 to 4 h.
• Obturate the rest of the canal with gutta-percha or a composite-bonded resin in
teeth with thin walls as indicated and seal the access cavity with a final
restoration (Fig. 4).
• Assess periradicular healing clinically and radiographically as indicated.

9. Repair of Root
Perforations
• Materials such as - Cavit, zinc oxide-eugenol,
calcium hydroxide, amalgam, gutta-percha,
tricalcium phosphate, and hydroxyapatite have
been used to repair root perforations.
• In an in vitro study, (Lee and associates
compared the sealing ability of MTA with that of
amalgam,IRM for repair of experimentally
induced root perforations in extracted teeth)
• The results (showed that MTA had significantly
less leakage than IRM or amalgam, and it
showed the least overfilling tendency)
• Based on the results of these studies ,it seems
that MTA is a suitable material for perforation
repair.

10. Seung-Jong Lee, DDS, MS, Mehdi Monsef, DMD, and Mahmoud Torabinejad, DMD, MSD
CASE
MATERIAL
ANALYSIS-
COMPARISON
REVIEW
Sealing Ability of a Mineral
Trioxide Aggregate for Repair of
Lateral Root Perforations

11. FLUORESCENT DYE-PENETRATION
IMAGE
Sealing Ability of a Mineral Trioxide Aggregate When Used As a Root End Filling Material M. Torabinejad, DMD, MSD, T. F. Watson, BDS, PhD, and T. R. Pitt Ford, BDS, PhD VOL. 19, NO. 12,
DECEMBER 1993
MTA AMALGAM

12. CLINICAL PROCEDURES
• After obtaining anesthesia, application of rubber dam and locating the perforation site, the area
should be rinsed thorough with diluted NaOCL.
• In cases of long-standing perforations or in the presence of contamination, NaOCL should be left
in the root canal for a few minutes to disinfect the site of the perforation.
• After complete instrumentation and obturation of the canals with gutta-percha and root canal
sealer apical to perforation sites (furcation and stripping), mix MTA with sterile water and place it
at the perforation site with an amalgam carrier and pack it against the site with a plugger or a
cotton pellet.
• After repairing the perforation area with MTA, place a wet cotton pellet over MTA and seal the
access cavity with a temporary filling material. For apical perforations, mixed MTA should be
placed into the apical portion of the canal with a messing gun
• Remove the temporary and the wet cotton pellet at least 3 to 4 h, later and place a permanent
filling material in the access cavity preparation.
• Assess the healing in 3 to 6 months as indicated (Figs. 6 and 7).

13. ROOT-END
FILLING
• The use of MTA as root-end filling material was
associated with significantly less inflammation,
cementum formation over MTA, and regeneration
of the periradicular tissues to normal
• To prevent penetration of irritants from the root
canal system into the periradicular tissues.
• It can be used as a coronal (3 to 4 mm) plug alter
complete obturation of the root canal system and
before internal bleaching of discolored teeth
• To repair a vertical fracture and bond the pieces
internally with composite bonded resin.

14. Mineral trioxide aggregate: a review of the
constituents and biological properties of the
material
J. Camilleri & T. R. Pitt Ford
CASE-
LITERATURE
REVIEW

15. Constituents
• consists of a) 50–75% (wt) calcium oxide
b) 15–25% silicon dioxide.
• These two components together comprise 70–
95% of the cement
• When these materials are mixed they produce
tricalcium silicate, dicalcium silicate, tricalcium
aluminate and tetracalcium aluminoferrite.
• On addition of water the cement hydrates to form
silicate hydrate gel.
• The powder of MTA was composed mainly of
tricalcium and dicalcium silicates with bismuth
oxide also present for radiopacity (Camilleri et al.
2005a).

17. Peri-radicular
Tissue
Reactions
• The most characteristic tissue reaction to MTA was the presence
of organizing connective tissue with occasional signs of
inflammation after the first postoperative week.
• MTA (ProRoot) supported complete regeneration of the
periradicular periodontium when used as a root-end filling
material on non-infected teeth .
• In addition, MTA (ProRoot) showed the most favourable
periapical tissue response with formation of cemental coverage
over MTA (Baek et al. 2005).
• Both fresh and set MTA (ProRoot) caused cementum deposition
when used after apical surgery (Apaydin et al. 2004).
• Use of MTA (ProRoot) in combination with calcium hydroxide in
one study has shown that the periodontium may regenerate
more quickly than either material used on its own in
apexification procedures (Ham et al. 2005).

18. Update …?

20. DISCUSSION
According to the results of this study, the compressive strength of MTA-Angelus was 41 MPa at 24 h that increased
to 76.8 MPa at 28 days. These results are similar to those reported by Torabinejad et al.(40 MPa at 24 h and 67.3
MPa after 21 days).Biodentine exhibited compressive strength of 170 MPa at 24 h that increased substantially to
304 MPa after the material was placed in moisture for 28 days. This value of compressive strength is close to that
reported for human dentine.
The compressive strength of Biodentine was significantly higher than that of MTA at all time intervals. (
The high mechanical strength of Biodentine may be attributed to the elimination of aluminates that leads to
weakening and fragility of the set material as reported by manufacturer. With physical properties superior to those
of MTA, especially in terms of setting time and compressive strength, it exhibits the same characteristics of sealing
ability, with controlled (size and spatial organization) formation of calcium salts.
The former cement displays advantageous shortened setting time and better handling properties and may have
potential for dentin repair applications in dentistry.
The differences in properties between Biodentine and MTA-Angelus may potentially be caused by the processing
parameters such as sintering temperature, oxide amounts, and raw materials.
Biodentine, a fast-setting calcium silicate-based endodontic material exhibits the same excellent biological
properties as MTA-Angelus.After mixing, the calcium silicate particles of Biodentine with water ,high-pH solution
containing Ca2+, OH− , and silicate ions. In the saturated layer, the CSH gel precipitates on the cement particles,
whereas calcium hydroxide nucleates. The CSH gel polymerizes over time to form a solid network and the release
of calcium hydroxide increases the alkalinity of the surrounding medium.
 Saliva, as other body fluids, contains phosphate ions, an interaction between the phosphate ions and the calcium
silicate-based cements leads to the formation of apatite deposits that can increase the sealing efficiency of the
material as reported previously.

21. The setting time is one of the most clinically relevant factors. The setting time of MTA-Angelus mixed with
water was 8.5 min. In contrast, Biodentine exhibited shorter setting time (6.5 min) Accelerated setting
reduces the risk of dislodgement and contamination of MTA-like cements when used as root-end filling
material.
MTA-Angelus is grainy and has a poor consistency, making it difficult to manipulate in clinical situations.
In contrast, Biodentine was relatively easier to handle and on thorough amalgamation it rolled into a
dough-like consistency that could be easily condensed.
Both Biodentine and MTA-Angelus provided a valid and stable apical seal during the entire 12-week
period.
Neither showed evidence of deterioration in the ability to restrict fluid movement along the walls of the
canal preparation.
The fluid filtration system, has been demonstrated as a valid technique to measure fluid movements. It is
widely used to test the sealing capacity of different restorative materials and endodontic sealers over
time (longitudinal period) without specimen destruction.
Various hydration products form in the hydration reaction between calcium silicate cements and water,
such as porous calcium silicate hydrate (CSH) colloidal gel, portlandite (calcium hydroxide), ettringite
(hexacalcium aluminate trisulfate hydrate), calcium monosulphoaluminate or calcium
monocarboaluminate.

22. CONCLUSION
 Within the limits of this study, it may be concluded the
sealing quality of Biodentine was comparatively better
than MTA.
 The enhancement in handling properties of Biodentine
may make it more convenient for use in various clinical
applications.
 The present results suggest that Biodentine is a potential
material for use as a dentin repair and root-end filling
material.

23. References
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1996;12:161-78.] MTA and Biodentine properties Butt, et al. Indian Journal of Dental Research, 25(6),
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• Torabinejad M, Hong CU, McDonald F, Pitt Ford TR. Physical and chemical properties of a new
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25. • Pitt Ford TR, Torabinejad M, Abedi HR, Bakland LK, Kariyawasam SP (1996)
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27. Thank you!