Comments on "arsenic release provided by MTA and Portland cement" by Duarte MA, et al.
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Aluminum Compounds↗
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Evaluation of tissue response to MTA and Portland cement with iodoform.
OBJECTIVE: The aim of this study was to evaluate the biocompatibility of Portland cement with the addition of iodoform, compared to MTA (ProRoot). STUDY DESIGN: Eighteen Wistar albino rats were divided into 3 groups of 6 animals each. Polyethylene tubes were filled either with freshly mixed MTA or Portland cement mixed with iodoform (20% wt/wt) and implanted subcutaneously. An empty tube served as control. After 7, 30, or 60 days, the implants together with the surrounding tissues were removed in blocks. Sections were evaluated for the presence and thickness of a fibrous capsule, presence of granulation tissue, and the severity of inflammatory response. Data were submitted to nonparametric statistical analysis with individual comparisons between groups at a significance level of P < 0.05. RESULTS: There were no differences between inflammatory responses at 7 and 30 days. After 60 days from surgical removal, there was significantly more tissue reaction to the MTA and Portland cement compared to the control group. CONCLUSION: There were no significant differences regarding inflammatory responses between MTA and Portland cement with iodoform after 7, 30, or 60 days. After 60 days, the fibrous capsule around the Portland cement appeared more organized than tissue surrounding MTA implants. After 60 days, there was still a significantly increased tissue reaction to the 2 cements compared to the empty polyethylene tubes.
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Tissue reaction to implanted super-EBA and mineral trioxide aggregate in the mandible of guinea pigs: a preliminary report.
In vitro sealing ability and biocompatibility tests on mineral trioxide aggregate (MTA) have shown similar or better properties for this material than for existing root-end filling substances. The purpose of this study was to examine the tissue reaction of implanted Super-EBA and MTA in the mandibles of guinea pigs. After anesthetizing seven guinea pigs, raising a tissue flap and preparing two bony cavities, the test materials were placed in Teflon cups and implanted in the mandibles. Two bony cavities without implanted materials were left to heal and used as negative controls. The presence of inflammation, predominant cell type, and thickness of fibrous connective tissue adjacent to each implant was recorded. The tissue reaction to MTA implantation was slightly than that observed with Super-EBA implantation. Based on these results , it seems that both Super-EBA and MTA are biocompatible.
Aluminum Compounds↗
Investigation of mineral trioxide aggregate for root-end filling in dogs.
Numerous compounds have been used as root-end filling materials. Based on the results of in vitro and intraosseous implantation tests, mineral trioxide aggregate (MTA) seems to have potential as a root-end filling material. The purpose of this study was to examine the periradicular tissue response of dogs to MTA and amalgam. Lesions were developed in periradicular tissues of 46 roots in six beagle dogs. The canals on half of the roots were instrumented and obturated with gutta-percha and sealer, and their access cavities were sealed with MTA. The remaining root canals were instrumented and obturated with gutta-percha and sealer, and their access cavities were sealed with MTA. The remaining root canals were instrumented and obturated with gutta-percha without root canal sealer. The access cavities of the teeth in this group were left open to the oral cavity. After surgical resection of roots, half of the root-end cavities were filled with amalgam and the rest with MTA. The periradicular tissue response of the dogs was evaluated histologically 2 to 5 and 10 to 18 wk following periradicular surgery. Statistical analysis of the results showed less periradicular inflammation and more fibrous capsules adjacent to MTA, compared with amalgam. In addition, the presence of cementum on the surface of MTA was a frequent finding. The results show that MTA can be used as a root-end filling material.
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Longitudinal sealing ability of mineral trioxide aggregate as a root-end filling material.
This study evaluated the ability of mineral trioxide aggregate (MTA) to seal the root end effectively. Seventy-six single-rooted, extracted human teeth were cleaned and shaped using a step-back technique. After root-end resection and ultrasonic preparation, 72 root sections were randomly allocated to three groups and filled with dental amalgam and cavity liner, Super-EBA, or MTA. Microleakage was assessed at 24 h, 72 h, 2 wk, 4 wk, 8 wk, and 12 wk, using a fluid filtration measurement system. MTA demonstrated excellent sealing ability throughout 12 wk of fluid immersion, comparable with that observed for Super-EBA. Microleakage in the MTA group, as well as the Super-EBA group, was significantly less (p < 0.05) than in the amalgam group at 24 h, 72 h, and 2 wk. At the subsequent periods, there were no significant differences among the three materials. In this study, MTA was determined to be superior to amalgam, and comparable with Super-EBA in preventing microleakage when used as a root-end filling.
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Histologic assessment of mineral trioxide aggregate as a root-end filling in monkeys.
Mineral Trioxide Aggregate (MTA) has been shown in a number of experiments to be a potential root-end filling material. The purpose of this study was to examine the periradicular tissue response of monkeys to MTA and amalgam as root-end fillings. The pulps were removed from all the maxillary incisors of three monkeys. The root canals were prepared and filled with laterally condensed guttapercha and sealer, and the access cavities were restored with amalgam. Buccal mucoperiosteal flaps were raised, and root-end resections were performed before root-end cavity preparation with burs. The root-end cavities in half of the teeth were filled with MTA, while amalgam was placed in the other cavities. After 5 months the periradicular tissue response was evaluated histologically. The results showed no periradicular inflammation adjacent to five of six root ends filled with MTA; also five of six root ends filled with MTA had a complete layer of cementum over the filling. In contrast, all root ends filled with amalgam showed periradicular inflammation, and cementum had not formed over the root-end filling material, although it was present over the cut root end. Based on these results and previous investigations, MTA is recommended as a root-end filling material in man.
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Long-term seal provided by some root-end filling materials.
A tight and long-lasting seal of root-end fillings is of prime clinical importance. A hundred standard bovine root sections, each 3 mm high and with a central pulp lumen of 2.6 mm in diameter, were filled with five commonly used or potential root-end filling materials. At 24 h, or at 3, 6, or 12 months after filling, leakage along these filling materials was determined under a low headspace pressure of 10 kPa (0.1 atm) using a fluid transport model. During the first 3 months, the percentage of gross leakage (> 20 microliters day-1) increased noticeably for Tytin amalgam (from 20 to 100%) and Super-EBA (from 0 to 55%), whereas it decreased noticeably for mineral trioxide aggregate (MTA; from 55% to 0%). Thereafter, the increased leakage of amalgam and Super-EBA decreased with time, whereas the improved seal of MTA was maintained until the end of the experiment. At 3-, 6-, and 12-month time intervals, both glass ionomer cements (Fuji II and Hi Dense) and MTA showed less leakage than the conventional amalgam and Super-Eba, of which amalgam leaked more.
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Reaction of dogs' teeth to root canal filling with mineral trioxide aggregate or a glass ionomer sealer.
This study was conducted to observe the reaction of apical tissues of dogs' teeth after root canal filling with gutta-percha and mineral trioxide aggregate (MTA) or a glass ionomer (Ketac-Endo) as a sealer. The root canals were instrumented and filled by the lateral condensation technique with the sealers studied. Animals were killed 6 months later, and the specimens were removed and prepared for histological analysis. Results showed no inflammatory reaction of apical tissue and total closure of the apical foramen of all the teeth sealed with MTA. The teeth sealed with Ketac-Endo showed two cases of partial closure and different degrees of chronic inflammatory reaction. In conclusion, MTA exhibited better biological properties than Ketac-Endo.
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Clinical applications of mineral trioxide aggregate.
An experimental material, mineral trioxide aggregate (MTA), has recently been investigated as a potential alternative restorative material to the presently used materials in endodontics. Several in vitro and in vivo studies have shown that MTA prevents microleakage, is biocompatible, and promotes regeneration of the original tissues when it is placed in contact with the dental pulp or periradicular tissues. This article describes the clinical procedures for application of MTA in capping of pulps with reversible pulpitis, apexification, repair of root perforations nonsurgically and surgically, as well as its use as a root-end filling material.
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Polyacrylamide + Al2(SO4)3 and polyacrylamide + CaO remove coliform bacteria and nutrients from swine wastewater.
Animal wastes are a major contributor of nutrients and enteric microorganisms to surface water and ground water. Polyacrylamide (PAM) mixtures are an effective flocculent, and we hypothesized that they would reduce transport of microorganisms in flowing water. After waste water running at 60.0 1 min(-1) flowed over PAM + Al2(SO4)3, or PAM + CaO in furrows, total coliform bacteria (TC) and fecal coliform bacteria (FC) were reduced by 30-50% at 1 and 50 m downstream of the treatments compared to the control. In a column study, PAM + Al2(SO4)3, and PAM + CaO applied to sandy, sandy loam, loam, and clay soils reduced NH4+ and ortho-P concentrations in leachate compared to the source waste water and the control. PAM + Al2(SO4)3 and PAM + CaO applied to sandy, sandy loam and loam soils reduced both total and ortho-P, concentrations in leachate compared to he source wastewater and control treatment. In a field study, PAM + Al2(SO4)3, or PAM + CaO treatments did not consistently reduce NH4+, NO3-, ortho-P, and total P concentrations in wastewater flowing over any soil compared to inflow wastewater or the control treatment. With proper application PAM + Al2(SO4)3 and PAM + CaO may be able to reduce the numbers of enteric bacteria in slowly flowing wastewater running off animal confinement areas, reducing the amount of pollutants entering surface water and groundwater.
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Nitric oxide-mediated Ca2+/calmodulin-dependent protein kinase IV activity during hypoxia in neuronal nuclei from newborn piglets.
The present study tested the hypothesis that hypoxia results in increased Ca(2+)/calmodulin-dependent protein kinase IV (CaM kinase IV) activity and that inhibition of nitric oxide (NO) synthase by N-nitro-L-arginine (NNLA) prevents the hypoxia- induced increase in neuronal nuclear CaM kinase IV activity in newborn piglets. CaM kinase IV activity was determined in normoxic (Nx), hypoxic (Hx), and NNLA-pretreated Hx piglets. Cerebral hypoxia was confirmed biochemically. There was a significant difference between CaM kinase IV activity (pmoles/mg protein/min) in Nx (285.22+/-86.12), Hx (494.77+/-99.79, P<0.05 vs. Nx), and NNLA-pretreated Hx (249.55+/-53.85)(P=NS vs. Nx, P<0.05 vs. Hx) animals. The results demonstrate that the cerebral tissue hypoxia results in an increase in neuronal nuclear CaM kinase IV activity, and the hypoxia-induced increase in CaM kinase IV activity is NO-mediated.
Animals↗
The role of Ca2+/calmodulin-dependent protein kinase II in mechanisms underlying neuronal hyperexcitability induced by repeated, brief exposure to hypoxia or high K+ in rat hippocampal slices.
Analysis of extracellular recordings of evoked excitatory postsynaptic potentials and population spikes from rat hippocampal slices has previously revealed that repeated, brief exposures to high extracellular K(+) or to episodes of hypoxia induce a sustained (more than 3 h) hyperexcitability of CA1 pyramidal neurons accompanied with epileptiform activity which was dependent on activation of L-type Ca(2+) channels and N-methyl-D-aspartate receptors. Using in vitro phosphorylation assay we have found the significant increase of Ca(2+)-independent activity of Ca(2+)/calmodulin-dependent protein kinase II in CA1 region of hippocampal slices 60 min after the high extracellular K(+) and 60-80 min after the hypoxic episodes. These data suggest possible involvement of Ca(2+)/calmodulin-dependent protein kinase II in Ca(2+)-dependent mechanisms of the maintenance phase of the observed epileptiform activity.
Animals↗
Use of mineral trioxide aggregate for repair of furcal perforations.
The histologic response to intentional perforation in the furcations of 28 mandibular premolars in seven dogs was investigated. In half the teeth, the perforations were repaired immediately with either amalgam or mineral trioxide aggregate; in the rest the perforations were left open to salivary contamination before repair. All repaired perforations were left for 4 months before histologic examination of vertical sections through the site. In the immediately repaired group, all the amalgam specimens were associated with inflammation, whereas only one of six with mineral trioxide aggregate was; further, the five noninflamed mineral trioxide aggregate specimens had some cementum over the repair material. In the delayed group, all the amalgam specimens were associated with inflammation; in contrast only four of seven filled with the aggregate were inflamed. On the basis of these results, it appears that mineral trioxide aggregate is a far more suitable material than amalgam for perforation repair, particularly when used immediately after perforation.
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Histologic evaluation of pulpotomies in dog using two types of mineral trioxide aggregate and regular and white Portland cements as wound dressings.
OBJECTIVE: The purpose of this study was to investigate the pulpal response of dogs' teeth after pulpotomy and direct pulp protection with MTA Angelus, ProRoot, Portland cement and white Portland cement. STUDY DESIGN: Seventy-six teeth were treated with these materials. One hundred twenty days after treatment, the animals were sacrificed and the specimens removed and prepared for histological analysis. RESULTS: All the materials demonstrated similar results when used as pulp-capping materials. Pulp vitality was maintained in all specimens and the pulp had healed with a hard tissue bridge. CONCLUSION: The materials used in this study were equally effective as pulp protection materials following pulpotomy.
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Sealing ability of amalgam, super EBA cement, and MTA when used as retrograde filling materials.
OBJECTIVE: To compare apical microleakage of MTA following reverse retrograde root filling with that following amalgam and EBA retrofilling. DESIGN: Prospective random control trial. SETTING: It was conducted at the University of Jordan in 1998. MATERIALS AND METHODS: The root canals of 79 extracted teeth were instrumented and obturated with vertically condensed gutta-percha. Each tooth was apically resected and the apex was prepared ultrasonically to 3 mm depth and the root surface isolated with nail varnish. Teeth were divided randomly into three groups of 25 teeth each. First group was retrofilled with amalgam, second group with EBA and the third group with MTA. Following immersion in 1% methylene blue dye for 72 hours, the roots were sectioned and the depth of dye penetration was evaluated by a stereomicroscope at x10 magnification. INTERVENTIONS: Super EBA is a reinforced zinc oxide cement based on a mixture of 32% eugenol and 68% ethoxy benzoic acid (EBA). MTA is a mineral trioxide aggregate cement (MTA) based on a mixture of sterile water. MAIN OUTCOME MEASURES: The sealing effectiveness of the retrograde filling materials used in this study was determined by their ability to inhibit dye penetration. RESULTS: 56% of the group filled with amalgam and 20% of the group filled with EBA showed dye leakage beyond the retrofilling material whereas the MTA group showed none, two samples from MTA group were eliminated because of their fractured roots. The chi-squared test revealed a statistically significant difference among all three groups (P < 0.05). CONCLUSION: MTA cement provides a better seal than amalgam and EBA cement when used as retrograde filling, but the extrapolation of this result into a clinical practice may be questionable.
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The dentinogenic effect of mineral trioxide aggregate (MTA) in short-term capping experiments.
AIM: The objective of the present experiment was to study the early pulpal cell response and the onset of reparative dentine formation after capping application of MTA in mechanically exposed pulps. METHODOLOGY: Thirty-three teeth from three dogs, 12-18 months of age were mechanically exposed via class V cavities. Light pressure was applied to control haemorrhage. ProRoot MTA (Dentsply Simfra, Paris) was placed at the exposure site and light pressure was applied with a wet cotton pellet. The cavities were restored with amalgam and the pulpal tissue reactions were assessed by light and electron microscopy (transmission and scanning) after healing intervals of 1, 2 or 3 weeks. RESULTS: A homogenous zone of crystalline structures was initially found along the pulp-MTA interface, whilst pulpal cells showing changes in their cytological and functional state were arranged in close proximity to the crystals. Deposition of hard tissue of osteotypic form was found in all teeth in direct contact with the capping material and the associated crystalline structures. Formation of reparative dentine (tubular matrix formation in a polar predentine-like pattern by elongated polarized cells) was consistently related to a firm osteodentinal zone. CONCLUSIONS: The present experiments indicate that MTA is an effective pulp-capping material, able to stimulate reparative dentine formation by the stereotypic defensive mechanism of early pulpal wound healing.
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A prospective clinical study of Mineral Trioxide Aggregate and IRM when used as root-end filling materials in endodontic surgery.
AIM: To assess the success rate of the root-end filling material, Mineral Trioxide Aggregate (MTA). METHODOLOGY: Referred adult patients were recruited using strict entry criteria and randomly allocated to receive MTA or IRM. A standardized surgical technique was employed: the root end was resected perpendicularly and a root-end cavity was prepared ultrasonically and filled. A radiograph taken immediately after surgery was compared with those taken at 12 and 24 months. Customised film holders and the paralleling technique were used; radiographs were assessed by two trained observers using agreed criteria. The results from 122 patients (58 in IRM group, 64 in MTA group) after 12 months and 108 patients (47 in IRM group, 61 in MTA group) for the 24-month review period were analysed using the chi2 test. RESULTS: The highest number of teeth with complete healing at both times was observed when MTA was used. When the numbers of teeth with complete and incomplete (scar) healing, and those with uncertain and unsatisfactory healing were combined, the success rate for MTA was higher (84% after 12 months, 92% after 24 months) compared with IRM (76% after 12 months, 87% after 24 months). However, statistical analysis showed no significant difference in success between materials (P > 0.05) at both 12 and 24 months. CONCLUSIONS: In this study, the use of MTA as a root-end filling material resulted in a high success rate that was not significantly better than that obtained using IRM.
Adult↗
Osteoblasts and MG-63 osteosarcoma cells behave differently when in contact with ProRoot MTA and White MTA.
AIM: To test the hypothesis that MG-63 osteosarcoma cells and primary osteoblasts react differently to ProRoot trade mark MTA (mineral trioxide aggregate) and White MTA by: (i) investigating the attachment of primary osteoblasts and MG-63 osteosarcoma cells to ProRoot trade mark MTA and White MTA; and (ii) comparing the osteogenic behaviour of both cell lines in contact with these endodontic materials. METHODOLOGY: Primary osteoblasts were harvested from foetal rat calvaria by sequential digestion and MG-63 osteosarcoma cells were purchased. Cells were exposed to ProRoot trade mark MTA and White MTA prepared according to the manufacturer's instructions. All samples and controls were prepared in quadruplicate. After 6, 9 and 13 days exposure to MTA, the cells were fixed and prepared for SEM examination. In addition, both the cell types were grown to confluence and exposed to beta-glycerophosphate and dexamethasone to assess mineralized nodule formation as a function of osteogenic behaviour. RESULTS: The number of cells on the surface of the culture dish and on top of the materials increased in all samples throughout the 3 time periods, except for White MTA where no primary osteoblasts were visible on top of the material by the end of 13 days. After exposing cells to differentiation medium nodules were observed in cultures of primary osteoblasts, but not of MG-63 osteosarcoma cells. CONCLUSIONS: Under the conditions of this study, whilst primary osteoblasts initially bound to White MTA, they did not survive on the surface by the end of 13 days. Primary osteoblasts formed mineralized nodules when exposed to differentiation medium, whilst MG-63 cells did not form nodules. As MG-63 cells do not behave osteogenically by forming mineralized nodules, and primary osteoblasts are more sensitive than MG-63 osteosarcoma cells to White MTA in cell culture, primary osteoblasts are more appropriate than MG-63 cells for testing endodontic materials in cell culture.
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