Editor’s intro: In this Step-by-step, Dr. Carlos A. Spironelli Ramos shows the improved mixing and delivering properties of MTAFlow second-generation MTA cement.
Dr. Carlos A. Spironelli Ramos discusses a second-generation MTA with improved mixing/delivering properties
Tricalcium silicate hydraulic cement materials such as the well-known mineral trioxide aggregate (MTA) are biocompatible materials with high-sealing ability and have been used for various reparative purposes in dentistry, including root-end ﬁlling, sealing perforations, treating open apices, and direct pulp-capping.1 Primarily composed of tricalcium silicates, MTA cements are radiopaque materials that form a self-setting calcium silicate hydrate mix when manipulated with water.2
The first formulation of MTA (1995) was composed of gray Portland cement with the addition of bismuth oxide powder as a radiopacifier. MTA has been recognized as a bioactive material that is hard tissue conductive, hard tissue inductive, and biocompatible, so the applications of this material have been rapidly expanding in dentistry. Despite such good characteristics, the first generation of MTA repair material presented some drawbacks, including difficult handling properties, a long setting time, and an unfriendly delivery method. The multipurpose use of MTA demanded the development of improved formulations. A shorter setting time and better washout performance were desired, so the clinician could feel confident that the product had set before the procedure was finished and wouldn’t be flushed out by water or blood. Considering the importance of the ideal flowability that a repair material should have to reduce the difficulty of handling and delivering, a high-plasticity MTA cement was developed with the aim of improving these characteristics.
Released in 2015, MTAFlow™ cement (Ultradent Products Inc.; South Jordan, Utah, Figure 1) is a bioactive repair material that represents a second-generation MTA with improved mixing/delivering properties. Keeping the same biological characteristics of the original MTA, this product presents advantages in the plasticity during mixing and versatility in terms of syringe-cannula delivery. The main differences in the presentation of MTAFlow are the particle size of the di- and tricalcium silicate powder and the viscosity of the water-soluble silicone-based gel. The use of antiwashout gel aims to increase viscosity and the resistance of particles to external water solutions while enhancing physical properties such as compressive strength, reduced setting time, and porosity. According to studies,3,4 the water-based gel in conjunction with the small particles facilitates manipulation and insertion into the cavity when compared with first-generation MTA, while showing biocompatibility and the ability to form biomineralizated tissue, representing an alternative to the conventional MTA.
Tricalcium silicate cements such as MTAFlow are now considered the materials of choice for vital pulp therapy. Histologic studies have demonstrated dentin-pulp regeneration without pulp inflammation in human teeth.5 The therapeutic use of these materials in direct pulp-capping implies their straight application on the underlying fibroblasts that have been reported to play a significant role in initiating pulp regeneration.6
A clinical direct pulp-capping application of MTAFlow is described in the numbered list.
What makes MTAFlow different than other second-generation MTA cements? See a product profile by Ultradent here.