Multifaceted Use of ProRoot MTA Root Canal Repair Material

Resident’s Name: Brian Schmid DMD Date: 8/28/09
Article title: Multifaceted Use of ProRoot MTA Root Canal Repair Material
Author(s): Don Schmitt DDS, Jacob Lee DDS, George Bogen DDS
Journal: Pediatric Dentistry
Month, Year: November 2000
Major topic: Varied uses and superiority of MTA
Type of Article: Review
Findings: MTA has been demonstrated to have diverse applications inclding: direct pulp capping, repair of internal resorption, root end filling, apexification and repair of root perforations. MTA has been shown to have a better seal than other pulp capping medicaments. While bonding systems and newer composites have a better seal than in the past, all systems will have some marginal microleakage so it is essential to have as tight a seal on the capping material as possible. The main components of MTA are calcium phosphate and calcium oxide and comes in a fine powder which is activated by hydration. Bismuth oxide powder is added to achieve a radiopacity similar to gutta percha. Studies have shown that MTA is more biocompatible than amalgam, IRM and ZOE, including one study which demonstrated cementum growing over MTA introduced into root canal perforations even when overstuffed. MTA stimulates the release of cytokines and interleukins which initiate an immune response and potential regeneration. MTA sets very slowly so all irrigation should be completed before MTA is placed. MTA is more expensive and comes in a box of five 1 gram single use packets ($300). The instructions suggest that extra MTA can be preserved in sterilized film canisters for later use. Case selection is essential for any pulp capping patient. Spontaneous pain or a dull constant ache are signs of a necrotic pulp and signify a tooth that would requires pulp treatment. A previous study found no significant link to success of pulp capping than ease of hemostasis. The article reviews the method of re-entry direct pulp capping emphasizing avoiding displacement of the MTA and disinfection with NaOCl. The method if apexification is also reviewed and recommends initial placement of CaOH, followed one week later by placement of 3-4mm of MTA as an apical plug, followed by moist cotton pellet followed by IRM. Filling of the entire canal with MTA as a definitive treatment is suggested, but may lead to discoloration of teeth.
Key points/Summary: MTA has varied uses which require some departure from our usual methodology.
Assessment of article: A good review article, but seemingly attempts to sell you MTA to some extent. Still generally considered too expensive for everyday use in any environments.