[Downloaded free from http://www.jorr.org on Saturday, October 29, 2016, IP: 36.84.134.

247]

REVIEW ARTICLE
Mineral trioxide aggregate (MTA) in dentistry: A review
of literature
Chirag Macwan, Anshula Deshpande
Department of Pedodontics and Preventive Dentistry, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara,
Gujarat, India

ABSTRACT
Mineral trioxide aggregate (MTA) is a unique material with several exciting clinical applications. MTA has potential and one of the most
versatile materials of this century in the field of dentistry. During endodontic treatment of primary and permanent tooth MTA can be
used in many ways. MTA materials have been shown to have a biocompatible nature and have excellent potential in endodontic use. MTA
materials provide better microleakage protection than traditional endodontic repair materials using dye, fluid filtration, and bacterial
penetration leakage models. In both animal and human studies, MTA materials have been shown to have excellent potential as pulpcapping and pulpotomy medicaments. MTA material can be used as apical and furcation restorative materials as well as medicaments for
apexogenesis and apexification treatments. In present article, we review the current dental literature on MTA, discussing composition,
physical, chemical and biological properties and clinical characteristics of MTA.

Key words: Biocompatible dental material, Mineral Trioxide Aggregate, MTA

Introduction

FeO.[4] Chemical composition of the both GMTA and WMTA is

mentioned in the Table 2 [Adapted from Asgary et al. (2005)[4]].

Mineral Trioxide Aggregate (MTA) was introduced by Mohmoud

Taorabinejad at Loma Linda University, California, USA in 1993[1]
and was given approval for endodontic use by the U.S. Food and
Drug Administration in 1998.[2,3] List of available MTA with
their trade name and manufacturer are summarised in Table 1.

Composition and Manipulation

of Mineral Trioxide Aggregate (MTA)
MTA is available in two types based on the color known as
gray and white MTA. Scanning electron microscopy (SEM) and
electron probe microanalysis characterized the differences between
GMTA and WMTA and found that the major difference between
GMTA and WMTA is in the concentrations of Al2O3, MgO and
Access this article online
Quick Response Code:

Website:
www.jorr.org

DOI:
10.4103/2249-4987.152914

Address for correspondence:

Dr. Chirag Macwan,
Department of Pedodontics and Preventive Dentistry, K. M.
Shah Dental College and Hospital, Sumandeep Vidyapeeth,
Vadodara - 391 760, Gujarat, India.
E-mail: chiragmacwan@yahoo.co.in

71

Sluyk et al. (1998)[5], Torabinejad et al. (1999)[6] and Schmitt et al.

(2001)[7] advocated that the powder water ratio for MTA should
be 3:1(P: W). Mixing can be done on paper pad or on a glass
slab using a plastic or metal spatula to achieve putty like paste
consistency. This mix should be cover with moistened cotton
pellet to prevent dehydration of mix.
Immediately after mixing MTA has a pH of 10.2. After 3 hours
of setting the pH increased to 12.5.[8] The pH of set MTA is
almost similar to calcium hydroxide. Sluyk et al.(1998)[5] suggested
that mixing time should be less than 4 minute. Torabinejad et al.
(1995)[8] found setting time about 2 hours and 45 minutes (
5 minutes) of grey MTA, similar research done by Islam et al.,
Table 1: List of commercially available MTA
Trade name

Manufacturer

ProRoot MTA
White ProRoot MTA
MTA-Angelus (Grey)
MTA (White)
MM MTA
Ortho MTA
Retro MTA
EndoCem MTA
MTA Plus
EndoCem Zr
EndoSeal
MTA Fillapex

Dentsply Tulsa Dental, Johnson City, USA

Dentsply Tulsa Dental, Johnson City, USA
Angelus, Londrina, Brazil
Angelus, Londrina, Brazil
MicoMegha, Besancon, France
BioMTA, Seoul, Korea
BioMTA, Seoul, Korea
Maruchi, Wonju, Korea
Avalon Biomed, Bradenton, USA
Maruchi, Wonju, Korea
Maruchi, Wonju, Korea
Angelus, Londrina, Brazil

Journal of Oral Research and Review

Vol. 6, Issue 2, | July-December 2014

[Downloaded free from http://www.jorr.org on Saturday, October 29, 2016, IP: 36.84.134.247]

Macwan and Deshpande: Mineral trioxide aggregate (MTA)

Table 2: Chemical compositions of GMTA and WMTA
[Adapted from Asgary et al. (2005)]
Chemicalcompound

GMTA (wt%)

WMTA (wt%)

40.45
17.00
15.90
4.26
3.10
0.51
0.43
4.39
0.18
0.06
13.72

44.23
21.20
16.13
1.92
1.35
0.53
0.43
0.40
0.21
0.11
14.49

Calcium oxide (CaO)

Silicon dioxide (SiO2)
Bismuth trioxide (Bi2O3)
Aluminium oxide (Al2O3)
Magnesium oxide (MgO)
Sulfur trioxide (SO3)
Chlorine (Cl)
Ferrous oxide (FeO)
Phosphorus pentoxide (P2O5)
Titanium dioxide (TiO2)
Carbonic acid (H2O+CO2)

2006 suggested that initial setting time about 2 hours and 55

minutes and 2 hours and 20 minutes for grey MTA and white
MTA, respectively. MTA being hydrophilic requires moisture to
set. Presence of moisture during setting improves the flexural
strength of the set cement.[6] Therefore, it is advised to place
a wet cotton pellet over the MTA in the first visit followed by
replacement by a permanent restoration at the second visit. The
long setting time is one of the drawbacks of MTA because of it
should not be applied in 1 visit. Inter-appointment moist cotton
palate is required till the final setting of MTA.
MTA powder must be kept tightly closed to avoid degradation
by moisture. The mixing time is critical as, if the mixing time
is prolonged; it results in dehydration of the mix. Torabinejad
and Chivian (1999)[6] advocated that after mixing, the mix
should be cover with moistened cotton pellet because if it is left
open it undergoes dehydration and dries into a sandy mixture.
MTA may be placed into the desired location using ultrasonic
condensation, plugger, paper point or specially designed carriers
and messing gun. Aminoshariae et al. (2003)[9] compared hand
condensation and the ultrasonic method and found that a
better adaptation of MTA to the walls with less voids in hand
condensation compared to the ultrasonic method. Lawley et al.
(2004)[10] concluded that after 90 days, the ultrasonically placed
MTA followed with composite provided a significantly better
MTA seal compared with the hand condensation. Nekoofar et al.
(2007)[11] compared the method and pressure of condensation
and found that condensation pressure may affect the strength
and hardness of MTA.

Chemical, Physical, and Mechanical

Properties of MTA
Compressive strength
Torabinejad M, et al. (1995)[8] studied physical properties of MTA
and found that compressive strength at 24 hours 40.0 MPa and
at 21 days 67.3MPa; and in comparison between GMTA and
WMTA result showed that compressive strength of Gray MTA
> White MTA.
Journal of Oral Research and Review

Vol. 6, Issue 2, | July-December 2014

Radio-opacity
Ding SJ (2008)[12]& Shah PMN (1996)[13] found that MTA has
comparable radiodensity as Zinc Oxide Eugenol and it is less
radio opaque than Super EBA, IRM, gutta-percha or amalgam.
Torabinejad M (1995)[8] concluded that the mean radio opacity of
MTA is 7.17 mm of equivalent thickness of aluminium, which is
adequate to make it easy to visualize radiographically.

Solubility
The set MTA shows no signs of solubility. But, if more water
is used during mixing the MTA it may results into increased
solubility. Buding (2008)[14] found that the set MTA when exposed
to water it releases calcium hydroxide (CaOH2). CaOH2 might
be responsible for its cementogenesis-inducing property. During
setting reaction if mix is exposed to acidic environment it does
not interfere in the setting.[15]

Marginal adaptation and sealing ability

Bates et al. (1996)[16] found that MTA is superior to the other
traditional root-end filling materials. According to Shipper et al.
(2004)[17] and Torabinejad et al. (1995)[18] explained that MTA has
excellent sealing ability which may occur because MTA expands
during setting reaction. In presence of moist environment
sealing ability of MTA is enhanced due to the setting expansion
so it is been suggested that a moistened cotton pellet should be
placed in contact with MTA before placement of the permanent
restoration. Valois et al. (2004)[19] found that about 4-mm
thickness of MTA is sufficient to ensure a good sealing.

Antibacterial and antifungal property

Al-Hazaimi et al. (2006)[20] stated that MTA has antibacterial
effect especially against Enterococcus faecalis and Streptococcus sanguis.
But, according to Torabinejad et al. (1995)[21] MTA showed no
antimicrobial action against any of the anerobes. But it did show
certain effect on facultative bacteria.

Reaction with other dental materials

Nandini S et al. (2006)[22] found MTA does not react or interfere
with any other restorative material. When GIC or composite
resins placed over MTA it doesnt affects the setting reaction.
Srinivasan V et al (2009)[3] stated that residual calcium hydroxide
may interfere with the adaptation of MTA to dentinal wall.
This results in reduced sealing ability which occurs either by a
mechanical obstacle of CaOH2 particle by chemically reaction
with MTA.

Biocompatibility
Kettering and Torabinejad (1995)[23] compared MTA with Super
EBA and IRM and found that MTA is not mutagenic and less
cytotoxic. Sumer et al. (2006)[24] concluded that MTA is well
tolerated by the tissues and biocompatible. Arens and Torabinejad
(1996)[25] treated furcation perforations and osseous repair with
MTA. Pelliccioni et al. (2004)[26] evaluated osteoblast-like cell
response to MTA and result showed MTA has good interaction
with periapical and periradicular tissues. MTA has potential effect
72

[Downloaded free from http://www.jorr.org on Saturday, October 29, 2016, IP: 36.84.134.247]

Macwan and Deshpande: Mineral trioxide aggregate (MTA)

on cell viabilities collagen release mechanism. Koh et al. (2001)[27]

concluded that property of MTA to produce interleukin and also
offers a biologically active substrate for bone cells.

2.

Tissue regeneration
Torabinejad et al. (1995)[28] concluded that MTA is potential to
activate the cementoblasts and eventually cementum production.
MTA also allows the overgrowth of PDL fiber over its surface.
Schwartz et al. (1999)[29] reported that MTA helps in elimination
of clinical symptoms bone healing. These properties of MTA
determine it as a potential regenerative material.

Mineralization
Myers K (1996)[2] determined that MTA, similar to calcium
hydroxide (CaOH 2), induces formation of dentin bridge.
According to Holland et al. (1999) [30] theorized that the
tricalcium oxide content of MTA interacts with tissue fluids
and form CaOH2, resulting in hard-tissue creation in a similar
manner to that of CaOH2. Faraco et al. (2001)[31] concluded
that the dentin bridge formed with MTA is relatively faster,
with good structural integrity than with CaOH2. According to
Dominguez et al. (2003)[32] and Tziafas (2002)[33] MTA stimulates
reparative dentin formation along with maintaining the integrity
of the pulp.

Clinical Applications of MTA

Diagrammatic representation of clinical usage of MTA is shown
in Figure 1.
1. In Primary teeth:
i.
Pulp capping[2,29,34]
ii.
Pulpotomy[35]
iii. Root canal filling[36]
iv. Furcation perforation repair[29]
v.
Resorption repair[29]

Conclusion
Considering the present literature review, MTA is an excellent
biocompatible material. MTA has various exciting clinical
applications as it has numerous qualities mandatory for an ideal
dental material. MTA required to be further explored by clinicians
so that its advantageous properties can be practiced.

References
1.
2.

3.
4.

5.

6.
7.
8.

9.
10.

11.

12.

13.

14.
Figure 1: Diagrammatic representation of clinical application of MTA
in Primary and Permanent dentition, where, (a) Pulp capping/Partial
pulpotomy, (b) Furcal repair, (c) Root canal sealer, (d) Root end filling/
Apexification, (e) Repair of root perforation/ resorption, (f) Pulp capping,
(g) Pulpotomy, (h) Resorption repair, (i) Furcation perforation repair,
(j) Root canal filling

73

In Permanent teeth:
i.
Pulp capping[2,29]
ii.
Partial pulpotomy[35]
iii. Perforation repair - Apical, lateral, furcation[29]
iv. Resorption repair - External and internal[29]
v.
Repair of fracture - Horizontal and Vertical
vi. Root end filling[22]
vii. Apical barrier for tooth with necrotic pulps and open
apex[10,22,37]
viii. Coronal barrier for regenerative endodontics[38]
ix. Root canal sealer[39]

15.
16.

17.

Lee SJ, Monsef M, Torabinejad M. Sealing ability of a mineral trioxide

aggregate for repair of lateral root perforations. J Endod 1993;19:541-4.
Schwartz RS, Mauger M, Clement DJ, Walker WA 3rd. Mineral
trioxide aggregate: A new material for endodontics. J Am Dent Assoc
1999;130:967-75.
Srinivasan V, Waterhouse P, Whitworth J. Mineral trioxide aggregate in
paediatric dentistry. Int J Pediatr Dent 2009;19:34-47.
Asgary S, Parirokh M, Egbbal MJ, Brink F. Chemical differences
between white and gray mineral trioxide aggregate. J Endod
2005;31:101-3.
Sluyk SR, Moon PC, Hartwell GR. Evaluation of setting properties and
retention characteristics of Mineral Trioxide Aggregate when used as a
furcation perforation repair material. J Endod 1998;24:768-71.
Torabinejad M, Chivian N. Clinical applications of mineral trioxide
aggregate. J Endod 1999;25:197-205.
Schmitt D, Lee J, Bogen G. Multifaceted use of ProRoot MTA root
canal repair material. Pediatr Dent 2001;23:326-30.
Torabinejad M, Hong CU, McDonald F, Pitt Ford TR. Physical
and chemical properties of a new root-end filling material. J Endod
1995;21:349-53.
Aminoshariae A, Hartwell GR, Moon PC. Placement of mineral trioxide
aggregate using two different techniques. J Endod 2003;29:679-82.
Lawley GR, Schindler WG, Walker WA 3rd, Kolodrubetz D. Evaluation
of ultrasonically placed MTA and fracture resistance with Intracanal
composite resin in a model of apexification. J Endod 2004;30:167-72.
Nekoofar MH, Adusei G, Sheykhrezae MS, Hayes SJ, Bryant ST,
Dummer PM. The effect of condensation pressure on selected physical
properties of mineral trioxide aggregate. Int Endod J 2007;40:453-61.
Ding SJ, Kao CT, Shie MY, Hung C Jr, Huang TH. The physical
and cytological properties of white MTA mixed with Na2HPO4 as an
accelerant. J Endod 2008;34:748-51.
Shah PM, Chong BS, Sidhu SK, Pitt Ford TR. Radio opacity of
potential root end filling materials. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod 1996;81:476-9.
Budig CG, Eleazer PD. In vitro comparison of the setting of dry ProRoot
MTA by moisture absorbed through the root. J Endod 2008;34:712-4.
Roy CO, Jeansonne BG, Gerrets TF. Effect of an acid environment on
leakage of root-end filling materials. J Endod 2001;27:7-8.
Bates CF, Carnes DL, del Rio CE. Longitudinal sealing ability of
mineral trioxide aggregate as a root-end filling material. J Endod
1996;22:575-8.
Shipper G, Grossman ES, Botha AJ, Cleaton-Jones PE. Marginal
adaptation of mineral trioxide aggregate (MTA) compared with

Journal of Oral Research and Review

Vol. 6, Issue 2, | July-December 2014

[Downloaded free from http://www.jorr.org on Saturday, October 29, 2016, IP: 36.84.134.247]

Macwan and Deshpande: Mineral trioxide aggregate (MTA)

18.

19.

20.

21.
22.

23.

24.

25.

26.

27.

28.

amalgam as a root-end filling material: A low vacuum (LV) versus high

vacuum (HV) SEM study. Int Endod J 2004;37:325-36.
Torabinejad M, Smith PW, Kettering JD, Pitt Ford TR. Comparative
investigation of marginal adaptation of Mineral Trioxide aggregate
and other commonly used root-end filling materials. J Endod
1995;21:295-9.
Valois CR, Costa ED Jr. Influence of the thickness of mineral trioxide
aggregate on sealing ability of root-end filling in vitro. Oral Surg Oral
Med Oral Pathol Oral Radiol Endod 2004;97:108-11.
Al-Hezaimi K, Al-Shalan TA, Naghshbandi J, Oglesby S, Simon JH,
Rotstein I. Antibacterial effect of two mineral trioxide aggregate
(MTA) preparations against Enterococcus faecalis and Streptococcus
sanguis in vitro. J Endod 2006;32:1053-6.
Torabinejad M, Hong CU, Pitt Ford TR, Kettering JD. Antibacterial
effects of some root end filling materials. J Endod 1995;21:403-6.
Nandini S, Ballal S, Kandaswamy D. Influence of glass Ionomer
cement on the interface and setting reaction of mineral trioxide
aggregate when used as a furcal repair material using laser Raman
spectroscopic analysis. J Endod 2007;33:167-72.
Kettering JD, Torabinejad M. Investigation of mutagenicity of mineral
trioxide aggregate and other commonly used root-end filling materials.
J Endod 1995;21:537-42.
Sumer M, Muglali M, Bodrumlu E, Guvenic T. Reactions of
connective tissue to amalgam, intermediate restorative material,
mineral trioxide aggregate mixed with chlorhexidine. J Endod
2006;32:1094-6.
Arens DE, Torabinejad M. Repair of furcal perforations with mineral
trioxide aggregate: Two case reports. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod 1996;82:84-8.
Pelliccioni GA, Ciapetti G, Cenni E, Granchi D, Nanni M, Pagani S,
et al. Evaluation of osteoblast-like cell response to Proroot MTA
(mineral trioxide aggregate) cement. J. Mater Sci Mater Med
2004;15:167-73.
Koh ET, Ford TR, Kariyawasam SP, Chen NN, Torabinejad M.
Prophylactic treatment of dens evaginatus using mineral trioxide
aggregate. J Endod 2001;27:540-2.
Torabinejad M, Hong CU, Lee SJ, Monsef M, Pitt Ford TR.
Investigation of mineral trioxide aggregate for root-end-filling in dogs.
J Endod 1995;21:603-8.

Journal of Oral Research and Review

Vol. 6, Issue 2, | July-December 2014

29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.

Schwartz RS, Mauger M, Clement DJ, Walker WA 3rd. Mineral

trioxide aggregate: A new material for endodontics. J Am Dent Assoc
1999;130:967-75.
Holland R, de Souza V, Nery MJ, Otoboni Filho JA, Bernab PF, Dezan
Jnior E. Reaction of dogs teeth to root canal filling with mineral
trioxide aggregate or a glass ionomer sealer. J Endod 1999;25:728-30.
Faraco IM Jr, Holland R. Response of the pulp of dogs to capping
with mineral trioxide aggregate or a calcium hydroxide cement. Dent
Traumatol 2001;17:163-6.
Dominguez MS, Witherspoon DE, Gutmann JL, Opperman LA.
Histological and scanning electron microscopy assessment of various
vital pulp-therapy materials. J Endod 2003;29:324-33.
Tziafas D, Pantelidou O, Alvanou A, Belibasakis G, Papadimitriou S.
The dentinogenic effect of mineral trioxide aggregate (MTA) in shortterm capping experiments. Int Endod J 2002;35:245-54.
Accorinte Mde L, Holland R, Reis A, Bortoluzzi MC, Murata SS, Dezan
E Jr, et al. Evaluation of mineral trioxide aggregate and calcium hydroxide
cement as pulpcapping agents in human teeth. J Endod 2008;34:1-6.
Ebrahim J, Mohammad RS, Neda A. Histopathologic responses
of dogs dental pulp to mineral trioxide aggregate, bio active glass,
formocresol, hydroxyapatite. Dent Res J 2007;4:83-7.
OSullivan SM, Hartwell GR. Obturation of a retained primary
mandibular second molar using mineral trioxide aggregate: A case
report. J Endod 2001;27:703-5.
Matt GD, Thorpe JR, Strother JM, McClanahan SB. Comparative
study of white and grey mineral trioxide aggregate (MTA) simulating a
one or two step apical barrier technique. J Endod 2004;30:876-9.
Garcia-Godoy F, Murray PE. Recommendations for using regenerative
endodontic procedures in permanent immature traumatized teeth. Dent
Traumatol 2012;28:33-41.
Vitti RP, Prati C, Silva EJ, Sinhoreti MA, Zanchi CH, de Souza e
Silva MG, et al. Physical properties of MTA Fillapex sealer. J Endod
2013;39:915-8.

How to cite this article: Macwan C, Deshpande A. Mineral trioxide

aggregate (MTA) in dentistry: A review of literature. J Oral Res Rev
2014;6:71-4.

Source of Support: Nil, Conflict of Interest: None declared.

74