Jr.of Orofac. Scie. 1(1)2009
Journal of
OROFACIAL SCIENCES Review
[MTA] - The Material Of Choice In Endodontics – A Review Nagesh Bollaa*, M. Madhusudanaa, Sarath Raj .Ka, CH. Sujanaa, Hema Iswaryaa a
Department of Conservative Dentistry & Endodontics, SIBAR Institute of Dental Sciences, Guntur, India.
ARTICLE INFO Article History : Received : 10 July 2009 Received in revised form : 27 July 2009 Accepted : 10 August 2009 Key Words : Mineral trioxide aggregate Apexification Apexogenesis Perforation
ABSTRACT
Mineral trioxide aggregate, or MTA, is a relatively new material developed for endodontics that appears to have a significant improvement over other materials. It is the first restorative material that consistently allows for the growth of cementum, and it may facilitate the regeneration of the periodontal ligament.
INTRODUCTION: Mineral trioxide aggregate, or MTA, is a new, biocompatible material with numerous exciting clinical implications in endodontics1. It has been used on an experimental basis by endodontists for several years with anecdotally reported success, some of it being quite impressive. MTA’s approval in 1998 by the U.S. Food and Drug Administration has lead to more widespread use. Since its first description in the dental literature by Lee and colleagues2 in 1993, MTA has been used in both surgical and nonsurgical applications, including root-end fillings3,5; direct pulp capping, pulpotomy9, perforation repairs in roots or furcations and apexification.8 It is also useful for the troublesome problems of strip perforations and perforating resorptive defects. The present article reviews the current dental literature on MTA, discussing its properties, clinical characteristics and few successful clinical cases. * Corresponding author : Dr. Nagesh Bolla Professor, Department Of Conservative Dentistry & Endodontics, SIBAR Institute of Dental Sciences, Takkellapadu, Guntur - 522 509. e-mail: bollanagesh@yahoo.co.in
©2009 SIDS.All Rights Reserved
COMPOSITION: Torabinajed et al developed the Gray MTA4, main constituents of it being -
Tricalcium silicate Tricalcium aluminate Tricalcium oxide Silicate oxide Bismuth oxide - to impart radioopacity Small amounts of other mineral oxides - for its chemical and physical properties
Recently variation in the original formulation was introduced commercially as White MTA differing by the absence of tetra calcium alumino ferrate and lesser quantities of aluminium oxide and magnesium oxide.10 PROPERTIES : Hydration of the powder results in a colloidal gel that solidifies in approximately three hours. MTA has a pH of 12.5 after setting4, similar to calcium hydroxide (or) Ca (OH) 2. This may impart some antimicrobial properties. The material has low solubility and a radiopacity slightly greater than that of dentin. Because 4
Jr.of Orofac. Scie. 1(1)2009
it has low compressive strength, it should not be placed in functional areas. INDICATIONS: -
As a root end filling material For perforation repair For pulp capping in young permanent teeth Apexification Apexogenesis In resorptive defects
CONTRAINDICATIONS : - Presence of infection (blood and pus) ADVANTAGES : -
Least toxic of all the other materials Excellent biocompatibility Hydrophilic Good radioopacity Reduced number of visits Less fatigue to the operator Less agony to the patient Increased patient acceptance
DISADVANTAGES: - Long setting time BIOCOMPATABILITY: Torabinejad and colleagues performed a series of biocompatibility studies with MTA. Kettering and Torabinejad found it to be nonmutagenic, and Torabinejad and colleagues found it to be less cytotoxic than SuperEBA and IRM. MTA allows for the overgrowth of cementum and it facilitates the regeneration of the periodontal ligaments. It has limited antibacterial effect and no effect on strict anaerobes. PROCEDURE : MTA is supplied in powder form. The manufacturer recommends that it should be mixed with sterile water into a thick, grainy paste. The mix is carried with a small amalgam carrier or messing gun or with a small hand instrument. If moisture is present in the preparation or resorptive defect, the MTA becomes “soupy” and difficult to condense. Moisture is drawn out of the MTA after placement with a dry paper point or cotton pellet. MTA is often pressed into the desired location. In preparing
the site to receive the MTA, the clinician should follow manufacturer’s instructions. Irrigation procedure should be performed before the MTA placement. If MTA is placed from inside the tooth, a moist cotton pellet or paper point should be placed against it, because the presence of moisture is essential for the material to set. The access cavity is then closed. MTA requires several hours to set into a hard mass. Most internal repairs with MTA require a second visit to complete the root canal therapy or restoration. MTA causes the repair of perforations and resorptive lesions by the deposition of cementum and establishment of a periodontal ligament in contrast to the formation of fibrous tissue that occurs with other materials. The cementum forms a biological seal that is similar to that of a normal root surface7. CONCLUSION : MTA is a promising material with an expanding foundation of research. In clinical practice, MTA helps in sealing iatrogenic and pathological perforation defects which helps in boosting of clinicians confidence. Multi visit procedures like Apexogenesis, Apexification performed with MTA minimizes the number of visits and increases the child’s acceptance towards the dental procedures. 1. APEXOGENESIS :
Fig: 1a Radiograph showing immature apex
Fig : 1b radiograph showing Apexogenesis with MTA after 3 years
2. APEXIFICATION :
Fig : 2a Radigraph showing immature apex
Fig : 2b Radiograph showing Apeogenesis with MTA after 3 years
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Jr.of Orofac. Scie. 1(1)2009
3. PERFORATION REPAIR :
Fig: 3a Radiograph showing supracrestal perforation
Fig : 3b radiograph showing supracrestal perforation repair after one month
REFERENCES : 1.
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Richard S. Schwartz, Micheal Mauger, David J.Clement,William A. Walker III, Mineral Trioxide Aggregate : A New Material For Endodontics. JADA 1999;130(7):967-975. Lee SJ, Monsef M, Torabinejad M. Sealing ability of a mineral trioxide aggregate for repair of lateral root perforations. J Endod 1993;19:541-4. Torabinejad M, Hong CU, Pitt Ford TR, Kariyawasam SP. Tissue reaction to implanted SuperEBA and mineral trioxide aggregate in the mandible of guinea pigs: a preliminary report. J Endod 1995;21:569-71 Stephen Cohen, Kenneth M. Hargreaves. Pathways of pulp. 9 ed. 278, 841, 862, 872-3.
5.
Torabinejad M, Hong CU, Lee SJ, Monsef M, Pitt Ford TR. Investigation of mineral trioxide aggregate for rootend filling in dogs. J Endod 1995;21:603-8. 6. Pitt Ford TR, Torabinejad M, McKendry DJ, Hong CU, Kariyawasam SP. Use of mineral trioxide aggregate for repair of furcal perforations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;79:756-63. 7. Andreason JO, Munksgaard EC, Fredebol L, Rud J. Periodontal tissue regeneration including cementogenesis adjacent to dentin-bonded retrograde composite fillings in humans. J Endod 1993;19:151-3. 8. Shabahang S, Boyne PJ, Abedi HR, McMillan P, Torabinejad M. Apexification in immature dog teeth using osteogenic protein- 1, mineral trioxide aggregate, and calcium hydroxide. J Endod 1997;23:265. 9. Mohammad Jafar Eghbal, Saeed Asgray, Reza Ali Baglue, MTA pulpotomy of human permanent molars with irreversible pulpitis Australian Society of Endodontology 2009;35:4-8. 10. D. Matt, Jeffery R. Thrope, James M. Strother, Comparative Study of White and Gray Mineral Trioide Aggregate (MTA) Simulating a One- or Two Step Apical Barrier Technique Gary 2004;30(12):876-879.
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