Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview – part II: other clinical applications and complications

Abstract

Mineral trioxide aggregate (MTA) is a dental material used extensively for vital pulp therapies (VPT), protecting scaffolds during regenerative endodontic procedures, apical barriers in teeth with necrotic pulps and open apices, perforation repairs as well as root canal filling and root-end filling during surgical endodontics. A number of bioactive endodontic cements (BECs) have recently been introduced to the market. Most of these materials have calcium and silicate in their compositions; however, bioactivity is a common property of these cements. These materials include the following: BioAggregate, Biodentine, BioRoot RCS, calciumenriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, Neo MTA Plus, Ortho MTA, Quick-Set, Retro MTA, Tech Biosealer, and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA but without the drawbacks. In Part I of this review, the available information on the chemical composition of the materials listed above was reviewed and their applications for VPT was discussed. In this article, the clinical applications of MTA and other BECs will be reviewed for apexification, regenerative endodontics, perforation repair, root canal filling, root-end filling, restorative procedures, periodontal defects and treatment of vertical and horizontal root fractures. In addition, the literature regarding the possible drawbacks of these materials following their clinical applications is reviewed. These drawbacks include their discolouration potential, systemic effects and retreatability following use as a root filling material. Based on selected keywords, all publications were searched regarding the use of MTA as well as BECs for the relevant clinical applications. Numerous publications were found regarding the use of BECs for various endodontic applications. The majority of these investigations compared BECs with MTA. Despite promising results for some materials, the number of publications using BECs for various clinical applications was limited. Furthermore, most studies had several methodological shortcomings and low levels of evidence.

What is of interest in Endodontology? A bibliometric review of research published in the International Endodontic Journal and the Journal of Endodontics from 1980 to 2019

“…, Torabinejad et al . ). The special conditions of humidity present during regenerative procedures, pulpotomy, perforation repair or endodontic microsurgery made MTA a close to ideal material in these clinical situations.…”

Effect of curing conditions on physical and chemical properties of MTA+

“…In the present study, a new commercial product (MTA+) was evaluated and compared with ProRoot MTA, which has been extensively investigated (Parikoh & Torabinejad ,, Torabinejad & Parikoh , Torabinejad et al . ). Humidity, saline and HBSS were used to simulate clinical conditions, as calcium silicate‐based cements come in contact with body fluids, such as exudates, blood or tissue fluids, immediately after mixing and placement.…”

Biocompatibility and biomineralization ability of Bio‐C Pulpecto. A histological and immunohistochemical study

“…Structures positively marked in von Kossa method are related with production of calcium/phosphorus, which is an amorphous form of calcium phosphate and/or carbonate apatite . Moreover, clinical studies showed the formation of mineralized tissue when the MTA was placed in contact with dental tissues, demonstrating the ability of this material to induce the formation of hard tissue where it is inserted …”

“…On the other hand, in this study MTA caused similar inflammatory responses to those observed in other studies using the same methodology including inflammatory process exacerbated in the initial periods (7 and 15 days) with significant reduction of inflammation after 30 days. MTA has also demonstrated biocompatibility and bioactivity in different methodologies, such as perforations, pulpotomies, and retrograde filling . Although MTA and Bio‐C Pulpecto have similar chemical composition and produce similar tissue reactions, Bio‐C Pulpecto has the advantage of being easy to handle.…”