I have used MTA since my MSc in Endo some 15 years ago. At that time there were not many other alternatives, especially when considering the non-vital open apex cases. Prior to that I remember as an undergraduate seeing post grads in Paediatric Dentistry rolling multiple GP accessory points to fill these large cavernous canals. MTA seemed to be a much better alternative although initially trickier to handle. As I finished my MSc Endo and went into hospital dentistry I must have done one of these cases every month or so for 4 years. Over and over my MTA plugs were consistent and cases came back with healed lesions-in some cases continued root maturity past the obturation-MTA is a great biomaterial in this respect. Visualisation of the cement being packed down into the canal gave you some reassurances that you would have a void free obturation unlike using other obturation techniques. You were also comforted that pushing MTA through may not be as catastrophic as other materials due to its biocompatibility. You heard the endo folklore relating to the use of portland cement in healing of wounds in WW2 or the fact that it sets in a wet environment which made it ideal for the mouth. Then there was the price-it was an expensive material. Then there were different colours, green then white, then different versions and brand names from Brazil and beyond. Then there were the implements and instruments to handle the material, from special carriers to blocks to guns to deliver right where you wanted it. Books on the material, papers and research galore it was something quite extraordinary. The basis of this material came from research conducted at UMDS (now KCL) by Torabinejad and Pitt-Ford. I published a few papers looking at its use in traumatised teeth and also in managing dens invaginatus.

And so to more recent time and competing materials. I am a creature of habit like many of us are. I like the same instruments and the more or less similar materials from one day to the next. To shift to a new ‘product’ for me is difficult as it is likely to be for many of us-which is likely to explain how fervent reps from companies become frustrated reps as it becomes clear that I am not keen on using a sample of a material on a patient on Monday morning from a conference I attended on the prior Saturday afternoon!

I have to say despite my staunch use of MTA my head has been turned of late-its not because I feel that there may be other products that could be better but a risk that I have seen with cases of MTA on review. I am seeing more and more cases of discoloured teeth with MTA and the examples are not solely to cases treated by me but also those of colleagues from near and afar. So at this point I do a literature search and low and behold tooth discolouration by MTA is an actual ‘thing’. So the Bismuth oxide contained in the MTA when in contact with a tooth that has been in irrigated or immersed in sodium hypochlorite results in discolouration at the tooth cement interface and this can leach unto the crown of the tooth. As a profession and a specialty its unlikely that we are going to drop Hypochlorite in favour of being able to use MTA without it discolouring the tooth.

So alternatively the use of Biodentine has been suggested-a material that as far as I can tell does not contain bismuth oxide and has gained some popularity with its multiple uses. Might be time to change or at least sample whats out there.

For the Endo bods and postgraduates who are training to be root canal treaters I have picked three papers. The first directly compares MTA and Biodentine, quite neat as it does put out the differences saliently. The second looks at apexification and the third is some basic research on tooth discolouration by MTA.


MTA versus Biodentine: Review of Literature with a Comparative Analysis

Apexification, A review by Rafter 2005

The discolouration effect of MTA by Salem-Milani