mineral trioxide aggregat

IJDA, 3(3), July-September, 2011 593

Mineral Trioxide Aggregate

Ravichandra P V1, Jayaprada Reddy S2, Harikumar V3, Kavita A4

Department of Conservative DentistryKamineni Institute of Dental Sciences,Narketpally, Nalgonda Dist. A.P.

Email for correspondence:[email protected]

INTRODUCTION

Oral health is indeed a reflection of a wholesomelifestyle. Man’s curiosity for new things andfascination for learning has led to revolution in everyfield, and dentistry is not been left behind. Astherapeutic techniques become more sophisticatedthe management of problems encountered orcreated during treatment has also becomeincreasingly complicated.

Every effort was put in to match the bestendeavor, result was a totally versatile material MTA- compositionally formulated to have physicalproperties, settings requirements and characteristicsnecessary for an ideal repair and medicamentmaterial.4

Mineral trioxide aggregate, or MTA, is a newbiocompatible material introduced by Mohmoud

Taorabinejad with numerous exciting clinicalapplications in Endodontics. It has been used on anexperimental basis by endodontists for several yearswith anecdotally reported success, some of it quiteimpressive; MTA’s approval in 1998 by the U.S. Foodand Drug Administration should lead to morewidespread use. The material appears to be animprovement over other materials for endodonticprocedures that involve root repair and bone healing.

COMPOSITION:

MTA consists of fine hydrophilic particles

� Tricalcium silicate

� Tricalcium aluminate

� Tricalcium oxide

� Silicate oxide

It also contains small amounts of mineral oxides,which modify its chemical and physical

Article InfoReceived: April 14, 2011Review Completed: May, 16, 2011Accepted: June, 19, 2011Available Online: October, 2011© NAD, 2011 - All rights reserved

REVIEW

ABSTRACT:

Mineral trioxide aggregate, or MTA, is a new material developed

for endodontics that appears to be a significant improvement

over other materials for procedures in bone. It is the first

restorative material that consistently allows for the overgrowth

of cementum, and it may facilitate the regeneration of the

periodontal ligament.In this article, we review the current dental

literature on MTA, discussing its composition, physical,chemical

and biological properties and clinical characteristics.

Key words: Mineral Trioxide Aggregate, Composition, Mechanismof action, Physical and Chemical properties, clinicalapplications.

INDIAN JOURNAL OF DENTAL ADVANCEMENTS

Jour nal homepage: www. nacd. in

Professor & HOD1

Professors2&3

Senior Lecturer4

doi:10.5866/3.3.593

IJDA, 3(3), July-September, 2011594

properties.Electron probe micro analysis of the MTApowder showed that calcium and phosphorus are themain ions present.

MTA is cement composed of tricalcium silicate,tricalcium aluminate, tricalcium oxide, silicate oxideand bismuth oxide. It also contains 5% calciumsulphate dehydrate and tetracalcium aluminoferrite.Off white colored formula lacks tetra calciumalumino ferrite and lack of this iron containingcompound accounts for off white appearance.

Both the formula contains;

70% Portland cements, 20% bismuth oxide and5% gypsum by weight.

MANIPULATION:

MTA is supplied as a powder. Each pack of Proroot MTA powder comes with a pre-measured unitdose of water for convenience in mixing.

MIXING TIME:

MTA is prepared by mixing 3 parts of powderwith one part aqueous solution by weight to obtaina putty consistency which is achieved after 30seconds of mixing.

MECHANISM OF ACTION: From the time that MTAis placed in direct contact with human tissues, itappears that the material does the following3

(1) Forms CH that releases calcium ions for cellattachment and proliferation

(2) Creates an antibacterial environment by itsalkaline pH

(3) Modulâtes cytokine production

(4) Encourages differentiation and migration of hardtissue-producing cells and

(5) Forms HA (or carbonated apatite) on the MTAsurface and provides a biologic seal.

PHYSICAL, CHEMICAL, BIOLOGICAL ANDHISTOLOGICAL PROPERTIES:

1. pH: 10.2 initially and it rose to 12.5 after 3 hours,and thereafter, it remained constant1,4,5

2. Radiopacity: radiopacity for MTA was 7 -17 mmof equivalent thickness of aluminium, because

it is more radiopaque than conventional gutta -percha and dentin, it should be easilydistinguishable on radiographs when used as aroot filing material.1,4,5

3. Setting time: Advantages of its longer settingtime are that, the quicker a material sets the moreit shrinks. This explains why MTA in previousexperiments had significantly less dye andbacterial leakage than other materials tested asroot filling materials.1,4,5

4. Compressive strength: In 24 hours MTA had thelowest compressive strength (40 Mpa) amongthe materials (Amalgam, Super EBA & IRM) tested,but it increased after 21 days to 67 MPa. Theincrease in compressive strength of MTArequired the presence of moisture.1,4,5

5. Solubility: MTA shows no signs of solubility inwater and this is a major factor in assessing thesuitability of potential substances to be used asrestorative materials in dentistry. Lack ofsolubility has been stated as an idealcharacteristic for root end filing material.1,4,5

6. Biocompatibility: Application of MTA as a rootend filling material promoters regeneration ofdental and osseous tissues, and may inducecementoblasts to produce matrix for cementumformation over MTA.1,4,5

7. Sealing ability MTA has enhanced sealing abilitywhich could be due to the setting expansionwhen it is used in moist oral environment.16,20

8. MTA has an antibacterial effect on some of thefacultative bacteria and no effect on any of thestrict anaerobic bacteria. The antibacterial effectof MTA against these organisms could bebecause of its alkaline pH or release of diffusiblesubstances into the growth medium.11,18

9. MTA is an effective pulp capping material ableto stimulate hard tissue bridge formation duringthe early wound healing process. The stereotypicpulp defence mechanism by which primitivematrix (fibro dentine) trigger expression of theodontoblastic potential of pulpal cells seems tobe related to the dentinogenic activity of MTA.Pulp capping with MTA induces cytological and

Mineral Trioxide Aggregate Ravichandra, et, al.


functional changes in pulpal cells resulting information of fibrodentine and reparative dentineat the surface of mechanically exposed dentalpulps.7,10,15

10. In-vitro study of human osteoblasts revealedthat MTA stimulated the release of cytokines andthe production of interleukine.20

CLINICAL APPLICATIONS: 2,6,12,14,17,19

IN PRIMARY TEETH:

� Pulp capping

� Pulpotomy

� Root canal filling

� Furcation perforation repair

� Resorption repair

IN PERMANENT TEETH:

� Pulp capping

� Partial pulpotomy

� Pulpotomy

� Root canal filling

� Perforation repair - apical, lateral, furcation

� Resorption repair - external & internal

� Root end filling

� Apical barrier for tooth with necrotic pulps &open apex

� Sealer & others…..

� MTA has been successfully used for thetreatment of strip and supracrestal perforations,horizontal root fractures, sealingcommunications between the root canal spaceand external root surfaces, filling root canals ofteeth with mature and open apexes, as well asmanagement of dens invaginatus.

ADVANTAGES:3

- High biocompatibility

- Hydrophilic

Radio-opaque

- Highly alkaline pH (Bacteriostatic)

- Excellent sealing ability (Low marginal leakage)

- Low solubility

DISADVANTAGES:3

- Discolouration potential (GMTA)

- Presence of toxic elements in the materialcomposition (arsenic)

- Difficult handling characteristics

MTA as a root canal filling material include difficultyin obturation of curved root canals, discolourationpotential & long ST

- Long setting time

- High cost

- An absence of a known solvent for set MTA.

- Difficulty in removal after curing

CONCLUSION:

MTA is a new biocompatible material withnumerous exciting clinical applications. It has beenused on an experimental basis by dentists for severalyears with anecdotally reported success, some of itquite impressive. An ideal root repair material whichhas qualities like resistance to marginal leakage,allows normal healing response, ease of clinicalmanipulation non- resorbable. And finally the mostimportant quality, especially of interest in our field -it is non toxic. Because of all these superior qualitiesand a high ph similar to calcium hydroxide it is notsurprising that induction of hard tissue formationoften occurs after the use of this substance. So nolonger are immature permanent teeth with cariouslesion or traumatic pulp exposure destined forendodontic therapy.

REFERENCES1. Mineral Trioxide Aggregate: A Comprehensive Literature

Review–Part I: Chemical, Physical, and AntibacterialProperties JOE – Volume 36, Number 1, January 2010

2. Mineral Trioxide Aggregate: A Comprehensive LiteratureReview–Part II: Leakage and BiocompatibilityInvestigations JOE – Volume 36, Number 2, February 2010

3. Mineral Trioxide Aggregate: A Comprehensive LiteratureReview–Part III: Clinical Applications, Drawbacks, andMechanism of Action JOE – Volume 36, Number 3, March 2010

4. Mohmoud Taorabinejad and T.T, Pit Ford: Physical andchemical properties of a new root end filing materials. TheAmerican Association of Endodontics Vo, 21, No 7 July 1995.

5. Intl Journal of Endodontics, 2005, 443-447, physico-chemproperties of MTA and novel experimental cement.


IJDA, 3(3), July-September, 2011596

6. IEJ, 39, 2005, MTA versus Portland cement as repair materialfor furcal perforations: a laboratory study using apolymicrobial leakage model.

7. IEJ, 35, 2002, the dentinogenic Effect of Mineral trioxideaggregate in short term capping experiments.

8. IEJ, 38, 59-69, 2005, Perforation repair with MTA: a Modifiedmatrix concept.

9. Int Endod J, 2006; 39(3) X-ray diffraction analysis of mineraltrioxide aggregate and Portland cement.

10. Int Endod J, 39,415-422, 2006, Effect of Mineral trioxideaggregate on proliferation of cultured human dental pulp cells.

11. Int endodontic Journal,39,747-754,2006 MTA:A review ofthe constituents and biological properties of the material

12. Int Endod J,39,2-9,2006 The effect of Mineral Trioxideaggregate on the apexification and periapical healing ofteeth with incomplete root formation.

13. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 102(6)Chemical analysis of powder and set forms of Portlandcement, gray ProRoot MTA, White Proroot MTA and grayMTA-Angelus.

14. JOE-Vol 31,5,march 2005 MTA repair of a supracrestalperforation: case report

15. JOE, Vol 31, 6 2005 Periapical tissue responses andcementum regeneration with amalgam, superEBA, MTA asroot end filling materials.

16. JOE, Vol 32, September 2006 sealing ability of MTA andradiopaque Portland cement with or without calciumchloride for root-end filling.

17. JOE,Vol 25,3,1999 Clinical applications of Mineral trioxideaggregate.

18. M. Torabeinejad and T.R. Pitt Ford : Antibacterial effects ofsome root end filling material. The American Associationof Endodontists VOP.21, No.8, August 1995.

19. HR Abedi, M. Torabinejad, TR Pitt Ford : The Use of mineraltrioxide aggregate cement. : Journal of Endodontics : Vol.22. No.4. April 1998.

20. M. Torabinejad and T.R. Pitt Ford : Sealing ability of mineraltrioxide aggregate when used as a root end fillingmaterials. The American Association of Endodontists Vo.19.,No. 12, Dec. 1999

Figure 1: Pre-Op cervical Perforation Figure 2: Post-Op MTA Seal


Figure 3: Pre-Op Furcation Perforation Figure 4 : Post-Op MTA Seal


Figure 5: Pre-Op open apex Figure 6: Post-Op MTA Seal

Figure 7: Pre-Op External resorption Figure 8: Post-Op MTA Seal

Figure 9: Pre-OP periapical lesion Figure 10: Post-Op MTA retro Seal


mineral trioxide aggregat

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