Mineral trioxide aggregate: A review of the constituents and biological properties of the material

ArticleinInternational Endodontic Journal 39(10):747-54 · November 2006with396 Reads
Impact Factor: 2.97 · DOI: 10.1111/j.1365-2591.2006.01135.x · Source: PubMed
Abstract

This paper reviews the literature on the constituents and biocompatibility of mineral trioxide aggregate (MTA). A Medline search was conducted. The first publication on the material was in November 1993. The Medline search identified 206 papers published from November 1993 to August 2005. Specific searches on constituents and biocompatibility of mineral trioxide aggregate, however, yielded few publications. Initially all abstracts were read to identify which fitted one of the two categories required for this review, constituents or biocompatibility. Based on this assessment and a review of the papers, 13 were included in the constituent category and 53 in the biocompatibility category. Relatively few articles addressed the constituents of MTA, whilst cytological evaluation was the most widely used biocompatibility test.

Figures

Full-text

Available from: Josette Camilleri, Mar 19, 2014
REVIEW
Mineral trioxide aggregate: a review of the
constituents and biological properties of the
material
J. Camilleri & T. R. Pitt Ford
Department of Conservative Dentistry, Dental Institute, King’s College London, London, UK
Abstract
Camilleri J, Pitt Ford TR. Mineral trioxide aggregate: a
review of the constituents and biological properties of the
material. International Endodontic Journal, 39, 747–754, 2006
.
This paper reviews the literature on the constituents
and biocompatibility of mineral trioxide aggregate
(MTA). A Medline search was conducted. The first
publication on the material was in November 1993.
The Medline search identified 206 papers published
from November 1993 to August 2005. Specific
searches on constituents and biocompatibility of min-
eral trioxide aggregate, however, yielded few publica-
tions. Initially all abstracts were read to identify which
fitted one of the two categories required for this review,
constituents or biocompatibility. Based on this assess-
ment and a review of the papers, 13 were included in
the constituent category and 53 in the biocompatibility
category. Relatively few articles addressed the constit-
uents of MTA, whilst cytological evaluation was the
most widely used biocompatibility test.
Keywords: biocompatibility, constituents, mineral
trioxide aggregate.
Received 5 January 2006; accepted 20 February 2006
Introduction
Mineral trioxide aggregate (MTA) was developed at
Loma Linda University in the 1990s as a root-end
filling material. It received acceptance by the US
Federal Drug Administration and became commercially
available as ProRoot MTA (Tulsa Dental Products,
Tulsa, OK, USA). Until recently, two commercial forms
of MTA have been available (ProRoot MTA) in either
the grey or white forms. Recently MTA-Angelus
(Angelus Soluc¸o˜es Odontolo
´
gicas, Londrina, Brazil)
has become available. The use of MTA as a root-end
filling material was identified because the material is a
hydraulic cement that sets in the presence of water.
Much work has been published on the biocompatibility
of this material, but relatively little on its constituents.
A literature review was thus undertaken to scrutinize
publications dealing with these two issues. The litera-
ture review was performed using a Medline electronic
search. The cut-off date was the end of August 2005.
The key words that were used and the results of this
search are shown in Table 1.
Constituents
The number of papers reviewed was 13. A patent was
taken out for MTA in 1995 (Torabinejad & White
1995). This states that MTA consists of 50–75% (wt)
calcium oxide and 15–25% silicon dioxide. These two
components together comprise 70–95% of the cement.
When these raw materials are blended they produce
tricalcium silicate, dicalcium silicate, tricalcium alumi-
nate and tetracalcium aluminoferrite. On addition of
water the cement hydrates to form silicate hydrate gel.
The patent states that MTA is a Type 1 ordinary
Correspondence: Dr Josette Camilleri, Department of Building
and Civil Engineering, Faculty of Architecture and Civil Engin-
eering, University of Malta, Msida, Malta (Tel.: +356 2340
2894; fax: +356 2133 0190; e-mail: joz@global.net.mt).
ª 2006
International Endodontic Journal International Endodontic Journal
, 39, 747–754, 2006
doi: 10.1111/j.1365-2591.2006.01135.x
747
Page 1
Portland cement (American Society for Testing Mate-
rials, http://www.astm.org) with a fineness (Blaine
number) in the range of 4500–4600 cm
2
g
)1
.A
radiopacifier (bismuth oxide) is added to the cement
for dental radiological diagnosis (Torabinejad & White
1995). Although the patent reported that MTA is
essentially ordinary Portland cement, few studies have
been conducted on the comparative constituents of
Portland cement and MTA.
The first research paper on the chemistry of
Portland cement that had potential for dental use
demonstrating the similarity of grey MTA (Loma
Linda University, Loma Linda, CA, USA) to Portland
cement was published in 2000 (Estrela et al. 2000). A
study comparing white MTA (White MTA, Dentsply;
Tulsa Dental Products) to white Portland cement
showed the cements to have similar constituent
elements except for the bismuth oxide in the MTA
(Asgary et al. 2004). No difference was found in the
presence of 14 elements between MTA (ProRoot MTA)
and Portland cement except for the bismuth which
was present in MTA (Funteas et al. 2003). Investiga-
tions of the chemical and physical, surface and bulk
material properties of Portland cement CEM I (Teuto-
nia Portlandzement, EN 197-1-CEM I 32,5 R; Teuto-
nia Zementwerk, Hannover, Germany), CEM II
(Felsenfest Portlandkalksandsteinzement, CEM II/A-LL
32,5 R EN 197-1; Spenner Zement, Erwitte, Germany)
and MTA Dentsply DeTrey (Konstanz, Germany;
batch: 02093081) have shown that MTA had less
gypsum. Decreased gypsum causes a reduction in
setting time of the cement (Lea 1998). Other findings
included a higher level of toxic heavy metals and
aluminium in Portland cement CEM I (Teutonia
Portlandzement, EN 197-1-CEM I 32,5 R; Teutonia
Zementwerk), CEM II (Felsenfest Portlandkalksand-
steinzement, CEM II/A-LL 32,5 R EN 197-1; Spenner
Zement) and a difference in the particle size distribu-
tion. Portland cement exhibited a wide range of sizes
whereas MTA Dentsply DeTrey (batch: 02093081)
showed a uniform and smaller particle size. Thus,
MTA cannot be substituted by a cheaper Portland
cement (Dammaschke et al. 2005). Both MTA (Pro-
Root) and Portland cement (Quikrete, Columbus, OH,
USA) had similar physical, chemical and biological
properties, and the biocompatibility of both materials
was due to the similarity in constituents (Saidon et al.
2003). The production of calcium hydroxide as a by-
product of the hydration reaction of MTA (ProRoot,
White MTA) has been published (Camilleri et al.
2005a). The biological response to MTA (ProRoot
MTA), had been likened to that of calcium hydroxide
(Holland et al. 1999a) and it was postulated that the
mechanisms of action were similar (Holland et al.
2001a). It has been reported that MTA (MTA
Angelus), released calcium ions and promoted an
alkaline pH (Duarte et al. 2003, Santos et al. 2005).
The physicochemical basis for the biological properties
of MTA (ProRoot), had recently been attributed to the
production of hydroxyapatite when the calcium ions
released by the MTA came into contact with tissue
fluid (Sarkar et al. 2005). Although the release of
calcium ions had been reported (Duarte et al. 2003,
Lee et al. 2004, Santos et al. 2005, Sarkar et al.
2005), none of the publications demonstrated the
origin of the calcium ions. Camilleri et al. (2005a)
showed that MTA (ProRoot, White MTA) and Port-
land cement (Italcementi spa, Bergamo, Italy) had the
same constituent elements, except for the bismuth
oxide present in MTA. Thus, on hydration both MTA
and Portland cement would produce calcium silicate
hydrate gel and calcium hydroxide. This would
Table 1 The keywords searched on
Medline at the end of August 2005 and
the number of publications found
Keyword
Number of
publications Earliest paper Latest paper
Mineral trioxide aggregate 206 November 1993 August 2005
Mineral trioxide aggregate
composition
7 July 1995 February 2005
Mineral trioxide aggregate
constitution
1 April 2005
Mineral trioxide aggregate
biocompatibility
19 November 1995 August 2005
Mineral trioxide aggregate
cells
37 October 1995 August 2005
Mineral trioxide aggregate
tissue response
10 December 1995 June 2005
Mineral trioxide aggregate
properties
28 July 1995 July 2005
Review of constituents and biological properties of mineral trioxide aggregate Camilleri & Pitt Ford
International Endodontic Journal
, 39, 747–754, 2006 ª 2006
International Endodontic Journal
748
Page 2
explain the similar mode of tissue reaction to MTA
and calcium hydroxide reported previously (Holland
et al. 1999a, 2001a).
The first research paper on the constituents of MTA
(Loma Linda University) in 1995 reported the presence
of calcium phosphate (Torabinejad et al. 1995a).
However, Asgary et al. (2005) using energy dispersive
analysis with X-ray (EDAX) could not detect the
presence of phosphorus. Camilleri et al. (2005a) also
showed MTA (ProRoot) did not contain phosphorus.
The samples used by Torabinejad et al. (1995a) were
contaminated by prior immersion in phosphate solu-
tion. The powder of MTA was composed mainly of
tricalcium and dicalcium silicates with bismuth oxide
also present for radiopacity (Camilleri et al. 2005a).
X-ray diffraction (XRD) analysis of the cement showed
that the material was completely crystalline, with
definite peaks attributable to specific phases (Fig. 1).
Two forms of MTA (Dentsply) are available on the
market, grey and white. The difference between them
has been reported to be in the concentrations of
aluminium, magnesium and iron compounds (Asgary
et al. 2005). The white MTA lacks the aluminoferrite
phase that imparts the grey colour to grey MTA
(Camilleri et al. 2005a).
Biocompatibility
The biocompatibility of MTA has been investigated in a
number of ways, using cell expression and growth,
subcutaneous and intra-osseous implantation and
direct contact with dental tissues in vivo.
Cytological investigation of biocompatibility
The number of papers reviewed was 27. The cell type,
contact time and method of assessment of the various
studies are shown in Table 2. Seven studies used more
than one cell type to study the behaviour of MTA. Most
of the cell studies showed good cell growth over MTA
with the formation of a cell monolayer over the
material. In comparison Haglund et al. (2003) showed
that MTA (ProRoot) was cytotoxic to both macroph-
ages and fibroblasts. Cell studies test the cytotoxicity in
vitro but cannot examine the complex interactions
between materials and host. Contact time was gener-
ally less than 7 days. Only one study evaluated
biocompatibility of MTA 28 days following its setting
(Camilleri et al. 2004).
The most commonly used method for evaluation of
cell proliferation was scanning electron microscopy
(SEM) followed by enzyme assay. The main issue with
the use of SEM in cell culture studies involving MTA
was the material reaction with the preparation media.
Calcium hydroxide which is a by-product of calcium
silicate hydration reacted with phosphate-buffered
solutions producing calcium phosphate crystals over
the material surface (Camilleri et al. 2005a). In addi-
tion, critical point drying, which is an essential step for
material preparation prior to viewing under SEM
0
10 20 30 40 50
°2Theta
27-0053 Bismite, syn
Bi
2
O
3
49-0442 Calcium silicate
Ca
3
SiO
5
03-1083 Calcium silicate Ca
2
SiO
4
60 70 80 90
100
400
900
Counts s
–1
1600
Figure 1 X-ray diffraction analysis of mineral trioxide aggregate (MTA) powder showing the main constituent elements of the
material (Camilleri et al. 2005a).
Camilleri & Pitt Ford Review of constituents and biological properties of mineral trioxide aggregate
ª 2006
International Endodontic Journal International Endodontic Journal
, 39, 747–754, 2006 749
Page 3
caused cement carbonation (Camilleri et al. 2004).
Enzyme assay, which is the next most common
method, would seem to be more reliable as it avoids
material preparation. Enzyme assay measures the
metabolic activity of cells grown over the materials
under study.
Few studies have been published on the material
extracts of MTA and this may reflect an incomplete
understanding of the chemical constitution of the
material. As MTA is calcium silicate cement, its
biocompatibility may be questioned. The observed
biocompatibility of MTA could arise from reaction
by-products. Good cell growth was demonstrated on
material extracts when tested using methyltetrazo-
lium (MTT) assay (Keiser et al. 2000, Huang et al.
2003, Camilleri et al. 2005b). The agar overlay
method and radiochromium release methods have
only been reported in one study (Torabinejad et al.
1995b).
In other experiments cytokine expression, primarily
interleukin (IL), has been used as a marker for cell
differentiation. MTA induced expression of inflamma-
tory cytokines from bone cells and exhibited good cell
attachment. MTA (ProRoot) caused an increase in IL-4
and IL-10 expression (Huang et al. 2005). Increase in
IL-6 and IL-8, with no increase in levels of IL-1a and
IL-1b was demonstrated in the presence of MTA (Loma
Linda University; Mitchell et al. 1999). Conversely, Koh
et al. (1997, 1998) showed a rise of both IL-1a and
IL-1b together with IL-6 after the cells were in contact
Table 2 Cell type, contact time and method of assessment used in cell culture studies conducted on MTA
Author and date Cell type
Contact
time
(days)
Method of
assessment Biocompatibility
Torabinejad et al. (1995) Mouse L929 1 Agar overlay Biocompatible
Torabinejad et al. (1995) Mouse L929 1 Radiochromium
release
Biocompatible
Koh et al. (1997) MG 63 6 SEM Biocompatible
Koh et al. (1998) MG 63 1–7 SEM Biocompatible
Osorio et al. (1998) Gingival fibroblasts, L929 Enzyme assay Biocompatible
Mitchell et al. (1999) MG 63 2, 4, 7 SEM Biocompatible
Keiser et al. (2000) Periodontal ligament
fibroblasts
1 Enzyme assay Biocompatible
Zhu et al. (2000) HOBs 1 SEM Biocompatible
Abdullah et al. (2002) SaOS-2 1, 2, 3 SEM Biocompatible
Saidon et al. (2003) Mouse L929 3 SEM Biocompatible
Haglund et al. (2003) Mouse L929,macrophages 3 SEM Not biocompatible
Huang et al. (2003) U2OS Enzyme assay Biocompatible
Perez et al. (2003) Osteoblasts, MG 63 6, 9, 13 SEM Not biocompatible
Pistorius et al. (2003) Periodontal ligament,
Gingival fibroblasts
4 Enzyme assay Biocompatible
Camp et al. (2003) Gingival fibroblasts 1, 2, 3 Fluorescence Biocompatible
Asrari and Lobner (2003) Neurons 12–14 Enzyme assay Biocompatible
Balto (2004) Periodontal ligament
fibroblasts
1 SEM Not biocompatible
Bonson et al. (2004) Periodontal ligament,
gingival fibroblasts
15 Fluorescence Biocompatible
Pelliccioni et al. (2004) SaOS 1, 3 Enzyme assay Biocompatible
Camilleri et al. (2004) SaOS 1, 5, 7 SEM Biocompatible
Camilleri et al. (2005b) HOS 1–7, 1–21 Enzyme assay Not biocompatible
a
Huang et al. (2005) U2OS 1, 2 Enzyme assay Biocompatible
Koulaouzidou et al. (2005) L929, BHK21/C13 fibroblasts 1, 2 Enzyme assay Biocompatible
Hernandez et al. (2005) Mouse fibroblasts, macrophages 1 Flow cytometry Biocompatible
Nakayama et al. (2005) Rat bone marrow cells 3 SEM, TEM Biocompatible
b
Moghaddame-Jafari
et al. (2005)
Mouse odontoblastic cells 1 Flow cytometry Biocompatible
Ribeiro et al. (2005) Mouse lymphoma cells Trypan blue exclusion test Biocompatible
SEM: Scanning electron microscopy; TEM: transmission electron microscopy.
a
good cell growth observed on material extracts but not on the material itself.
b
material does not inhibit cell growth but suppresses differentiation of osteoblast-like cells.
Review of constituents and biological properties of mineral trioxide aggregate Camilleri & Pitt Ford
International Endodontic Journal
, 39, 747–754, 2006 ª 2006
International Endodontic Journal
750
Page 4
with the material for 6 days. Osteocalcin levels were
also increased in the presence of MTA (ProRoot;
Thomson et al. 2003). There was a negligible increase
in levels of cytokines with the other materials used as
controls. MTA (ProRoot) also preferentially induced
alkaline phosphatase expression and activity in both
periodontal ligament and gingival fibroblasts (Bonson
et al. 2004). In general, MTA elicited an inflammatory
cytokine response. In contrast, no cytokine production
was observed in one study. The lack of cytokines was
accompanied by cell lysis and protein denaturing
around the MTA (Haglund et al. 2003). Cell culture
experiments are easier, quicker and cheaper than other
methods used to test biocompatibility.
Subcutaneous and intra-osseous implantation
The number of papers reviewed was 11. Histological
evaluation of tissue reaction to MTA has been evaluated
by subcutaneous and intra-osseous implantation of the
materials in test animals. Subcutaneous implantation in
rats showed that MTA (ProRoot) initially elicited severe
reactions with coagulation necrosis and dystrophic
calcification (Moretton et al. 2000, Yaltirik et al.
2004). The reactions, however, subsided with time.
Osteogenesis was not observed with MTA (Loma Linda
University) upon subcutaneous implantation indicating
that the material was not osteo-inductive in this tissue.
Implantation of MTA in rat connective tissue (Holland
et al. 2001a, 2002) and dog (Holland et al. 1999b,
2001b) produced granulations that were birefringent to
polarized light and an irregular structure like a bridge
was observed next to the material. Reactions to intra-
osseous implants of MTA (ProRoot) were less intense
than with subcutaneous implantation. Osteogenesis
occurred in association with these implants (Moretton
et al. 2000). With intra-osseous implantation the tissue
reactions to the material subsided with time over a period
of 12 weeks (Sousa et al. 2004). MTA (ProRoot) implan-
tation in the mandible of guinea pigs resulted in bone
healing and minimal inflammatory reactions (Saidon
et al. 2003). The tissue reaction to MTA (Loma Linda
University) implantation was the most favourable reac-
tion observed in both tibia and mandible of test animals,
as in every specimen, it was free of inflammation. In the
tibia, MTA (Loma Linda University) was the material
most often observed with direct bone apposition (Tora-
binejad et al. 1995c, 1998). In another study MTA
(ProRoot,) was shown to be biocompatible and did not
produce any adverse effect on microcirculation of the
connective tissue (Masuda et al. 2005).
Periradicular tissue reactions
The number of papers reviewed was eight. When MTA
(Loma Linda University) has been used for root-end
filling in vivo, less periradicular inflammation was
reported compared with amalgam (Torabinejad et al.
1995d). In addition, the presence of cementum on the
surface of MTA (Loma Linda University) was a frequent
finding (Torabinejad et al. 1997). It induced apical hard
tissue formation with significantly greater consistency,
but not quantity, in a study of three materials, although
the degree of inflammation was not significantly different
between the groups (Shabahang et al. 1999). Again,
MTA (ProRoot) supported almost complete regeneration
of the periradicular periodontium when used as a root-
end filling material on noninfected teeth (Regan et al.
2002). The most characteristic tissue reaction to MTA
was the presence of organizing connective tissue with
occasional signs of inflammation after the first post-
operative week (Economides et al. 2003). Early tissue
healing events after MTA root-end filling were chara-
cterized by hard tissue formation, activated progressively
from the peripheral root walls along the MTA–soft tissue
interface (Economides et al. 2003). Both fresh and set
MTA (ProRoot) caused cementum deposition when used
after apical surgery (Apaydin et al. 2004). In addition,
MTA (ProRoot) showed the most favourable periapical
tissue response of three materials tested, with formation
of cemental coverage over MTA (Baek et al. 2005). Use of
MTA (ProRoot) in combination with calcium hydroxide
in one study has shown that the periodontium may
regenerate more quickly than either material used on its
own in apexification procedures (Ham et al. 2005). All
these studies in vivo have shown a favourable tissue
response to MTA.
Pulpal reactions
The number of papers reviewed was seven. MTA used for
pulp capping or partial pulpotomy stimulates reparative
dentine formation. MTA-capped pulps showed complete
bridge formation with no signs of inflammation (Pitt Ford
et al. 1996, Tziafas et al. 2002, Andelin et al. 2003,
Faraco & Holland 2004). The same results were obtained
when MTA (Loma Linda University) was placed over
pulp stumps following pulpotomy (Holland et al. 2001b).
This hard tissue bridge formed over the pulp was
documented after using ProRoot MTA and MTA Angelus
and both grey and white Portland cement (grey: Voto-
rantim-Cimentos, Sao˜ Paulo, Brazil and white: Ira-
jazinho; Votorantim-Cimentos; Menezes et al. 2004).
Camilleri & Pitt Ford Review of constituents and biological properties of mineral trioxide aggregate
ª 2006
International Endodontic Journal International Endodontic Journal
, 39, 747–754, 2006 751
Page 5
The incidence of dentine bridge formation was higher
with MTA (Loma Linda University) than with calcium
hydroxide (Faraco & Holland 2001).
Comparison of MTA and Portland cement
Both MTA and Portland cement have been shown to be
biocompatible. The biocompatibility of Portland cement
was tested using a cell culture study and the material
allowed complete cell confluence (Abdullah et al.
2002). Implantation of Portland cement and MTA
(Loma Linda University and ProRoot respectively) in
rat connective tissue and mandibles of guinea pigs
showed that both materials were biocompatible (Hol-
land et al. 2001a, Saidon et al. 2003). Histological
evaluation of pulpotomies in dogs using both MTA
(ProRoot and MTA) and Portland cement (Irajazinho;
Votorantim-Cimentos) showed that both types of
material were equally effective as pulp protection
materials (Menezes et al. 2004).
Comparison of grey and white materials
Most studies have been performed with grey MTA, as
white MTA was introduced more recently. There has
been some conflicting data on the biocompatibility of
grey and white MTA. Holland et al. (1999a,b,
2001a,b,c, 2002) showed that both types (Loma
Linda University) were biocompatible when implanted
in rat connective tissue; however, the materials were
not tested in the same experiment. In contrast,
Perez et al. (2003) using a different type of cell
showed that white MTA (White MTA) was not as
biocompatible as the grey version (ProRoot) and
postulated that the difference might be due to surface
morphology of the materials. Camilleri et al. (2004)
showed no difference between the two variants
(Dentsply), however, both materials exhibited reduced
cell growth when allowed to set for 28 days. Thus,
aged material may not be as biocompatible as freshly
mixed material. This could indicate that
biocompatibility might be related to the amount of
calcium hydroxide produced during the hydration
reaction.
Conclusions
In the past 10 years, 13 studies have been published on
the constituents, while 53 studies have been published
on the biocompatibility of MTA: 27 studying the
material to host interactions at a cellular level and 26
using histological methods to study host tissue reac-
tions. Collectively, these studies have shown that MTA
is biocompatible. There has, however, been a lack of
knowledge and understanding about the constituents
of the material and its interaction with the surrounding
tissues. Recent studies on the material constituents
have clarified that MTA is a silicate cement rather than
an oxide mixture.
References
Abdullah D, Pitt Ford TR, Papaioannou S, Nicholson J,
McDonald F (2002) An evaluation of accelerated Portland
cement as a restorative material. Biomaterials 23, 4001–10.
Andelin WE, Shabahang S, Wright K, Torabinejad M (2003)
Identification of hard tissue after experimental pulp capping
using dentin sialoprotein (DSP) as a marker. Journal of
Endodontics 29, 646–50.
Apaydin ES, Shabahang S, Torabinejad M (2004) Hard-tissue
healing after application of fresh or set MTA as root-end-
filling material. Journal of Endodontics 30, 21–4.
Asgary S, Parirokh M, Eghbal MJ, Brink F (2004) A compar-
ative study of white mineral trioxide aggregate and white
Portland cements using X-ray microanalysis. Australian
Endodontic Journal 30, 89–92.
Asgary S, Parirokh M, Eghbal MJ, Brink F (2005) Chemical
differences between white and gray mineral trioxide aggre-
gate. Journal of Endodontics 31, 101–3.
Asrari M, Lobner D (2003) In vitro neurotoxic evaluation of
root-end-filling materials. Journal of Endodontics 29, 743–6.
Baek SH, Plenk H, Kim S (2005) Periapical tissue responses and
cementum regeneration with amalgam, Super EBA, and MTA
as root-end filling materials. Journal of Endodontics 31, 444–9.
Balto HA (2004) Attachment and morphological behavior of
human periodontal ligament fibroblasts to mineral trioxide
aggregate: a scanning electron microscope study. Journal of
Endodontics 30, 25–9.
Bonson S, Jeansonne BG, Lallier TE (2004) Root-end filling
materials alter fibroblast differentiation. Journal of Dental
Research 83, 408–13.
Camilleri J, Montesin FE, Papaioannou S, McDonald F, Pitt
Ford TR (2004) Biocompatibility of two commercial forms of
mineral trioxide aggregate. International Endodontic Journal
37, 699–704.
Camilleri J, Montesin FE, Brady K, Sweeney R, Curtis RV, Pitt
Ford TR (2005a) The constitution of mineral trioxide
aggregate. Dental Materials 21, 297–303.
Camilleri J, Montesin FE, Di Silvio L, Pitt Ford TR (2005b) The
chemical constitution and biocompatibilility of accelerated
Portland cement for endodontic use. International Endodontic
Journal 38, 834–42.
Camp MA, Jeansonne BG, Lallier T (2003) Adhesion of human
fibroblasts to root-end-filling materials. Journal of Endodontics
29, 602–7.
Review of constituents and biological properties of mineral trioxide aggregate Camilleri & Pitt Ford
International Endodontic Journal
, 39, 747–754, 2006 ª 2006
International Endodontic Journal
752
Page 6
Dammaschke T, Gerth HU, Zuchner H, Schafer E (2005)
Chemical and physical surface and bulk material charac-
terization of white ProRoot MTA and two Portland cements.
Dental Materials 21, 731–8.
Duarte MA, Demarchi AC, Yamashita JC, Kuga MC, Fraga Sde
C (2003) pH and calcium ion release of 2 root-end filling
materials. Oral Surgery, Oral Medicine, Oral Pathology, Oral
Radiology and Endodontics 95, 345–7.
Economides N, Pantelidou O, Kokkas A, Tziafas D (2003)
Short-term periradicular tissue response to mineral trioxide
aggregate (MTA) as root-end filling material. International
Endodontic Journal 36, 44–8.
Estrela C, Bammann LL, Estrela CR, Silva RS, Pecora JD (2000)
Antimicrobial and chemical study of MTA, Portland cement,
calcium hydroxide paste, Sealapex and Dycal. Brazilian
Dental Journal 11, 3–9.
Faraco IM, Holland R (2001) Response of the pulp of dogs to
capping with mineral trioxide aggregate or a calcium
hydroxide cement. Dental Traumatology 17, 163–6.
Faraco IM, Holland R (2004) Histomorphological response of
dogs’ dental pulp capped with white mineral trioxide
aggregate. Brazilian Dental Journal 15, 104–8.
Funteas UR, Wallace JA, Fochtman EW (2003) A comparative
analysis of Mineral Trioxide Aggregate and Portland
cement. Australian Dental Journal 29, 43–4.
Haglund R, He J, Jarvis J et al. (2003) Effects of root-end filling
materials on fibroblasts and macrophages in vitro. Oral
Surgery, Oral Medicine, Oral Pathology, Oral Radiology and
Endodontics 95, 739–45.
Ham KA, Witherspoon DE, Gutmann JL, Ravindranath S, Gait
TC, Opperman LA (2005) Preliminary evaluation of BMP-2
expression and histological characteristics during apexifica-
tion with calcium hydroxide and mineral trioxide aggregate.
Journal of Endodontics 31, 275–9.
Hernandez EP, Botero TM, Mantellini MG, McDonald NJ,
Nor JE (2005) Effect of ProRoot MTA mixed with
chlorhexidine on apoptosis and cell cycle of fibroblasts
and macrophages in vitro. International Endodontic Journal
38, 137–43.
Holland R, de Souza V, Nery MJ, Otoboni Filho JA, Bernabe PF,
Dezan E Jr (1999a) Reaction of rat connective tissue to
implanted dentin tubes filled with mineral trioxide aggregate
or calcium hydroxide. Journal of Endodontics 25, 161–6.
Holland R, de Souza V, Nery MJ, Otoboni Filho JA, Bernabe PF,
Dezan E Jr (1999b) Reaction of dogs’ teeth to root canal
filling with mineral trioxide aggregate or a glass ionomer
sealer. Journal of Endodontics 25, 728–30.
Holland R, de Souza V, Nery MJ et al. (2001a) Reaction of rat
connective tissue to implanted dentin tube filled with
mineral trioxide aggregate, Portland cement or calcium
hydroxide. Brazilian Dental Journal 12, 3–8.
Holland R, de Souza V, Murata SS et al. (2001b) Healing
process of dog dental pulp after pulpotomy and pulp
covering with mineral trioxide aggregate and Portland
cement. Brazilian Dental Journal 12, 109–13.
Holland R, de Souza V, Murata SS et al. (2001c) Mineral
trioxide aggregate repair of root perforations. Journal of
Endodontics 27, 281–4.
Holland R, de Souza V, Nery MJ et al. (2002) Reaction of rat
connective tissue to implanted dentin tubes filled with a
white mineral trioxide aggregate. Brazilian Dental Journal
13, 23–6.
Huang TH, Ding SJ, Hsu TC, Kao CT (2003) Effects of mineral
trioxide aggregate (MTA) extracts on mitogen-activated
protein kinase activity in human osteosarcoma cell line
(U2OS). Biomaterials 24, 3909–13.
Huang TH, Yang CC, Ding SJ, Yeng M, Kao CT, Chou MY
(2005) Inflammatory cytokines reaction elicited by root-end
filling materials. Journal of Biomedical Material Research, Part
B Applied Biomaterials 73, 123–8.
Keiser K, Johnson CC, Tipton DA (2000) Cytotoxicity of
mineral trioxide aggregate using human periodontal liga-
ment fibroblasts. Journal of Endodontics 26, 288–91.
Koh ET, Torabinejad M, Pitt Ford TR, Brady K, McDonald F
(1997) Mineral Trioxide Aggregate stimulates a biological
response in human osteoblasts. Journal of Biomedical Mate-
rials Research 37, 432–9.
Koh ET, McDonald F, Pitt Ford TR, Torabinejad M (1998)
Cellular response to Mineral Trioxide Aggregate. Journal of
Endodontics 24, 543–7.
Koulaouzidou EA, Papazisis KT, Economides NA, Beltes P,
Kortsaris AH (2005) Antiproliferative effect of mineral
trioxide aggregate, zinc oxide–eugenol cement, and glass–
ionomer cement against three fibroblastic cell lines. Journal
of Endodontics 31, 44–6.
Lea FM (1998) Lea’s Chemistry of Cement and Concrete, 4th edn.
London: Edward Arnold.
Lee Y-L, Lee B-S, Lin F-H, Lin AY, Lan W-H, Lin C-P (2004)
Effects of physiological environments on the hydration
behavior of mineral trioxide aggregate. Biomaterials 25,
787–793.
Masuda YM, Wang X, Hossain M et al. (2005) Evaluation of
biocompatibility of mineral trioxide aggregate with an
improved rabbit ear chamber. Journal of Oral Rehabilitation
32, 145–50.
Menezes R, Bramante CM, Letra A, Carvalho VG, Garcia RB
(2004) Histologic evaluation of pulpotomies in dog using
two types of mineral trioxide aggregate and regular and
white Portland cements as wound dressings. Oral Surgery,
Oral Medicine, Oral Pathology, Oral Radiology and Endodontics
98, 376–9.
Mitchell PJC, Pitt Ford TR, Torabinejad M, McDonald F (1999)
Osteoblast biocompatibility of mineral trioxide aggregate.
Biomaterials 20, 167–73.
Moghaddame-Jafari S, Mantellini MG, Botero TM, McDonald
NJ, Nor JE (2005) Effect of ProRoot MTA on pulp cell
apoptosis and proliferation in vitro. Journal of Endodontics
31, 387–91.
Moretton TR, Brown CE, Legan JJ, Kafrawy AH (2000)
Tissue reactions after subcutaneous and intraosseous
Camilleri & Pitt Ford Review of constituents and biological properties of mineral trioxide aggregate
ª 2006
International Endodontic Journal International Endodontic Journal
, 39, 747–754, 2006 753
Page 7
implantation of mineral trioxide aggregate and ethoxyben-
zoic acid cement. Journal of Biomedical Material Research
52, 528–33.
Nakayama A, Ogiso B, Tanabe N, Takeichi O, Matsuzaka K,
Inoue T (2005) Behaviour of bone marrow osteoblast-like
cells on mineral trioxide aggregate: morphology and
expression of type I collagen and bone-related protein
mRNAs. International Endodontic Journal 38, 203–10.
Osorio RM, Hefti A, Vertucci FJ, Shawley AL (1998) Cytotoxicity
of endodontic materials. Journal of Endodontics 24, 91–6.
Pelliccioni GA, Ciapetti G, Cenni E et al. (2004) Evaluation of
osteoblast-like cell response to Proroot MTA (mineral
trioxide aggregate) cement. Journal of Material Science of
Materials in Medicine 15, 167–73.
Perez Al, Spears R, Gutmann JL, Opperman LA (2003)
Osteoblasts and MG63 osteosarcoma cells behave differently
when in contact with ProRoot
TM
MTA and white MTA.
International Endodontic Journal 36, 564–70.
Pistorius A, Willershausen B, Briseno Marroquin B (2003)
Effect of apical root-end filling materials on gingival fibro-
blasts. International Endodontic Journal 36, 610–5.
Pitt Ford TR, Torabinejad M, Abedi HR, Bakland LK,
Kariyawasam SP (1996) Using mineral trioxide aggregate
as a pulp-capping material. Journal of the American Dental
Association 127, 1491–4.
Regan JD, Gutmann JL, Witherspoon DE (2002) Comparison
of Diaket and MTA when used as root-end filling materials
to support regeneration of the periradicular tissues. Interna-
tional Endodontic Journal 35, 840–7.
Ribeiro DA, Duarte MA, Matsumoto MA, Marques ME,
Salvadori DM (2005) Biocompatibility in vitro tests of
mineral trioxide aggregate and regular and white Portland
cements. Journal of Endodontics 31, 605–7.
Saidon J, He J, Zhu Q, Safavi K, Spangberg LS (2003) Cell and
tissue reactions to mineral trioxide aggregate and Portland
cement. Oral Surgery, Oral Medicine, Oral Pathology, Oral
Radiology and Endodontics 95, 483–9.
Santos AD, Moraes JC, Araujo EB, Yukimitu K, Valerio Filho
WV (2005) Physico-chemical properties of MTA and a novel
experimental cement. International Endodontic Journal 38,
443–7.
Sarkar NK, Caicedo R, Ritwik P, Moiseyeva R, Kawashima I
(2005) Physicochemical basis of the biologic properties of
mineral trioxide aggregate. Journal of Endodontics 31, 97–
100.
Shabahang S, Torabinejad M, Boyne PP, Abedi H, McMillan P
(1999) A comparative study of root-end induction using
osteogenic protein-1, calcium hydroxide, and mineral
trioxide aggregate in dogs. Journal of Endodontics 25, 1–5.
Sousa CJ, Loyola AM, Versiani MA, Biffi JC, Oliveira RP,
Pascon EA (2004) A comparative histological evaluation of
the biocompatibility of materials used in apical surgery.
International Endodontic Journal 37, 738–48.
Thomson TS, Berry JE, Somerman MJ, Kirkwood KL (2003)
Cementoblasts maintain expression of osteocalcin in the
presence of mineral trioxide aggregate. Journal of Endodontics
29, 407–12.
Torabinejad M, White DJ (1995) Tooth Filling Material and Use.
US Patent Number 5,769,638.
Torabinejad M, Hong CU, McDonald F, Pitt Ford TR (1995a)
Physical and chemical properties of a new root-end filling
material. Journal of Endodontics 21, 349–53.
Torabinejad M, Hong CU, Pitt Ford TR, Kettering JD (1995b)
Cytotoxicity of four root- end filling materials. Journal of
Endodontics 21, 489–92.
Torabinejad M, Hong CU, Pitt Ford TR, Kariyawasam SP
(1995c) Tissue reaction to implanted Super EBA and
Mineral Trioxide Aggregate in the mandible of guinea pigs:
a preliminary report. Journal of Endodontics 21, 569–71.
Torabinejad M, Hong CU, Lee SJ, Monsef M, Pitt Ford TR
(1995d) Investigation of mineral trioxide aggregate for root-
end filling in dogs. Journal of Endodontics 21, 603–8.
Torabinejad M, Pitt Ford TR, McKendry DJ, Abedi HR, Miller
DA, Kariyawasam SP (1997) Histologic assessment of
Mineral Trioxide Aggregate as root end filling material in
monkeys. Journal of Endodontics 23, 225–8.
Torabinejad M, Ford TR, Abedi HR, Kariyawasam SP, Tang
HM (1998) Tissue reaction to implanted root-end filling
materials in the tibia and mandible of guinea pigs. Journal of
Endodontics 24, 468–71.
Tziafas D, Pantelidou O, Alvanou A, Belibasakis G, Papadi-
mitriou S (2002) The dentinogenic effect of mineral trioxide
aggregate (MTA) in short-term capping experiments. Inter-
national Endodontic Journal 35, 245–54.
Yaltirik M, Ozbas H, Bilgic B, Issever H (2004) Reactions of
connective tissue to mineral trioxide aggregate and amal-
gam. Journal of Endodontics 30, 95–9.
Zhu Q, Haglund R, Safavi KE, Spangberg LS (2000) Adhesion
of human osteoblasts on root-end filling materials. Journal of
Endodontics 26, 404–6.
Review of constituents and biological properties of mineral trioxide aggregate Camilleri & Pitt Ford
International Endodontic Journal
, 39, 747–754, 2006 ª 2006
International Endodontic Journal
754
Page 8
    • "Ten years follow-up studies indicate 30% to 85% success rate [23,24]. MTA is a bioactive material that can be used for direct pulp capping [25,26]. It is non-resorbable, may set in wet conditions, and stimulates dentin hard tissue formation [27]. "
    Preview · Article · Feb 2016
    0Comments 0Citations
    • "MTA and CEM showed a statistically significant decrease in cell viability after 72 hours of incubation whereas Biodentine showed less cell viability after 24 hours of incubation compared with other time periods. The reason for the decrease in cell viability for MTA and CEM after 72 hours of incubation may be the production of calcium hydroxide due to the hydration reaction in the materials [10, 24]. Similarly, calcium hydroxide is produced as a by-product of the reaction in Biodentine [25]. "
    [Show abstract] [Hide abstract] ABSTRACT: The aim of this study was to evaluate the cytotoxicity of three types of calcium silicate-based endodontic cement after different incubation periods with human periodontal ligament fibroblasts. Human periodontal ligament fibroblasts were cultured from extracted third molars and seeded in 96-well plates. MTA, calcium enriched mixture (CEM) cement, and Biodentine were prepared and added to culture insert plates which were immediately placed into 96-well plates containing cultured cells. After incubation periods of 24, 48, and 72 hours, cell viability was determined with WST-1 assay. Data were analysed statistically by ANOVA with repeated measures and Bonferroni tests. There was no significant difference in cell viability amongst the test materials after each incubation period ( P > 0.05 ). MTA and CEM presented more than 90% cell viability after 24 and 48 hours of incubation and showed statistically significant decrease in cell viability after 72 hours of incubation ( P < 0.05 ). Biodentine showed significantly less cell viability (73%) after 24 hours of incubation, whereas more than 90% cell viability was seen after 48 and 72 hours of incubation ( P < 0.05 ). Despite the significant changes in cell viability over time, materials presented similar cytotoxicity profile. Biodentine and CEM can be considered as alternative materials for root-end surgery procedures.
    Full-text · Article · Jan 2016
    0Comments 0Citations
    • "Another material with the ability to induce regeneration is mineral trioxide aggregate (MTA). MTA is a mixture of dicalcium silicate, tricalcium silicate, tricalcium aluminate, gypsum, and tetracalcium aluminoferrite [35]. Torabinejad et al. [36] reported a favorable biologic performance of MTA when in direct contact with bone, through the deposition and formation of hydroxyl apatite on its surface. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Regeneration of periodontal tissues is a major goal of periodontal therapy. Dental pulp stem cells (DPSCs) show mesenchymal cell properties with the potential for dental tissue engineering. Enamel matrix derivative (EMD) and platelet-derived growth factor (PDGF) are examples of materials that act as signaling molecules to enhance periodontal regeneration. Mineral trioxide aggregate (MTA) has been proven to be biocompatible and appears to have some osteoconductive properties. The objective of this study was to evaluate the effects of EMD, MTA, and PDGF on DPSC osteogenic differentiation. Methods Human DPSCs were cultured in medium containing EMD, MTA, or PDGF. Control groups were also established. Evaluation of the achieved osteogenesis was carried out by computer analysis of alkaline phosphatase (ALP)-stained chambers, and spectrophotometric analysis of alizarin red S-stained mineralized nodules. Results EMD significantly increased the amounts of ALP expression and mineralization compared with all other groups (P < 0.05). Meanwhile, MTA gave variable results with slight increases in certain differentiation parameters, and PDGF showed no significant increase in the achieved differentiation. Conclusions EMD showed a very strong osteogenic ability compared with PDGF and MTA, and the present results provide support for its use in periodontal regeneration.
    Full-text · Article · Dec 2015 · BMC Oral Health
    0Comments 1Citation
Show more

Discover cutting-edge research

ResearchGate is where you can find and access the latest publications from your field of research.

Discover more