Mineral Trioxide Aggregate

Mahmoud Torabinejad, DMD, MSD, PhD, is Professor of Endodontics and Director of the Advanced Specialty Education Program in Endodontics at Loma Linda University School of Dentistry in Loma Linda, California. As a researcher and international lecturer on dental and endodontic issues and procedures, Dr. Torabinejad has made over 200 national and international presentations in more than 40 countries. In addition to co-authoring three textbooks in nonsurgical and surgical endodontics, he has authored more than 300 publications on various endodontic and dental topics. As a researcher, he is the top -cited author in endodontic journals, with authorship in 16 articles of the top 100 list. Dr. Torabinejad was the principle investigator in the applications of MTA in dental procedures.

• Contributors xvPreface xvii1 Pulp and Periradicular Pathways, Pathosis, and Closure 1Mahmoud TorabinejadPulp and Periradicular Pathways 2Natural Pathways 2Apical foramen 2Lateral canals 4Dentinal tubules 4Pathological and Iatrogenic Pathways 5Dental caries 5Role of microorganisms 6Root perforations 7Root perforations during access preparation 7Root perforations during cleaning and shaping 8Root perforations during post space preparations 10Vertical fracture 10Periradicular Pathosis 11Inflammatory process of periradicular lesions 11Materials to Seal the Pathways to the Root Canal System and the Periodontium 13References 152 Chemical Properties of MTA 17David W. BerzinsIntroduction 17MTA Composition 19Portland cement 19Role of bismuth oxide and gypsum 20MTA powder morphology 21Trace elements and compounds 23Setting Reactions 23Setting time 26Maturation 26Factors that affect setting: additives and accelerants 26Effect of water and moisture 27Interaction with environment 27Development of Reaction Zones 28References 313 Physical Properties of MTA 37Ricardo Caicedo and Lawrence GettlemanIntroduction 38pH 38Solubility 40Setting Expansion 45Radiopacity 46Various Types of Strength 49Compressive strength 49Flexural strength 54Shear strength 55Push-out strength 56Shear bond strength 56Overview 57Microhardness 59Color and Aesthetics 61Physicochemical Properties 62Acknowledgment 66References 664 MTA in Vital Pulp Therapy 71Till Dammaschke, Joe H. Camp, and George BogenIntroduction 72Advantages 74Pulp Responses to Capping Materials 74Direct Pulp Capping with Calcium Hydroxide 75Mineral Trioxide Aggregate 77Physiochemical properties 77Mode of action in pulp capping and pulpotomy 80Comparison with calcium hydroxide 83Pulpotomy in Primary Teeth 85MTA Pulpotomy 86Primary teeth 86Immature permanent teeth 88Symptomatic permanent teeth 90Pulp Capping in Teeth Diagnosed with Reversible Pulpitis 94Treatment Considerations 96Disadvantages 98Summary 99Acknowledgment 99References 1005 Management of Teeth with Necrotic Pulps and Open Apices 111Shahrokh Shabahang and David E. WitherspoonDiagnosis in Immature Teeth 111History of Treating Immature Teeth 114Infection Control in Immature Teeth 116Apexification 118Calcium Hydroxide Apexification Therapy: Outcomes 119Non-Vital Pulp Therapy 121Root-end closure via the use of apical barriers 121Mineral trioxide aggregate apical plug 122Technical placement 124Outcomes 124References 1316 Regenerative Endodontics (Revitalization/Revascularization) 141Mahmoud Torabinejad, Robert P. Corr, and George T.-J. HuangIntroduction 142Revascularization after Replantation and Autotransplantation 143Revitalization of Nonvital-Infected Teeth in Animals 145Clinical Evidence for Revitalization in Nonvital-Infected Teeth in Humans 152Potential Role of Stem Cells in Canal Tissue Generation and Regeneration 160Role of DPSCs and SCAP in revitalization and regenerative endodontic treatments 161Scaffolds and growth factors for regenerative endodontics (Revitalization) 164Clinical Procedures for Pulp Revitalization 168First appointment 168Second appointment 168Clinical and radiographic follow-up 170References 1707 Use of MTA as Root Perforation Repair 177Mahmoud Torabinejad and Ron LemonIntroduction 178Types of Perforation Defects 182Access preparation-related perforations 182Cleaning and shaping related (“strip”) perforations 184Resorption-related perforations (internal/external) 184Factors Influencing Prognosis for Repair 187Size of perforation 187Location of the perforation 187Pulp Chamber Perforations 189Etiologies 189Prevention 189Recognition and treatment of pulp chamber perforations 189Lateral surface repairs 190Furcation repairs 190Root Perforations During Cleaning and Shaping 191Coronal root perforations 191Causes, indicators and prevention 191Treatment 193Prognosis 193Lateral perforations 194Causes and indicators 194Treatment of mid-root perforation 194Prognosis 195Apical perforations 195Causes and indicators 196Treatment 197Prognosis 197Root Perforation during Post Space preparation 197Causes, indicators and prevention 197Treatment 197Prognosis 199Time elapsed since perforation 199Techniques for Internal Repair Using MTA 199Method 199Summary 202References 2038 MTA Root Canal Obturation 207George Bogen, Ingrid Lawaty, and Nicholas ChandlerIntroduction 208Charactertics/Properties 210Mechanisms of action in obturation 210Particle size 211Hydration products and pH 211Formation of interstitial layer 212Fracture resistance 212Sealing ability and setting expansion 213Applications/Uses 214Conventional obturation 214Retreatment 216Obturation prior to surgery 219Obturation with perforation repair 219Apexification using MTA obturation 222Obturation for dental anomalies 225Obturation Techniques 225Standard compaction technique 226Lawaty technique 229Auger technique 231Restorative Considerations 234Drawbacks 234Sealers 235Zinc oxide–eugenol sealers 236Calcium hydroxide sealers 236Epoxy resin-based sealers 236Glass ionomer sealers 237Silicone-based sealers 237Monoblock sealer systems 237Calcium silicate-based sealers 237Summary 238References 2399 Root-End Fillings Using MTA 251Seung-Ho Baek and Su-Jung ShinIntroduction of Root-End Filling Materials 252Purpose of root-end fillings 252History of Root-End Filling Materials 253Amalgam 254ZOE-based materials: IRM and SuperEBA 254Resin-based materials: Retroplast and Geristore 256Mineral trioxide aggregate (MTA) 256Gray vs. White MTA 257New types of MTA-like cements 257Requirements of Ideal Root-End Filling Materials 258Advantages and disadvantages of MTA as a root-end filling material 258Advantages of MTA 258Disadvantages of MTA 259MTA as a Root-End Filling Material 260Cytotoxicity and biocompatibility 260Bioactivity 263Sealability 264Antibacterial effect 265Clinical Applications of MTA 265Retropreparation and root-end filling 265Cavity preparation for MTA root-end filling 265Mixing procedure 266Methods for placement of MTA 266Clinical outcomes 268Conclusion 272References 27510 Calcium Silicate–Based Cements 281Masoud Parirokh and Mahmoud TorabinejadIntroduction 284Portland Cement (PC) 285Chemical composition 285Physical properties 286Antibacterial activity 287Sealing ability 288Biocompatibility 288Cell culture studies 288Subcutaneous implantation 288In vivo investigations 289Clinical applications 289Limitations 289Angelus MTA 291Chemical composition 291Physical properties 292Antibacterial activity 293Sealing ability 293Biocompatibility properties 293Cell structure studies 293Subcutaneous implantation 294Intraosseous implantation 294In vivo investigations 294Clinical applications 295Bioaggregate (BA) 295Chemical composition 295Physical properties 296Antibacterial activity 296Sealing ability 296Biocompatibility 296Cell culture studies 296Biodentine (BD) 297Chemical composition 297Physical properties 297Biocompatibility and clinical applications 297iRoot 298Chemical composition 298Physical properties 298Biocompatibility 299Calcium Enriched Mixture (CEM) Cement 299Chemical composition 299Physical properties 300Antibacterial activities 301Sealing ability 301Biocompatibility 301Cell culture studies 301Skin test and subcutaneous implantation 302Intraosseous implantation 302In vivo investigations 302Clinical investigations 303MTA Fillapex 304Chemical composition 304Physical properties 304Antibacterial activities 305Biocompatibility 306Cell culture studies 306Subcutaneous implantation 306Endo-CPM 306Chemical composition 307Physical properties 307Antibacterial activity 307Sealing ability 307Biocompatibility 307Cell culture studies 307Subcutaneous implantation 307In vivo investigations 308Cimento Endodontico Rapido (CER) 308Chemical composition 308Physical properties 308Biocompatibility 308Subcutaneous implantation 308Endosequence 309Chemical composition 309Physical properties 309Antibacterial activities 310Sealing ability 310Biocompatibility 310Cell culture studies 310EndoSequence BC Sealer 310Chemical composition 311Physical properties 311Biocompatibility 311ProRoot Endo Sealer 311Chemical composition 311Physical properties 312MTA Plus 312Chemical composition 312Physical properties 312Ortho MTA 313Chemical composition 313Biocompatibility 313Cell culture studies 313MTA Bio 313Chemical composition 313Physical properties 314Biocompatibility 314Cell culture studies 314Subcutaneous implantation 315MTA Sealer (MTAS) 315Chemical compositions and physical properties 315Fluoride-Doped MTA Cement 315Chemical composition 315Physical properties 316Sealing ability 316Capasio 316Chemical composition and physical properties 316Generex A 317Chemical composition and physical properties 317Biocompatibility 317Cell culture study 317Ceramicrete-D 317Chemical composition and physical properties 317Nano-Modified MTA (NMTA) 318Chemical composition and physical properties 318Light-Cured MTA 318Chemical composition and physical properties 318Biocompatibility 319Subcutaneous implantation 319Calcium Silicate (CS) 319Chemical composition and physical properties 319Endocem 320Chemical composition and physical properties 320Biocompatibility 320Cell culture study 320Other Experimental MTA Lookalike Mixtures 320Conclusion 320References 321Index 333