Mineral Trioxide Aggregate (MTA) and its Uses		What's New

Mineral Trioxide Aggregate (MTA) and its Uses by Yosef Nahmias, DDS, MS and Paul Bery, DDS Amongst the exciting new products introduced in Endodontics, Mineral Trioxide Aggregate* (MTA) must rank as one of the most interesting (Fig. #1). Figure 1  MTA comes in sterile packages of 2 grams each. The material is mixed with sterile water that is supplied by the manufacturer. MTA is a cement composed of tricalcium silicate, dicalcium silicate, tricalcium aluminate, tetracalcium aluminoferrite, calcium sulfate and bismuth oxide (1). An independent analysis we requested from a laboratory reveals that MTA is identical to Portland's cement except for the addition of bismuthoxide, believed to help modifying its setting properties (Fig. #2). Figure 2 Independent analysis of MTA suggests that the material is very similar to Portland’s cement. MTA is very alkaline, and it can be compared to Calcium Hydroxide when it comes to some of its biological and histological properties. The material is mixed with sterile water to provide a grainy, sandy mixture. Once the material has acquired this consistency it can be applied by using a Messing gun or an instrument supplied with it (Fig. #3). Figure 3  This carrier can be used for the placement of MTA into the desired area At this point it is gently packed into the desired area. MTA being hydrophilic requires moisture to set, making absolute dryness not only unnecessary but contraindicated. Some techniques require the placement of a moist cotton pellet directly in contact with the MTA in order to allow proper setting. It takes an average of four hours for the material to completely solidify. It has been shown that once its has set, it has a compressive strength equal to IRM and Super EBA but less than amalgam (2). Its consistency is that of a very hard cement, it can be compared to "concrete"! Torabinejad and others (3,4) have widely and extensively documented the response of connective tissue in contact with MTA. When studied as a root-end filling material, MTA has shown to be better than amalgam (5). Histologic examination revealed that it had actually induced cementogenesis, and bone deposition with minimal or absent inflammatory response (5). Holland showed that the histological responses of MTA were similar to those induced by Calcium Hydroxide after six months (6). Dye and bacterial leakage studies have shown the sealing ability of MTA to be superior to amalgam and equal or better to Super EBA (7-8). It has also been shown to be less cytotoxic than IRM and Super EBA (3). As a retrofilling material, MTA fulfills many of the requirements of the ideal material such as; biocompatible with periradicular tissues, non-toxic, non-resorbable and minimal or no leakage around the margins. Given the favorable results of MTA as a root-end filling material, its use has been expanded for procedures such as pulp capping, apexification, and most importantly the sealing of perforations (Fig. #4). Figure 4  Illustration showing the many uses for MTA. MTA is now the material of choice in the non-surgical treatment of furcal and radicular strip perforations!

	Mineral Trioxide Aggregate (MTA) and its Uses		Clinical Cases

 

	IMTA and its Uses	Clinical Cases

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