all about mta & biodentine + differences between them

1. MTA &
BIODENTINE
Done by Marwa Mazin
Supervised by Dr. Enas
Mizhir

2. MTA

3. Mineral trioxide aggregate (MTA) was
developed for use as a dental root repair
material by Dr. Mahmoud Torabinejad, it is
the most commonly recommended
material for sealing communications
between the root canal system and the
periodontium.

4. CLINICAL APPLICATIONS OF MTA

5. MTA COMPOSITION
• 75 % Portland cement
• 20 % bismuth oxide (Bi2O3)
• 5 % calcium sulfate dihydrate or gypsum
(CaSO4 ∙ 2H2O)
• Additional minor trace elements may also
be present .
*Portland cement –based endodontic material
– MTA, coined from the three oxides present
in portland cement namely – calcia , silica
,alumina .

6. Types of MTA
Gray MTA White MTA

7. Gray MTA
Contains Ferrous oxide which
causes gray discoloration.
*Not used with anterior teeth.
Large particles
Longer setting time
Greater compressive
strength
White MTA
Ferrous oxide is replaced by
Magnesium oxide, so no tooth
discoloration.
Smaller particles
Shorter setting time
Less compressive strength

8. Mixing MTA
• 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. It requires moisture to set. Once the
mix is dry sandy form its ready for application.

9. MTA Placement

10. MTA Placement

11. When MTA is placed in direct
contact with human tissues it:
Creates an
antibacterial
environment
by its alkaline
pH
Modulate
cytokine
production
Encourages
differentiation
of hard tissue-
producing
cells
Forms
hydroxyapatite
on the MTA
surface and
provides a
biological seal
MECHANISM OF ACTION

12. Characteristics of
MTA
Biocompatible
Antimicrobial
Non-
resorbable
Minimal
leakage
Compressive strength
develops over a
period of 28 days
*more
than 133 MPa
Low or
no
solubility
pH: initially-10.2,
after 3 hours- 12.5
(remains constant)
Set in the
presence of
moisture
Radio
opaque
Setting time:
about 2 hours
and 45 min

13. MTA is a biocompatible material
with good sealing ability
generate little
or no
inflammatory
response in
periradicular
tissues
encourage the
formation of
fibrous
connective
tissue
formation of
cementum
covering the
entire root
end
Ca & P are the
main ions
present in
this material,
which are the
components
of dental
tissues
Biocompatibility

14. MTA expands
during setting
reaction
excellent
sealing
ability
In presence of
moisture
sealing ability
of MTA is
increased
Moistened cotton pellet should be placed
in contact with MTA before placement of
the permanent restoration
Sealing ability

15. Setting Time
• MTA powder consists of fine hydrophilic
particles.
• Hydration of MTA powder results in a colloidal
gel that solidifies to a hard structure in ~ 4 hrs
which has a long setting time.
• MTA has long setting time with less
shrinkage.

16. MTA has a high pH of
12.5 similar to
calcium hydroxide
prevents the
bacterial growth and
maintains the long
lasting bactericidal
potential
Induction of hard
tissue formation /
barrier in
Apexification
procedures and root
end filling
minimize the
interaction between
material and host
tissues.
pH

17. • Lack of solubility is an ideal
characteristic of MTA as a root end
filling material.
Solubility
• Is an important factor to be
considered when a filling material is
placed in a cavity that bears occlusal
pressure.
Compressive
Strength
• Bismuth oxide added for
radiopacity and it is more radio
opaque than its surrounding
structures.
Radiopacity

18. Tricalcium oxide
content of MTA
interacts with
tissue fluids
form CaOH2
resulting in
hard-tissue
creation
Similar to
calcium
hydroxide
(CaOH2 )
induces
formation of
dentin bridge
Mineralization

19. CLINICAL APPLICATIONS OF MTA

23. Direct Pulp Capping
• Reparative dentin formed by MTA does
not originate from severely damaged
odontoblasts, but from
undifferentiated cells that migrated
from deep regions of pulp, which
replaced the degenerated odontoblasts.
• Reparative dentin formed is regular
and odontoblasts remain intact.

24. (a) Pulp exposure following caries excavation. (b) Mineral trioxide
aggregate placed over the exposed pulp. (c) Radiograph showing
mineral trioxide aggregate placement immediately after pulp
capping. (d) Six months follow-up radiograph

26. Pulpotomy in deciduous teeth

27. Apical Plug
• For necrotic pulps and with open apices.
• MTA can be used as a material of choice for
apical plug and placed 3- 4mm in the apical
plug.
• It creates a hard tissue formation or as an apical
plug to prevent the extrusion of filling material
during obturation of the canal
with open apices.

28. Root-end Filling after Apicectomy
• In root canal therapy where an apical infection is
persistent, an apicectomy may be required.
• Flap is raised over the tooth and the root tip is
resected and a cavity created (3–4 mm) in the
root tip removed.
• Retrograde application of MTA to the root tip
cavity is completed.

29. • 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.
Internal root resorption

30. External root resorption
• 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.

31. Root Perforations
• Root perforations can
occur during root canal
treatment, post space
preparation or as a
consequence of internal
resorption.
• MTA can be placed in the
repair area as a reparative
material. Repair can be
achieved by Intracoronal /
Extracoronal placement.

34. Apexification (Necrotic pulp)
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.

35. 1. Perform root canal treatment.
2. Mix MTA and insert it to the
apex of the tooth, creating a 3
mm thickness of plug.
3. Fill the canal with sealer and
gutta percha.

36. Apexogenesis (Vital pulp)
The process of maintaining
pulp vitality during pulpal
treatment to allow continued
development of the entire
root (apical closure occurs
approximately 3 years after
eruption).

37. Apexogenesis (Vital pulp)
1. Perform a pulpotomy
procedure.
2. Place the MTA material
over the pulp and close
the tooth with temporary
cement until the apex is
completely formed.

39. • Rapid cell growth promotion in vitro
• Greater ability to maintain the integrity of pulp
tissue
• Thicker dentinal bridge, less inflammation, less
hyperemia and less pulpal necrosis
• High ability to resist the penetration of
microorganisms
• Induce the formation of a dentin bridge at a faster
rate
• Limited antibacterial effect
MTA advantages over calcium hydroxide

41. BIODENTINE

42. • Biodentin - calcium silicate based product
which became commercially available in 2009
by septodont and that was specifically designed
as a “ dentine replacement “ material

43. • Fine Hydrophilic powder
composed of modified
powder composition of
MTA.
• Biodentine is available as
powder in a capsule and
liquid in a pipette.
BIODENTINE COMPOSITION

44. BIODENTINE COMPOSITION
• Tricalcium silicate( main core
material)
• Dicalcium silicate
• Calcium carbonate
• Iron oxide (shade)
• Zirconium oxide(radiopacity)
Powder
packaged in
capsule(0,7g)
• Calcium chloride(accelerator)
• Hydrosoluble polymer (water
reducing agent, faster setting)
• Water
Liquid
(packaged in
pipette(0,18ml)

45. MANIPULATION
• The powder is mixed with the liquid in a capsule
in the triturator for 30 seconds
1 capsule powder: 5 drops of liquid
• Setting time: Approximately 12 min

47. The reaction of
the powder
with the liquid
leads to
the setting and
hardening of
the cement.
The hydration of
the tri-calcium
silicate leads to
the formation of a
hydrated calcium
silicate gel and
calcium hydroxide
Mechanism of action

48. Mechanism of action

49. Characteristics of
BIODENTINE
Biocompatible
Antibacterial
Non-
resorbable
Minimal
leakage
Compressive
strength 220Mpa ,
with time it reaches
300Mpa
pH: during
setting phase of
increases to 12
Has the
least wash-
out
resistance
Radio
opaque
Setting time:
12mins.
Low or no
solubility

51. Tissue Regeneration & Early
Mineralisation
Biodentine induces early minerlization by
increasing the secretion of TGF-beta1 from
pulpal cells after its application.
It also acts by odontoblasts stimulation and cell
differentiation-facilitating reactionary and
tertiary dentin formation.

52. Marginal Adaptation and Sealing Ability:
• The micromechanical adhesion of biodentine -is
caused by the alkaline effect during the setting
reaction.
• This high pH causes organic tissues to dissolve out of
the dentin tubule.
The alkaline environment at the boundary area of
contact between biodentine and hard tooth substance
opens a path via which the dentin substitute mass can
enter the exposed opening of the dentin canaliculi.

53. Density and porosity

54. MTA & BIODENTINE

55. MTA & BIODENTINE

56. CLINICAL APPLICATIONS

57. Biodentine under composite restoration

60. Biodentine in direct pulp capping
procedure

62. THANK
YOU!