Mineral trioxide aggregate and other bioactive endodontic cements: An updated overview- Part II: Other clinical applications and complications

Abstract

Mineral trioxide aggregate (MTA) is a dental material used extensively for vital pulp therapy (VPT), scaffold cover during regenerative endodontic procedures, apical barrier in teeth with necrotic pulps and open apices, perforation repair, and root canal filling and root-end filling during surgical endodontics. A number of bioactive endodontic cements (BECs) have recently been introduced to the market. Most of these materials had calcium and silicate in their compositions; however, the bioactivity is the common property of these cements. These materials include: BioAggregate, Biodentine, BioRoot RCS, calcium enriched mixture (CEM) cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA,, MTA Bio, MTA Fillapex, MTA Plus, Neo MTA Plus, Ortho MTA, Quick-Set, Retro MTA, Tech Biosealer, and TheraCal. It has been claimed that these materials have properties similar to those of MTA but without the drawbacks. In Part I of this discussion we extensively reviewed available information on the chemical composition of the materials listed above and reported their applications for VPT.

In this article the clinical applications of MTA and other BECs will be reviewed for apexification, regenerative endodontics, perforation repair, root canal filling, root-end filling, restorative procedures, periodontal defects and treatment of vertical and horizontal root fractures. In addition, the literature regarding the possible drawbacks of these materials after their clinical applications is reviewed. These drawbacks are including the materials' discoloration potential, systemic effects, and retreatability following use as a root canal filling. Furthermore, the current levels of evidence of these materials are also reported.

Based on selected keywords, all publications were searched regarding the use of MTA as well as BECs for the rest of clinical applications. Additionally, the levels of evidence for MTA's clinical applications and the newly introduced materials was evaluated through a scientometric study.

Numerous publications were found regarding the use of BECs for various endodontic applications. The majority of these investigations compared BECs with MTA.

Despite promising results of some materials, the number of publications using BECs for various clinical applications was very limited. Furthermore, most studies had several methodological shortcomings and low levels of evidence.

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