ReviewMineral trioxide aggregate material use in endodontic treatment: A review of the literature☆
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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The effects of chlorhexidine gluconate (0.12%) on the antimicrobial properties of tooth-colored ProRoot mineral trioxide aggregate
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Evaluation of antifungal activity of mineral trioxided aggregate
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Comparison of antifungal activity of white-colored and gray-colored mineral trioxide aggregate (MTA) at similar concentrations against Candida albicans
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Bacterial leakage of mineral trioxide aggregate as a root-end filling material
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Sealing ability of a mineral trioxide aggregate when used as a root-end filling material
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Longitudinal sealing ability of mineral trioxide aggregate as a root-end filling material
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Microleakage of root-end filling materials
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Effect of root resection on the apical sealing ability of mineral trioxide aggregate
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Influence of the thickness of mineral trioxide aggregate on the sealing ability of root-end fillings in vitro
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Effect of an acid environment on leakage of root-end filling materials
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The effect of irrigation with doxycycline or citric acid on leakage and osseous would healing
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Comparative study of white and gray mineral trioxide aggregate (MTA) simulating a one- or two-step apical barrier technique
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A comparison of laterally condensed gutta-percha, thermoplasticized gutta-percha, and mineral trioxide aggregate as root canal filling materials
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Sealing ability of three materials in the orifice of root canal systems obturated with gutta-percha
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Furcation perforation repair comparing gray and white MTA: a dye extraction study
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Sealing ability of MTA and radiopaque Portland cement with or without calcium chloride for root-end filling
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Sealing ability of One-Up Bond and MTA and without a secondary seal as furcation perforation repair materials
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Microleakage of resected MTA
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Bacterial leakage of mineral trioxide aggregate as compared with zinc-free amalgam, intermediate restorative material, and Super EBA as a root-end filling material
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Perforation repair comparing mineral trioxide aggregate and amalgam using an anaerobic bacterial leakage model
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2022, HeliyonCitation Excerpt :Unfortunately, the conventional composite resin and glass ionomer cements are potentially contradictive in biological effect in vivo, and even may cause long-term inflammatory responses [10, 11]. In general, the Ca-silicate-based inorganic pastes have gained clinical acceptance as valuable root canal fillers for nearly 30 years [12]. For instance, mineral trioxide aggregate (MTA) is composed of tricalcium silicate (C3S), β-dicalcium silicate (β-C2S) and other inorganic components.
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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.