From my point of view Portland cement is not a viable substitute for MTA. We should take care and avoid to use it in clinical practice even if most of its properties is close to MTA's ones. Just one exemple, if i well remember, Portland cement leads to an exothermic reaction during the setting process by hydration (i have to check this allegation). It is not the case with MTA to avoid this kind of phenomenon which could lead to bad consequences for the pulp.

I think it's necessary that MTA contains radiopacifers to controle our treatments.

For instance, BIodentine, from my point of view is not enough visible on radiographs.

Finally, setting accelerators such as Calcium Chloride are optionnal even if it can be convenient in a few clinical cases.

Actually the hydration reactions of Portland cement based materials, including MTA, is mostly exothermic, probably MTA is less. This exothermic reaction together with the high pH are responsible for the transient inflammatory reactions, that is more pronounced when there is no dentine barrier (perforation repair, root-end filling,....). This is followed by repair and hard tissue induction. Indeed, the addition of setting accelerators would affect the chemical and biological properties of MTA or PC, but I believe this additive is important, especially if it will maintain the biological profile of the material.

Thanks Hany for all your interesting precisions. I just realize that my previous comment was not clear. Setting accelerators are usefull for instance in endodontic surgery or to avoid an additional appointment in other indications.

Finally Hany, could you give us your opinion concerning the different available products including BioDentin, Proroot, MMTA, Angelus Mta... Which one do you use or do you choose the product depending on the clinical case?

Actually I have clinical/research experience with grey and white formulations of MTA, and my main current research area is on Portland cement. I didn't work before with BioDentin. The problem I am facing Frederic with MTA mainly is the cost a) An overhead on the patient and endodontist, besides some compromised handling properties/application and setting time. I believe Collacote is a good matrix for MTA, but again there will be additional expenses; b) An overhead if you want to make a well-controlled study and you should suspect repeats of some experiments/groups.

That's why in my clinical practice, I have tried different formulations of GIC and I find it a reasonable alternative as a retro-grade filling. I have a case published in JCD and the long term follow up was acceptable.

That's why, in many countries in Africa and Asia, the search of an alternative (such as Portland cement) is essential. By the way, this is the same problem regarding rotary NiTi files, especially in some areas with limited financial outcomes.

Do you also face such problems regarding the cost, or the price of MTA and similar endodontic biomaterials are quite OK to both the patient and endodontist?, and those materials are able to serve for a wide range of patients of different financial supports.

In France, the cost of the different treatments can be a problem but certainly less than in your country. In Private practice, there are some patients who cannot afford certains techniques or biomaterials especially if they are not refunded by the social security system. In Univeristy Hospital, it can be different. Having said that, i think it's a good way to make reserach in order to find new effective and less expensive treatments to open access for the depressed areas

I totally agree with you. Do you also find the same problems such as difficult handling properties, challenging application and delayed setting time with ProRoot MTA, Angelus and BioDentin?. Do you use a collagen matrix, in case of perforation, to overcome some of these shortcomings?.

I think all countries now, with different degrees, are facing some sort of financial problems, and it looks reasonable to find out other less expensive endodontic bio-materials. Is there in France a trend or a research group/cluster for other substitutes such as Portland cement?.

Hi,

probably your search has ended before it began...

Another product, as far as I know very cheap, without some toxic ingredients of the original MTA. Developed by colleagues whom I would rate "very reliable".

Comes from Switzerland, can be ordered worldwide, afaik.

Just modified for radiographic visibility.

www.medcem.ch

Hi Yango,

Very interesting. I will visit the website in order to obtain more details about this product. Having said that i think there are many projects to do around the MTA with several purposes. Hany will not be jobless...LOL

Hi Yango and Frederic,

That looks very interesting!!. It looks to me as a "shortcut" for the application of Portland cement in dentistry. I will try to go further with the company regarding this product. Indeed, this product will be a subject for future comparative studies.

- Yes, Frederic. It seems as you said :-))

The idea behind this product was to spare lots of money, since one of the colleagues is responsible for all dental clinics for schools in a big town in Switzerland. Using MTA regularly he was angry that the costs were that high while to original Portland Cement is just nothing. So they started to work with portland cement and modifications. As far as I know it is their expressed will that prices are kept low...

They also offer a tri-antibiotic paste (TreVitaMix) for intentional revascularisation which I thought would make sense, as up to now everyone mixes this paste by his own, and nobody really knew whether the concentrations of these 3 AB would meet the recommendations or be quite different. So I suggested that they should go also for this, it is in my opinion a basic prerequisite for studies to have defined concentrations, built up from the generic original medicaments and not just substances, including fillers, pounded in a mortar with a pestle...

And I asked them to offer medicaments (glucocorticoids, doxycyclin) in a correct concentration (NoResorb) for use for teeth to be replanted (see my publication from 2005 part 2. on periodontal healing, and "ART").

see: http://www.medcem.ch/cms/index.php?option=com_content&view=article&id=64&Itemid=189&lang=de

Unfortunately these products can only shipped within Switzerland.... Afaik it is a customs problem...

So long

Yango

Hi Yango,

Many thanks for the information. Of course, it is a big problem that such products are only shipped within Switzerland. But anyway, I believe that it seems reasonable that countries with economical concerns should be self-dependent in producing modified formulations of cost-effective materials such as Portland cement.

Hi,

just met the guy of that pharmacy. There is a big problem with the European Union (Switzerland is no member of the EU). That means they can't export to Germany but to most countries worldwide.

As far as I know they offer surprisingly low prices, at least when compared to existing alternatives.

I don't know whether every country with economical concerns should produce own modified materials; there may be some quality problems and overall it may not be efficient. But I agree that the actual situation is not acceptable. However I don't have any idea how to change it. That is not my issue. What I can do or offer is to share my knowledge freely (for example here). This is at least one step on the long way to a fair world....