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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 pulp-
capping 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
Sluyk et al. (1998)[5], Torabinejad et al. (1999)[6] and Schmitt et al.
Taorabinejad at Loma Linda University, California, USA in 1993[1]
(2001)[7] advocated that the powder water ratio for MTA should
and was given approval for endodontic use by the U.S. Food and
be 3:1(P: W). Mixing can be done on paper pad or on a glass
Drug Administration in 1998.[2,3] List of available MTA with
slab using a plastic or metal spatula to achieve putty like paste
their trade name and manufacturer are summarised in Table 1.
consistency. This mix should be cover with moistened cotton
Composition and Manipulation pellet to prevent dehydration of mix.
of Mineral Trioxide Aggregate (MTA) 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
MTA is available in two types based on the color known as
almost similar to calcium hydroxide. Sluyk et al.(1998)[5] suggested
gray and white MTA. Scanning electron microscopy (SEM) and
that mixing time should be less than 4 minute. Torabinejad et al.
electron probe microanalysis characterized the differences between
(1995)[8] found setting time about 2 hours and 45 minutes (±
GMTA and WMTA and found that the major difference between
5 minutes) of grey MTA, similar research done by Islam et al.,
GMTA and WMTA is in the concentrations of Al2O3, MgO and

Access this article online Table 1: List of commercially available MTA

Quick Response Code: Trade name Manufacturer
Website:
ProRoot MTA Dentsply Tulsa Dental, Johnson City, USA
www.jorr.org
White ProRoot MTA Dentsply Tulsa Dental, Johnson City, USA
MTA-Angelus (Grey) Angelus, Londrina, Brazil
DOI: MTA (White) Angelus, Londrina, Brazil
10.4103/2249-4987.152914 MM MTA MicoMegha, Besancon, France
Ortho MTA BioMTA, Seoul, Korea
Retro MTA BioMTA, Seoul, Korea
Address for correspondence: EndoCem MTA Maruchi, Wonju, Korea
Dr. Chirag Macwan, MTA Plus Avalon Biomed, Bradenton, USA
Department of Pedodontics and Preventive Dentistry, K. M. EndoCem Zr Maruchi, Wonju, Korea
Shah Dental College and Hospital, Sumandeep Vidyapeeth, EndoSeal Maruchi, Wonju, Korea
Vadodara - 391 760, Gujarat, India.
MTA Fillapex Angelus, Londrina, Brazil
E-mail: chiragmacwan@yahoo.co.in

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Macwan and Deshpande: Mineral trioxide aggregate (MTA)

Table 2: Chemical compositions of GMTA and WMTA Radio-opacity

[Adapted from Asgary et al. (2005)] Ding SJ (2008)[12]& Shah PMN (1996)[13] found that MTA has
comparable radiodensity as Zinc Oxide Eugenol and it is less
Chemicalcompound GMTA (wt%) WMTA (wt%)
Calcium oxide (CaO) 40.45 44.23
radio opaque than Super EBA, IRM, gutta-percha or amalgam.
Silicon dioxide (SiO2) 17.00 21.20 Torabinejad M (1995)[8] concluded that the mean radio opacity of
Bismuth trioxide (Bi2O3) 15.90 16.13 MTA is 7.17 mm of equivalent thickness of aluminium, which is
Aluminium oxide (Al2O3) 4.26 1.92 adequate to make it easy to visualize radiographically.
Magnesium oxide (MgO) 3.10 1.35
Sulfur trioxide (SO3) 0.51 0.53
Solubility
Chlorine (Cl) 0.43 0.43
The set MTA shows no signs of solubility. But, if more water
Ferrous oxide (FeO) 4.39 0.40 is used during mixing the MTA it may results into increased
Phosphorus pentoxide (P2O5) 0.18 0.21 solubility. Buding (2008)[14] found that the set MTA when exposed
Titanium dioxide (TiO2) 0.06 0.11 to water it releases calcium hydroxide (CaOH2). CaOH2 might
Carbonic acid (H2O+CO2) 13.72 14.49 be responsible for its cementogenesis-inducing property. During
setting reaction if mix is exposed to acidic environment it does
2006 suggested that initial setting time about 2 hours and 55 not interfere in the setting.[15]
minutes and 2 hours and 20 minutes for grey MTA and white Marginal adaptation and sealing ability
MTA, respectively. MTA being hydrophilic requires moisture to Bates et al. (1996)[16] found that MTA is superior to the other
set. Presence of moisture during setting improves the flexural traditional root-end filling materials. According to Shipper et al.
strength of the set cement.[6] Therefore, it is advised to place (2004)[17] and Torabinejad et al. (1995)[18] explained that MTA has
a wet cotton pellet over the MTA in the first visit followed by excellent sealing ability which may occur because MTA expands
replacement by a permanent restoration at the second visit. The during setting reaction. In presence of moist environment
long setting time is one of the drawbacks of MTA because of it sealing ability of MTA is enhanced due to the setting expansion
should not be applied in 1 visit. Inter-appointment moist cotton so it is been suggested that a moistened cotton pellet should be
palate is required till the final setting of MTA. placed in contact with MTA before placement of the permanent
restoration. Valois et al. (2004)[19] found that about 4-mm
MTA powder must be kept tightly closed to avoid degradation
thickness of MTA is sufficient to ensure a good sealing.
by moisture. The mixing time is critical as, if the mixing time
is prolonged; it results in dehydration of the mix. Torabinejad Antibacterial and antifungal property
and Chivian (1999)[6] advocated that after mixing, the mix Al-Hazaimi et al. (2006)[20] stated that MTA has antibacterial
should be cover with moistened cotton pellet because if it is left effect especially against Enterococcus faecalis and Streptococcus sanguis.
open it undergoes dehydration and dries into a sandy mixture. But, according to Torabinejad et al. (1995)[21] MTA showed no
MTA may be placed into the desired location using ultrasonic antimicrobial action against any of the anerobes. But it did show
condensation, plugger, paper point or specially designed carriers certain effect on facultative bacteria.
and messing gun. Aminoshariae et al. (2003)[9] compared hand
condensation and the ultrasonic method and found that a Reaction with other dental materials
better adaptation of MTA to the walls with less voids in hand Nandini S et al. (2006)[22] found MTA does not react or interfere
condensation compared to the ultrasonic method. Lawley et al. with any other restorative material. When GIC or composite
(2004)[10] concluded that after 90 days, the ultrasonically placed resins placed over MTA it doesn’t affects the setting reaction.
MTA followed with composite provided a significantly better Srinivasan V et al (2009)[3] stated that residual calcium hydroxide
MTA seal compared with the hand condensation. Nekoofar et al. may interfere with the adaptation of MTA to dentinal wall.
(2007)[11] compared the method and pressure of condensation This results in reduced sealing ability which occurs either by a
and found that condensation pressure may affect the strength mechanical obstacle of CaOH2 particle by chemically reaction
and hardness of MTA. with MTA.

Chemical, Physical, and Mechanical Biocompatibility

Properties of MTA Kettering and Torabinejad (1995)[23] compared MTA with Super
EBA and IRM and found that MTA is not mutagenic and less
Compressive strength cytotoxic. Sumer et al. (2006)[24] concluded that MTA is well
Torabinejad M, et al. (1995)[8] studied physical properties of MTA tolerated by the tissues and biocompatible. Arens and Torabinejad
and found that compressive strength at 24 hours 40.0 MPa and (1996)[25] treated furcation perforations and osseous repair with
at 21 days 67.3MPa; and in comparison between GMTA and MTA. Pelliccioni et al. (2004)[26] evaluated osteoblast-like cell
WMTA result showed that compressive strength of Gray MTA response to MTA and result showed MTA has good interaction
> White MTA. with periapical and periradicular tissues. MTA has potential effect

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Macwan and Deshpande: Mineral trioxide aggregate (MTA)

on cell viabilities collagen release mechanism. Koh et al. (2001)[27] 2. In Permanent teeth:
concluded that property of MTA to produce interleukin and also i. Pulp capping[2,29]
offers a biologically active substrate for bone cells. ii. Partial pulpotomy[35]
iii. Perforation repair - Apical, lateral, furcation[29]
Tissue regeneration iv. Resorption repair - External and internal[29]
Torabinejad et al. (1995)[28] concluded that MTA is potential to v. Repair of fracture - Horizontal and Vertical
activate the cementoblasts and eventually cementum production. vi. Root end filling[22]
MTA also allows the overgrowth of PDL fiber over its surface. vii. Apical barrier for tooth with necrotic pulps and open
Schwartz et al. (1999)[29] reported that MTA helps in elimination apex[10,22,37]
of clinical symptoms bone healing. These properties of MTA viii. Coronal barrier for regenerative endodontics[38]
determine it as a potential regenerative material. ix. Root canal sealer[39]
Mineralization Conclusion
Myers K (1996)[2] determined that MTA, similar to calcium
hydroxide (CaOH 2), induces formation of dentin bridge. Considering the present literature review, MTA is an excellent
According to Holland et al. (1999) [30] theorized that the biocompatible material. MTA has various exciting clinical
tricalcium oxide content of MTA interacts with tissue fluids applications as it has numerous qualities mandatory for an ideal
and form CaOH2, resulting in hard-tissue creation in a similar dental material. MTA required to be further explored by clinicians
manner to that of CaOH2. Faraco et al. (2001)[31] concluded so that its advantageous properties can be practiced.
that the dentin bridge formed with MTA is relatively faster,
with good structural integrity than with CaOH2. According to References
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Prophylactic treatment of dens evaginatus using mineral trioxide How to cite this article: Macwan C, Deshpande A. Mineral trioxide
aggregate. J Endod 2001;27:540-2. aggregate (MTA) in dentistry: A review of literature. J Oral Res Rev
28. Torabinejad M, Hong CU, Lee SJ, Monsef M, Pitt Ford TR. 2014;6:71-4.
Investigation of mineral trioxide aggregate for root-end-filling in dogs. Source of Support: Nil, Conflict of Interest: None declared.
J Endod 1995;21:603-8.

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