Traditionally, apexification has been used to treat immature permanent teeth that have lost pulp vitality. This technique promotes the formation of an apical barrier to close the open apex so that the filling materials can be confined to the root canal. Because tissue regeneration cannot be achieved with apexification, a new technique called regenerative endodontic treatment was presented recently to treat immature permanent teeth. Regenerative endodontic treatment is a treatment procedure designed to replace damaged pulp tissue with viable tissue which restores the normal function of the pulp-dentin structure. After regenerative endodontic treatment, continued root development and hard tissue deposition on the dentinal wall can occur under ideal circumstances. However, it is difficult to predict the result of regenerative endodontic treatment. Therefore, the purpose of this study was to summarize multiple factors effects on the result of regenerative endodontic treatment in order to achieve more predictable results. In this study, we investigated the features of regenerative endodontic treatment in comparison with those of other pulp treatment procedures and analyzed the factors that have an effect on regenerative endodontic treatment.

Mineral trioxide aggregate (MTA), which was originally developed for repair of root perforations, is a biocompatible material with numerous clinical applications in endodontics. MTA must be allowed to set in the presence of moisture to optimize the material's physical and chemical properties. In the clinic, occasionally unset MTA has been detected after application of MTA on the tooth, and the reason has been unclear.

This case report presents MTA washed-out for several years after placement at the root apex as an apical plug, and discusses the reason and things to consider in clinics.

The purpose of this study was to compare mineral trioxide aggregate (MTA; Dentsply, Tulsa Dental, Tulsa, OK, USA), which is widely used as root-end filling material, with DiaRoot BioAggregate (DB; Innovative BioCaramix Inc, Vancouver, BC, Canada), newly developed product, by using MG63 osteoblast-like cells. MTA, DB, and Intermediate Restorative Material (IRM; Dentsply Caulk, Milford, DE, USA) were used for root-end filling material while tissue culture plastic was used for control group. Each material was mixed and, the mixtures were left to set for 24 hours. MG63 cells were seeded to each group and then they were cultured for attachment for 4 hours. Following the attachment of cells to the root-end filling material, early cellular response was observed. After another 12 hours'culture, the level of attachment between cells and material was observed and in order to identify the effect of each material to bone formation, transforming growth factor beta1 (TGFβ1) and osteocalin (OC) were estimated by using enzyme-linked immunosorbent assay (ELISA), and the amount of alkaline phosphatase (ALP) was also measured. The data were analyzed using one-way ANOVA. As a result, only at OC and the number of cells which were attached to materials, there was no statistical difference between MTA and DB. At other items, there was statistically significant difference in all groups. Although DB has not shown exactly the same cellular response like that of MTA, the number of attached cells shows that biocompatibility of the material and OC indicates bone formation rate. Therefore, if DB is used for root end filling material, it is expected to lead to similar results to MTA.

Since its introduction in 1993, Mineral Trioxide Aggregate (MTA) has been shown to be superior to others in sealing, biocompatibility, and many other aspects of clinical endodontics. MTA is primarily Portland cement with bismuth oxide as a radiopacitifier.

Although some studies suggested that the reasonable-priced Portland cement could be used instead of MTA, but MTAs are different from Portland cement in its composition, especially in heavy metal contents. Therefore, clinicians should be meticulous adapting the Portland cement as a MTA substitute.

We evaluated in vitro microleakage of Mineral Trioxide Aggregate (MTA) powder with 4-methacryloxyethyl trimellitate anhydride (4-META) / methyl methacrylate (MMA) & tri-n-butylborane (TBB) resin as a retrograde filling material by using methylene blue dye method.

Fifty-two single rooted, extracted teeth were instrumented and obturated with gutta percha and AH plus sealer. The apical 3mm of each root was resected and 3mm deep ultrasonic root end preparation was done. External surface of roots was coated with nail varnish. Prepared teeth were randomly divided into five groups; Negative control: completely covered with nail varnish; Positive control: coated with nail varnish except for apical foramen; Group 1 (retrofilled with Portland cement); Group 2 (retrofilled with MTA); Group 3 (retrofilled with MTA powder mixed with 4-META/MMA & TBB resin). Immediately after completion of root-end filling, all specimens were submerged in methylene blue dye for 72 hours in 37℃ incubator. The roots were longitudinally sectioned and measured for extent of dye penetration by three different examiners under microscope (×10). The results were statistically analyzed using one way ANOVA and Turkey's HSD test. No leakage was evident in negative control and complete leakage in positive control group. Group 3 showed significantly less leakage than group 1 and 2 (p < 0.01). There was no significant difference between group 1 and 2 (p > 0.01).

It was concluded that MTA powder with 4-META/MMA & TBB resin was excellent in reducing initial apical microleakage.

The purpose of this study was to compare the dye leakage of MTA (mineral trioxide aggregate) apical plug produced by two orthograde placement techniques (hand condensation technique and ultrasonically assisted hand condensation technique).

To simulate straight canal, 60 transparent acrylic blocks with straight canal were fabricated. These transparent acrylic blocks were divided into 2 groups (Group C; hand condensation technique (HC) and Group U; ultrasonically assisted hand condensation technique (UAHC)) of 30 blocks with each MTA application method. Each group was divided into 2 subgroups (n = 15) with different canal size of #70 (subgroup C70 and subgroup U70) and #120 (subgroup C120 and subgroup U120). After apical plug was created, a wet paper point was placed over the MTA plug and specimen was kept in a humid condition at room temperature to allow MTA to set. After 24 hours, remaining canal space was backfilled using Obtura II. All specimens were transferred to floral form socked by 0.2% rhodamine B solution and stored in 100% humidity at room temperature. After 48 hours, resin block specimens were washed and scanned using a scanner. The maximum length of microleakage was measured from the scanned images of four surfaces of each resin block using Photoshop 6.0.

Statistical analysis was performed with Mann-Whitney U test. Group U of UAHC had significantly lower leakage than Group C of HC in #70-size canal (subgroup U70) (p < 0.05).

This study was carried out in order to determine in vitro biocompatibility of white mineral trioxide aggregate (MTA), and to compare it with that of the commonly used materials, i. e. calcium hydroxide liner (Dycal), glass ionomer cement (GIC), and Portland cement which has a similar composition of MTA. To assess the biocompatibility of each material, cytotoxicity was examined using MG-63 cells. The degree of cytotoxicity was evaluated by scanning electron microscopy (SEM) and a colorimetric method, based on reduction of the tetrazolium salt 2,3 bis {2methoxy 4nitro 5[(sulfenylamino) carbonyl] 2H tetrazolium hydroxide} (XTT) assay.

The results of SEM revealed the cells in contact with GIC, MTA, and Portland cement at 1 and 3 days were apparently healthy. In contrast, cells in the presence of Dycal appeared rounded and detached. In XTT assay, the cellular activities of the cells incubated with all the test materials except Dycal were similar, which corresponded with the SEM observation. The present study supports the view that MTA is a very biocompatible root perforation repair material. It also suggests that cellular response of Portland cement and GIC are very similar to that of MTA.

The purpose of this study was to evaluate the effects of MTAD, EDTA and sodium hypochlorite(NaOCl) as final irrigants on coronal leakage resistance to Enterococcus faecalis. Forty extracted human maxillary molars were used in this experiment. The teeth were randomly divided into positive control group (Group 1; n = 5), negative control group (Group 2; n = 5) and three experimental groups (n = 30). In Group 3 (n = 10), the root canals were irrigated with sodium hypochlorite. In Group 4 (n = 10) and 5 (n = 10), the root canals were irrigated with sodium hypochlorite and rinsed with EDTA and MTAD, respectively. The teeth in each group were cleaned and shaped to #40 profile with .04 taper, and obturated with gutta-percha and AH-26 root canal sealer. The coronal portion of each tooth was placed in contact with inoculum of Enterococcus faecalis in Brain Heart Infusion (BHI) culture media. Each root tip was placed in a vial containing sterile culture media. The vials were placed in anaerobic chamber and observed everyday for turbidity for 180 days. Statistical analysis was performed using Fisher's Exact Test. After 180 days, Group 3, 4, and 5 showed 7, 4 and 5 leaking samples respectively. The differences in leakage resistance were not statistically significant among Group 3, 4 and 5.

The aim of this study was to compare the compositions and cytotoxicity of white ProRoot MTA (white mineral trioxide aggregate) and 3 kinds of Portland cements. The elements, simple oxides and phase compositions of white MTA (WMTA), gray Portland cement (GPC), white Portland cement (WPC) and fast setting cement (FSC) were measured by inductively coupled plasma atomic emission spectrometry (ICP-AES), X-ray fluorescence spectrometry (XRF) and X-ray diffractometry (XRD). Agar diffusion test was carried out to evaluate the cytotoxicity of WMTA and 3 kinds of Portland cements.

The results showed that WMTA and WPC contained far less magnesium (Mg), iron (Fe), manganese (Mn), and zinc (Zn) than GPC and FSC. FSC contained far more aluminum oxide (Al₂O₃) than WMTA, GPC, and WPC. WMTA, GPC, WPC and FSC were composed of main phases, such as tricalcicium silicate (3CaO·SiO₂), dicalcium silicate (2CaO·SiO₂), tricalcium aluminate (3CaO·Al₂O₃), and tetracalcium aluminoferrite (4CaO·Al₂O₃·Fe₂O₃). The significance of the differences in cellular response between WMTA, GPC, WPC and FSC was statistically analyzed by Kruskal-Wallis Exact test with Bonferroni's correction. The result showed no statistically significant difference (p > 0.05).

WMTA, GPC, WPC and FSC showed similar compositions. However there were notable differences in the content of minor elements, such as aluminum (Al), magnesium, iron, manganese, and zinc. These differences might influence the physical properties of cements.

The purpose of this study was to investigate whether rhBMP-2 (BMP2) could induce synergistic effect with Pro-Root® MTA (MTA) in pulpotomized teeth in the rats. Healthy upper first molars from thirty-two, 10 weeks old, Sprague-Dawley rats were used for this investigation. The molars were exposed with round bur, and light pressure was applied with sterilized cotton to control hemorrhage. 1.2 grams of MTA cement was placed in right first molars as a control group. In left first molars, 1 µg of BMP2 was additionally placed on exposed pulps with MTA. All cavities were back-filled with light-cured glass-ionomer cements. The rats were sacrificed after 2 weeks and 7 weeks, respectively. Then histologic sections were made and assessed by light microscopy. Data were statistically analyzed via student t-test with SPSSWIN 12.0 program (p < 0.05).

Inflammation observed in 2 weeks groups were severe compared to the 7 weeks groups. But the differences were not statistically significant. BMP2-addition groups had less inflammation than MTA groups in both periods, though these differences were also not statistically significant. In conclusion, the combination of BMP2 and MTA showed no differences with MTA only for pulpotomy of rat teeth.

Mineral trioxide aggregate (MTA) would influence healing of periapical tissues by modulating the production of growth factors and cytokines from PDL fibroblasts, however, the studies are insufficient. Therefore, the purpose of this study was to monitor the expression of transforming growth factor-beta1 (TGF-β1), fibroblast growth factor-2 (FGF-2), and interleukin-6 (IL-6) from PDL fibroblasts in the presence of MTA. The human PDL fibroblasts were seeded onto the set MTA or IRM at a level of 1 × 10⁵ cells per unit well, and further incubated for 6, 12, 24, and 48 hours. The levels of TGF-β1, FGF-2, and IL-6 from the supernatant were measured by enzyme-linked immunosorbent assay (ELISA). The data were analyzed using one-way ANOVA. The level of TGF-β1 was down-regulated when the cells were grown in the presence of MTA except at 6 hours. The levels of FGF-2 release were significantly suppressed when PDL fibroblasts were grown in the presence of MTA or IRM at all time intervals (p < 0.05). The expressions of IL-6 from MTA treated cells were comparable to those of untreated control cells throughout the observation periods. We presume that this material inhibits the stimulatory function of growth factors on granulation tissue formation and in turn, it promotes the healing process modulated by other bone-remodeling cells.

This study was performed to verify the possibility of MTA and calcium sulfate as a pulp capping agent through comparing the dental pulp response in dogs after capping with MTA, calcium sulfate, and calcium hydroxide.

24 teeth of 2 dogs, 8 month old, were used in this study.

Under general anesthesia, cervical cavities were prepared and pulp was exposed with sterilized #2 round bur in a high speed handpiece.

MTA, calcium hydroxide, and calcium sulfate were applied on the exposed pulp. Then the coronal openings were sealed with IRM and light-cured composite.

Two months after treatment, the animals were sacrificed. The extracted teeth were fixed in 10% neutral-buffered formalin solution and were decalcified in formic acid-sodium citrate. They were prepared for histological examination in the usual manner. The sections were stained with haematoxylin and eosin.

In MTA group, a hard tissue bridges formation and newly formed odontoblasts layer was observed. There was no sign of pulp inflammatory reaction in pulp tissue.

In calcium hydroxide group, there was no odontoblast layer below the dentin bridge. In pulpal tissue, chronic inflammatory reaction with variable intensity and extension occurred in all samples.

In calcium sulfate group, newly formed odontoblast layer was observed below the bridge. Mild chronic inflammation with a few neutrophil infiltrations was observed on pulp tissue.

These results suggest that MTA is more biocompatible on pulp tissue than calcium hydroxide or calcium sulfate.

The purpose of this study was to evaluate the apical sealing ability of Super-EBA, MTA and Dyract-flow as retrofilling materials. Forty-eight extracted human teeth with straight and single root canal were used in this study. The root canals were prepared to a #40 apical canal size and obturated with gutter-percha. Apicoectomies were performed and root end cavities were prepared to a depth of 3mm using an ultrasonic device. The root end cavities were filled with Super-EBA, MTA or Dyract-flow. Leakage was measured using an electrochemical technique for 4 weeks.

According to this study, the results were as follows.

1. Increasing leakage with time was observed in all groups.

2. No significant difference was noted among the 3 groups with time (p = 0.216).

3. No significant difference was noted among the 3 groups when measured within the same time interval (p = 0.814).

The results of this study suggest that the sealing ability of Dyract-flow is equal to that of Super-EBA and MTA, and Dyract-flow may be an alternative to other materials for root-end filling.

The purpose of this study is to evaluate the sealing effect of several root-end filling materials using spectrophotometric analysis. 180 single root teeth with one canal were instrumented and canal filled. Root resected and root end preparation was made. Teeth were randomly classified to 5 experimental group(MTA, EBA, IRM, TCP, ZOE) and 1 control group according to root-end filling material MTA group used PRO ROOT MTA, EBA group used Super EBA, TCP group used NEW APATITE LINER TYPE II main component of which is α-tricalcium phosphate(TCP). According to manufacture's instruction experimental material was mixed and retrfilled. After 2% methylene blue solution penetration absorbance for each test sample was measured with spectrophotometer (JASCO UV-530, Japan).

The mean absorbance of control and experimental group was as follows;

MTA : 0.092, IRM : 0.226, Super EBA : 0.255, ZOE : 0.374, Control : 0.425, TCP : 0.501 and the result analyzed by Turkey test at P=0.05 level.

Conclusions of this study are as follows;

The absorbance increase in follwing sequence MTA, IRM, Super EBA, ZOE, Control, TCP.