MTA is a biocompatible material composed mainly of Portland cement with bismuth oxide added. It has a high pH and seals well against tooth structures. MTA has applications in pulp capping, pulpotomies, apexification, repair of root perforations, and as a root-end filling material. Its advantages include biocompatibility, ability to set in the presence of moisture and blood, and promotion of hard tissue formation.

2. INTRODUCTION
Independent analysis suggests that the material of Mineral Trioxide
Aggregate (MTA) is identical to Portland cement. It is a new remarkable
biocompatiblematerial with exciting clinical applications pioneered by Dr.
Mahmoud Torabinejad, Loma Linda University, in 1993. Its first description
in the dental literature in 1993, by Lee & colleagues, It was improved for
human usage by 1998
MTA has been used in both surgical and non – surgical applications, including
root end fillings, direct pulp capping,
perforation repairs in roots or furcations and Apexification.

3. Composition
 MTA is a mechanical mixture of 3 powder ingredients:
• Portland cement (75%)
• Bismuth oxide (20%)
• Gypsum (5%)
 Composition includes :
• Tricalcium silicate
• Dicalcium silicate
• Tricalcium aluminate
• Tetracalcium aluminoferrite
• Calcium sulfate
• Bismuth oxide
NOTES :
1. Its composition is said to be similar to Portland cement except for the absence of bismuth
oxide in Portland cement . Bismuth oxide is added to improve the properties and the radio
opacity .
2. The MTA particles are smaller & uniform in size whereas the particle size of Portland
cement vary in size .
Effect of bismuth oxide

4. Why we use MTA not Portland cement
Limitations of :
1. Separate investigations reported results regarding the composition of PC . Since PC is manufactured
widely around the world, it is difficult if not impossible to evaluate the purity of all manufacturers’
compositions.
2. PC had higher concentrations of chromium, lead, and arsenic, is acid-soluble, and leaches out in
HBSS compared to AMTA . In addition, PC contains higher concentrations of heavy metals such as
copper, manganese, and strontium, which are known to be toxic, compared to white ProRoot MTA . One
of the major concerns about using PC is the amount of lead and arsenic in its composition that are
released from the material into the surrounding tissues
3. Another concern for PC’s higher solubility is the fact that the material might degrade after one of its
clinical applications and therefore jeopardize the seal of the material
4. PC produces a significantly lower amount of portlandite after setting, compared to white ProRoot MTA,
up to 1 year after hydration, which may affect
long-term efficacy of the material
5. Excessive setting expansion of a material, particularly as a root-end filling substance, might result in a
cracked tooth, which is undesirable

5. Types of MTA
Gray MTA White MTA
Contains aluminoferrite (contains iron), which is
responsible for the gray discoloration. It discolors both
the tooth & gingival tissue close to the repaired root
surface..
• Produces 43% more surface hydroxyapatite crystals
than WMTA in an environment with PBS
(phosphatebuffered saline).
• Induced dentin formation more efficiently; high
number of dentin bridge formation (reparative dentin
)
1- tooth colored due to lower
amount of Fe2O3
2- smaller particles with narrower
size distribution ( 8 times smaller
than G.MTA
3- Greater compressive strength

6. Characteristics of MTA
1. Biocompatible with periradicular tissues
2. Non cytotoxic to cells, but antimicrobial to bacteria
3. Non-resorbable
4. Minimal leakage around the margins.
5. Very basic AKA alkaline initial pH: 10.2 initially and it rose to 12.5 after 3 hours .
6. MTA powder contains fine hydrophilic particles that set in the presence of
moisture .
7. Compressive strength develops over a period of 28 days, similar to Portland
cement. Strengths of more than 133 MPa
8. MTA displays low or nearly no solubility
9. Radio opaque

7. MTA
Advantages Disadvantage
• Antimicrobial Activity (due to Highly alkaline pH
= 10.2 then increase to 12.5 after 3hr )
• Hardens (sets) in the presence of moisture
• Non toxic & Non-mutagenic
• Vasoconstrictive. This could be beneficial for
hemostasis (most importantly in pulp capping)
• Cell adherence & growth
• Interleukin production
• Periodontal ligament attachment to cementum
growth
• Dentinal bridge formation
• More difficult to manipulate as a root
canal filling material include
difficulty in obturation of curved root
canals due to sandy nature of MTA
• Longer setting time (24hr after
mixing).
• Discolouration potential
• An absence of a known solvent for
set MTA. - Difficulty in removal after
curing

8. MTA Mixing
Prepared immediately before use. Kept always in closed containers or free from moisture.
Powder: Water = 3: 1
Glass or paper slab used for mixing with – plastic / metal spatula.
Poor handling properties. The loose sandy nature of the mixture causes much difficulty
for the insertion & packing
MTA takes longer time to set compared to any other material . Gray MTA setting time is about 2
hours and 45:55 minutes and 2hours and 20 minutes for white MTA
MTA being hydrophilic requires moisture to set , making absolute dryness contraindication
MTA may be placed into the desired location using hand instruments and it should not be
condensed with excess pressure because it might reduse the surface hardness .
Applied MTA should be cover by A moist pellet of cotton because for correct setting moisture is
required . Then the tooth should be capped with a hermetic dressing for 1-2 days

9. MTA Mixing

10. Another liquid may be used with MTA
 Saline : NaOCl has been shown to be an accelerator, but also with reduced final strengths.
 Local anesthetics solutions OR Chlorhexidine : Retarders (slow down the
setting) – may totally inhibit the setting

11. Instrument used for Placement of MTA
MTA carrier BLOCK MATRIX
MTA
Teflon sleeve &
plugger
MAP system
MTA matrix have mould with
the description of diameter
from 0.7 to 1.0mm.
Or messing gun-type
syringe
The MAP (Micro-Apical Placement) System,
provides an efficient method for placing
repair materials for the treatment of
perforations, root end fillings and pulp
cappings using curved needles or by
retrograde obturation after apical resection
of anterior teeth, using the hooked needles.
NiTi 'memory' needle (PEEK Plunger). Will
return to original shape when autoclaved

12. Usage of MTA in some clinical cases
1.Pulp capping
2. Internal & external root resorption & obturation
3. Lateral or furcation perforation
4. Root canal sealer
5. Apexification
6. Apexogenesis (Vital pulp)
7.Root-end Filling after Apicoectomy

13. Pulp capping
) Vital pulp therapy (
The advantages of MTA in direct pulp capping, when compared with CH, include lower solubility,
improved mechanical strength, and superior marginal adaptation to dentin . Furthermore, using MTA for
direct pulp capping eliminates some of the disadvantages of CH, such as absorption of the capping
material, mechanical instability, and subsequent inadequate long-term sealing ability due to leakage .
MTA is a hydrophilic and hygroscopic cement that allows the material to set in the presence of blood
and tissue fluids . It is known that calcium silicate cements like MTA not only have the ability to release
calcium and hydroxyl ions after contact with cell and tissue fluid, but also to form hydroxyapatite
crystals on its surface. The apatite formation contributes to leakage reduction not only by filling the gap
along the interface but also via interactions with dentin during intrafibrillar apatite deposition
Steps of pulp capping: After achieving anesthesia and isolation with a
rubber dam, the exposed pulp is irrigated with NaClO to control bleeding. The prepared MTA is placed
in contact with the exposure 1-1.5 thick layer

15. Pulptomy
) Vital pulp therapy (
 In children with carious exposure of pulp in teeth with incompletely formed root , Formacresol has
been routinely used as pulpotomy agent for deciduous teeth . But this material has been criticized for
its tissue irritating , cytotoxic and mutagenic effect .
 MTA was tested and found to be an ideal material with low toxic effects , incresed tissue regenerating
properties and good clinical results .
 Furthermore , the presence of blood has little impact on the setting or degree of leakage when a 2mm
thick layer of MTA was placed after the coronal pulp tissue is removed allowing placement of MTA
against the pulp tissue at floor of the pulp chamber.
 Discoloration of teeth was observed in 60% of the deciduous molars treated with MTA . But this was
not of significance since the tooth was later restored with a stainlessn crown .
 MTA can be used for vital pulp therapy in patient with traumatic crown fractures exposing vital pulp
tissue a shallow {partial pulpotomy } is performed in which MTA is placed directly against the pulp
wound

17. Apexification
) Non-Vital pulp therapy )
When the root is incompletely formed in adolescents and an infection occurs, apexification can be performed
to maintain the tooth in position as the roots develop.
Technical placement
Once cleaning of the root canal system is complete, a series of pluggers that are customarily used for warm
vertical compaction of gutta percha are loosely fitted sequentially in the root canal system .The smallest
plugger should fit loosely ~0.5 mm from the working length.
MTA is then placed in the middle to apical third of the root canal system using one of several commercially
available delivery systems. It is then compacted with a series of pluggers previously fitted to the root canal
system. The pluggers can be vibrated ultrasonically to help advance MTA towards the apex of the tooth.
Additionally the ultrasonic activity will compact the MTA apically . Typically an additional apical matrix to limit
the movement of MTA into the periradicular tissues is not warranted.
Once an adequate apical plug of MTA is compacted to the working length and confirmed with a radiograph,
the excess can be removed from the coronal and middle third of the canal system by irrigating with sterile
water.

18. The remaining fluid is removed with sterile paper points. The apical plug of MTA should be
approximately 3–5 mm thick to allow minimal leakage .The remainder of the canal system can be
restored with a core material adjacent to the MTA.
The core layer can extend into the coronal third of the canal to enhance fracture resistance of the tooth
.Lastly, composite is layered against the core material, extending coronally to fill the access opening .
(A) (B) (C) (D) (E) (F)
(A) Preoperative radiograph of an immature 2nd premolar tooth with pulpal
necrosis in a 12-year-old male patient; (B) working length radiograph; (C) plugger
fit radiograph; (D) immediate postoperative radiograph. (E) 15-month recall
radiograph; (F) 33-month recall radiograph.

19. (A) Preoperative radiograph of immature right and left central incisor teeth with
pulpal necrosis as a result of a traumatic injury. (11-year-old male patient).
(B) Immediate postoperative radiograph .
(C) 36-month recall radiograph .
(D) 85-month recall radiograph .
(E) sagittal view from a CBCT taken at the 85-month recall of the left central incisor .
(F) sagittal view from a CBCT taken at the 85-month recall of the left central incisor .
(A) (B) (C) (D) (E) (F)

20. Regenerative Endodontics
(Revitalization/Revascularization)
First appointment
1. After administration of local anesthetic and placement of rubber dam, an access cavity should be prepared in the
affected tooth.
2. Gently but thoroughly irrigate the canal(s) with copious amounts of 1.5% NaOCl using an irrigation system that
minimizes the possibility of extrusion of irrigants into the periapical tissues.
3. Dry the canal(s) and place either antibiotic paste or calcium hydroxide to disinfect the root canal system. If you
decide to use the triple antibiotic paste, consider sealing the pulp chamber with a dentin bonding agent to reduce
the risk of staining. If you plan to use the triple antibiotic paste, mix 1:1:1 ( ciprofloxacin :metronidazole :
minocycline ) in a lower concentration (0.01–0.1 mg/mL) to reduce toxicity. Place the triple antibiotic paste into the
canal system using a lentulo spiral, MAP system, or syringe and ensure the paste remains below the
cementoenamel junction (CEJ) to minimize crown staining. Seal the access cavity with 3–4 mm of Cavity followed
by glass ionomer cement
Second appointment
Evaluate the response of your initial treatment 3–4 weeks later. If there are signs of persistent infection, consider
additional antimicrobial treatment with the same antibacterial material or disinfect the canal(s) with an alternative
antimicrobial agent and see the patient again in an additional 3–4 weeks. If there are no signs or symptoms of
persistent infection, continue with the second phase of the revascularization procedure.

21. After administration of 3% mepivacaine without vasoconstrictor (to allow for better induction of apical
bleeding), place the dental dam and remove the temporary filling materials. Irrigate the canal(s) with
copious amounts of 1.5% NaOCl followed by 20 ml of 17% EDTA. A final rinse with normal saline is done
using an irrigation system that minimizes the possibility of extrusion of irrigants into the periapical tissues.
Dry the canal(s) with paper points. Create bleeding in the canal(s) by over-instrumenting with endodontic
files (#10–15). Keep the level of bleeding 3 mm from the CEJ. Allow the blood to clot for 10 minutes.
Alternatively, a scaffold of PRP or PRF can be placed in the canal(s). Some clinicians suggest placing a
CollaPlug/Collacote over the scaffold to control the level of MTA.
After placing 3–4 mm of MTA, apply a wet cotton pellet to encourage complete setting of the MTA and then
place your temporary filling material .
After the MTA has set, remove the temporary filling material and seal the access cavity with a definitive
restorative material such as composite. An alternative procedure is to place reinforced glass ionomer
directly over MTA and place a permanent restoration. Consider sealing the pulp chamber with a dentin
bonding agent to reduce the risk of staining with MTA in esthetic areas.
Clinical and radiographic follow-up
The patient should be examined postoperatively every 3–6 months for at least 1–2 years .
By the end of the follow-up period, a successful clinical outcome would present as a lack of clinical
symptoms, resolution of apical lesions radiographically, and thickening of the root canal walls with extended
root length.

22. (A) (B) (C) (D) (E)
(A) A preoperative radiograph of a mandibular second premolar with an open apex, necrotic pulp, and a periapical lesion. (B) An
access cavity is made into the root canal of this tooth, which contains a necrotic pulp. (C) After cleaning and disinfecting the
canal, bleeding is generated inside the canal. (D) A layer of MTA is placed over the blood clot. (E) A radiograph taken 15 months
later shows resolution of the periapical lesion and thickening of the root canal walls .
(A) (B) (C) (D)
(A) A preoperative radiograph of a maxillary second premolar with an open apex, necrotic pulp, and a periapical lesion. (B) After
making an access cavity into the root canal of this tooth, its canal was cleaned and disinfected using triple antibiotics. (C) Three
weeks later, PRP was placed inside the canal, which was sealed with a layer of MTA and
Cavit. A week later, a permanent filling was placed in the access cavity. (D) A radiograph taken 15 months later shows resolution of
the periapical lesion and thickening of the root canal walls. The tooth was sensitive to both cold and electricity. Because of its
sensitivity, a root canal was performed on this tooth. (E) Examination of the content of the canal shows presence of connective
tissue without any inflammation.

23. Internal & external root resorption &
obturation
In internal resorption, root canal therapy is performed, a putty mixture of MTA is inserted in the canal
using pluggers to the level of the defect. Gutta percha and root canal sealer are
placed above the defect to complete the root canal treatment. In direct cases, the canal may be
completely obturated with MTA. The MTA will provide structure and strength to the tooth by replacing
the resorbed tooth structure. In external resorption, after root canal therapy is performed, the flap is
raised over the tooth and the defect removed from the root surface with a round bur. Retrograde
application of MTA to the root surface is then completed.

24. MTA as Root Perforation
Repair
FACTORS INFLUENCING PROGNOSIS FOR REPAIR :
Size of perforation : The larger the perforation, the greater the potential damage to the per radicular
tissues. Repair of a large perforation is more complex. Hemorrhage is more difficult to control and
placement of an internal matrix is usually necessary. This material is composed of collagen fibers that
promote hemostasis but remain wet and provide the additional moisture MTA requires to set. The collagen
fibers will resorb a few weeks after placement.
Location of the perforation : Root perforations may occur at different locations during access preparation,
cleaning and shaping, and post space preparation . The anatomy of the tooth and the location of the
perforation will affect the difficulty of repair of the defect and the prognosis for the mishap .
TECHNIQUES FOR INTERNAL REPAIR USING MTA
1. Site preparation : If the perforation occurred prior to the completion of endodontic therapy,
repair of the defect must be completed before continuing the endodontic procedure). Protection of canal
patency must be maintained during the perforation repair process. Hemorrhage from the perforation site
must be controlled and, if indicated, the surrounding dentin must be disinfected. A cotton pellet saturated
with sodium hypochlorite can be applied to infected dentin around the perforation for two minutes to provide
hemostasis and disinfection. If hemostasis is inadequate or the perforation def large, an internal matrix with
Collatape should be placed. The collagen is then packed through the perforation into the bone defect. As
mentioned, the collagen provides a soft matrix to minimize overfil while allowing moisture for hardening of
the MTA.

25. 2. MTA delivery : Just enough sterile water is added to the MTA powder to wet the particles.
Lightly blot the mixture with sterile gauze to remove any excess water. When a large volume of MTA is
required to repair the perforation, an amalgam carrier can be used to deliver the MTA to the site. For smaller
perforations, MTA can be delivered with specially designed micro carriers After placement, blot the MTA with a
sterile cotton pellet. An endodontic plugger is used to gently condense the mixture into the perforation. This
process is repeated if necessary to place an adequate thickness of the MTA. Excess material can be removed
by carving with an endodontic excavator. A cotton pellet saturated with sterile water should be placed in the
chamber over the MTA. The MTA requires additional moisture during the setting process. A temporary
restoration is placed over the wet cotton pellet.
3. Follow-up Therapy : Allow 1 week for the MTA to set. Establish access to the perforated area
and remove the cotton. Check for set of the MTA. If endodontic therapy has not been completed, routine
procedures for completion of the nonsurgical endodontic therapy can proceed. If canal patency is lost during
perforation repair, the treatment prognosis decreases. Therefore, great attention must be given to patency
protection during the repair process with MTA.
4. Recall evaluation : Evaluation times should be at 1, 3, and 6 months. Success or failure of
the repair can be determined within these time parameters . At 1 month, the patient should be experiencing
no discomfort during function. If a preoperative sinus tract was present, healing should be complete with no
recurrence. If a periodontal pocket was present preoperatively, reduction in
depth would be expected. If no periodontal pocket or sinus tract was present preoperatively, the presence on
either of these on recall would indicate failure. There may be no obvious changes radiographically are used
for the 3- and 6-month evaluations, and early evidence of osseous
repair should be seen radiographically.

26. (A) (B) (C)
Repair of strip-type perforation. (A) Pretreatment radiograph shows extensive furcation bone loss.
(B) Nonsurgical repair with MTA. (C) Six-month recall showing furcation bone fill.
(A) (B)
Radiographs of the mandibular right first molar with a perforationof the furcationregion. (A)
Postoperative radiograph taken immediately after the repair of the perforation. (B)
Radiograph taken 45 months after perforation repair.

27. Root-End Fillings Using MTA
Cavity preparation for MTA root-end filling : The purpose of a root-end preparation is to clean and
create a space for a root-end filling material. One of the most significant recent improvements in
endodontic surgery was the introduction of ultrasonic tips by Dr. Carr for root-end preparation in the
early 1990s. These replaced the use of conventional air-turbine handpieces with burs. Many ultrasonic
tips for root-end preparation are available invarious shapes, sizes, and designs: CT series tips , KiS
ultrasonic tips , ProUltra Surgical tips , and B&L JET tips . The cavity preparation for MTA root-end
fillings is the same as for other root-end filling materials. Under a microscope, root-end preparation
with ultrasonic tips can make a class I preparation to a depth of 3 mm along the long axis of the root.
Mixing procedure : The powder/liquid ratio of MTA is three parts powder to one part sterile aqueous
solution . After 30 s of mixing, the mixture should exhibit a wet sand consistency.
Methods for placement of MTA : MTA is difficult to deliver to a small cavity for root-end filling
because its physical properties differ from those of other root-end filling materials.
For delivery of the MTA, most clinicians use a syringe-type carrier or MTA pellet forming block.

28. (A) (B) (C) (D)
(E) (F) (G) (H)
MTA delivery devices. (A,B) A syringe-type device (Dentsply, Tulsa, OK, USA). MTA powder is placed into the
mixing pot and mixed with sterile liquid or water. With light tapping, a small amount of MTA is placed into the tip of
the syringe. By pushing the finger holder, the inserted MTA is extracted through the tip. (C,D) Surgical carriers of
MTA (Dentsply, Tulsa, OK, USA). The Teflon sleeve is inserted into the tip of carrier, which is configured with the
proper angle to reach the surgical site. The MTA mixture is placed into the sleeve by tapping the carrier (Courtesy
of Dr. Dong-Ryul Shin at Luden Dental Clinic.)
(E,F). The Lee MTA pellet forming blocks seen in this image (G. Hartzell & Sons, Concord, CA, USA). A small
amount of MTA mixture is placed into a groove of the block. A special carrier is used to scoop a pellet of MTA.
(G) MTA application using surgical carriers of MTA delivery system. (H) MTA application using Lee MTA Pellet
forming block and Lee carver (G. Hartzell & Sons). (Courtesy of Dr. Dong-Ryul Shin.)

29. (A) (B) (C)
(E) (F)(D)
Root-end filling procedure during apical surgery (A,C,E) and intentional replantation (B,D,F).
(A,B) Resected root ends (C,D) 3-mm deep root end cavity preparations (E,F). Root end
cavities filled with MTA and observed under the microscope.

30. (A) (B) (C)
(E) (F)(D)
Apical Microsurgery procedure. (A) An ultrasonic tip is positioned in the direction of the long axis of the root. (B)
Old gutta-percha and apical root canal dentin is removed using an ultrasonic tip until the depth of cavity is 3 mm.
(C) A surgical micromirror is used to inspect the retropreparation. (D,E) The MTA pellet is applied into the cavity.
(F) Excess MTA is removed using a cotton pellet or an endodontic spoon excavator. A clean root surface filled
with MTA is observed under the microscope.

31. DEFERANT MTA BASE ROOT
CANAL SEALER1. ANGELUS MTA
2. BIODENTINE
3. iROOT
4. MTA FILLAPEX
5. ENDO-CPM
6. CIMENTO ENDODONTICO RAPIDO (CER)
7. ENDOSEQUENCE
8. PROROOT ENDO SEALER
9. MTA PLUS
10. ORTHO MTA
11. MTA BIO
12. MTA SEALER (MTAS)
13. FLUORIDE-DOPED MTA CEMENT
14. CAPASIO
15. CERAMICRETE-D
16. LIGHT-CURED MTA
17. CALCIUM SILICATE ( Theracal Lc )
18. BIOAGGREGATE
19. Endo-CPM

33. BIODENTINE (BD)
 Biodentine™ was developed by Septodont’s Research Group . The material
is actually formulated using the MTA-based cement technology and the
improvement of some properties of these types of cements, such as
physical qualities and handling.
Composition :

34. Mta vs Biodentine

35. MTA FILLAPEX
MTA Fill apex is an endodontic sealer based on MTA, developed by Angelus (Londrina /Parana/
Brazil) and launched commercially in 2010. It is a new product that combines the proven
advantages of MTA with a superior canal obturation product. Its formulation in the paste/paste
system allows a complete filling of the entire root canal, including accessory and lateral canals.
MTA, present in the composition of MTA Fill apex, is more stable than calcium hydroxide,
providing constant release of calcium ions for the tissues and maintaining a pH which elicits
antibacterial effects. The tissue recovery and the lack of inflammatory response are optimized by
the use of MTA and disalicylate resin. The product is Eugenol free and will not interfere with
adhesive procedures inside the root canal. Also, it does not cause discoloration of the tooth
structure .
Indication :
MTA Fillapex is indicated for filling root canals of permanent
teeth. It can be inserted with the gutta-percha points or with
Lentulo drills. It can also be used with thermal condensation
techniques (heated gutta percha) because the boiling point of
MTA Fill apex is 150°C.

36. Main feature and advantage :
1. Presence of MTA in the formula: allows the formation of new tissue, including root cementum
2. Biocompatibility: rapid recovery of tissues without causing inflammatory reaction
3. High Radio opacity: perfect radiographic visualization
4. Excellent Flow: the flow able consistency of MTA Fill apex is engineered to penetrate and also to fill
lateral canals
5. Setting expansion: provides excellent sealing of the root canal, avoiding the penetration of tissue
fluids and/or bacterial recontamination
6. Calcium ion release: induces rapid tissue regeneration in sites with
bone lesion and microbial activity
7. System paste x paste: easy handling and insertion
8. Working time: allows adequate working time to be used by
specialists and/or general
Working time: 35 minutes. Setting time: Minimum of 120 minutes (two hours)

37. MM-MTA (MICRO MEGA MTA)
 Is a modified Portland Cement with added calcium carbonate (CaCO3), which allows the
reduction of the setting time to 20 minutes .
 available as capsules containing MM-MTA powder and liquid, automatic mixing is achieved
quickly with a vibrating mixer to produce homogenous mixing.
 (mixing time 30 seconds) is achieved by a high frequency mixer

38. CALCIUM SILICATE ( Theracal Lc )
( Light cure)
It has been claimed that the sealer produces CH and releases calcium and
hydroxyl ions when set, resulting in the formation of apatite structures over
the material’s surface in a synthetic tissue fluid. A cell culture study revealed
that the set form of the material has minimal
cytotoxicity after one week and is less cytotoxic than AH Plus. The material
showed alkaline phosphatase activity similar to that of white ProRoot MTA

39. ENDOSEQUENCE
EndoSequence has been introduced as EndoSequence Root Repair Material (RRM),
EndoSequence Root Repair Putty (RRP) (Damas et al. 2011) and EndoSequence BC obturation
system (EndoSequence BC Gutta-percha, EndoSequence BC sealer). It has been claimed that
EndoSequence BC sealer and iRoot SP have had the same formula distributing with different
manufacturers EndoSequence RRM has been developed for pulp capping, perforation repair,
apexification, root-end filling, and repair of root resorption.
EndoSequence BC Sealer
EndoSequence BC Sealer is a premixed, ready-to-use root canal
sealer that can be employed for both single cone and lateral
condensation techniques of permanent root canal obturation
Chemical composition
According to the manufacturer’s safety data sheet, EndoSequence BC
Sealer is composed of zirconium oxide, calcium silicates, calcium
phosphate monobasic,
CH, and filling and thickening agents

40. Physical properties
EndoSequence BC Sealer has an alkaline pH (Candeiro et al. 2012); however, it
could not completely be removed from the root canal by using conventional
retreatment techniques (Hess et al. 2011). Candeiro and associates (2012) reported
that Endosequence BC Sealer has had radiopacity and flow according to ISO
6876/2001 recommendations. In addition, the material releases calcium ions higher
than AH Plus.
Biocompatibility
EndoSequence BC Sealer remained moderately cytotoxic over five weeks during a
cell culture investigation on mouse osteoblast cells (Loushine et al. 2011). In contrast
to the results of Loushine and associates (2011), results of a cell culture study on
L929 mouse fibroblasts showed that EndoSequence BC Sealer induced significantly
lower cytotoxicity compared to AH Plus and Tubliseal root canal sealers (Zoufan et
al. 2011). In conclusion, EndoSequence Root Repair Material is an alkaline,
bioactive ,radiopaque material with fine particle sizes. However, so far, investigations
on EndoSequence RRM have been confined to laboratory studies and, therefore, in
vivo and human investigations are highly recommended.