Mineral Trioxide Aggregrate seminar

Mineral Trioxide Aggregate
GUIDED BY:
DR.RAHUL MARIA
PRESENTED BY:
DR. ANUBHUTI
PG 3rd year student

CONTENTSIntroduction 4
Types 7
Composition 112
Mechanism of action 15
Indications 19
Contraindications 21
Advantages 22
Disadvantages 24
Manipulation 25
Clinical Applications 32
Chemical properties 59
Physical Properties 66
Leakage and Biocompatibility Investigations 89 2

pthways of pulp by cohen 9th edition ,JOE-
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3

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4

MTA has been recognized as a bioactive material
that is
Hard tissue
conductive,
Hard tissue
inductive,
Biocompatible
5
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Types
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6

MTAiscurrentlymarketed
Gray (GMTA)
White (WMTA).
MTA –Angelous
7
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Other Types of MTA
Angelus
MTA
(AMTA) –
from Brazil
both white
and gray
(AGMTA &
AWMTA)
Egeo (CPM)
– from
Argentina, in
white form
MTA
Bio
Light
cured
MTA
MTA root
canal
sealer –
CPM sealer
(Egeo)
MTA
obtura
(Angelus)
8
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9

MTA was introduced in gray, but
because of the discoloration
potential of GMTA, WMTA was
developed .
10
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VARIATION
• A variation of the original formula was
introduced and the material was white cream
Colour, often called as White MTA
• absence of significant FeO in white MTA is
most likely cause the change in color from
gray to white.
pthways of pulp by cohen 9th edition ,JOE- Vol 36, No.1, 11

COMPOSITION
12
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MTA powder
contains fine
hydrophilic
particles that set
in the presence
of moisture
13
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The material is primarily derived from calcium
oxide(50-75%) ,silicon dioxide (15-25%) raw materials
are grind and clinkered in a kiln to produce
Dicalcium
silicate
Tricalcium
silicate
Tricalcium
aluminate
Tetracalcium
aluminate
pthways of pulp by cohen 9th edition ,JOE- Vol 39, 747-754, Feb206
14
WMTA is primarily composed of tricalcium silicate and bismuth oxide

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15
Powder
 Tri-calciu Silicate (C3S) - Main core material
 Di-calcium Silicate (C2S)- Second core material
 Calcium Carbonate and -Oxide- Filler
 Iron Oxide -Shade
 Zirconium Oxide -Radiopacifier
Liquid
 Calcium chloride Accelerator Hydro soluble polymer
 Water reducing agent

16
MTA and Bio-Aggregate show similar chemical
composition with some differences
VS
Tantalum oxide Bismuth oxide

17
MTA
(GRAY MTA)
PORTLAND
CEMENT
75%;SETTING AND BIOLOGIC
PROPERTIES
CALCIUM
SILICATE
BISMUTH
OXIDE
20% its added to the aggregate
to make it radiopaque. 20%
CALCIUM
CARBONATE
CALCIUM
SULPHATE
CALCIUM
ALUMINATE

18
(GREY MTA)
75% of MTA
(WMTA)
Ca O -65%••
SiO2-21%
Fe2O3 -5% LOWER AMOUNTS
Al2O3 -4% LOWER AMOUNTS
Mg O -2% LOWER AMOUNTS
Alkalies
(Na2O,K2O)- 0.5%

19
(GRAY MTA) (WHITE MTA)
Composition dicalcium and tricalcium silicate and
bismuth oxide
primarily composed of
tricalcium silicate and bismuth
oxide
Crystal size 8 times larger than WMTA Smaller particles with narrower
size distribution (8 times
smaller than that of GMTA)
Greater compressive strength
Produces 43% more hydroxyapatite crystals
than WMTA in an environment with PBS
(phosphate- buffered saline
Induced dentin formation more efficiently
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To improve MTA’s setting time,
many investigations have
described MTA preparations
with various additives .
5% calcium chloride (CaCl2) or
sodium hypochlorite (NaOCl)
gel in place of water when mixing
MTA to be used in single-visit
endodontic procedures.
]0E 11 Volume 41, Number 1, january 2015

Energy
dispersive
analysis
with x-ray
EDAX),
Inductively
coupled
plasma
optical
emission
spectroscop
y (ICP-OES),
X-ray
diffraction
analyses
(XRD),
X-ray
fluorescence
spectromet
ry (XRF),
Energy x-
ray
spectrometry
Energy
dispersive
spectrosc
opy
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Various methods have been used to examine MTA composition

22
INDICATIONS
In Apexification
Perforation repair
For Hard tissue barrier, after crown fracture
For Retrogade obturation
Pulp capping agents
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INDICATIONS
For Root end filling material
In Vital pulp therapy
Pulpotmy agent in primary teeth
In Cvek pulpotomy in young permanent teeth
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The material is not recommended
for obturation of primary teeth that
are expected to exfoliate since the
material is slowly absorbed, if at all.
Contraindication
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Advantages
Least
cytotoxic
compared to
other
materials
Sets in the
presence of
moisture
Excellent
sealing
properties
Versatile
applications
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High
Biocompatible
Facilitates
regeneration
of periodontal
ligament.
Induces
cementum
apposition
Has
dentinogenic,
osteogenic
potential
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Disadvantages
Material cost
Technique sensitive requires operator expertise
Delayed setting time.
Irreversible application
Endodontics ,JOE- Vol 36, No.1, Feb2010 27

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Mixing anesthetic solution
with MTA powder
increases its setting time
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MTA is prepared by mixing its powder
with sterile water in a 3:1 powder-to-
liquid ratio
30pthways of pulp by cohen 9th edition ,JOE-

Setting Time
2 hours 45 min – 4 hours

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Biodentine™ 9 to 12 minutes
Due to calcium chloride as acclerator
Hydrosoluble polymer (water reducing
agent)

MICRO BALL BURNISHER &
CONDENSOR
34
placing MTA in 1 visit without
external moisture is not
recommended.
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Effect of the Method of Placement on
MTA Physical Properties
Various
carriers have
been used to
enhance the
ease of
handling,
including
Teflon sleeves
and pluggers
specially
designed for
placement of
MTA
specially
designed carriers
for dispersing
MTA,and
scooping out
MTA from
grooves in a
plastic block and
a Messing gun-
type syringe
MAP SYSTEM
Ingle’s 6th edition pg no 1124 ,
35

38
DIRECT PULP CAPPING
Ingle’s 6th edition .pg no 859-860,The use of Mineral Trioxide Aggregate in clinical and surgical
endodontics.Arnaldo Castellucci, MD, DDS

Initial deep caries and
immature apices
Pulpal
exposure
39
The use of Mineral Trioxide Aggregate in clinical and surgical
endodontics.Arnaldo Castellucci, MD, DDS

40
Five-minute application of 5.25% sodium hypochlorite
hemostasis, on two 1.5- to 2.0-mm exposures
gle’s 6th edition pg no 859-860,The ,The use of Mineral Trioxide Aggregate in clinical and
rgical endodontics.Arnaldo Castellucci, MD, DDS

41
The cotton pellet provides the moisture for a proper set. Due to its hygroscopic
nature, Cavit absorbs water and can be inflammatory to the vital pulp and
therefore should not be used as a temporary filling material in vital teeth.
1-1.5 mm thick layer of freshly mixed MTA is placed over the exposed pulp; a wet
thinned, flattened cotton pellet is placed over it.
Once MTA has been placed, no further irrigation can be accomplished, since the
unset MTA can be easily washed off.
ngle’s 6th edition pg no 859-860,The use of Mineral Trioxide Aggregate in clinical and surgical

42
The patient should return one week later for final
restoration. At that time, the temporary and cotton
pellet should be removed and vitality reassured.
Light cured photocore, IRM, or other suitable
material is used for temporization
he use of Mineral Trioxide Aggregate in clinical and surgical endodontics.Arnaldo Castellucci,
D, DDS

Radiograph of molar with MTA after
initial visit
Radiograph taken at the recall appointment
showing permanent restoration and
evidence of complete root formation.
(From Bogen G, Kim JS, Bakland LK: Direct pulp capping with mineral trioxide aggregate. An
observational study. J Am Dent Assoc 139:305-315, 2008. 43

PERFORATION REPAIRS IN ROOTS OR FURCATIONS
44

It is described by C.Bargholz for
perforation repair with MTA in an article
published in 2005.Freshly mixed MTA has
a soft consistency and may be applied
without pressure.
Small pieces of Collagen (Kollagen-
Resorb; Resorba, Nuremberg, Germany.)
are used to push the granulation tissue
out of the perforation and keep it in place
outside the root.
45

MTA may be layered against the collagen until the
perforation is repaired. For this process no pressure is
required at any time due to the consistency of the
material.
Direct observation of the material site through
the operating microscope is very helpful to
avoid inadvertent blockage of the still empty
root canal space with MTA to confirm correct
placement of the repair material.
46

Following application of the
collagen the sealed perforation
and the newly accomplished
reconstruction of the root surface
are monitored radiographically.
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Inadequate
sealing of the
defect
Extrusion of the
repair material
Inadequate
material
biocompatibility.
pthways of pulp by cohen 9th edition 48
Difficulties encountered when repairing
furcation perforations include

A characteristic that differentiates MTA
from other materials is its ability to
promote regeneration of cementum,
despite its extrusion in to the
periradicular tissues, thus facilitating
regeneration of periodontal apparatus.
pthways of pulp by cohen 9th edition 49

In some cases granulation tissue may
have grown in to the perforation. This
granulation tissue must be displaced
from the perforation to allow exact
reconstruction of the root surface.
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Lemon et al (1992) introduced the “internal matrix
concept” for treatment of root perforations.
He recommended the use of amalgam for sealing the
perforation, which would be condensed against an
external matrix of hydroxyapatite, carefully pushed
through the perforation thus serving as an external
barrier of matrix.
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In teeth with incomplete root end and necrotic pulps, the
root canals must be completely debrided. Because of a lack
of apical seal and the presence of thin and fragile walls in
these teeth, it is imperative to perform apexification to
obtain an adequate apical seal.
52
APEXIFICATION
he use of Mineral Trioxide Aggregate in clinical and surgical endodontics.Arnaldo Castellucci,
D, DDS

53
After application of the rubber dam and
preparation of an adequate access cavity, the
root canal system should be cleansed with
copious irrigation using sodium hypochlorite
(which can be delivered ultrasonically for
enhanced activation).
The root canals require only minimum
shaping, and because of their size and the
thinness of the dentinal walls, they need to be
cleansed more than shaped in order not to
increase fragility.

54
To improve
disinfection of the
canals, an intracanal
medication is used
with calcium
hydroxide for one
week.
After rinsing calcium
hydroxide from the root
canal with irrigation and
drying with paper points,
the MTA powder is mixed
with saline or sterile water
and the mixture is carried
to the apical area with the
pre-fitted Dovgan carrier
th

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After completion, the extension of the apical plug is checked radiographically. If
the apical plug is not satisfactory, the MTA is removed via saline solution
irrigation, and the filling procedure is repeated
The thickness of the apical plug must be 3-4 mm. In order not to have voids,
the use of ultrasonics is suggested (while slightly condensing the MTA with the
plugger, the assistant is asked to touch the plugger with the ultrasonic tip.
MTA must be positioned exactly at the foramen, as the material must be in
direct contact with periapical tissues. Overfilling should be avoided.

56
When the radiographic
appearance looks ideal, a wet
paper point is placed in direct
contact with the MTA and the
access cavity is closed with a
temporary seal, and allowed
to set for 3-4 hours.
At the next visit the rubber
dam is placed, the temporary
seal and paper point are
removed, the hardness of the
material is checked, and then
root canal therapy is
completed by filling the root
canal with warm gutta-percha
th

57
As stated previously, the use of the operating microscope is essential in
these cases
If the canal walls appear to be thin and fragile, it has been suggested that
the rest of the root canal be completely filled with adhesive composite
resin (without using gutta-percha) to strengthen the root structure.
Ingle 6th edition The use of Mineral Trioxide Aggregate in clinical and surgical endodontics.Arnaldo Castellucci, MD, DDS

Root end filling
58
After the preparation of the root end has been
completed with ultrasonic instruments, the MTA is
placed with a carrier and gently compacted with a
small plugger.
The best instruments for this purpose include the
use of amalgam carriers like the Messing gun, or
the new Dovgan MTA carriers which are straight,
bendable, or pre-bent .
Ingle 6th edition The use of Mineral Trioxide Aggregate in clinical and surgical

59
Another method of comfortably
carrying MTA into the cavity is by using
a carrier described by Edward Lee The
material remains attached to a small
spatula.
This method has the advantage of being
less cumbersome and therefore
allowing easier access even to small
cavities on posterior teeth, without the
long wait necessary for the mixing and

60
The material should be kept
relatively dry so it does not readily
flow, yet moist enough to allow
manipulation and a workable
consistency.
If the assistant touches the plugger
with an ultrasonic tip during the
placement process, voids are
eliminated, the density of the fill is
better, and radiopacity is increased.

CHEMICAL PROPERTIES
61
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MTA powder
is mixed
water
calcium hydroxide
(CH) and calcium
silicate hydrate are
initially formed and
eventually transform
into a poorly
crystallized and
porous solid gel
62

The ratio of
calcium silicate
drops because
of the formation
of a calcium
precipitate.
The precipitated
calcium produces
CH, which is the
cause of MTA’s high
alkalinity after
hydration
63

The production source for CH is a matter of controversy.
Camilleri believed CH is formed from dicalcium and
tricalcium silicate after mixing MTA powder with
water
Dammaschke et al
reported
CH is a product of tricalcium aluminate
hydrogenation.
64
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Bismuth affects CH precipitation after MTA hydration .
Because bismuth oxide dissolves in an acidic
environment, it has been suggested that placing MTA in
an acidic environment such as inflammatory tissues
might result in the release of bismuth oxide.
This might decrease MTA’s biocompatibility because
bismuth oxide does not encourage cell proliferation in
cell culture
65
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In 2005Dammaschke et al reported that the
amount of sulfur at the surface of set MTA is times
higher than the powder forms of MTA, and that
this layer protects the cement from further
hydration and increases the cement’s setting time.
66
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Physical Properties
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Flexural Strength
Torabinejad and Chivian recommended
placing a wet cotton pellet over GMTA
when it is used for perforation repair,
pulp capping, or an apical plug.
Two-sided moisture, as has been
recommended , showed
significantly more flexural
strength after 24 hours
68hways of pulp by cohen 9th edition ,JOE-

On the basis of limited literature, it
appears that placing a moist cotton
pellet over MTA for the first 24
hours increases its flexural strength.
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Setting Expansion
WMTA
expands
slightly more
than GMTA
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SOLUBILITY
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72
The addition of
bismuth oxide to
MTA, which is
insoluble in water
cause for MTA
insolubility
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Compressive Strength
The compressive strength of MTA is significantly less than
that of amalgam, IRM, and Super EBA after 24 hours.
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One study reported that
compressive strength of WMTA at 3
and 28 days after mixing is
significantly less than that of GMTA
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Another recent experiment revealed that
keeping WMTA in dry conditions
decreases its compressive strength
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A recent investigation reported significantly
lower compressive strength for WMTA when the
material was etched by phosphoric acid (37%).
The investigators suggested that restoration
with acid-etch composite after MTA placement
should be postponed for at least 96 hours
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The push-out strength of perforation repair materials is an important
factor because shortly after perforation repair, tooth function might
dislodge the material.
MTA has lower push-out strength in comparison with IRM or Super
EBA after immersion in walking bleach materials
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PUSH-OUT STRENGTH

BOND STRENGTH WITH OTHER DENTAL
MATERIALS
An in vitro study investigated dentin-bond strength of MTA after
immersion in 5.25% NaOCl and 2% chlorhexidine (CHX) and
Glyde file preparation for 2 hours. Results of the study showed
that Glyde file preparation significantly decreased bond strength
between dentin and MTA;
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RETENTIVE STRENGTH
MTA is not a suitable luting
agent.
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DISPLACEMENT
4-mm thickness of the
apical barrier offers
significantly more
resistance to displacement
than 1-mm thickness.
This suggests that the
thickness of MTA directly
affects its displacement
when used as an apical
barrier.
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pH
The pH value
of MTA is 10.2
after mixing.
value rises to
12.5 at 3 hours
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81

RADIOPACITY
The mean radio-pacity for
MTA has been reported at
7.17mmof an equivalent
thickness of aluminum .
This value is higher than
that reported for Super
EBA or IRM
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82

PARTICLE SIZE
Lee et al reported particle
sizes ranging from 1–10
mm for GMTA powder
WMTA has finer particles
than GMTA
pthways of pulp by cohen 9th edition ,JOE- 83

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84
The physical properties
of cement might be
influenced by crystal
size.
Smaller particles
increase surface contact
with the mixing liquid
and lead to greater early
strength as well as ease
of handling.

POROSITY
The amount of porosity in mixed
cement is related to the amount of
water added to make a cement paste,
entrapment of air bubbles during the
mixing procedure, or the
environmental acidic pH value
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85

Micro hardness
The micro hardness of MTA can be influenced by several factors such
as the pH value of the environment, the thickness of the material,
the condensation pressure, the amount of entrapped air in the
mixture, humidity, acid etching of the material, and temperature
An acidic environment has an adverse effect on the microhardness
of both GMTA and WMTA
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86

Leakage and Biocompatibility
Investigations
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87

One of the most important
criteria for an ideal
endodontic material is its
sealing ability and marginal
adaptation
The sealing ability of original
mineral trioxide aggregate
(MTA), other types of MTA, and
its new compositions has been
tested by leakage studies
,JOE- Vol 36, No.1, Feb2010 88

Dye fluid filtration
bacteria and
bacterial by-
products
scanning
electron
microscopy
(SEM)
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89

Dye Leakage
Methylene
blue
Fuchsin Rhodamine
B
Silver
nitrate
India ink Pelikan
ink.
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90

Results from most of these investigations indicated that
MTA exhibits significantly less dye leakage in comparison
with Super EBA, amalgam and intermediate restorative
material (IRM)
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91

 MTA is one of the most resistant root-end filling materials
to dye penetration.
 Different factors influence MTA leakage. They include
thickness of the dentinal wall ,the dye pH, the type of dye,
pretreatment with chelating agents, the tooth storage
environment before the experiment, and the setting status
of MTA before its placement in the dyepthways of pulp by cohen 9th edition ,JOE-
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Fluid Filtration.
 Fluid filtration investigations showed the
superiority of MTA compared with
amalgam and Super EBA
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93

Protein Leakage
• On the basis of limited available data and using
protein as a tracer, it appears that a thin layer of
MTA and acidic conditions adversely influence the
leakage of MTA to protein leakage.
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Bacterial Penetration.
MTA is more resistant to bacterial
penetration than amalgam
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95

Leakage of MTA as a Perforation
Repair Material
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96

Dye Leakage Investigations
 Gray MTA (GMTA) has superior sealing ability as a perforation
repair material compared with Vitrebond (a modified GIC) ,
Cavit W, and tricalcium phosphate in conjunction with AH26
 Most studies showed that MTA is resistant to dye penetration
when used as a perforation repair material.
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Fluid Filtration.
 Fluid filtration investigations showed the
WMTA partially dissolves when it remains
in contact with BioPure MTAD for 5
minutes
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98

Bacterial Leakage
MTA has been
shown to be
superior to
amalgam
when challenged by
a bacterial leakage
model using
Fusobacterium
nucleatum
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99

Leakage of MTA as a Coronal Plug
Material
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100

Two bacterial leakage investigations
compared WMTA and GMTA with
Fuji II and Fuji Triage glass ionomer
as a coronal plug and reported no
significant difference among the
tested materials
However, a dye comparison of GIC
and GMTA as an orifice plug showed
that GMTA is more resistant to
dye penetration than GIC
Vol 36, No.1, Feb2010 101

Leakage of MTA as an Apical Plug
Material
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102

Traditionally, Apexification with CH has been the treatment of
choice for teeth with necrotic pulps and open apexes .
Generally, it is accepted that treatment time is too long, takes more
visits, costs more, and increases the susceptibility of the tooth to
fracture
In addition, the patient might experience periradicular necrosis
after CH therapy
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103

Dye Leakage Investigations
 Inserting GMTA as an apical barrier and
obturating the rest of the canal space later with
gutta-percha improve resistance to dye
penetration.
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Fluid Filtration.
 Teeth whose root canals were filled
completely with WMTA leaked significantly
less after 48 hours.
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Bacterial Leakage
The method of
insertion might play an
important role in
bacterial penetration
when MTA is used as
an apical barrier.
Ultrasonic placement
resulted in a significant
reduction of bacterial
penetration after 45
days
lower E. faecalis
penetration after use
of MTA as an apical
barrier with ultrasonic
activation
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Leakage of MTA as a Root Canal
Filling Material
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107

Vizgirda et al compared
lateral condensation,
thermoplasticized gutta-
percha, and MTA as root
canal filling materials in
bovine teeth.
Both gutta-percha
obturation techniques
showed less methylene
blue penetration than MTA
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108

There are 3 important differences between the
methods of these studies.
These studies used different methods (dye, bacteria, saliva for leakage evaluation )
There are many investigations that have questioned the similarity of human and bovine
teeth in terms of dye leakage dentin tubule size and diffusion of cations and liquids
Use of lentulo spiral for MTA placement, which has not been previously recommended
for MTA placement
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Fluid Filtration.
 Showed less leakage after 48 hours when
WMTA was used as a root canal filling
material compared with an apical plug and
gutta-percha insertion
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110

MTA can be used as a root canal filling
material .Clinicians should be aware of
some of its limitations such as
difficulty in controlling the
length of the filling, the chance
of producing voids, and the
absence of a known solvent for
MTA removal.
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Marginal Adaptation of MTA
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112
MTA has shown better marginal adaptation
than IRM, Super EBA , amalgam, and GIC

Leakage Studies and Marginal
Adaptation of Other Types of MTA
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113
Dye leakage study compared Angelus MTA (AMTA), zinc-free
amalgam, Vitremer (a resin-modified GIC), and Super EBA
The results showed that AMTA presented the best seal
among all of the tested materials.

However, the major drawback for this study was use of
methylene blue dye for assessing leakage of the materials
Another investigation compared AWMTA and WMTA as
apical barrier for open apex teeth. Results showed no
significant difference in dye penetration .
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Leakage Studies and Marginal Adaptation of
New Compositions of MTA
Pelliccioni et al compared WMTA mixed with sterile water as
recommended or dry MTA for filling root-end preparations
Investigations showed better results when MTA is mixed with
10% CC rather than with sterile water.
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Biocompatibility
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Mutagenicity
Results of this study determined that MTA is not mutagenic.
The Ames mutagenicity test was used to assess the mutagenicity
of MTA . This test uses strains of Salmonella typhimurium LT-2,
which are sensitive to various classes of mutagens.
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Neurotoxicity and Neurologic Effects
Results showed that all of the materials except MTA are toxic
in either freshly mixed or set conditions
With murine cerebral cortical cells, neurotoxic effects of MTA,
Diaket, amalgam, and Super EBA were compared on both glial
and neuronal cultures.
Vol 36, No.1, Feb2010
118

Vascular Effect
MTA is non mutagenic and non-neurotoxic and does
not produce a side effect on microcirculation, despite
the fact that it can influence a vessel’s contraction.
Vol 36, No.1, Feb2010
119

Human Study
Min et al capped human third molar pulps with MTA or
Dycal and examined dentin bridge formation, expression
of DSP, andheme oxygenase-1 in the dental pulp.
Results indicated the presence of significantly more
positive immunostaining in the MTA group than in the
Dycal group for DSP and heme oxygenase-1.
Vol 36, No.1, Feb2010
120

These studies showed that
subcutaneous responses to MTA
range from necrosis to dystrophic
calcification.
In addition, at first, MTA produces
a moderate to severe
subcutaneous response, which
subsides at longer time intervals
Vol 36, No.1, Feb2010
121

REFERENCES
Vol 36, No.1, Feb2010
122
Clinical Applications of MTA in Endodontics.
The use of Mineral Trioxide Aggregate in clinical and surgical endodontics.Arnaldo Castellucci, MD, DDS
Mineral Trioxide Aggregate: A Comprehensive Literature Review—Part I: Chemical, Physical, and Antibacterial
Properties. Parirokh and Torabinejad JOE — Volume 36, Number 1, January 2010
Mineral Trioxide Aggregate: A Comprehensive Literature Review—Part II: Leakage and Biocompatibility
Investigations. Parirokh and Torabinejad JOE — Volume 36, Number 2, February 2010
Mineral Trioxide Aggregate: A Comprehensive Literature Review—Part III: Clinical Applications, Drawbacks, and
Mechanism of Action.Parirokh and Torabinejad .JOE — Volume 36, Number 3, March 2010
X-ray diffraction analysis of MTA-Plus, MTA-Angelus and DiaRoot BioAggregate.Guven, et al.European Journal of
Dentistry, Vol 8 / Issue 2 / Apr-Jun 2014
Periapical Tissue Responses and Cementum Regeneration with Amalgam, SuperEBA, and MTA as Root-End Filling
Materials.JOE—Volume 31, Number 6, June 2005

REFERENCES
123
he Composition and Biologic Actions of Mineral Trioxide Aggregate: A Review.Toptancı İR et al.Konuralp Tıp Dergisi 2013;5(2):70-74
linical long-term evaluation of MTA as a direct pulp capping material in primary teeth. Tuna & O¨ lmezInternational Endodontic Journal,
1, 273–278, 2008
Mineral trioxide aggregate material use in endodontic treatment: A review of the literature.Howard W. Robertsa et al dental materials 2 4
2 0 0 8 ) 149–164
Mineral trioxide aggregate: a review of the constituents and biological properties of the material.Camilleri & Pitt Ford .International
ndodontic Journal, 39, 747–754, 2006
eriapical Tissue Responses and Cementum Regeneration with Amalgam, SuperEBA, and MTA as Root-End Filling Materials.JOE—Volume
1, Number 6, June 2005
isinfection of Immature Teeth with a Triple Antibiotic Paste.JOE — Volume 31, Number 6, June 2005
NGLE’S 6TH edition
athways of cohen 6th,9th ,13th edition
extbook of endodontics Anil kohli’s

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