بسم هللا الرحمن الرحيم

MTAMineral trioxide aggregate

Done by dr.duaa abd matr

INTRODUCTION

Mineral Trioxide Aggregate (MTA) is a new material with

numerous exciting clinical applications.

MTA be one of the most versatile materials of this century in

the field of dentistry. Some of the appreciable

properties of MTA include its good physical properties and its

ability to stimulate tissue regeneration

as well as good pulp response.

HISTORY

It was introduced by mohmoud torabinejad

in 1993

It was improved for human usage by 1998

This material appear to be improvement

over other material for some procedure

that involve root repair and bone healing

Composition

MTA is mainly composed of 3

powder ingredients

* Portland cement(75%) is the major constituent.

It is responsible for the setting & biologic

properties.

* Bismuth oxide(20%) provides radiopacity.

* Gypsum (5%)is an important determinant of

setting time.

Portland cement is composed of 4 major

Components

dicalcium silicate

tricalcium aluminate

tetracalcium aluminoferrite

tricalcium silicate

* Dicalcium silicate hydrates more slowly than

tricalcium silicate & is responsiple for the latter’s

strength

* Tricalcium silicate is the most

important constituent of Portland

cement. It is the major component in the

formation of calcium silicate hydrate

which gives early strength to Portland

cement

.

* Aluminoferrite (contains iron) is present

in gray MTA. It is responsible for the gray

discoloration. It may discolor the tooth.

GRAY MTA WHITE MTA

Gray MTA

. Contains aluminoferrite (contains

iron), which is responsible for the gray

discoloration. It discolors both the

tooth & gingival tissue close to the

repaired root surface..

4. Produces 43% more surface

hydroxyapatite crystals than WMTA in

an environment with PBS (phosphate-

buffered saline).

5. Induced dentin formation more

efficiently; high number of dentin

bridge formation (reparative dentin

White MTA (PROROOT)

1. Tooth-colored, due to lower amounts of

Fe2O3.

2. Smaller particles with narrower size

distribution (8 times smaller than that

of GMTA).

3. Greater compressive strength.

the main diffirance between The difference observed between the 2 types of

MTA was the lack of iron ions in white MTA

* Hydration reaction.

* Notes: - MTA is called hydraulic silicate cement (HSC).- It is called hydraulic cement

(i.e. sets & is stable under water) relying primarily on hydration reactions for setting.

- The material consists primarily of calcium silicate.

* When mixed with water, MTA sets. The pH of MTA increases from 10 to 12.5 three hours after mixing. In high pH environment, the calcium ions that are

released from MTA react with phosphates in the tissue fluid to form hydroxyapatite (the principal mineral in

teeth & bones).

MTA

ManipulationMixing: gray MTA & white MTA are mixed with supplied sterile water in a powder to liquid ratio of 3:1 according to the manufacturer’s

instruction.

Note: Poor handling properties. The loose sandy nature of the mixture causes much difficulty

for the insertion & packing of MTA.

.

Insertion: Ultrasonic-assisted condensation [the ultrasonic vibration applied to endodontic

plugger(condenser)] is more efficient than hand condensation in:

- the apical flowing of MTA (enable better flow).- delaying bacterial leakage (enable better

adaptation).- the production of denser MTA apical plug

MTA* Thickness: 5-mm MTA apical plug provided

reduced microleakage.

* A Radiogragh is made.

* A moist (wet) cotton pellet is placed above the MTA (to ensure setting), & a well-sealing

temporary restoration is placed. Note: MTA sets 3-4 h after mixing.

* The patient is recalled when MTA has set (at least 24 hours) for obturation & placement

of permanent restoration.

PULP CAPING

Perforation repair in roots or furcation

Perforation repair

Root end filling

0

Apexification and apexogenesis

Apexification is ‘a method to induce a calcified barrier in a root with anopen apex or the continued apical development of an incomplete root in a tooth with anecrotic pulp.’33

apexogenesisApexogenesis is ‘a vital pulp therapy

procedure performed to encourage continued physiological development and formation

of the root end.’

contraindication

This material is not recommended for obturation to the primary teeth that expect

to exfoliate since it slowly absorb

1. (Bacteriostatic)

due to Highly alkaline pH

Ph=10.2 increase to 12.5 after 3 hr of mixing

2.Save treatment time. High success rate.

3. Can induce formation (regeneration) of dentin, cementum, bone &

periodontal ligament.

High biocompatibility

5. Excellent sealing ability.

Due to setting expansion

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

6. Produces an artificial barrier, against which an obturating material can

be condensed.

7.Hardens (sets) in the presence of moisture.

apicoectomy

8.More radiopaque than Ca(OH)2.

mtaCa(oH)2

9.Vasoconstrictive. This could be beneficial for haemostasis (most

importantly in pulp capping)

1)Long setting time (24 hr after mixing).

2.Difficult handling characteristics MTA as a root canal filling material include difficulty in obturation of curved root

canals,

3.Discolouration potential (GMTA)

4.An absence of a known solvent for set MTA. -Difficulty in removal after curing

3.High cost.

REFERENCES1. Parirokh M and Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review- part I : chemical, Physical, and Antibacterial Properties. J Endod 2010;36:16-27.2. Parirokh M and Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review- part II : leakage and Biocompatibility Investigations J Endod 2010;36:190-202.3. Parirokh M and Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review- part III : clinical Applications, Drawbacks, and Mechanism of Action J Endod 2010;36:400-413.4. Mahmoud Torabinejad and T.T, Pit Ford: Physical and chemical properties of a new root end filing materials. The American Association of Endodontics Vol, 21, No. 7 July 1995.5. Santos AD, Moraes JC, Arau jo EB, Yukimitu K, Vale rio Filho WV. Physico-chemical properties of MTA and a novel experimental cement. Int Endod J 2005;38:443-447.6. G. De-Deus, V. Petruccelli, E. Gurgel-Filho , T. Coutinho-Filho MTA versus Portland cement as repair material for furcalperforations: a laboratory study using a polymicrobial leakage model. Int Endod J 2006;39:293-298.7. Tziafas D, Pantelidou O, Alvanou A, Belibasakis G, Papadimitriou S. The dentinogenic effect of mineral trioxide aggregate (MTA) in short-term capping experiments. Int Endod J 2002;35:245-254.8. Bargholz C. Perforation repair with mineral trioxide aggregate: a modified matrix concept. Int Endod J 2005;38:59-69.9. Islam I, Chng HK, Yap AU. X-ray diffraction analysis of mineral trioxide aggregate and Portland cement. Int Endod J 2006;39:220-225.10. Effect of Mineral trioxide aggregate on proliferation of cultured human dental pulp cells. Int Endod J,2006;39:415- 422.11. Camilleri J, Pitt Ford TR. Mineral trioxide aggregate: a review of the constituents and biological properties of the material. Int Endod J 2006;39:747-54.12. Felippe WT, Felippe MC, Rocha MJ. The effect of mineral trioxide aggregate on the apexification and periapical healing of teeth with incomplete root formation. Int Endod J 2006;39:2-9.13. Song JS, Mante FK, Romanow WJ, Kim S. Chemical analysis of powder and set forms of Portland cement, gray ProRoot , white ProRootMTA, and gray MTA-Angelus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:809-15.14. Menezes R, da Silva Neto UX, Carneiro E, Letra A, Bramante CM, Bernadinelli N. MTA repair of a supracrestal perforation: a case report. J Endod 2005;31:212-214.15. Baek SH, Plenk H Jr., Kim S. Periapical tissue responses and cementum regeneration with amalgam, Super EBA, and MTA as root-end filling materials. J Endod 2005;31:444-449.16. Bortoluzzi EA, Broon NJ, Bramante CM, Garcia RB, de Moraes IG, Bernardineli N. Sealing ability of MTA and radiopaque Portland cement with or without calciumchloride for rootend filling. J Endod 2006;32:897-900.17. Torabinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. J Endod 1999;25:197-205.18. M. Torabeinejad and T.R. Pitt Ford : Antibacterial effects of some root end filling material. The American Association of Endodontists Vo.21, No.8, August 1995.19. Torabinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. J Endod 1999;25:197-205.20. 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.