Mineral trioxide aggregate (MTA) is an alkaline, cementitious dental repair material.
[1] For pulp capping, it has a success rate higher than calcium hydroxide, and indistinguishable from Biodentin.
Bismuth oxide, which was added as a radioopacifier (to make the filling stand out on X-rays),[citation needed] can discolour the teeth.
[3] Original versions were also hard for dentists to handle and had a long setting time, but otherwise had few drawbacks.
[clarification needed] Originally, MTA products required a few hours for the initial and final setting, which is uncommon in dental materials.
There were several different materials such as amalgam, reinforced zinc oxide eugenol cements (interim restorative material - IRM), super ethoxy benzonic acid [EBA], glass ionomer cement and composite resin for root-end filling after apicectomy.
MTA, a refined "Portland cement" - calcium alumino-silicate cement-, was found to have less cytotoxic and better results in biocompatibility and micro-leakage sealing ability, giving it more success over root-end filling materials.
MTA is not acceptable as "ideal root-end filling material" because MTA has some drawbacks of toxic heavy metal presence, discoloration, difficult handling, short working time, long setting time, washout before setting and washout after set (calcium carbonate based MTA has solvent of carbonic acid).
So current GIC as root-end filling material is reducing the cytotoxic acclerator's concentration.
But actual bioceramic aggregates are composed of pure medical graded calcium silicate based material.
Calcium aluminate bioceramic material - (alumina cement in minerals, calcium aluminate cements in bioceramics) Alumina is an initial fast setting element and high compressive strength.
Calcium aluminate cement (bioceramic) has been developed for dental products and root-end filling material.
BioMaterials can reduce the issues on discoloration and toxic heavy metals' presence initially.
The perforation can be sealed with a thick mixture of an MTA-type product, preventing bacterial ingress.
Make sure that you can locate the canal while the MTA has not set and remove the excess material from the area.
MTA Angelus Fillapex sealer contains less than 20% tri/dicalcium silicate powder in a salicylate carrier medium similar to Sealapex.
Brasseler Endosequence offers a pre-mixed sealer with a non-reactive carrier medium and the product only sets in vivo.
Brasseler's EndoSequence bioceramic sealers are tricalcium silicate-based materials without any calcium aluminate phase.
Mix MTA and insert it to the apex of the tooth, creating a 3 mm thickness of plug.
Later a blood clot is formed in the canal and a coronal plug of MTA is placed.
Place the MTA material over the pulp and close the tooth with temporary cement until the apex is completely formed.
MTA provides a higher incidence and faster rate of reparative dentin formation without the pulpal inflammation.
In root-end filling after apicoectomy, the anti-washout agent (chitosan or gelatin) is useful to prevent from MTA washout.
But in vital pulp therapy, anti-washout gel doesn't increase bioactivity or bacterial tight sealing ability of MTA.
Instead, hydraulic (100% pure water) MTA shows the higher success rate than anti-washout gel or resin medium.