Clinical Oral Investigations

, Volume 23, Issue 1, pp 169–177 | Cite as

Biocompatibility and biomineralization assessment of mineral trioxide aggregate flow

  • Carlos Roberto Emerenciano Bueno
  • Ana Maria Veiga Vasques
  • Marina Tolomei Sandoval Cury
  • Gustavo Sivieri-Araújo
  • Rogério Castilho Jacinto
  • João Eduardo Gomes-Filho
  • Luciano Tavares Angelo Cintra
  • Eloi Dezan-JúniorEmail author
Original Article



Evaluate, in vivo, the biocompatibility via subcutaneous inflammatory tissue response and mineralization ability of the new MTA Flow compared to MTA Angelus and ProRoot MTA.

Materials and methods

Forty male Wistar rats were assigned and received subcutaneous polyethylene tube implants containing the test materials and a control group with empty tube (n = 10 animals/group). After days 7, 15, 30, and 60, the animals were euthanized and the polyethylene tubes were removed with the surrounding tissues. Inflammatory infiltrate and thickness of the fibrous capsule were histologically evaluated. Mineralization was analyzed by Von Kossa staining and under polarized light. Data were analyzed via Kruskal-Wallis and Dunn’s test with a significance level of 5%.


MTA Angelus induced the mildest reaction after 7 (P > .05) and 15 days (P < .05) followed by MTA Flow, both cements achieving mild inflammatory reaction after 15 days. ProRoot MTA induced a severe inflammation on day 7 and was reducing after day 15 (P > .05). No difference was observed after days 30 or 60 (P > .05). Von Kossa staining and birefringent structures were positive to all materials.


At the end of the experiment, the novel MTA Flow showed biocompatibility and induced biomineralization in all time periods.

Clinical relevance

The final consistence obtained in MTA Flow may facilitate several procedures, indicating that the MTA Flow has a promising application in endodontics.


Biocompatibility Biomineralization Inflammation Mineral trioxide aggregate 



The authors would like to thank Ultradent Products, Inc. for providing the MTA Flow used in this study.


This research was supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed. Before any procedure, the project was approved by Faculdade de Odontologia de Araçatuba, UNESP, Animal Ethical Committee (CEUA protocol 00225-2017).

Informed consent

For this type of study, formal consent is not required.


  1. 1.
    Mori GG, Teixeira LM, de Oliveira DL et al (2014) Biocompatibility evaluation of biodentine in subcutaneous tissue of rats. J Endod 40:1485–1488CrossRefGoogle Scholar
  2. 2.
    Edanami N, Yoshiba N, Ohkura N, Takeuchi R, Tohma A, Noiri Y, Yoshiba K (2017) Characterization of dental pulp myofibroblasts in rat molars after pulpotomy. J Endod 43:1116–1121CrossRefGoogle Scholar
  3. 3.
    Bueno CRE, Valentim D, Marques VAS, Gomes-Filho JE, Cintra LT, Jacinto RC et al (2016) Biocompatibility and biomineralization assessment of bioceramic-, epoxy-, and calcium hydroxide-based sealers. Braz Oral Res 30(1):81CrossRefGoogle Scholar
  4. 4.
    Cintra LTA, Benetti F, Queiroz IOA, Ferreira LL, Massunari L, Bueno CRE, Oliveira SHPO, Gomes-Filho JE (2017) Evaluation of the cytotoxicity and biocompatibility of new resin epoxy-based endodontic sealer containing calcium hydroxide. J Endod 43:2088–2092CrossRefGoogle Scholar
  5. 5.
    Bueno CRE, Lopes GA, Valentim D, Marques VAS, Vasques AMV, Cury MT, Sivieri-Araujo G, Jacinto RDC, Cintra LTA, Dezan-Junior E (2017) Mixing failures of endodontic sealers: an in vivo biocompatibility study. Braz Dent Sci 20(4):85–92CrossRefGoogle Scholar
  6. 6.
    ISO 10993-6. Biological evaluation of medical devices. Part 6: Tests for local effects after implantation International Standard Norm, Porto, Portugal (2007)Google Scholar
  7. 7.
    Olsson B, Sliwkowsky A, Langeland K (1981) Subcutaneous implantation for the biological evaluation of endodontic materials. J Endod 7:355–369CrossRefGoogle Scholar
  8. 8.
    Cintra LTA, Benetti F, Queiroz IOA, Lopes JMA, Sandra Oliveira SHP, Sivieri Araujo G, Gomes-Filho JE (2017) Cytotoxicity, biocompatibility, and biomineralization of the new high-plasticity MTA material. J Endod 43:774–778CrossRefGoogle Scholar
  9. 9.
    Cintra LT, Ribeiro TA, Gomes-Filho JE et al (2013) Biocompatibility and biomineralization assessment of a new root canal sealer and root-end filling material. Dent Traumatol 29:145–150CrossRefGoogle Scholar
  10. 10.
    Federation Dentaire Internationale (1980) Recommended standard practices for the biological evaluation of dental materials. Int Dent J 30:174–176Google Scholar
  11. 11.
    Hinata G, Yoshiba K, Han L, Edanami N, Yoshiba N, Okiji T (2017) Bioactivity and biomineralization ability of calcium silicate-based pulp-capping materials after subcutaneous implantation. Int Endod J 50:40–45CrossRefGoogle Scholar
  12. 12.
    Torabinejad M, Watson TF, PittFord TR (1993) Sealing ability of a mineral trioxide aggregate when used as a root end filling material. J Endod 19:591–595CrossRefGoogle Scholar
  13. 13.
    Lee SJ, Monse FM, Torabinejad M (1993) Sealing ability of a mineral trioxide aggregate for repair of lateral root perforations. J Endod 19:541–544CrossRefGoogle Scholar
  14. 14.
    Sarkar NK, Caicedo R, Ritwik P, Moiseyeva R, Kawashima I (2005) Physicochemical basis of the biologic properties of mineral trioxide aggregate. J Endod 31(2):97–100CrossRefGoogle Scholar
  15. 15.
    Tanomaru-Filho M, Torres FFE, Bosso-Martelo R, Chávez-Andrade GM, Bonetti-Filho I, Guerreiro-Tanomaru JM (2017) A novel model for evaluating the flow of endodontic materials using micro-computed tomography. J Endod 43:796–800CrossRefGoogle Scholar
  16. 16.
    Zarrabi MH, Javidi M, Jafarian AH, Joushan B (2010) Histologic assessment of human pulp response to capping with mineral trioxide aggregate and a novel endodontic cement. J Endod 11:1778–81. 12Google Scholar
  17. 17.
    Parirokh M, Torabinejad M (2010) Mineral trioxide aggregate: a comprehensive literature review—part I: chemical, physical, and antibacterial properties. J Endod 36:16–27CrossRefGoogle Scholar
  18. 18.
    Camilleri J (2008) The chemical composition of mineral trioxide aggregate. J Conserv Dent 11:141–143CrossRefGoogle Scholar
  19. 19.
    Canadas PS, Berastegui E, Gaton-Hernandez P et al (2014) Physicochemical properties and interfacial adaptation of root canal sealers. Braz Dent J 25:435–441CrossRefGoogle Scholar
  20. 20.
    Duarte MA, Ordinola-Zapata R, Bernardes RA et al (2010) Influence of calcium hydroxide association on the physical properties of AH Plus. J Endod 36:1048–1051CrossRefGoogle Scholar
  21. 21.
  22. 22.
    Ultradent Products, Inc. Products and Procedures Manual (2017) Repair Material: MTA Flow p. 54–57Google Scholar
  23. 23.
    Valentim D, Bueno CRE, Marques VAS, Vasques AMV, Cury MTS, Cintra LTA, Dezan-Junior E (2017) Calcium hydroxide associated with a new vehicle: Psidium cattleianum leaf extracts. Tissue response evaluation. Braz Oral Res 31(43):1-8Google Scholar
  24. 24.
    Gomes-Filho JE, de Azevedo Queiroz IO, Watanabe S, da Silva Santos LM, Lodi CS, Okamoto R, Ervolino E, Dezan E Jr, Cintra LTA (2015) Influence of diabetes mellitus on tissue response to MTA and its ability to stimulate mineralization. Dent Traumatol 31:67–72CrossRefGoogle Scholar
  25. 25.
    American Association of Endodontists (2013) New materials/technologies position paper. American Association of Endodontists, ChicagoGoogle Scholar
  26. 26.
    Chhabra A, Teja TS, Jindal V, Singla MG, Warring K (2011) Fate of extruded sealer: a matter of concern. J Oral Health Comm Dent 5(3):168–172Google Scholar
  27. 27.
    International Organization for Standardization. Dentistry—preclinical evaluation of biocompatibility of medical devices used in dentistry. Test methods for dental materials: ISO/TR 7405-1997(E). Switzerland: ISO, 1997Google Scholar
  28. 28.
    Gomes-Filho JE, de Moraes Costa MT, Cintra LT et al (2010) Evaluation of alveolar socket response to Angelus MTA and experimental light-cure MTA. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 110:93–97CrossRefGoogle Scholar
  29. 29.
    Holland R, Souza V, Nery MJ, Otoboni-Filho JA, Bernabé PFE, Dezan-Júnior E (1999) Reaction of rat connective tissue to implanted dentin tubes filled with mineral trioxide aggregate or calcium hydroxide. J Endod 25(3):161–166CrossRefGoogle Scholar
  30. 30.
    Cintra LT, de Moraes IG, Estrada BP et al (2006) Evaluation of the tissue response to MTA and MBPC: microscopic analysis of implants in alveolar bone of rats. J Endod 32:556–559CrossRefGoogle Scholar
  31. 31.
    Gomes-Filho JE, de Moraes Costa MM, Cintra LT et al (2011) Evaluation of rat alveolar bone response to Angelus MTA or experimental light-cured mineral trioxide aggregate using fluorochromes. J Endod 37:250–254CrossRefGoogle Scholar
  32. 32.
    Gomes-Filho JE, Watanabe S, Lodi CS, Cintra LT, Nery MJ, Otobon Filho JA et al (2012) Rat tissue reaction to MTA FILLAPEX. Dent Traumatol 28(6):452–456CrossRefGoogle Scholar
  33. 33.
    Silveira CM, Pinto SC, Zedebski Rde A et al (2011) Biocompatibility of four root canal sealers: a histopathological evaluation in rat subcutaneous connective tissue. Braz Dent J 22:21–27CrossRefGoogle Scholar
  34. 34.
    Camilleri J (2008) Characterization of hydration products of mineral trioxide aggregate. Int Endod J 41:408–417CrossRefGoogle Scholar
  35. 35.
    Sarkar NK, Caicedo R, Ritwik P, Moiseyeva R, Kawashima I (2005) Physicochemical basis of the biologic properties of mineral trioxide aggregate. J Endod 31:97–100CrossRefGoogle Scholar
  36. 36.
    Tay FR, Pashley DH, Rueggeberg FA, Loushine RJ, Weller RN (2007) Calcium phosphate phase transformation produced by the interaction of the Portland cement component of white mineral trioxide aggregate with a phosphate-containing fluid. J Endod 33:1347–1351CrossRefGoogle Scholar
  37. 37.
    Gandolfi MG, Taddei P, Tinti A, Prati C (2010) Apatite-forming ability (bioactivity) of ProRoot MTA. Int Endod J 43:917–929CrossRefGoogle Scholar
  38. 38.
    Camilleri J (2015) Mineral trioxide aggregate: present and future developments. Endod Top 32:31–46CrossRefGoogle Scholar
  39. 39.
    Parirokh M, Torabinejad M (2010) Mineral trioxide aggregate: a comprehensive literature review—part III: clinical applications, drawbacks, and mechanism of action. J Endod 36:400–413CrossRefGoogle Scholar
  40. 40.
    Marciano MA, Guimarães BM, Amoroso-Silva P, Camilleri J, Hungaro Duarte MA (2016) Physical and chemical properties and subcutaneous implantation of mineral trioxide aggregate mixed with propylene glycol. J Endod 42:474–479CrossRefGoogle Scholar
  41. 41.
    Hsieh SC, Teng NC, Lin YC, Lee PY, Ji DY, Chen CC, Ke ES, Lee SY, Yang JC (2009) A novel accelerator for improving the handling properties of dental filling materials. J Endod 35:1292–1295CrossRefGoogle Scholar
  42. 42.
    Guimarães BM, Vivan RR, Piazza B, Alcalde MP, Bramante CM, Duarte MAH (2017) Chemical-physical properties and apatite-forming ability of mineral trioxide aggregate flow. J Endod 43(10):1692–1696CrossRefGoogle Scholar
  43. 43.
    Komabayashi T, Spångberg LSW (2008) Comparative analysis of the particle size and shape of commercially available mineral trioxide aggregates and Portland cement: a study with a flow particle image analyzer. J Endod 34:94–98CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Carlos Roberto Emerenciano Bueno
    • 1
  • Ana Maria Veiga Vasques
    • 1
  • Marina Tolomei Sandoval Cury
    • 1
  • Gustavo Sivieri-Araújo
    • 1
  • Rogério Castilho Jacinto
    • 1
  • João Eduardo Gomes-Filho
    • 1
  • Luciano Tavares Angelo Cintra
    • 1
  • Eloi Dezan-Júnior
    • 1
    Email author
  1. 1.Department of Endodontics, Araçatuba School of DentistrySao Paulo State University (Unesp)Araçatuba/São PauloBrazil

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