Printer Friendly

Bio-active cements-Mineral Trioxide Aggregate based calcium silicate materials: a narrative review.

Byline: Kamil Zafar, Shizrah Jamal and Robia Ghafoor

Keywords: Bioactive materials, Calcium silicate, MTA, Biodentine, Bioceramics, Calcium-enriched mixture, BioAggregate, Endosequence.


In modern dentistry, the field of endodontics is also im proving with the advent of new materials and techniques.1 The term bioactivity is defined as materials that are durable in tissues and have the capability to undergo interfacial changes with surrounding tissues. When these bioactive materials contact the tissue fluids, they release calcium hydroxide (Ca[OH]2), which can interact with and induce surrounding tissues to promote their regeneration.2 The major emphasis has been on the development of bio active and biocompatible materials that can specifically promote regeneration of pulpal and peri-radicular tissues rather than repair.3

Among the bio-materials that have gaine d great importance in regenerative endodontics, calcium silicate (CS)-based materials, like Mineral Tri-oxide Aggregate (MTA), Biodentine, Bioceramics, calcium-enriched mixture etc., are common.4 CS-based materials are defined as those that are composed of either di/tri/tetra-CS phases with a basic setting mechanism involving hydration process resulting in the formation of leachate and crystalline phases.3 CS-based materials were first used in dentistry in 1878 when Portland cement was used to fill the root canals. They later became common in practice and remained so till the 1990s when MTA was first introduced.5 The main indication of these CS materials are pulpal and hard tissue regeneration, such as pulp capping, pulpotomy, apexogenesis, apexification, endodontic sealers, root per foration repair and as retrograde filling materials.6

There are certain common desirable characteristics of CS-based materials (Table 1). On the basis of chemistry, a classification of CS-based materials has been mentioned in literature3 (Table 2). The current narrative review was planned to discuss bioactive cements, their basic composition, manipulation, mechanism of setting reaction and clinical applications, drawbacks, and modifications.

Table-1: Common properties of Bioactive materials

Adequate strength

Antimicrobial properties


Bioactivity (capability of stimulation and modulation of native tissue)

Dimensionally stable

Easy manipulation

Sealing ability

Lacks moisture sensitivity


Non-toxic, non-carcinogenic, non-genotoxic


Table-2: Classification of Bioactive materials.

Generation###Bio-Active materials

Generation I###Grey MTA

###White MTA

Generation II Modifications to MTA

###MTA Angelus

Generation III Endo CPM (Cement Portland Modified)

###iRootSP (also retailed as Endosequence BC and SmartPaste Bio)

###MTA Obtura,

###Tech Biosealer Endo

###- New Endodontic Cement/Calcium Enriched Mixture

###- Bioaggregate

###- Biodentine

###- Ortho MTA

###- MTA plus

###- Generex A, Generx B

Generation IV Hybrid cements:

###- Calcium phosphate/Calcium silicate/Bismutite cement

###- NRC (Incorporating HEMA)

###- MTA with 4-META/MMA-TBB (4-methacryloxyethyl trimellitate

###anhydride in methyl methacrylate initiated by tri-n-butyl borane)

###- Light-cured cements including (TheraCal LC)

Mineral Tri-oxide aggregate (MTA)

In the quest for bioactive and osteo-conductive materials, the introduction of MTA in 1993 by Dr. Mahmoud Torabinejad led to a paradigm shift in the application of dental materials in endodontics.3 Some of the notable properties of MTA are its good physical properties and its capability to stimulate hard tissue regeneration as well as good pulpal response. MTA, when in contact with dentine of the pulp chamber, stimulates the production and release of signalling molecules, which are essential for the formation of new tissue in the pulp space.6 MTA is also capable of activation of cementoblast and regeneration of periodontal ligament.7


The principal constituents of MTA powder are tricalcium silicate (52-53%), dicalcium silicate (23%), tricalcium aluminate (0-4%), calcium sulphate (1.5%), and bismuth oxide (20%) as radio-opacifier.8


MTA is a fine hydrophilic powder available in single-use sachets (1gm) with some manufacturers providing pre-measured water sachets for the ease of use.9 The first commercially available product was ProRoot MTA,3 in the form of grey-coloured powder owing to the presence of iron (ferrous oxide). As this grey colour affected the aesthetics, the composition was later modified to replace ferrous oxide with magnesium oxide and marketed as white ProRoot MTA in 2002.10

Setting reaction

MTA, being a hydrophilic cement, requires moisture to set. The presence of moisture during the setting also improves flexural strength.11 The powder is mixed with water and a chemical reaction occurs known as hydration. On hydration, colloidal gel composed of calcium oxide crystals in an amorphous structure is formed.12-15 The initial setting time for grey and white MTA is 2.45 hours and 2.20 hours, respectively. On mixing,the immediate value of potential hydrogen (pH) is 10.2 which increases to 12.5 after 3 hours of mixing. This is comparable to Ca(OH)2. 16


Manipulation of MTA is difficult owing to its granular consistency, making it difficult to manage and deliver at clinical site.17 Specialised carriers such as retro-amalgam carrier, MTA carrier, Micro-apical placement system etc. were made available to tackle and enhance manipulation.3

Modifications of MTA

The main drawbacks of MTA are its long setting time, discolouration potential, manipulation that makes its utilisation difficult and sometimes requiring multiple visits for treatment completion. To minimise these limitations, and enhance clinical utilisation, the composition of MTA was modified, and MTA Angelus was introduced in 2001, in which calcium sulphate was eliminated from its composition to decrease the setting time.18 A fast-setting nano-white MTA (NW-MTA) was also introduced that reduced particle size, resulting in increased surface area (7.8mg), leading to decrease in initial setting time from 43 minutes (White MTA) to 6 minutes for NW-MTA. NW-MTA also contains strontium salts in its composition, improving the bio-activity.17 Addition of sodium hypochlorite (NaOCl) gel has also been reported to reduce (30-60%) the setting times of MTA. 17

Light cured based MTA was also introduced to control the setting reaction. Further, 2-hydroxy ethylmeth acrylate (HEMA) and triethylene glycol dimethacrylate (TEGDMA) were added to the liquid component to initiate the setting reaction.19 Various other types of MTA, such as Micro-Mega (MM) MTA, and Ortho MTA, were formulated to improve the limitations of conventional materials.

Applications and Literature review

Studies have shown good clinical success of MTA when used as retrograde filling20-21 perforation repair, pulp capping,22, 23 a pexification 24 and pulpotomy. 25

Formation of natural hard tissue barrier on the surface of apical plug is important owing to the requirement of providing biological seal around apical plug. Systematic reviews and meta-analysis comparing Ca(OH)2 and MTA in successfully forming hard tissue barrier around open apices were not significant, but the time needed by MTA to form apical barrier was significantly lower than Ca(OH)2.24, 26 As a per foration repair material (non-surgical), systematic reviews and meta-analysis reported the overall success rate of 81% of MTA.27 Another systematic review evaluating the revitalisation and apical placement reported high success rate and successful outcome.28 When used as root-end filling material after peri-apical surgery, MTA is considered the gold standard, with systematic reviews and meta-analyses reporting significantly better outcome when compared with gutta percha, glass ionomer cement and amalgam.29 However, MTA was not significantly different than intermediate restorative material.29,30

Evidence regarding the use of MTA as an indirec t pulp capping is scarce. A study compared ProRoot MTA and Dycal as an indirect pulp capping agent and reported non-significant results at 6 months in terms of calcific bridge thickness.31 As a direct pulp capping agent, MTA had significantly better outcome with regard to complete calcific bridge formation and reducing the inf lammation when compared to Dycal.31-35 A recent systematic review concluded that the risk of failure was significantly lower when MTA was used as a direct pulp capping agent in permanent teeth.36 When considered as pulpotomy medicament in primary teeth, several systematic reviews and meta-analyses reported superiority of MTA in comparison to the other currently used materials, but they studies failed to find significant difference between Ca(OH)2 and MTA when used as pulpotomy agent over cariously exposed pulps.37-41

To further overcome the drawbacks of MTA, newer bioactive cements have been introduced, with characteristics similar to MTA but without its disadvantages.


Biodentine (Septodont) has now been recognised as a promising material, serving as a chief representative of the CS family,42 first marketed in 2009. Biodentine has a wide range of applications, including pulp capping, pulpotomy medicament, and as an endodontic repair (perforation repair, resoprtive lesions, root-end filling material), and can be regarded as a dentine replacement material. Biodentine, which is technically based on MTA technology, is formulated to overcome the deficiencies of MTA.43


The setting time of the material is 12-13 minutes, which is significantly less than the MTA.42 This fast-setting reaction is attributed to the increased particle size, addition of calcium chloride (CaCl2) in the liquid component, decreasing the liquid content.43 Studies have also linked the short setting time to the absence of di-calcium silicate from the composition of biodentine, which was associated with a slow hydration reaction.44

Another important difference was the addition of calcium carbonate which can act as a nucleation site for calcium-silicate-hydrate (CSH), hence accelerating the setting reaction.36

Setting reaction

The setting reaction of biodentine is similar to MTA and results in the formation of CSH and Ca(OH)2. Biodentine additionally contains calcium carbonate in the powder which explains the presence of carbonate phase. The tri-calcium silicate grains in the biodentine are finer than MTA and the addition of hydrophilic polymer in the composition makes the manipulation and handling easier. 44

Applications and literature review

When used as a root-end filling material, biodentine showed significantly better sealing ability in comparison to MTA and intermediate restorative material (IRM).46,47 No significant difference was found when biodentine and ProRoot MTA were tested in acidic environment.47

Studies have also reported superior compressive strength48,49 flexural strength, microhardness, and push-out bond strength and calciumion release when compared to other CS-based cements.50-53 However, studies have shown conflicting results regarding radio-opacity of biodentine, and its colour stability.53,54 Direct contact of biodentine with dentine provided significantly thicker reparative dentine formation in comparison to Dycal.55 When biodentine was compared with MTA, no significant difference was found with regard to calcific bridge formation after pulp capping.33 Studies comparing outcomes of biodentine and MTA as pulpotomy agent in primary teeth also reported insignificant results.56-60

Calcium-enriched mixture cement (CEC) Calcium-enriched cement (CEC) was introduced in the field of dentistry in 2006 as an endodontic filling materi al.61 It has also got favourable physical characteristics, like film thickness, flow and setting time. It also has the capability to set in wet conditions in a shorter time compared to MTA. 61,62 The clinical applications of CEC are similar to MTA and biodentine, and it has demonstrated encouraging success when used as capping, pulpotomy, resor ption or repair material.63-65


CEC is very similar to MTA.66 In contrast to MTA, CEC has similar composition to dentine containing hydroxyapatite.67

Setting reaction

When CEC powder is mixed with water-based solution, bioactive calcium and phosphate-enriched materials are formed as a result of hydration reaction. In addition, calcium and phosphorous ions are released that are consumed in the formation of hydroxyapat ite. 68 CEC appeared to exhibit better physical properties, such as consistency, manipulation, setting time, antibacterial and antifungal properties, biocompatibility, lack of staining and better sealing ability.69

Literature review

A recent review reported that CEC is a suitable alternative material for vital pulp therapies of primar y molars (mature/immature) with reversible/irreversible pulpitis.69

Asgary et al. reported 5-year success of CEC-pulpotomy when compared with root canal treatment in mature permanent teeth with the established diagnosis of irreversible pulpitis.70 Most of the literature on CEC is currently based on case reports and case series which are considered weak levels of evidence. More clinical trials are needed to be conducted to assess the role of CEC as a wide-range endodontic application so that concrete level of evidence is generated.

Bio Aggregate

It is a new tailored adaptaption of MTA now available for endodontic repair utilising the advanced science of nanotechnology.


It is composed of nano-particle-sized tricalcium silicate, tantalum penta oxide, calcium phosphate and silicon dioxide, and presents improved performance compared to MTA.71 Tricalcium silicate is the main component phase.71 This material is claimed to be an aluminium-free ceramic biomaterial. Replacing bismuth oxide with tantlum penta oxide for radio-opacity makes it different from MTA.71

Setting reaction

The powder has to be mixed with deionized water in a ratio of 1 g/0.38 mL for 2-5 minutes. The material takes 4 hours to set, and permanent restoration has to be done after the final set. This turns out to be a clinic al disadvantage if the final restoration has to be placed on the same day. A nano-composite network of Hydrated Calcium Silicate (HCS) gel forms a firm tight seal at the site.71,72

Literature review

It is reported to be biocompatible in human fibroblast cells and stimulates osteoblastic differentiation in osteoblasts.73 BioAggregate (Innovative Bioceramix) stimulates odontoblastic differentiation of human dental pulp cells. 72 Its efficiency in odonto blastic and mineralisation differentiation is comparable with MTA. The results are comparable with those observed with human dental pulp cells (HDPCs) exposed to MTA. Clinical application of BioAggregate as pulp capping agent promotes mineralisation of dentine beneath the capping material, and then stimulates reparative odontogenesis from the injured dental pulp tissue.72 There were concerns regarding c ytotoxicity of BioAggregate but Yen et al. found it to be nontoxic to human cells and it also had the ability to induce differentiation of human periodontal ligament (PDL) fibroblasts.74

Table-3: Composition of bioactive cements.


ProRoot MTA (Dentsply, Tulsa, OK, USA)###Portland cement, bismuth oxide (MSDS)

MTA-angelus (Londrina, PR, Brazil)###Tricalcium silicate, dicalcium silicate, tricalcium

###aluminate, tetracalcium aluminoferrite, bismuth oxide (MSDS)

MM-MTA (MicroMega, Besancon, France)###Mixture of several mineral oxides and bismuth oxides (MSDS)

Ortho MTA (BioMTA, Seoul, Korea)###Calcium carbonate, silicon dioxide, aluminum

###oxide, dibismuth trioxide (MSDS)

Biodentine (Septodont,###Powder: Tricalcium silicate, calcium carbonate and

St. Maur-des-Foss'es, France)###oxide, iron oxide, zirconium oxide

###Liquid: calcium chloride (accelerator),

###hydrosoluble polymer (water reducing agent)

Calcium enriched mixture###Calcium oxide, sulphur tri-oxide, P2O5, SiO2. The

###other main components are calcium hydroxide,

###calcium phosphate, and calcium silicate. Minor

###components are Al2O3, Na2O, MgO, Cl.

Bioaggregate (Diadent, Burnaby, Canada)###Tricalcium silicate, dicalcium silicate, tantalum

###pentoxide, calcium phosphate monobasic,

###amorphous silicon oxide (MSDS)

Endosequence###Zirconium oxide, calcium silicates, calcium

###phosphate monobasic, calcium hydroxide, filler and

###thickening agents.

Clinical Application

It is similar to MTA with respect to sealing ability and biocompatibility, but it has more potential to form hard tissue barrier at the site. This advantage is due to the presence of Pi source present in the material. It is indicated for root perforation repair, root resorption repair, root-end filling, apexification and pulp capping.75 Its hard tissue-forming potential is expected to be greater than MTA because of the presence of Pi source in Bio-Aggregate, but the poorer mechanical properties and long setting time of BioAggregate limits the situations where it could replace MTA.71


Endosequence BC sealer (Brasseler USA) is another bioactive material that is highly radiopaque, dimensionally stable, hydrophilic, and forms hydroxyapatite upon setting. It is a material that needs natural canal moisture in the dentinal tubule for setting reaction.


It is a pre-mixed CS in the form of syringe-able paste or putty with easier handling and more feasible in application compared to MTA (Table 3). 61 The manufacturer claims that the material is aluminium-free, less soluble, and dimensionally more stable during setting.76

Setting reaction

It is a radiopaque material with a setting time of 2-4 h.77 Micro hardness reduces in the presence of environmental moisture whereas premature setting accelerates.78 It complies with the Inter national Organisation for Standards (ISO) in terms of dimensional accuracy, solubility and film thickness. It penetrates dentinal tubules due to its nano particles. Dentine liquid will create a mechanical bond with material upon setting.

This results in less shrinkage, thus maintaining dimensional stability.79 Sealing ability of endosequence is as good as MTA w hen used as root-end filling material.80 In contact with saliva, it forms a hydroxyapatite layer on the surface.81 Hard tissue is deposited due to calcium release as it has an alkaline pH. It also has antibacterial properties against enterococcus faecalis owing to its high pH.82

Literature Review

An in vitro study has reported that this material up-regulates alkaline phosphatase (ALP) and denitinesialo protein (DSP) genes, suggesting greater odontoblastic differentiation potential. In addition, Runx2 determines the lineage of osteoblasts and odontoblasts from mesenchymal cells, and its expression is high in response to bioceramics and MTA. 83

Lovato and Sedgley83 investigated the antibacterial activity of Endosequence against enterococcus (E.) faecalis and found that Endosequence root repair material (ERRM) and white ProRoot MTA demonstrated similar antibacterial efficacy against clinical strains of E. faecalis. Additionally, another study found that the ERRM had cell viability similar to MTA.84 These materials are still evolving and are under research.

Clinical Application

It is a suitable material for perforation repair, apical surgery, apical plug, and pulp capping. It has strengths and biological properties comparable with MTA.71 It is easy to handle and apply, and thus can be considered an alternative to MTA.


MTA has been proven as a table-turner in bio-active materials and has a wide horizon of applications in endodontics and restorative dentistr y. The newer modifications and materials are continuously on the verge of improving the properties by combating the drawbacks of the previous material. The newer materials could be seen as the promising alternative to MTA, but more long-term follow-up studies are needed to this notion.

Disclaimer: None.

Conflict of Interest: None.

Source of Funding: None.


1. Raghavendra SS, Jadhav GR, Gathani KM, Kotadia P. Bioceramics in endodontics - a review. J Istanb Univ Fac Dent 2017;51(Suppl 1):S128-S37.

2. Debelian G, Trope M. The use of premixed bioceramic materials in endodontics. G Ital Endod 2016;30:70-80.

3. Dutta A, Saunders WP. Calcium silicate materials in endodontics.Dental Update 2014;41:708-22.

4. Saghiri MA, Orangi J, Asatourian A, Gutmann JL, Garcia-Godoy F, Lotfi M, etal. Calcium silicate-based cements and functional impacts of various constituents. Dent Mater J 201 7 31;3 6: 8-18.

5. Johnson W, Kulild JC, Tay F. Obturation of the Cleaned and Shaped Root Canal System. In: Hargreaves KM, Berman LH, eds. Cohen's Pathways of the PULP, 11th ed. St. Louis, Missouri: Elsevier Inc,2016; pp 280.

6. Parirokh M, Torabinejad M. Mi neral trioxide aggregate: a comprehensive literature review--Part III: Clinical applications, drawbacks, and mechanism of action. J Endod 2010;36:400-13.

7. Torabinejad M, Hong CU, Lee SJ, Monsef M, Pitt Ford TR.Investigation of mineral trioxide aggregate for root-end filling in dogs. J Endod 1995;21:603-8.

8. Camilleri J, Montesin FE, Brady K, Sweeney R, Curtis RV, Ford TR. The constitution of mineral trioxide aggregate. Dent Mater 2005;21:297-303.

9. Rao A, Rao A, Shenoy R. Mineral trioxide aggregate--a review. J Clin Pediatr Dent 2009;34:1-7.

10. Bozeman TB, Lemon RR, Eleazer PD. Elemental analysis of crystal precipitate from gray and white MTA. J Endod 2006;32:425-8.

11. Torabinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. J Endod 1999;25:197-205.

12. Andelin WE, Shabahang S, Wright K, Torabinejad M. Identification of hard tissue after experimental pulp capping using dentin sialop rotein (DSP) as a marker. J Endod 2003;29:646-50.

13. Camilleri J. Hydration mechanisms of mineral trioxide aggregate. Int Endod J 2007;40:462-70.

14. Ford TR, Torabinejad M, Abedi HR, Bakland LK, Kariyawasam SP.Using mineral trioxide aggregate as a pulp-capping material. J Am Dent Assoc 1996;127:1491-4.

15. Sark ar NK, Caicedo R, Ritwik P, Moiseyeva R, Kawashima I.Physicochemical basis of the biologic properties of mineral trioxide aggregate. J Endod 2005;31:97-100.

16. Torabinejad M, Hong CU, McDonald F, Pitt Ford TR. Physical and chemical properties of a new root-end filling material. J Endod1995;21:349-53.

17. Kogan P, He J, Glickman GN, Watanabe I. The effects of various additives on setting properties of MTA. J Endod 2006;32:569-72.

18. Camilleri J. The physical properties of accelerated Portland cement for endodontic use. Int Endod J 2008;41:151-7.

19. Gandolfi MG, Taddei P, Siboni F, Modena E, Ciapetti G, Prati C.Development of the foremost light-curable calcium-silicate MTA cement as root-end in oral surgery. Chemical-physical properties, bioactivity and biological behavior. Dent Mater 2011;27:e134-57.

20. Christiansen R, Kirkevang LL, Horsted-Bindslev P, Wenzel A.Randomized clinical trial of root-end resection followed by root-end filling with mineral trioxide aggregate or smoothing of the orthograde gutta-percha root filling--1-year follow-up. Int Endod J 2009;42:105-14.

21. Saunders WP. A prospective clinical study of periradicular surgery using mineral trioxide aggregate as a root-end filling. J Endod2008;34:660-5.

22. Mente J, Geletneky B, Ohle M, Koch MJ, Friedrich Ding PG, Wolff D, et al. Mineral trioxide aggregate or calcium hydroxide direct pulp capping: an analysis of the clinical treatment outcome. J Endod 2010;36:806-13.

23. Mente J, Hage N, Pfefferle T, Koch MJ, Geletneky B, Dreyhaupt J, et al. Treatment outcome of mineral trioxide aggregate: repair of root perforations. J Endod 2010;36:208-13.

24. Chala S, Abouqal R, Rida S. Apexification of immature teeth with calcium hydroxide or mineral trioxide aggregate: systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:e36-42.

25. Erdem AP, Guven Y, Balli B, Ilhan B, Sepet E, Ulukapi I, et al. Success rates of mineral trioxide aggregate, ferric sulfate, and formocresol pulpotomies: a 24-month study. Pediatr Dent 2011;33:165-70.

26. Lin JC, Lu JX, Zeng Q, Zhao W, Li WQ, Ling JQ. Comparison of mineral trioxide aggregate and calcium hydroxide for apexification of immature permanent teeth: A systematic review and meta-analysis. J Formos Med Assoc 2016;115:523-30.

27. Siew K, Lee AH, Cheung GS. Treatment Outcome of Repaired RootPerforation: A Systematic Review and Meta-analysis. J Endod 2015;41:1795-804.

28. Torabinejad M, Nosrat A, Verma P, Udochukwu O. Regenerative Endodontic Treatment or Mineral Trioxide Aggregate Apical Plug in Teeth with Necrotic Pulps and Open Apices: A Systematic Review and Meta-analysis. J Endod 2017;43:1806-20.

29. von Arx T, Penarrocha M, Jensen S. Prognostic factors in apical surgery with root-end filling: a meta-analysis. J Endod 2010;36:957-73.

30. Tang Y, Li X, Yin S. Outcomes of MTA as root-end filling in endodontic surgery: a systematic review. Quintessence Int 2010;41:557-66.

31. Leye Benoist F, Gaye Ndiaye F, Kane AW, Benoist HM, Farge P.Evaluation of mineral trioxide aggregate (MTA) versus calcium hydroxide cement (Dycal(A(r))) in the formation of a dentine bridge: a randomised controlled trial. Int Dent J 2012;62:33-9.

32. Eskandarizadeh A, Shahpasandzadeh MH, Shahpasandzadeh M, Torabi M, Parirokh M. A comparative study on dental pulp response to calcium hydroxide, white and grey mineral trioxide aggregate as pulp capping agents. J Conser v Dent 2011;14: 351-5.

33. Nowicka A, Wilk G, Lipski M, Ko?ecki J, Buczkowska-Radli?ska J.Tomographic Evaluation of Reparative Dentin Formation after Direct Pulp Capping with Ca(OH)2, MTA, Biodentine, and Dentin Bonding System in Human Teeth. J Endod 2015;41:1234-40.

34. Parolia A, Kundabala M, Rao NN, Acharya SR, Agrawal P, Mohan M, et al. A comparative histological analysis of human pulp following direct pulp capping with Propolis, mineral trioxide aggregate and Dycal. Aust Dent J 2010;55:59-64.

35. Swarup SJ, Rao A, Boaz K, Srikant N, Shenoy R. Pulpal response to nano hydroxyapatite, mineral trioxide aggregate and calcium hydroxide when used as a direct pulp capping agent: an in vivo study. J Clin Pediatr Dent 2014;38:201-6.

36. Grech L, Mallia B, Camilleri J. Characterization of set Intermediate Restorative Material, Biodentine, Bioaggregate and a prototype calcium silicate cement for use as root-end filling materials. Int Endod J 2013;46:632-41.

37. Aguilar P, Linsuwanont P. Vital pulp therapy in vital permanent teeth with cariously exposed pulp: a systematic review. J Endod 2011;37:581-7.

38. Asgary S, Shirvani A, Fazlyab M. MTA and ferric sulfate in pulpotomy outcomes of primary molars: a systematic review and meta-analysis. J Clin Pediatr Dent 2014;39:1-8.

39. Shirvani A, Asgary S. Mineral trioxide aggregate versus formocresol pulpotomy: a systematic review and meta-analysis of randomized clinical trials. Clin Oral Investig 2014;18:1023-30.

40. Shirvani A, Hassanizadeh R, Asgary S. Mineral Trioxide Aggregate vs. Calcium Hydroxide in Primary Molar Pulpotomy. A Systematic Review. Iran Endod J 2014;9:83-8.

41. Stringhini Junior E, Vitcel ME, Oliveira LB. Evidence of pulpotomy in primary teeth comparing MTA, calcium hydroxide, ferric sulphate, and electrosurgery with formocresol. Eur Arch Paediatr Dent 2015;16:303-12.

42. Rajasekharan S, Martens LC, Cauwels RGEC, Anthonappa RP, Verbeeck RMH. Correction to: Biodentine(tm) material characteristics and clinical applications: a 3 year literature review and update. Eur Arch Paediatr Dent 2018;19:129.

43. Malkondu O, Karapinar Kazanda? M, Kazazo?lu E. A review on biodentine, a contemporary dentine replacement and repair material. Biomed Res Int 2014;2014:e160951.

44. Darvell BW, Wu RC. "MTA"-an Hydraulic Silicate Cement: review update and setting reac tion. Dent Mater 2011;27:407-22.

45. Camilleri J, Sorrentino F, Damidot D. Investigation of the hydration and bioactivity of radiopacified tricalcium silicate cement, Biodentine and MTA Angelus. Dent Mater 2013;29:580-93.

46. Agrafioti A, Tzimpoulas N, Chatzitheodoridis E, Kontakiotis EG. Comparative evaluation of sealing ability and microstructure of MTA and Biodentine after exposure to different environments. Clin Oral Investig 2016;20:1535-40.

47. Soundappan S, Sundaramurthy JL, Raghu S, Natanasabapathy V.Biodentine versus Mineral Trioxide Aggregate versus Intermediate Restorative Material for Retrograde Root End Filling: An Invitro Study. J Dent (Tehran) 2014;11:143-9.

48. Butt N, Talwar S, Chaudhry S, Nawal RR, Yadav S, Bali A. Comparison of physical and mechanical properties of mineral trioxide aggregate and Biodentine. Indian J Dent Res 2014; 25: 692-7.

49. Kayahan MB, Nekoofar MH, McCann A, Sunay H, Kaptan RF, Meraji N, et al. Effect of acid etching procedures on the compressive strength of 4 calcium silicate-based endodontic cements. J Endod 2013;39:1646-8.

50. Kaup M, Schafer E, Dammaschke T. An in vitro study of different material properties of Biodentine compared to ProRoot MTA. Head Face Med 2015 2;11:16.

51. Natale LC, Rodrigues MC, Xavier TA, Simoes A, de Souza DN, Braga RR. Ion release and mechanical properties of calcium silicate and calcium hydroxide materials used for pulp capping. Int Endod J 2015;48:89-94.

52. Tanalp J, Karap?nar-Kazanda? M, Doleko?lu S, Kayahan MB.Comparison of the radiopacities of different root-end filling andrepair materials. ScientificWorldJournal 2013;2013:e594950.

53. Valles M, Roig M, Duran-Sindreu F, Martinez S, Mercade M. Color Stability of Teeth Restored with Biodentine: A 6-month In Vitro Study. J Endod 2015;41:1157-60.

54. Dawood AE, Manton DJ, Parashos P, Wong RH, Palamara JE, Reynolds EC. Push-out bond strength of CPP-ACP-modified calcium silicate-based cements. Dent Mater J 2015;34:490-4.

55. Grewal N, Salhan R, Kaur N, Patel HB. Comparative evaluation of calcium silicate-based dentin substitute (Biodentine((R))) and calcium hydroxide (pulpdent) in the formation of reactive dentin bridge in regenerative pulpotomy of vital primary teeth: Triple blind, randomized clinical trial. Contemp Clin Dent 2016;7:457-63.

56. Kang CM, Kim SH, Shin Y, Lee HS, Lee JH, Kim GT, et al. A randomized controlled trial of ProRoot MTA, OrthoMTA and RetroMTA for pulpotomy in primary molars. Oral Dis 20 15;21: 785-91.

57. Kusum B, Rakesh K, Richa K. Clinical and radiographical evaluation of mineral trioxide aggregate, biodentine and propolis as pulpotomy medicaments in primary teeth. Restor Dent Endod2015;40:276-85.

58. Malekafzali B, Shekarchi F, Asgary S. Treatment outcomes of pulpotomy in primary molars using two endodontic biomaterials. A 2-year randomised clinical trial. Eur J Paediatr Dent 2011;12:189-93.

59. Niranjani K, Prasad MG, Vasa AA, Divya G, Thakur MS, Saujanya K.Clinical Evaluation of Success of Primary Teeth Pulpotomy Using Mineral Trioxide Aggregate(A(r)), Laser and Biodentine(TM)-an In Vivo Study. J Clin Diagn Res 2015;9:35-7.

60. Togaru H, Muppa R, Srinivas N, Naveen K, Reddy VK, Rebecca VC.Clinical and Radiographic Evaluation of Success of Two commercially Available Pulpotomy Agents in Primary Teeth: An in vivo Study. J Contemp Dent Pract 2016;17:557-63.

61. Asgary S, Eghbal MJ, Parirokh M, Torabzadeh H. Sealing ability of three commercial mineral trioxide aggregates and an experimental root-end filling material. Iran Endod J 2006; 1: 101-5.

62. Asgary S, Shahabi S, Jafarzadeh T, Amini S, Kheirieh S. The properties of a new endodontic material. J Endod 2008; 34: 990-3.

63. Asgary S, Eghbal MJ, Parirok h M, Ghanavati F, Rahimi H. A comparative study of histologic response to different pulp capping materials and a novel endodontic cement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:609-14.

64. Asgary S, Ehsani S. Permanent molar pulpotomy with a new endodontic cement: A case series. J Conserv Dent 2009;12:31-6.

65. Samiee M, Eghbal MJ, Parirokh M, Abbas FM, Asgary S. Repair of furcal perforation using a new endodontic cement. Clin Oral Investig 2010;14:653-8.

66. Asgary S, Eghbal MJ, Parirokh M, Ghoddusi J, Kheirieh S, Brink F.Comparison of mineral trioxide aggregate's composition with Portland cements and a new endodontic cement. J Endod 2009;35:243-50.

67. Asgary S, Eghbal MJ, Parirokh M, Ghoddusi J. Effect of two storage solutions on surface topography of two root-end fillings. Aust Endod 2009;35:147-52.

68. Amini Ghazvini S, Abdo Tabrizi M, Kobarfard F, Akbarzadeh Baghban A, Asgary S. Ion release and pH of a new endodontic cement, MTA and Portland cement. Iran Endod J 2009;4:74-8.

69. Utneja S, Nawal RR, Talwar S, Verma M. Current perspectives of bio-ceramic technology in endodontics: calcium enriched mixture cement - review of its composition, properties and applications. Restor Dent Endod 2015;40:1-13.

70. Asgary S, Eghbal MJ, Fazlyab M, Baghban AA, Ghoddusi J. Five-year

71. Mreasudlftas AofAv,iAtall-SpaunlpabthaenriaFpAy, iAnlp-Keurmd amnei nNtHmAoQla. rEsnwdiothdoirnretivceresipbaleir fpilulilnpgitims: atneorina-lisn: fAerrieovr iteywmaurltiiclen. tBer JraMneddomMiezeddRcelisn2ic0a1l 4tr;4ia:l3. Investig 2015;19:335-41.

72. Chang SW, Lee SY, Kum KY, Kim EC. Effects of ProRoot MTA, Bioaggregate, and Micromega MTA on odontoblastic differentiation in human dental pulp cells. J Endod 2014; 40: 113-8.
COPYRIGHT 2020 Knowledge Bylanes
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2020 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Author:Zafar, Kamil; Jamal, Shizrah; Ghafoor, Robia
Publication:Journal of Pakistan Medical Association
Article Type:Report
Geographic Code:9PAKI
Date:Mar 31, 2020
Previous Article:Effectiveness of basic training session regarding the awareness of Ebola virus disease among nurses of public tertiary care hospitals of Lahore.
Next Article:Emotiv EPOC+ fed electrical muscle stimulation system; an inexpensive brain-computer interface for rehabilitation of neuro-muscular disorders.

Terms of use | Privacy policy | Copyright © 2021 Farlex, Inc. | Feedback | For webmasters |