Mineral Trioxide Aggregat

INDIAN JOURNAL OF DENTAL ADVANCEMENTS
J o u r n a l h o m e p a g e : w w w. n a c d . i n
REVIEW
Mineral Trioxide Aggregate

Ravichandra P V1, Jayaprada Reddy S2, Harikumar V3, Kavita A4
doi:10.5866/3.3.593
Department of Conservative Dentistry

Kamineni Institute of Dental Sciences,
Narketpally, Nalgonda Dist. A.P.
Professor & HOD1

Professors2&3
Senior Lecturer4
Article Info
Received: April 14, 2011
Review Completed: May, 16, 2011
Accepted: June, 19, 2011
Available Online: October, 2011
NAD, 2011 - All rights reserved
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, Mechanism

of action, Physical and Chemical properties, clinical
applications.
INTRODUCTION
Oral health is indeed a reflection of a wholesome
lifestyle. Mans curiosity for new things and
fascination for learning has led to revolution in every
field, and dentistry is not been left behind. As
therapeutic techniques become more sophisticated
the management of problems encountered or
created during treatment has also become
increasingly complicated.
Every effort was put in to match the best
endeavor, result was a totally versatile material MTA
- compositionally formulated to have physical
properties, settings requirements and characteristics
necessary for an ideal repair and medicament
material.4
Mineral trioxide aggregate, or MTA, is a new
biocompatible material introduced by Mohmoud
Email for correspondence:
sjayaprada@yahoo.com
Taorabinejad with numerous exciting clinical

applications in Endodontics. It has been used on an
experimental basis by endodontists for several years
with anecdotally reported success, some of it quite
impressive; MTAs approval in 1998 by the U.S. Food
and Drug Administration should lead to more
widespread use. The material appears to be an
improvement over other materials for endodontic
procedures 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
IJDA, 3(3), July-September, 2011
593
Ravichandra, et, al.
it is more radiopaque than conventional gutta percha and dentin, it should be easily
distinguishable on radiographs when used as a
root filing material.1,4,5
properties.Electron probe micro analysis of the MTA

powder showed that calcium and phosphorus are the
main ions present.
MTA is cement composed of tricalcium silicate,
tricalcium aluminate, tricalcium oxide, silicate oxide
and bismuth oxide. It also contains 5% calcium
sulphate dehydrate and tetracalcium alumino
ferrite.Off white colored formula lacks tetra calcium
alumino ferrite and lack of this iron containing
compound accounts for off white appearance.
Both the formula contains;
70% Portland cements, 20% bismuth oxide and
5% gypsum by weight.
MANIPULATION:
MTA is supplied as a powder. Each pack of Pro
root MTA powder comes with a pre-measured unit
dose of water for convenience in mixing.
MIXING TIME:
MTA is prepared by mixing 3 parts of powder
with one part aqueous solution by weight to obtain
a putty consistency which is achieved after 30
seconds of mixing.
MECHANISM OF ACTION: From the time that MTA
is placed in direct contact with human tissues, it
appears that the material does the following3
(1) Forms CH that releases calcium ions for cell
attachment and proliferation
(2) Creates an antibacterial environment by its
alkaline pH
3.
4. Compressive strength: In 24 hours MTA had the

lowest compressive strength (40 Mpa) among
the materials (Amalgam, Super EBA & IRM) tested,
but it increased after 21 days to 67 MPa. The
increase in compressive strength of MTA
required the presence of moisture.1,4,5
5. Solubility: MTA shows no signs of solubility in
water and this is a major factor in assessing the
suitability of potential substances to be used as
restorative materials in dentistry. Lack of
solubility has been stated as an ideal
characteristic for root end filing material.1,4,5
6. Biocompatibility: Application of MTA as a root
end filling material promoters regeneration of
dental and osseous tissues, and may induce
cementoblasts to produce matrix for cementum
formation over MTA.1,4,5
7. Sealing ability MTA has enhanced sealing ability
which could be due to the setting expansion
when it is used in moist oral environment.16,20
8.
MTA has an antibacterial effect on some of the

facultative bacteria and no effect on any of the
strict anaerobic bacteria. The antibacterial effect
of MTA against these organisms could be
because of its alkaline pH or release of diffusible
substances into the growth medium.11,18
9.
MTA is an effective pulp capping material able

to stimulate hard tissue bridge formation during
the early wound healing process. The stereotypic
pulp defence mechanism by which primitive
matrix (fibro dentine) trigger expression of the
odontoblastic potential of pulpal cells seems to
be related to the dentinogenic activity of MTA.
Pulp capping with MTA induces cytological and
(3) Modultes cytokine production

(4) Encourages differentiation and migration of hard
tissue-producing cells and
(5) Forms HA (or carbonated apatite) on the MTA
surface and provides a biologic seal.
PHYSICAL, CHEMICAL, BIOLOGICAL
HISTOLOGICAL PROPERTIES:
AND
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 mm
of equivalent thickness of aluminium, because
594 IJDA, 3(3), July-September, 2011
Setting time: Advantages of its longer setting

time are that, the quicker a material sets the more
it shrinks. This explains why MTA in previous
experiments had significantly less dye and
bacterial leakage than other materials tested as
root filling materials.1,4,5
functional changes in pulpal cells resulting in

formation of fibrodentine and reparative dentine
at the surface of mechanically exposed dental
pulps.7,10,15
10. In-vitro study of human osteoblasts revealed
that MTA stimulated the release of cytokines and
the 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 the

treatment of strip and supracrestal perforations,
horizontal
root
fractures,
sealing
communications between the root canal space
and external root surfaces, filling root canals of
teeth with mature and open apexes, as well as
management of dens invaginatus.
ADVANTAGES:3
-
High biocompatibility
Hydrophilic
DISADVANTAGES:3
-
Discolouration potential (GMTA)
Presence of toxic elements in the material

composition (arsenic)
Difficult handling characteristics
MTA as a root canal filling material include difficulty

in obturation of curved root canals, discolouration
potential & 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 with
numerous exciting clinical applications. It has been
used on an experimental basis by dentists for several
years with anecdotally reported success, some of it
quite impressive. An ideal root repair material which
has qualities like resistance to marginal leakage,
allows normal healing response, ease of clinical
manipulation non- resorbable. And finally the most
important quality, especially of interest in our field it is non toxic. Because of all these superior qualities
and a high ph similar to calcium hydroxide it is not
surprising that induction of hard tissue formation
often occurs after the use of this substance. So no
longer are immature permanent teeth with carious
lesion or traumatic pulp exposure destined for
endodontic therapy.
REFERENCES
1.
Mineral Trioxide Aggregate: A Comprehensive Literature

ReviewPart I: Chemical, Physical, and Antibacterial
Properties JOE Volume 36, Number 1, January 2010
2.

ReviewPart II: Leakage and Biocompatibility
Investigations JOE Volume 36, Number 2, February 2010
3.

ReviewPart III: Clinical Applications, Drawbacks, and
Mechanism of Action JOE Volume 36, Number 3, March 2010
4.
Mohmoud Taorabinejad and T.T, Pit Ford: Physical and

chemical properties of a new root end filing materials. The
American Association of Endodontics Vo, 21, No 7 July 1995.
5.
Intl Journal of Endodontics, 2005, 443-447, physico-chem

properties of MTA and novel experimental cement.
Radio-opaque
-
Highly alkaline pH (Bacteriostatic)
Excellent sealing ability (Low marginal leakage)
Low solubility
595
6.
IEJ, 39, 2005, MTA versus Portland cement as repair material

for furcal perforations: a laboratory study using a
polymicrobial leakage model.
7.
IEJ, 35, 2002, the dentinogenic Effect of Mineral trioxide

aggregate in short term capping experiments.
8.
IEJ, 38, 59-69, 2005, Perforation repair with MTA: a Modified

matrix concept.
9.
Int Endod J, 2006; 39(3) X-ray diffraction analysis of mineral

trioxide aggregate and Portland cement.
10. Int Endod J, 39,415-422, 2006, Effect of Mineral trioxide

aggregate on proliferation of cultured human dental pulp cells.
14. JOE-Vol 31,5,march 2005 MTA repair of a supracrestal

perforation: case report
15. JOE, Vol 31, 6 2005 Periapical tissue responses and
cementum regeneration with amalgam, superEBA, MTA as
root end filling materials.
16. JOE, Vol 32, September 2006 sealing ability of MTA and
radiopaque Portland cement with or without calcium
chloride for root-end filling.
17. JOE,Vol 25,3,1999 Clinical applications of Mineral trioxide
aggregate.
11. Int endodontic Journal,39,747-754,2006 MTA:A review of

the constituents and biological properties of the material
18. M. Torabeinejad and T.R. Pitt Ford : Antibacterial effects of

some root end filling material. The American Association
of Endodontists VOP.21, No.8, August 1995.
12. Int Endod J,39,2-9,2006 The effect of Mineral Trioxide

aggregate on the apexification and periapical healing of
teeth with incomplete root formation.
19. HR Abedi, M. Torabinejad, TR Pitt Ford : The Use of mineral

trioxide aggregate cement. : Journal of Endodontics : Vol.
22. No.4. April 1998.
13. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 102(6)
Chemical analysis of powder and set forms of Portland
cement, gray ProRoot MTA, White Proroot MTA and gray
MTA-Angelus.
20. M. Torabinejad and T.R. Pitt Ford : Sealing ability of mineral

trioxide aggregate when used as a root end filling
materials. 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
596 IJDA, 3(3), July-September, 2011
Figure 5: Pre-Op open apex
Figure 7: Pre-Op External resorption
Figure 9: Pre-OP periapical lesion
Figure 10: Post-Op MTA retro Seal
597

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INDIAN JOURNAL OF DENTAL ADVANCEMENTS

Mineral Trioxide Aggregate

Department of Conservative Dentistry

Professor & HOD1

Key words: Mineral Trioxide Aggregate, Composition, Mechanism

Taorabinejad with numerous exciting clinical

It also contains small amounts of mineral oxides,

Mineral Trioxide Aggregate

Ravichandra, et, al.

properties.Electron probe micro analysis of the MTA

4. Compressive strength: In 24 hours MTA had the

MTA has an antibacterial effect on some of the

MTA is an effective pulp capping material able

(3) Modultes cytokine production

1. pH: 10.2 initially and it rose to 12.5 after 3 hours,

Setting time: Advantages of its longer setting

Mineral Trioxide Aggregate

functional changes in pulpal cells resulting in

MTA has been successfully used for the

Ravichandra, et, al.

Discolouration potential (GMTA)

Presence of toxic elements in the material

Difficult handling characteristics

MTA as a root canal filling material include difficulty

Long setting time

An absence of a known solvent for set MTA.

Difficulty in removal after curing

Mineral Trioxide Aggregate: A Comprehensive Literature

Mineral Trioxide Aggregate: A Comprehensive Literature

Mineral Trioxide Aggregate: A Comprehensive Literature

Mohmoud Taorabinejad and T.T, Pit Ford: Physical and

Intl Journal of Endodontics, 2005, 443-447, physico-chem

Highly alkaline pH (Bacteriostatic)

Excellent sealing ability (Low marginal leakage)

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

Mineral Trioxide Aggregate

IEJ, 39, 2005, MTA versus Portland cement as repair material

IEJ, 35, 2002, the dentinogenic Effect of Mineral trioxide

IEJ, 38, 59-69, 2005, Perforation repair with MTA: a Modified

Int Endod J, 2006; 39(3) X-ray diffraction analysis of mineral

10. Int Endod J, 39,415-422, 2006, Effect of Mineral trioxide

Ravichandra, et, al.

14. JOE-Vol 31,5,march 2005 MTA repair of a supracrestal

11. Int endodontic Journal,39,747-754,2006 MTA:A review of

18. M. Torabeinejad and T.R. Pitt Ford : Antibacterial effects of

12. Int Endod J,39,2-9,2006 The effect of Mineral Trioxide

19. HR Abedi, M. Torabinejad, TR Pitt Ford : The Use of mineral

20. M. Torabinejad and T.R. Pitt Ford : Sealing ability of mineral

Figure 1: Pre-Op cervical Perforation

Figure 2: Post-Op MTA Seal

Figure 3: Pre-Op Furcation Perforation

Figure 4 : Post-Op MTA Seal

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

Mineral Trioxide Aggregate

Ravichandra, et, al.

Figure 5: Pre-Op open apex

Figure 6: Post-Op MTA Seal

Figure 7: Pre-Op External resorption

Figure 8: Post-Op MTA Seal