Clinical Applications
When MTA was introduced in 1993, it was initially employed in cases of root perforations and as a retrograde filling material. Eventually, its uses were broadened, and it started being used in several clinical situations in which calcium hydroxide was emp
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Clinical Applications Marco Antonio Hungaro Duarte, Clóvis Monteiro Bramante, and Gustavo De Deus
6.1
Introduction
Following the introduction of MTA in 1993, its use has broadened considerably and is nowadays used in several clinical situations in which calcium hydroxide was employed. Initially, MTA was employed in cases of root perforations and as a retrograde filling material [82]; eventually, other indications for the use of the material evolved, and it is being used in cases of direct or indirect pulp capping, pulpotomy, root perforation, repair internal and external root resorptions, endodontic treatment, incomplete root formation, apical plug, deciduous teeth, dens invaginatus, and revascularization. For its effective use, it is important to know the mechanism of action and the correct way of employing the material.
M.A. Hungaro Duarte, PhD (*) Department of Dentistry, Endodontics and Dental Materials, Bauru Dental School, University of Sao Paulo, Al Octavio Pinheiro Brisola 9-75, Bauru, SP 17012-901, Brazil e-mail: [email protected] C. Monteiro Bramante, PhD Department of Dentistry, Endodontics and Dental materials, Bauru Dental School, University of Sao Paulo, Al Octavio Pinheiro Brisola 9-75, Orlando Cardoso 1-40 Apto 22, Bauru, SP 17016-260, Brazil e-mail: [email protected], [email protected] G. De Deus, DDS, MSc, PhD Department of Endodontics, Grande Rio University (UNIGRANRIO), Av. Henrique Dodsworth 85 apto 808 Lagoa, Rio de Janeiro RJ 22061-030, Brazil e-mail: [email protected]
The mechanism of action of MTA is similar to that of calcium hydroxide. The calcium hydroxide produced as a by-product of hydration of MTA is leached out in solution and dissociates into Ca++ and OH− ions. The Ca++ ions, when in contact with the connective tissue, form an area of necrosis, forming carbon dioxide which in turn together with the calcium hydroxide forms calcite crystals (calcium carbonate), which serve as the core of calcification. The alkalinity of the medium stimulates the tissue to secrete a glycoprotein named fibronectin, which together with the calcite crystals stimulate the formation of collagen type I, which together with the calcium, induces mineralization [43].
6.2
Mode of Use
6.2.1
Manipulation
MTA is mixed with distilled water in a 3:1 ratio. The ratio can be changed according to the area where the material will be utilized [32]. In the pulp chamber, MTA may be mixed to a stiffer mix, while in the root canal, where access is difficult, and it can also be more fluid (Fig. 6.1).
6.2.2
Insertion
The MTA should be inserted in place immediately after handling, avoiding its dehydration.
J. Camilleri (ed.), Mineral Trioxide Aggregate in Dentistry, DOI 10.1007/978-3-642-55157-4_6, © Springer-Verlag Berlin Heidelberg 2014
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A Lentulo spiral can be used for its insertion or alternatively a micro amalgam carrier, guttapercha plugger, Map system, Dovgan applicator, or ultrasound (Fig. 6.2).
6.3
Clinical Applications of MTA
The variety of MTA uses include: (
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