On the other hand, Tay et al. However, the mechanism by which MTA induces dentine repair remains unclear. Therefore, we believe that the mechanism of action of MTA is similar to that of calcium hydroxide. Only Holland et al. : +45 35 45 24 31 ... Abstract – Mineral trioxide aggregate (MTA) has over the last two decades begun to take the place of calcium hydroxide (CH) in the treatment of a variety of pulpal and periodontal healing complications following dental trauma. (1998) , Torabinejad et al. On the basis of available information, it appears that MTA is the material of choice for some clinical applications. The mechanism of action of MTA is similar to that of calcium hydroxide and portland cement. Biological response and mechanism of action of MTA is similar to Calcium hydroxide , , , , , , , . 3, Fig. We are committed to sharing findings related to COVID-19 as quickly as possible. MTA requires approximately three hours for initial setting [7, 82], and the reaction continues slowly for weeks [82, 88, 89] and probably months. Many studies have addressed MTA as a potential alternative to formocresol pulpotomy in primary teeth. [14] Calcium oxide, one of its components, is converted into calcium hydroxide when the … A recent report has documented that the addition of VI. 16 The mechanism of action of ferric sulfate is still de-bated, but agglutination of blood proteins results from the reaction of blood with both the ferric and sulfate ions. Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In addition, Si and Al show an increased concentration within the Ca-leached layer [93], probably resulting from the formation and/or accumulation of insoluble components such as calcium silicate hydrate and ettringite. One study recommended an admix of 1% methylcellulose and 2% calcium chloride because it improved the handling properties of MTA without reducing its compressive strength [145]. Thus, the capacity of MTA to induce hard tissue repair of exposed pulps may depend heavily on its ability to create a local environment in which the inherent wound healing capacity of the pulp is not deteriorated. The purpose of Part III of this literature review is to present a comprehensive list of articles regarding animal studies, clinical applications, drawbacks, and mechanism of action of MTA. In a recent study, Tomson et al (260) demonstrated that WMTA and GMTA release different signaling molecules from dentin powder that might influence their effect on the quality and the rate of calcified bridge formation. Dr. Jens O. Andreasen. In a recent review article, on the mechanism of action of MTA on pulpal and periodontal tissues, the following actions are described: when placed, MTA immediately releases calcium ions activating cell attachment and proliferation, and at the same time, the high pH creates an antibacterial environment. Mineral trioxide aggregate (MTA) has been recommended for various uses in endodontics. 1999) and it was postulated that the mechanisms of action of MTA, PC and calcium Permanent molar pulpotomy with a new endodontic cement: Biodentine pulpotomy several days after pulp exposure: Biodentine pulpotomy consisted of pulp tissue Taken together, the MTA-dentin interfacial layer formation that results from the capacity of MTA to induce spontaneous apatite formation may contribute to minimizing leakage not only by filling the gap along the interface but also via interactions with dentin such as intrafibrillar apatite deposition to promote mineral nucleation on dentin. At 12 months, 8 teeth out of 127 in MTA group were declared as treatment failure in comparison to 15 among 109 in Calcium hydroxide group (OR = 0.40, 95% CI:0.16–0.97,p = 0.63; I … The precipitates are also formed at the MTA-dentin interface [57, 58, 99, 105], and thus may play a role in the achievement of a good marginal seal, as will be described below. Four studies regarding MTA pulpotomies in cariously exposed permanent teeth have reported high success rates ranging from 93%–100% [132–135]. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. MTA in Pulpotomy Pulpotomy procedure involves removing only part of the pulp ,eliminatingtissues that have inflammatory or degenerative changes and leavingintact the underlying healthy pulp [ 23 ]. Tomson et al showed that GMTA and WMTA Various MTA preparations show antibacterial [119–125] and antifungal [124, 126–128] activities against different microbial strains. In conclusion, the observed results and the mechanism of action of white MTA is very similar to those reported for gray MTA (9,15). MTA has several beneficial physical properties over calcium hydroxide, including a good sealing ability, a lower degree of dissolution, and a higher structural stability. Its mechanism of action is similar to the traditional pulpotomy agent calcium hydroxide (CH) because MTA releases CH inducing dentine formation when applied to vital pulp [4]. This finding was confirmed by Bozeman et al. Using X-ray diffraction (XRD) analysis, the authors identified the crystals as hydroxyapatite, although their calcium-to-phosphorus ratios were different from that reported for hydroxyapatite. When set MTA is immersed in water, it shows solubility of less than 3% of weight loss in 24 hours [46, 81, 82, 90–92], which is lower than that of zinc oxide-eugenol cement [82]. Copyright © 2020 Elsevier B.V. or its licensors or contributors. MTA has some known drawbacks such as a long setting time, high cost, and potential of discoloration. GMTA-dentin bond failure usually occurs cohesively within the MTA material [116]. Pulpotomy Medicaments: Continued Search for New Alternatives- A Review Kumar Praveen NH, Nayak Rashmi, Bhaskar Vipin K, Mopkar Pujan P Department of Paediatric and Preventive Dentistry, Manipal College of Dental sciences, Manipal University, Karnataka, India. MTA preparations from different origins may vary in their antimicrobial activity. Nevertheless, in vitro studies suggest the presence of dentinogenic mechanisms specific to MTA, since MTA can stimulate hard tissue-forming cells to induce matrix formation and mineralization. MTA has a similar mechanism of action to calcium hydroxide 11 in that the main component of the material, calcium oxide, when in contact with a humid environment, is converted into calcium hydroxide. Currently, an exact mechanism explaining why ferric sul-fate would be expected to be superior to previous pulpotomy agents, such as formocresol, has yet to be provided. to WMTA creates a more biocompatible material, as demonstrated by subcutaneous implantation [60]. A. S. El Meligy and D. R. Avery, “Comparison of mineral trioxide aggregate and calcium hydroxide as pulpotomy agents in young permanent teeth (apexogenesis),”, D. E. Witherspoon, J. C. Small, and G. Z. Harris, “Mineral trioxide aggregate pulpotomies: a case series outcomes assessment,”, M. A. Qudeimat, K. M. Barrieshi-Nusair, and A. I. Owais, “Calcium hydroxide vs mineral trioxide aggregates for partial pulpotomy of permanent molars with deep caries,”, E. T. Koh, T. R. Pitt Ford, S. P. Kariyawasam, N. N. Chen, and M. Torabinejad, “Prophylactic treatment of dens evaginatus using mineral trioxide aggregate,”, H. A. Agamy, N. S. Bakry, M. M. F. Mounir, and D. R. Avery, “Comparison of mineral trioxide aggregate and formocresol as pulp-capping agents in pulpotomized primary teeth,”, S. E. Jabbarifar, D. D. Khademi, and D. D. Ghasemi, “Success rates of formocresol pulpotomy vs mineral trioxide aggregate in human primary molar tooth,”, N. Farsi, N. Alamoudi, K. Balto, and A. Mushayt, “Success of mineral trioxide aggregate in pulpotomized primary molars,”, G. Holan, E. Eidelman, and A. Meta-analysis of MTA versus calcium hydroxide pulpotomy at the end of 12 months is shown in Fig. Introduction: Mineral trioxide aggregate (MTA) has been recommended for … None of the teeth exhibited clinical or radiographical failure during the follow-up period of up to 24 months. Mechanism of action of Formocresol Aim to create a chemically altered zone at the pulp-medicament interface - leaving the deeper untreated pulp tissue vital and un-inflamed Diffuses into the pulp tissue - degree of penetration is time and dose dependent ability of MTA[13]. Another study was conducted by Niranjani et al. The aim of the present study was to histologically analyze the pulpal response of human primary teeth pulp following calcium hydroxide (CH) and mineral trioxide aggregate (MTA) pulpotomies with and without 5 % NaOCl. WMTA exposed to a water-soluble dye before achieving full set showed poorer adaptation and more leakage compared with those of IRM and Super EBA cements [115]. 2005; Tani-Ishii et al. acidic. .
The cement’s setting time is 3 to 4 hours.
MTA paste is obtained by mixing MTA powder with sterile saline at a 3:1 powder/saline ratio.
IRM is place over the MTA.
33. Mode of action in pulp capping and pulpotomy. MTA was developed and recommended for endodontic procedures cause of it is nontoxic, noncarcinogenic, nongenotoxic, biocompatible, ... mechanism of action of MTA is very similar to the effect of CH on pulp tissue after pulp capping (6). Sarkar et al. MTA and Portland cements are virtually devoid of phosphorus [5–7]. MTA also has the ability to interact with phosphate-containing fluids to spontaneously form apatite precipitates, which not only explains its biocompatibility and bioactivity but may also contribute to its sealing ability. The authors concluded that pulpotomies performed with either MTA, laser, or Biodentine are equally efficient with similar clinical/radiographic success and hence can be considered as alternatives to formocresol. Ding, “The effect of setting accelerator on properties of mineral trioxide aggregate,”, S. J. Ding, C. T. Kao, M. Y. Shie, C. Hung Jr., and T. H. Huang, “The physical and cytological properties of white MTA mixed with, J.E. More clinical studies are needed to confirm its efficacy compared with other materials. Blood contamination has little impact on the degree of leakage [87]. We will be providing unlimited waivers of publication charges for accepted research articles as well as case reports and case series related to COVID-19. PULPOTOMY PROCEDURES IN PRIMARY DENTITION . The human studies with ferric sulfate are … This indicates that the calcium ions supplied by portlandite dissolution interact with the phosphate ions in the medium, allowing for the formation of apatite crystals. The minimally invasive endodontic techniques of vital pulp therapy (VPT) are based on improved understanding of the capacity of pulp (nerve) tissues to heal and regenerate plus the availability of advanced endodontic materials. Mixing can be done on paper pad or on a glass slab using a plastic or metal spatula to achieve putty like paste consistency. Such dissolution of calcium hydroxide may be a key mechanism behind the biological properties of MTA. appears that MTA is the material of choice for some clin-ical applications. MTA is a promising material for root-end filling, perforation repair, vital pulp therapy, and apical barrier formation for teeth with necrotic pulps and open apexes. 33 The aim of pulpotomy was to retain a symptom-free, functional primary tooth until it reaches the age of its physiologic exfoliation Antimicrobial capacity due to high pH is considered one of the advantages of the calcium hydroxide-based materials used for direct pulp capping, since this procedure is often carried out on pulps that have already been bacterially contaminated and/or carry a potential risk of bacterial leakage along the restoration margins [96, 97, 118]. trioxide aggregate (MTA) is a universally accepted pul-potomy agent. MTA had been likened to calcium hydroxide (Holland et al. In addition, the authors also found that GMTA produces twice as many crystals as WMTA, suggesting that the two MTA materials do not possess the same level of bioactivity [100]. The available literature suggests that MTA is more efficient at inducing reparative dentinogenesis in vivo compared with calcium hydroxide-based materials. Aust Endod J 2009;35:4-8. [100], who also used XRD and SEM and analyzed both WMTA and GMTA that had been subjected to PBS immersion. 2004; Nakayama et al. hydration reaction of PC and MTA was only published recently (Camilleri et al. One hundred twenty-eight primary molars were … Use of MTA as a pulpotomy agent in permanent teeth has demonstrated excellent histological and clinical results.4,7,12,13 MTA has demonstrated acceptable biocompatibility, sealing ability and the ability to promote healing in8, They identified the precipitates as calcium-deficient poorly crystalline carbonated apatite, which had been transformed from an initially formed amorphous calcium phosphate. Son, “Influence of TGF-, M. Kuratate, K. Yoshiba, Y. Shigetani, N. Yoshiba, H. Ohshima, and T. Okiji, “Immunohistochemical analysis of nestin, osteopontin, and proliferating cells in the reparative process of exposed dental pulp capped with mineral trioxide aggregate,”, R. N. D'Souza, T. Bachman, K. R. Baumgardner, W. T. Butler, and M. Litz, “Characterization of cellular responses involved in reparative dentinogenesis in rat molars,”, K.-S. Min, H.-J. This can act as a nidus for the formation of calcified structures after the use of this material in endodontic treatments. •Its mechanism of action is the cauterization of the superficial pulp tissue Sheller B. Electrosurgical pulpotomy: a pilot study in humans. Park, S.-K. Lee et al., “Effect of mineral trioxide aggregate on dentin bridge formation and expression of dentin sialoprotein and heme oxygenase-1 in human dental pulp,”, J. Sodek, B. Ganss, and M. D. McKee, “Osteopontin,”, A. J. Smith, J. Introduction: The main aim during any dental treatment is to maintain vital pulp as long as possible.Objective: The aim of this study was to assess clinically the use of MTA in direct pulp capping in adult patient. NEC is reported to show a shorter setting time [155], better handling properties, and a similar sealing ability [157] compared with those of MTA. Success rates of 100% can be attributed to smaller sample size or wider range of patients (5-12 years), which can reduce validity and reliability of results. Similar to calcium hydroxide-based materials, the antimicrobial action of MTA is most likely associated with elevated pH resulting from ionization that releases hydroxyl ions. These studies showed 100% success rate of MTA, both clinically and radiographically, through different follow-up protocols., It is a biocompatible material and its sealing ability is … Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review – part III: clinical applications, drawbacks, and mechanism of action. Water immersion of MTA results in the formation of a subsurface layer of low Ca concentration (Ca-leached layer) [93]. Hydroxyapatite crystals form over MTA when it comes in contact with tissue synthetic fluid. However, the question of why MTA exhibits such a good seal has not yet fully been resolved. Sign up here as a reviewer to help fast-track new submissions. In addition, a case report in which partial pulpotomies were conducted on 2 cases of dens evaginatus and histologic examination was conducted after 6 months; complete dentin bridge formation without pulp inflammation was demonstrated [136]. He, G. N. Glickman, and I. Watanabe, “The effects of various additives on setting properties of MTA,”, B. S. Ber, J. F. Hatton, and G. P. Stewart, “Chemical modification of ProRoot MTA to improve handling characteristics and decrease setting time,”, K. B. Wiltbank, S. A. Schwartz, and W. G. Schindler, “Effect of selected accelerants on the physical properties of mineral trioxide aggregate and Portland cement,”, E. A. Bortoluzzi, N. J. Broon, C. M. Bramante, W. T. Felippe, M. Tanomaru Filho, and R. M. Esberard, “The influence of calcium chloride on the setting time, solubility, disintegration, and pH of mineral trioxide aggregate and white Portland cement with a radiopacifier,”, E. A. Bortoluzzi, N. J. Broon, C. M. Bramante, R. B. Garcia, I. G. de Moraes, and N. Bernardineli, “Sealing ability of MTA and radiopaque Portland cement with or without calcium chloride for root-end filling,”, T.-H. Huang, M.-Y. A. Zaia, B. P. F. A. Gomes, C. C. R. Ferraz, F. B. Teixeira, and F. J. Souza-Filho, “Investigation of the marginal adaptation of root-end filling materials in root-end cavities prepared with ultrasonic tips,”, G. Shipper, E. S. Grossman, A. J. Botha, and P. E. Cleaton-Jones, “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,”, C. B. Xavier, R. Weismann, M. G. de Oliveira, F. F. Demarco, and D. H. Pozza, “Root-end filling materials: apical microleakage and marginal adaptation,”, S. I. Tobón-Arroyave, M. M. Restrepo-Peérez, J. However, an antibacterial Shie, C.-T. Kao, and S.-J. in pulpotomy therapy without an attempt to categorize the underlying mechanism of action, does not permit the clinician to adequately weigh the pros and cons of … A. Arismendi-Echavarría, Z. Velásquez-Restrepo, M. L. Marín-Botero, and E. C. García-Dorado, “Ex vivo microscopic assessment of factors affecting the quality of apical seal created by root-end fillings,”, P. Yan, B. Peng, B. Some known drawbacks such as a potential alternative to formocresol pulpotomy in primary teeth pulpotomy using,! Provide and enhance our service and tailor content and ads ) advocated that the mechanism of of., we believe that the mechanism of action of MTA to Application is converted calcium! Related to COVID-19 as quickly as possible subsurface layer of low Ca (! Literature suggests that MTA is similar to hydroxyapatite also reduces the compressive strength of set MTA [ ]. 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