Elsevier

Dental Materials

Volume 24, Issue 2, February 2008, Pages 149-164
Dental Materials

Review
Mineral trioxide aggregate material use in endodontic treatment: A review of the literature

https://doi.org/10.1016/j.dental.2007.04.007Get rights and content

Abstract

Objective

The purpose of this paper was to review the composition, properties, biocompatibility, and the clinical results involving the use of mineral trioxide aggregate (MTA) materials in endodontic treatment.

Methods

Electronic search of scientific papers from January 1990 to August 2006 was accomplished using PubMed and Scopus search engines (search terms: MTA, GMTA, WMTA, mineral AND trioxide AND aggregate).

Results

Selected exclusion criteria resulted in 156 citations from the scientific, peer-reviewed dental literature. MTA materials are derived from a Portland cement parent compound and have been demonstrated to be biocompatible endodontic repair materials, with its biocompatible nature strongly suggested by its ability to form hydroxyappatite when exposed to physiologic solutions. With some exceptions, MTA materials provide better microleakage protection than traditional endodontic repair materials using dye, fluid filtration, and bacterial penetration leakage models. In both animal and human studies, MTA materials have been shown to have excellent potential as pulp-capping and pulpotomy medicaments but studies with long-term follow-up are limited. Preliminary studies suggested a favorable MTA material use as apical and furcation restorative materials as well as medicaments for apexogenesis and apexification treatments; however, long-term clinical studies are needed in these areas.

Conclusion

MTA materials have been shown to have a biocompatible nature and have excellent potential in endodontic use. MTA materials are a refined Portland cement material and the substitution of Portland cement for MTA products is presently discouraged. Existing human studies involving MTA materials are very promising, however, insufficient randomized, double-blind clinical studies of sufficient duration exist involving MTA for all of its clinical indications. Further clinical studies are needed in these areas.

Introduction

It is estimated that over 24 million endodontic procedures are performed on an annual basis, with up to 5.5% of those procedures involving endodontic apical surgery, perforation repair, and apexification treatment [1]. Endodontic surgery is performed to resolve inflammatory processes that cannot be successfully treated by conventional techniques, which may be due to complex canal and/or apical anatomy and external inflammatory processes [2]. Surgical procedures may also be indicated for the resolution of procedural misadventures, to include root perforation that may occur either during canal instrumentation or post-space preparation [2], [3]. Surgical treatment usually involves the placement of a material designed to seal the root canal contents from the peri-radicular tissues and repair root defects [2]. Understandably, this material should demonstrate the ability to form a seal with dental tissues while also exhibiting biocompatible behavior with the periodontal tissues [3].

An ideal endodontic repair material ideally would adhere to tooth structure, maintain a sufficient seal, be insoluble in tissue fluids, dimensionally stable, non-resorbable, radiopaque, and exhibit biocompatibility if not bioactivity [2], [4], [5]. A number of materials have historically been used for retrograde fillings and perforation repair, such as amalgam, zinc-oxide-eugenol cements, composite resin, and glass-ionomer cements [4], [6]. Unfortunately, none of these materials have been able to satisfy the total requirements of an ideal material [4], [5].

Mineral trioxide aggregate (MTA) is a biomaterial that has been investigated for endodontic applications since the early 1990s. MTA was first described in the dental scientific literature in 1993 [7] and was given approval for endodontic use by the U.S. Food and Drug Administration in 1998 [8]. As it will soon follow, MTA materials are derived from a Portland cement parent compound: it is interesting that no information has been published regarding to any investigations that led to the precise delineation of the present MTA materials. The aim of this article is to present a systematic review of the physical properties, biocompatibility testing, and pertinent clinical studies involving MTA materials.

A structured literature review was performed for articles published between January 1990 and August 2006. The Internet database PubMed (www.ncbi.nlm.nih.gov/entrez) and Scopus (www.scopus.com) was used to search for the keywords MTA, GMTA, WMTA, and mineral AND trioxide AND aggregate. For further refinement, the following exclusion criteria were defined: Publications were limited to those of English language and from the scientific, peer-reviewed literature. Furthermore, publications possessing a questionable peer-review process (e.g., manufacturer-supported) were excluded for consideration. Although clinical case reports were included, only clinical studies involving appropriate number, sufficient controls and analysis were given serious consideration [9]. Using the search keywords limited to dental publications produced a total of 245 results, of which application of inclusion criteria produced the 156 citations that forms the basis for this review (Fig. 1).

Section snippets

Chemical, physical, and mechanical properties

MTA materials are a mixture of a refined Portland cement and bismuth oxide, and are reported to contain trace amounts of SiO2, CaO, MgO, K2SO4, and Na2SO4 [10], [11], [12]. The major component, Portland cement, is a mixture of dicalcium silicate, tricalcium silicate, tricalcium aluminate, gypsum, and tetracalcium aluminoferrite [10], [11], [12]. Gypsum is an important determinant of setting time, as is tetracalcium aluminoferrate, although to a lesser extent [12]. MTA products may contain

Microleakage studies

The success of an endodontic material may largely depend on its sealing ability, as most post-treatment endodontic disease is thought to occur due to tissue and other materials in uncleaned and/or unobturated areas of the root canal system that egress into the surrounding tissues [41].

Animal models

GMTA has been compared with calcium hydroxide as a pulp-capping medicament using a cynomolgus monkey model in which GMTA was found associated with little tissue inflammation and a thick and continuous dentin bridge at 5 months. In contrast, only one-third of the calcium hydroxide-treated specimens exhibited dentin bridge formation with all displaying severe tissue inflammation [123]. A canine model study reported similar results with GMTA exhibiting good tissue response and dentinal bridge

Conclusion

The physical properties, sealing ability, biocompatibility, and clinical performance of MTA materials have been discussed. MTA materials appear not only to demonstrate acceptable biocompatible behavior but also exhibits acceptable in vivo biologic performance when used for root-end fillings, perforation repairs, pulp-capping and pulpotomy, and apexification treatment. However, it should be noted that the supporting data have been overwhelmingly from either in vitro or animal studies. Reports

Acknowledgements

The authors wish to express appreciation to Col. Richard Rutledge, Majors Dennis Holt, James Watts, Kim Wilkinson; and Captain Brian Min at the Endodontic Residency, 59 Dental Group, Lackland Air Force Base, Texas, for corroboration with the clinical photographs.

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    None of the authors have any financial interests in any of the products mentioned in this manuscript. The opinions stated in this manuscript are solely those of the authors and do not represent the opinion of the United States Air Force, the United States Navy, the Department of Defense, or the United States Government.

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