Mineral Trioxide Aggregate (MTA): Free full text articles II

To see previously published list of free full text articles on MTA (part I), please click here.

Endodontics - Case reports
Unal GC, Maden M, Isidan T. Repair of Furcal Iatrogenic Perforation with Mineral Trioxide Aggregate: Two Years Follow-up of Two Cases. Eur J Dent. 2010 Oct;4(4):475-81.  

Yildirim T, Gencoglu N. Use of mineral trioxide aggregate in the treatment of large periapical lesions: reports of three cases. Eur J Dent. 2010 Oct;4(4):468-74.

Abarajithan M, Velmurugan N, Kandaswamy D. Management of recently traumatized maxillary central incisors by partial pulpotomy using MTA: Case reports with two-year follow-up. J Conserv Dent. 2010 Apr;13(2):110-3.

Chhabra N, Singbal KP, Kamat S. Successful apexification with resolution of the periapical lesion using mineral trioxide aggregate and demineralized freeze-dried bone allograft. J Conserv Dent. 2010 Apr;13(2):106-9.

Adiga S, Ataide I, Fernandes M, Adiga S. Nonsurgical approach for strip perforation repair using mineral trioxide aggregate. J Conserv Dent. 2010 Apr;13(2):97-101.

Ozbas H, Subay RK, Ordulu M. Surgical retreatment of an invaginated maxillary central incisor following overfilled endodontic treatment: a case report. Eur J Dent. 2010 Jul;4(3):324-8.

Araújo RA, Silveira CF, Cunha RS, De Martin AS, Fontana CE, Bueno CE. Single-session use of mineral trioxide aggregate as an apical barrier in a case of external root resorption. J Oral Sci. 2010;52(2):325-8.

Khatavkar RA, Hegde VS. Use of a matrix for apexification procedure with mineral trioxide aggregate. J Conserv Dent. 2010 Jan;13(1):54-7.

Mirikar P, Shenoy A, Mallikarjun GK. Nonsurgical management of endodontic mishaps in a case of radix entomolaris. J Conserv Dent. 2009 Oct;12(4):169-74.

Endodontics - scientific articles
Orosco FA, Bramante CM, Garcia RB, Bernardineli N, de Moraes IG. Sealing ability, marginal adaptation and their correlation using three root-end filling materials as apical plugs. J Appl Oral Sci. 2010 Mar-Apr;18(2):127-34.

Biocompatibility
Lessa FC, Aranha AM, Hebling J, Costa CA. Cytotoxic effects of White-MTA and MTA-Bio cements on odontoblast-like cells (MDPC-23). Braz Dent J. 2010 Jan;21(1):24-31.

Cintra LT, Bernabé PF, de Moraes IG, Gomes-Filho JE, Okamoto T, Consolaro A, Pinheiro TN. Evaluation of subcutaneous and alveolar implantation surgical sites in the study of the biological properties of root-end filling endodontic materials. J Appl Oral Sci. 2010 Feb;18(1):75-82.

Chemical analysis
Han L, Okiji T, Okawa S. Morphological and chemical analysis of different precipitates on mineral trioxide aggregate immersed in different fluids. Dent Mater J. 2010 Oct 14;29(5):512-7.

Mineral Trioxide Aggregate (MTA) and direct pulp capping

Two papers have been published recently on the use of mineral trioxide aggregate (MTA) for direct pulp capping.

A large clinical trial was conducted between 2001 and 2006 at Ruprecht-Karls-University of Heidelberg, Germany (1). Direct pulp capping with either MTA or Calcium hydroxide was done in 167 teeth of 149 patients. Treatment outcome was evaluated clinically and radiographically by calibrated examiners 12-80 months post-treatment. The authors reported a high recall rate of more than 70% and based the statistical analysis on 108 patients and 122 treated teeth. A significantly greater success rate was found for MTA (78% of teeth) than Calcium hydroxide (60% of teeth). It seems critical to restore such teeth permanently as soon as possible after pulp capping. This study showed that teeth permanently restored ≥2 days after capping had a significantly worse prognosis irrespective of the capping material. The authors concluded that "MTA appears to be more effective than calcium hydroxide for maintaining long-term pulp vitality after direct pulp capping".

Another study is an immunohistological study on Wistar rats (2). It compared the proliferation of pulp cells 1, 3, and 7 days after direct pulp capping with either MTA or Calcium hydroxide. After 3 days, the number of proliferating cells (fibroblasts, endothelial cells and Hoell's cells) was significantly greater when capping was performed irrespective of the material compared to the control group with no capping. After 7 days, however, there were no differences between MTA and Calcium hydroxide groups and the control group. The authors concluded that "Immunohistologic analysis demonstrated that MTA showed similar results when compared with Calcium hydroxide within the first week after direct pulp capping".

(1) Mente J, Geletneky B, Ohle M, Koch MJ, Friedrich Ding PG, Wolff D, Dreyhaupt J, Martin N, Staehle HJ and Pfefferle T. Mineral trioxide aggregate or calcium hydroxide direct pulp capping: an analysis of the clinical treatment outcome. J Endod 2010;36:806-13.

(2) Dammaschke T, Stratmann U, Wolff P, Sagheri D and Schafer E. Direct pulp capping with mineral trioxide aggregate: an immunohistologic comparison with calcium hydroxide in rodents. J Endod 2010;36:814-9.

Reprints of both studies should be available from the authors: (1) johannes.mente@med.uni-heidelberg.de
and (2) tillda@uni-muenster.de

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Mineral Trioxide Aggregate (MTA): Free Full Text Articles I

This is the list of scientific articles on mineral trioxide aggregate (MTA) available in full text. All articles can be downloaded following the links on MEDLINE. You may also be interested in other posts on MTA. Click here for part II of the list of free full text articles on MTA.

Pulp capping

1. Bogen G, Kim JS, Bakland LK. Direct pulp capping with mineral trioxide aggregate: an observational study. J Am Dent Assoc. 2008 Mar;139(3):305-15; quiz 305-15.

2. Ford TR, Torabinejad M, Abedi HR, Bakland LK, Kariyawasam SP. Using mineral trioxide aggregate as a pulp-capping material. J Am Dent Assoc. 1996 Oct;127(10):1491-4.

Endodontics

3. Ghaziani P, Aghasizadeh N, Sheikh-Nezami M. Endodontic treatment with MTA apical plugs: a case report. J Oral Sci. 2007 Dec;49(4):325-9.

4. Winik R, Araki AT, Negrão JA, Bello-Silva MS, Lage-Marques JL. Sealer penetration and marginal permeability after apicoectomy varying retrocavity preparation and retrofilling material. Braz Dent J. 2006;17(4):323-7.

5. Witherspoon DE, Small JC, Harris GZ. Mineral trioxide aggregate pulpotomies: a case series outcomes assessment. J Am Dent Assoc. 2006 May;137(5):610-8.

6. Silberman A, Cohenca N, Simon JH. Anatomical redesign for the treatment of dens invaginatus type III with open apexes: a literature review and case presentation. J Am Dent Assoc. 2006 Feb;137(2):180-5. Review.


7. Schwartz RS, Mauger M, Clement DJ, Walker WA 3rd. Mineral trioxide aggregate: a new material for endodontics. J Am Dent Assoc. 1999 Jul;130(7):967-75. Review.

Chemical analysis

8. Oliveira MG, Xavier CB, Demarco FF, Pinheiro AL, Costa AT, Pozza DH. Comparative chemical study of MTA and Portland cements. Braz Dent J. 2007;18(1):3-7.

(The link to each article is in the top right corner as shown in this image. Click to enlarge.)


The following articles are available from PubMed Central.

Immunology

9. Taia Maria Berto Rezende, Leda Quercia Vieira, Antônio Paulino Ribeiro Sobrinho, Ricardo Reis Oliveira, Martin A. Taubman, and Toshihisa Kawai. The influence of Mineral Trioxide Aggregate (MTA) on adaptive immune responses to endodontic pathogens in mice. J Endod. 2008 September; 34(9): 1066–1071.

Tissue engineering (Genetics)

10. Paul C Edwards and James M Mason. Gene-enhanced tissue engineering for dental hard tissue regeneration: (2) dentin-pulp and periodontal regeneration. Head Face Med. 2006; 2: 16.

11. Rebecca S. Prescott, Rajaa Alsanea, Mohamed I. Fayad, Bradford R. Johnson, Christopher S. Wenckus, Jianjun Hao, Asha S. John, and Anne George. In-vivo Generation of Dental Pulp-Like Tissue Using Human Pulpal Stem Cells, a Collagen Scaffold and Dentin Matrix Protein 1 Following Subcutaneous Transplantation in Mice. J Endod. 2008 April; 34(4): 421–426.

(The link is shown in the image below. Click to enlarge.)


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Mineral trioxide aggregate (MTA) in endodontics

Mineral trioxide aggregate (MTA) is a mixture of a refined Portland cement and bismuth oxide, and also contains trace amounts of SiO2, CaO, MgO, K2SO4, and Na2SO4. MTA was first described for endodontic applications in the scientific literature in 1993. Nowadays, there are two forms of MTA on the market, the traditional gray MTA (GMTA) and white MTA (WMTA), which was introduced in 2002. WMTA has less Al2O3, MgO, and FeO and, also, smaller particles than GMTA.

MTA is prepared by mixing the powder with sterile water in a 3:1 powder/liquid ratio. This results in the formation of a colloidal gel that solidifies to a hard structure in approximately 3–4h. It is believed that moisture from the surrounding tissues favours the setting reaction.

Similar or less microleakage has been reported for MTA compared to traditional endodontic sealing materials [gutta-percha and pastes] when used as an apical restoration, furcation repair, and in the treatment of immature apices. 3mm of MTA is recommended as the minimal amount against microleakage and 5mm in the treatment of immature apices. In vitro and in vivo studies support the biocompatibility of freshly mixed and set MTA when compared to other dental materials

Clinical applications of MTA include:
pulp capping,
pulpotomy dressing,
root-end filling,
root repair [resorption and perforations] and
apexification.

Clinical prospective studies suggest that both GMTA and WMTA have similar results as traditional calcium hydroxide in non-carious mechanical pulp exposures in teeth with normal pulp tissue. However, further clinical studies are needed, particularly involving pulp exposures in carious teeth.

Clinical prospective studies using MTA as pulpotomy dressings for primary and permanent teeth reported similar or better results for MTA materials compared to formocresol or calcium hydroxide in the formation of dentine bridges and continued root development. Histological analysis has suggested a more homogenous and continuous dentine bridge formation by MTA than calcium hydroxide at both 4 and 8 weeks after treatment and less inflammation associated with MTA than calcium hydroxide.

There are several case reports in which MTA has been successfully used to repair horizontal root fractures, root resorption, internal resorption, furcation perforations and apexification and/or apexogenesis which was confirmed clinically and radiographically.

Overall results on the use of MTA in endodontics are favourable, but more well-designed and controlled clinical longitudinal studies are needed to allow systematic review and confirmation of all suggested clinical indications of MTA.

You may be interested in a list of free full text scientific articles published in international peer-reviewed journals.

Research: Portland cement, a possible substitute for MTA in pulpotomy of primary teeth

Pulpotomy of human primary molars with MTA and Portland cement: a randomised controlled trial
V. T. Sakai, A. B. S. Moretti, T. M. Oliveira, A. P. C. Fornetti, C. F. Santos, M. A. A. M. Machado & R. C. C. Abdo

British Dental Journal 207, E5 (2009) Published online: 24 July 2009 doi:10.1038/sj.bdj.2009.665


Objective: This study compared the clinical and radiographic effectiveness of mineral trioxide aggregate (MTA) and Portland cement (PC) as pulp dressing agents in carious primary teeth.

Methodology: Thirty carious primary mandibular molars of children aged 5-9 years old were randomly assigned to MTA or PC groups, and treated by a conventional pulpotomy technique. The teeth were restored with resin modified glass ionomer cement. Clinical and radiographic successes and failures were recorded at 6, 12, 18 and 24-month follow-up.

Results: All pulpotomised teeth were clinically and radiographically successful at all follow-up appointments. Six out of 15 teeth in the PC group and five out of 14 teeth in the MTA group exfoliated throughout the follow-up period. No statistically significant difference regarding dentine bridge formation was found between both groups throughout the follow-up period. As far as pulp canal obliteration is concerned, a statistically significant difference was detected at 6-month follow-up (p <0.05), since the beginning of mineralised material deposition could be radiographically detected in 100% and 57.14% of the teeth treated with PC and MTA, respectively.

Conclusions: Portland cement (PC) may serve as a substitute for MTA in pulpotomy of primary teeth. Besides the similar clinical and radiographic effectiveness of PC and MTA as pulpotomy dressing agents, PC has the advantage of being an inexpensive material. Before unlimited clinical use of PC, further studies with large samples and long follow-up assessments are needed.