|Year : 2014 | Volume
| Issue : 2 | Page : 71-74
Mineral trioxide aggregate (MTA) in dentistry: A review of literature
Chirag Macwan, Anshula Deshpande
Department of Pedodontics and Preventive Dentistry, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
|Date of Web Publication||10-Mar-2015|
Department of Pedodontics and Preventive Dentistry, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara - 391 760, Gujarat
Source of Support: None, Conflict of Interest: None
Mineral trioxide aggregate (MTA) is a unique material with several exciting clinical applications. MTA has potential and one of the most versatile materials of this century in the field of dentistry. During endodontic treatment of primary and permanent tooth MTA can be used in many ways. MTA materials have been shown to have a biocompatible nature and have excellent potential in endodontic use. MTA materials provide better microleakage protection than traditional endodontic repair materials using dye, fluid filtration, and bacterial penetration leakage models. In both animal and human studies, MTA materials have been shown to have excellent potential as pulp-capping and pulpotomy medicaments. MTA material can be used as apical and furcation restorative materials as well as medicaments for apexogenesis and apexification treatments. In present article, we review the current dental literature on MTA, discussing composition, physical, chemical and biological properties and clinical characteristics of MTA.
Keywords: Biocompatible dental material, Mineral Trioxide Aggregate, MTA
|How to cite this article:|
Macwan C, Deshpande A. Mineral trioxide aggregate (MTA) in dentistry: A review of literature. J Oral Res Rev 2014;6:71-4
|How to cite this URL:|
Macwan C, Deshpande A. Mineral trioxide aggregate (MTA) in dentistry: A review of literature. J Oral Res Rev [serial online] 2014 [cited 2020 Apr 4];6:71-4. Available from: http://www.jorr.org/text.asp?2014/6/2/71/152914
| Introduction|| |
Mineral Trioxide Aggregate (MTA) was introduced by Mohmoud Taorabinejad at Loma Linda University, California, USA in 1993  and was given approval for endodontic use by the U.S. Food and Drug Administration in 1998. [2,3] List of available MTA with their trade name and manufacturer are summarised in [Table 1].
| Composition and Manipulation of Mineral Trioxide Aggregate (MTA)|| |
MTA is available in two types based on the color known as gray and white MTA. Scanning electron microscopy (SEM) and electron probe microanalysis characterized the differences between GMTA and WMTA and found that the major difference between GMTA and WMTA is in the concentrations of Al 2 O 3 , MgO and FeO.  Chemical composition of the both GMTA and WMTA is mentioned in the [Table 2] [Adapted from Asgary et al. (2005)  .
|Table 2: Chemical compositions of GMTA and WMTA [Adapted from Asgary et al. (2005)] |
Click here to view
Sluyk et al. (1998)  , Torabinejad et al. (1999)  and Schmitt et al. (2001)  advocated that the powder water ratio for MTA should be 3:1(P: W). Mixing can be done on paper pad or on a glass slab using a plastic or metal spatula to achieve putty like paste consistency. This mix should be cover with moistened cotton pellet to prevent dehydration of mix.
Immediately after mixing MTA has a pH of 10.2. After 3 hours of setting the pH increased to 12.5.  The pH of set MTA is almost similar to calcium hydroxide. Sluyk et al.(1998)  suggested that mixing time should be less than 4 minute. Torabinejad et al. (1995)  found setting time about 2 hours and 45 minutes (± 5 minutes) of grey MTA, similar research done by Islam et al., 2006 suggested that initial setting time about 2 hours and 55 minutes and 2 hours and 20 minutes for grey MTA and white MTA, respectively. MTA being hydrophilic requires moisture to set. Presence of moisture during setting improves the flexural strength of the set cement.  Therefore, it is advised to place a wet cotton pellet over the MTA in the first visit followed by replacement by a permanent restoration at the second visit. The long setting time is one of the drawbacks of MTA because of it should not be applied in 1 visit. Inter-appointment moist cotton palate is required till the final setting of MTA.
MTA powder must be kept tightly closed to avoid degradation by moisture. The mixing time is critical as, if the mixing time is prolonged; it results in dehydration of the mix. Torabinejad and Chivian (1999)  advocated that after mixing, the mix should be cover with moistened cotton pellet because if it is left open it undergoes dehydration and dries into a sandy mixture. MTA may be placed into the desired location using ultrasonic condensation, plugger, paper point or specially designed carriers and messing gun. Aminoshariae et al. (2003)  compared hand condensation and the ultrasonic method and found that a better adaptation of MTA to the walls with less voids in hand condensation compared to the ultrasonic method. Lawley et al. (2004)  concluded that after 90 days, the ultrasonically placed MTA followed with composite provided a significantly better MTA seal compared with the hand condensation. Nekoofar et al. (2007)  compared the method and pressure of condensation and found that condensation pressure may affect the strength and hardness of MTA.
[TAG:2]Chemical, Physical, and Mechanical Properties of M ta0 [/TAG:2]
Torabinejad M, et al. (1995)  studied physical properties of MTA and found that compressive strength at 24 hours 40.0 MPa and at 21 days 67.3MPa; and in comparison between GMTA and WMTA result showed that compressive strength of Gray MTA > White MTA.
Ding SJ (2008)  & Shah PMN (1996)  found that MTA has comparable radiodensity as Zinc Oxide Eugenol and it is less radio opaque than Super EBA, IRM, gutta-percha or amalgam. Torabinejad M (1995)  concluded that the mean radio opacity of MTA is 7.17 mm of equivalent thickness of aluminium, which is adequate to make it easy to visualize radiographically.
The set MTA shows no signs of solubility. But, if more water is used during mixing the MTA it may results into increased solubility. Buding (2008)  found that the set MTA when exposed to water it releases calcium hydroxide (CaOH 2 ). CaOH 2 might be responsible for its cementogenesis-inducing property. During setting reaction if mix is exposed to acidic environment it does not interfere in the setting. 
Marginal adaptation and sealing ability
Bates et al. (1996)  found that MTA is superior to the other traditional root-end filling materials. According to Shipper et al. (2004)  and Torabinejad et al. (1995)  explained that MTA has excellent sealing ability which may occur because MTA expands during setting reaction. In presence of moist environment sealing ability of MTA is enhanced due to the setting expansion so it is been suggested that a moistened cotton pellet should be placed in contact with MTA before placement of the permanent restoration. Valois et al. (2004)  found that about 4-mm thickness of MTA is sufficient to ensure a good sealing.
Antibacterial and antifungal property
Al-Hazaimi et al. (2006)  stated that MTA has antibacterial effect especially against Enterococcus faecalis and Streptococcus sanguis. But, according to Torabinejad et al. (1995)  MTA showed no antimicrobial action against any of the anerobes. But it did show certain effect on facultative bacteria.
Reaction with other dental materials
Nandini S et al. (2006)  found MTA does not react or interfere with any other restorative material. When GIC or composite resins placed over MTA it doesn't affects the setting reaction. Srinivasan V et al (2009)  stated that residual calcium hydroxide may interfere with the adaptation of MTA to dentinal wall. This results in reduced sealing ability which occurs either by a mechanical obstacle of CaOH 2 particle by chemically reaction with MTA.
Kettering and Torabinejad (1995)  compared MTA with Super EBA and IRM and found that MTA is not mutagenic and less cytotoxic. Sumer et al. (2006)  concluded that MTA is well tolerated by the tissues and biocompatible. Arens and Torabinejad (1996)  treated furcation perforations and osseous repair with MTA. Pelliccioni et al. (2004)  evaluated osteoblast-like cell response to MTA and result showed MTA has good interaction with periapical and periradicular tissues. MTA has potential effect on cell viabilities collagen release mechanism. Koh et al. (2001)  concluded that property of MTA to produce interleukin and also offers a biologically active substrate for bone cells.
Torabinejad et al. (1995)  concluded that MTA is potential to activate the cementoblasts and eventually cementum production. MTA also allows the overgrowth of PDL fiber over its surface. Schwartz et al. (1999)  reported that MTA helps in elimination of clinical symptoms bone healing. These properties of MTA determine it as a potential regenerative material.
Myers K (1996)  determined that MTA, similar to calcium hydroxide (CaOH 2 ), induces formation of dentin bridge. According to Holland et al. (1999)  theorized that the tricalcium oxide content of MTA interacts with tissue fluids and form CaOH 2 , resulting in hard-tissue creation in a similar manner to that of CaOH 2 . Faraco et al. (2001)  concluded that the dentin bridge formed with MTA is relatively faster, with good structural integrity than with CaOH 2 . According to Dominguez et al. (2003)  and Tziafas (2002)  MTA stimulates reparative dentin formation along with maintaining the integrity of the pulp.
[TAG:2]Clinical Applications of Mta0 [/TAG:2]
Diagrammatic representation of clinical usage of MTA is shown in [Figure 1].
|Figure 1: Diagrammatic representation of clinical application of MTA in Primary and Permanent dentition, where, (a) Pulp capping/Partial pulpotomy, (b) Furcal repair, (c) Root canal sealer, (d) Root end filling/ Apexification, (e) Repair of root perforation/ resorption, (f) Pulp capping, (g) Pulpotomy, (h) Resorption repair, (i) Furcation perforation repair, (j) Root canal filling|
Click here to view
1. In Primary teeth:
- Pulp capping [2, 29, 34]
- Pulpotomy 
- Root canal filling 
- Furcation perforation repair 
- Resorption repair 
In Permanent teeth:
- Pulp capping [2,29]
- Partial pulpotomy 
- Perforation repair - Apical, lateral, furcation 
- Resorption repair - External and internal 
- Repair of fracture - Horizontal and Vertical
- Root end filling 
- Apical barrier for tooth with necrotic pulps and open apex [10, 22, 37]
- Coronal barrier for regenerative endodontics 
- Root canal sealer 
| Conclusion|| |
Considering the present literature review, MTA is an excellent biocompatible material. MTA has various exciting clinical applications as it has numerous qualities mandatory for an ideal dental material. MTA required to be further explored by clinicians so that its advantageous properties can be practiced.
| References|| |
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.
Schwartz RS, Mauger M, Clement DJ, Walker WA 3rd. Mineral trioxide aggregate: A new material for endodontics. J Am Dent Assoc 1999;130:967-75.
Srinivasan V, Waterhouse P, Whitworth J. Mineral trioxide aggregate in paediatric dentistry. Int J Pediatr Dent 2009;19:34-47.
Asgary S, Parirokh M, Egbbal MJ, Brink F. Chemical differences between white and gray mineral trioxide aggregate. J Endod 2005;31:101-3.
Sluyk SR, Moon PC, Hartwell GR. Evaluation of setting properties and retention characteristics of Mineral Trioxide Aggregate when used as a furcation perforation repair material. J Endod 1998;24:768-71.
Torabinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. J Endod 1999;25:197-205.
Schmitt D, Lee J, Bogen G. Multifaceted use of ProRoot MTA root canal repair material. Pediatr Dent 2001;23:326-30.
Torabinejad M, Hong CU, McDonald F, Pitt Ford TR. Physical and chemical properties of a new root-end filling material. J Endod 1995;21:349-53.
Aminoshariae A, Hartwell GR, Moon PC. Placement of mineral trioxide aggregate using two different techniques. J Endod 2003;29:679-82.
Lawley GR, Schindler WG, Walker WA 3 rd
, Kolodrubetz D. Evaluation of ultrasonically placed MTA and fracture resistance with Intracanal composite resin in a model of apexification. J Endod 2004;30:167-72.
Nekoofar MH, Adusei G, Sheykhrezae MS, Hayes SJ, Bryant ST, Dummer PM. The effect of condensation pressure on selected physical properties of mineral trioxide aggregate. Int Endod J 2007;40:453-61.
Ding SJ, Kao CT, Shie MY, Hung C Jr, Huang TH. The physical and cytological properties of white MTA mixed with Na 2
as an accelerant. J Endod 2008;34:748-51.
Shah PM, Chong BS, Sidhu SK, Pitt Ford TR. Radio opacity of potential root end filling materials. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81:476-9.
Budig CG, Eleazer PD. In vitro
comparison of the setting of dry ProRoot MTA by moisture absorbed through the root. J Endod 2008;34:712-4.
Roy CO, Jeansonne BG, Gerrets TF. Effect of an acid environment on leakage of root-end filling materials. J Endod 2001;27:7-8.
Bates CF, Carnes DL, del Rio CE. Longitudinal sealing ability of mineral trioxide aggregate as a root-end filling material. J Endod 1996;22:575-8.
Shipper G, Grossman ES, Botha AJ, Cleaton-Jones PE. Marginal adaptation of mineral trioxide aggregate (MTA) compared with amalgam as a root-end filling material: A low vacuum (LV) versus high vacuum (HV) SEM study. Int Endod J 2004;37:325-36.
Torabinejad M, Smith PW, Kettering JD, Pitt Ford TR. Comparative investigation of marginal adaptation of Mineral Trioxide aggregate and other commonly used root-end filling materials. J Endod 1995;21:295-9.
Valois CR, Costa ED Jr. Influence of the thickness of mineral trioxide aggregate on sealing ability of root-end filling in vitro
. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:108-11.
Al-Hezaimi K, Al-Shalan TA, Naghshbandi J, Oglesby S, Simon JH, Rotstein I. Antibacterial effect of two mineral trioxide aggregate (MTA) preparations against Enterococcus faecalis and Streptococcus sanguis in vitro
. J Endod 2006;32:1053-6.
Torabinejad M, Hong CU, Pitt Ford TR, Kettering JD. Antibacterial effects of some root end filling materials. J Endod 1995;21:403-6.
Nandini S, Ballal S, Kandaswamy D. Influence of glass Ionomer cement on the interface and setting reaction of mineral trioxide aggregate when used as a furcal repair material using laser Raman spectroscopic analysis. J Endod 2007;33:167-72.
Kettering JD, Torabinejad M. Investigation of mutagenicity of mineral trioxide aggregate and other commonly used root-end filling materials. J Endod 1995;21:537-42.
Sumer M, Muglali M, Bodrumlu E, Guvenic T. Reactions of connective tissue to amalgam, intermediate restorative material, mineral trioxide aggregate mixed with chlorhexidine. J Endod 2006;32:1094-6.
Arens DE, Torabinejad M. Repair of furcal perforations with mineral trioxide aggregate: Two case reports. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:84-8.
Pelliccioni GA, Ciapetti G, Cenni E, Granchi D, Nanni M, Pagani S, et al
. Evaluation of osteoblast-like cell response to Proroot MTA (mineral trioxide aggregate) cement. J. Mater Sci Mater Med 2004;15:167-73.
Koh ET, Ford TR, Kariyawasam SP, Chen NN, Torabinejad M. Prophylactic treatment of dens evaginatus using mineral trioxide aggregate. J Endod 2001;27:540-2.
Torabinejad M, Hong CU, Lee SJ, Monsef M, Pitt Ford TR. Investigation of mineral trioxide aggregate for root-end-filling in dogs. J Endod 1995;21:603-8.
Schwartz RS, Mauger M, Clement DJ, Walker WA 3rd. Mineral trioxide aggregate: A new material for endodontics. J Am Dent Assoc 1999;130:967-75.
Holland R, de Souza V, Nery MJ, Otoboni Filho JA, Bernabé PF, Dezan Júnior E. Reaction of dogs' teeth to root canal filling with mineral trioxide aggregate or a glass ionomer sealer. J Endod 1999;25:728-30.
Faraco IM Jr, Holland R. Response of the pulp of dogs to capping with mineral trioxide aggregate or a calcium hydroxide cement. Dent Traumatol 2001;17:163-6.
Dominguez MS, Witherspoon DE, Gutmann JL, Opperman LA. Histological and scanning electron microscopy assessment of various vital pulp-therapy materials. J Endod 2003;29:324-33.
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;35:245-54.
Accorinte Mde L, Holland R, Reis A, Bortoluzzi MC, Murata SS, Dezan E Jr, et al
. Evaluation of mineral trioxide aggregate and calcium hydroxide cement as pulp-capping agents in human teeth. J Endod 2008;34:1-6.
Ebrahim J, Mohammad RS, Neda A. Histopathologic responses of dog's dental pulp to mineral trioxide aggregate, bio active glass, formocresol, hydroxyapatite. Dent Res J 2007;4:83-7.
O'Sullivan SM, Hartwell GR. Obturation of a retained primary mandibular second molar using mineral trioxide aggregate: A case report. J Endod 2001;27:703-5.
Matt GD, Thorpe JR, Strother JM, McClanahan SB. Comparative study of white and grey mineral trioxide aggregate (MTA) simulating a one or two step apical barrier technique. J Endod 2004;30:876-9.
Garcia-Godoy F, Murray PE. Recommendations for using regenerative endodontic procedures in permanent immature traumatized teeth. Dent Traumatol 2012;28:33-41.
Vitti RP, Prati C, Silva EJ, Sinhoreti MA, Zanchi CH, de Souza e Silva MG, et al
. Physical properties of MTA Fillapex sealer. J Endod 2013;39:915-8.
[Table 1], [Table 2]