Mineral Trioxide Aggregate - Characteristics & Products

Characteristics & Products

1.Biocompatible with periradicular tissues 2.Non cytotoxic to cells, but antimicrobial to bacteria 3.Non-resorbable 4.Minimal leakage around the margins. 5.Very basic AKA alkaline (high pH when mixed with water). 6. As a root-end filling material MTA shows less leakage than other root-end filling materials, which means bacterial migration to the apex is diminished. 7. Treated area needs to be infection free when applying MTA, because an acidic environment will prevent MTA from setting. 8. Compressive strength develops over a period of 28 days, similar to Portland cement. Strengths of more than 50 MPa are achieved when mixed in a powder-to-liquid ratio of more than 3 to 1.

Originally, MTA products required a few hours for the initial and final setting, which is uncommon in dental materials. The first patented products were either gray or white ProRoot MTA from Dentsply. http://www.tulsadentalspecialties.com/default/endodontics/Ultrasonics/rootrepair.aspx Newer materials are available that set more quickly and have added characteristics. For instance, Angelus company has made MTA products similar to ProRoot MTA, but added a salicylate based sealer, have less than 20% MTA powder.

MTA Plus® is washout resistant. MTA Plus is available from www.avalonbiomed.com and may be used for 10 indications.

MTA Products: Original ProRoot MTA Grey: Calcium Alumino-Silicate Cement (C3S, C2S with C3A)- Portland Cement Type I with Bismuth Trioxide. (ex. MTA Angelus Grey) ProRoot MTA White : Calcium Carbonate alumino-silicate Cement (CaCO3 + SiO2 with Al2O3). Final phase is similare to Portland Cement. (Limestone Portland Cement) -ex. MTA Angelus Blanc, EndoCem/Zr, MM MTA, Tech BioSeal MTA, Trioxident, most white MTAs.

Setting Time: Original ProRoot MTA is set by water. But for faster/quicker setting, there are hydration accelerants. Also Alumina more containing MTA can be set faster than less alumina containing MTA. GIC Solultion is Polyacrylic acid. GIC is alumino-SILICATE (Glass) bioceramic cement. As MTA is mainly composed of calcium-alumino-silicate, PAA (Polyacrylic acid) is an accelerant for MTA. PAA set MTA within 15-18 minutes. More aluminate, faster set. Also high concentrated Calcium Chloride (CaCl2, 70% more) is well known as accelerator of Portland Cement. So high concentrated -over 70%- Calcium Chloride solution sets MTA within 12 minutes. Or Pozzolanic reaction is also faster set chemical reation of calcium silicate hydrate. By this pozzolanic reaction, MTA Agelus, MM MTA and EndoCem MTA are pozzolan -calcium carbonate with fumed silica- hydration for fast set. But pozzolanic reacted cement has lower compressive strength at 15 MPa maximum. Easy broken and easily removable property of Pozzolanic MTA.

Alternative to MTAs - BioA, Bioceramic Aggregate

Mineral is ceramic in nature. MTA was used by mineral aggregates from natural resources. Instead of mineral aggregate, sythetic artificial pure calcium silicate is used for dental and medical products. It is named as Bioceramic (chemically bonded cermic) cement. Recently medical graded Calcium Silicate Based Materials were developed. It is the replacement of MTA. So it is classified as Bio-Aggregates, BA or BioA. Hydraulic Calcium Silicate Cements are integrated name of Calcium Silicate Based Materials. The examples are BioDentine and BioAggregate (DiaRoot). Silicate based bioceramic is a glass ionomer cement (GIC) as restorative material. Calcium based bioceramics are Calcium Phosphate, Calcium Carbonate, Calcium Aluminate, Calcium Sulfate and Calcium Silicate, etc. However, as Calcium Phosphate, Calcium Sulfate and Calcium Carbonate are biodegradable materials, these are used for bone grafting material. As root canal filling material and root repair material is non-biodegradable material permanently, so Calcium Aluminate Cement and Calcium Silicate Bioceramic materials have been used for endodontic materials and restorative materials. Calcium Alumino-Silicate cement is a potential material. In Root canal sealing/filling material, Calcium Based Material with bioactivity is commonly used rather than Alumina-based material of Calcium Aluminate Cement because alumina is bioinert bioceramic.

BioAggregate was marketed after FDA approval in 2006, 2 years faster than White Portland Cement MTA by Dr. Carolyn Primus in 2008. BioAggregate is newly pure medical graded Calcium Silicates (tricalcium silicate and dicalcium silicate) by 65% and Calcium Phosphate as admixture by 6% and Tantalum Pentoxide by 25% as radiopcifier. This is the artificial name of Bioceramic Aggregate in opposition of Mineral Aggregate. Mineral is Ceramic in Nature, Bioceramic is Chemically Bonded Ceramic, Artificial sythetic pure Calcium Silicates. So there is no toxic heavy metals and unnecessary heavy metals of iron, manganese, nickel, copper, zinc. Also BioA is not used by bismuth Trioxide, but by Tantalum Pentoxide, Zirconia, or Calcium Tungstate as radiopaque material. It is a differentiation from MTA, Trioxide. Before MTA was developed, Calcium Phosphate Bioceramic materials were developed as root-end filling material. But Calcium Silicate Bioceramic materials have been used only as bone cement or admixture. After MTA is nothing but Portland Cement (Calcium-Alumino-Silicate Cement), pure calcium silicate bioceramic materials were developed for root-end and root canal filling material. After researching, BioAggregate (DiaRoot) was approved by FDA and then marketed. It's an alternative to Mineral Trioxide Aggregate.

Biodentine material is a newer tri/dicalcium silicate powder (aluminum-free) that is made radiopaque with zirconia, and has salt and other additives for quicker setting. http://www.septodontusa.com/products/biodentine Biodentine is pure tricalcium silicate and dicalcium silicate with calcium carbonate by 20% and high concentrated calcium chloride solution as hydration accelerant. It is called as tricalcium biosilicate technology. Biodentine is also an alternative to MTA. - aluminum-free (non-tricalcium aluminate) and zirconia (ZrO2) instead of Bismuth Trioxide.

Brasseler offers paste and putty versions of tri/dicalcium silicate, including sealer, which set in vivo. http://shop.brasselerusa.com/storefrontB2CWEB/itemdetail.do?action=prepare_detail&itm_id=58731 The Brasseler products are based on the same free-tricalcium aluminate containing powders as Diaroot BioAggregate, Bioceramic Aggregate. These powders are very white, non-discoloration and are made radiopaque by tantalum pentoxide and zirconia or any other radiopacifying agents except Bismuth Trioxide. Brasseler's Bioceramic sealers (BC Sealer, RRM and RRM Putty) are different from powderic bioceramic materials. The compositions are similar to bio-Aggregate, but the material is in paste-form of bioceramic gel formation. BioAggregate is an alternative to MTA. Bioceramic pastes are higher technologies of Bio Tech, Ceramic Tech and Nano Tech integrated technology based advanced bioMaterial (esp. Bioceramic Science) for dental and medical purpose.

These hydraulic Calcium Silicate based materials are alternatives to Mineral calcium silicate cements. Alumino-silicate bioceramic, Calcium Aluminate Bioceramic, Calcium Alumino-Silicate Bioceramics are developed for Root-end filling and root canal filling materials rather than mineral aggregate based materials.