Mineral Trioxide Aggregate Research Articles

Evaluation of the Effects of MTA Apexification and Regenerative Endodontic Therapy on Lesion Healing using Fractal Analysis: A Retrospective Study.

A comparison between mineral trioxide aggregate (MTA) apexification and regenerative endodontic therapy (RET) in immature permanent teeth is pivotal for optimising treatment outcomes and enhancing clinical decision-making. Understanding the efficacy, limitations and long-term implications of each approach is essential for achieving predictable, successful outcomes when managing immature teeth with necrotic pulps. The aim of this retrospective study was to compare the changes in the periapical bone using fractal dimension (FD) on the periapical radiographs of patients who underwent apexification and RET. The lesion area was evaluated using fractal analysis on periapical radiographs obtained before and one year after treatment with the ImageJ program. Additionally, periapical status was classified using the periapical index (PAI). The significance level was set at 0.05. In the present study, we found that the changes in FD and PAI over a one-year observation period were independent of the specific root canal treatment technique used. According to the fractal analysis, neither MTA apexification nor RET with tripleantibiotic paste is superior for immature teeth with pulp necrosis resulting from dental trauma.

Comparing effectiveness of mineral trioxide aggregate, bioceramic putty and tannic acid in maintaining pulp vitality after experimental pulpotomy in rats

This study aimed to evaluate and compare the effectiveness of mineral trioxide aggregate (MTA), bioceramic putty (BP) and tannic acid (TA) for experimental pulpotomy. Our in-vivo experimental study involved sample of 45 rats that were randomly divided into 4 groups: Group 1 (subdivided into negative (1-A) and positive (1-B) subgroups), Group 2 (MTA treated), Group 3 (BP treated) and Group 4 (TA treated). 4 weeks post pulpotomy, specimens were analyzed histologically, immunohistochemically using dentin sialoprotein marker, and histomorphometrically by assessing the thickness of newly formed dentin bridge. Group 1-B showed pulp necrosis without hard tissue formation. Group 2 showed moderate dentin formation while group 3 presented a thick layer of calcific barrier. Group 4 showed dentin bridge formation, however, irregular pulp calcifications and radicular pulp necrosis were seen. The thickness of newly formed dentin bridge showed a significant difference between group 1-B and group 2, 3 &4. Significant difference was found between group 2&3 and group 3&4. Dentin sialoprotein immunohistochemical expression was negative in group 1-B, mild in group 2, strong in group 3 and moderate in group 4. MTA and BP proved to be effective pulpotomy agents with BP being superior. For TA, further studies are required to explain the recorded unfavorable effects in some specimens.

To Evaluate and Compare the Microleakage of Chitosan Nano Hydrogel-Incorporated MTA and Glass Ionomer Cements When used as a Retrograde Filling Material

ABSTRACT Background: An inadequate apical seal stands out as a primary cause of disappointment in surgical endodontic procedures. Therefore, the choice of root-end filling material should aim to prevent the leakage of potential contaminants into the periapical tissue. Aim: To evaluate and compare microleakage of chitosan nano hydrogel-incorporated mineral trioxide aggregate (MTA) and glass ionomer cement (GIC) when used as a retrograde filling material. Materials and Methods: Sixty single-rooted premolars were decoronated at cemento enamel junction (CEJ), and root canals were prepared and obturated, with the coronal part sealed with a composite. The dye absorption was measured by an automatic spectrophotometer. Results: The results showed that the MTA + chitosan group had less microleakage values compared to the MTA group but was not statistically significant and GIC + chitosan had less microleakage values compared to the GIC group and was statistically significant. Conclusion: Chitosan-incorporated MTA and chitosan-incorporated GIC can be considered as retrograde filling material; however, further in vitro and in vivo research and long-term clinical studies are required.

Comparison of iRoot BP Plus and mineral trioxide aggregate for pulpotomy in primary molars under general anesthesia: a 3-year retrospective study.

Pulpotomy is a widely recommended treatment for deep caries and reversible pulpitis in primary teeth. However, there is a significant lack of large-scale clinical studies evaluating the long-term efficacy of pulpotomy in primary molars, especially in studies with follow-up periods extending beyond a two years. This study aimed to evaluate the long-term efficacy of mineral trioxide aggregate (MTA) and iRoot BP Plus for pulpotomy in primary molars performed under general anesthesia and to investigate factors influencing the success rate. In this retrospective study, a total of 942 primary molars from 422 children who met the inclusion criteria underwent pulpotomy. Propensity score matching method (PSM) was used to match the MTA and iRoot BP Plus groups in a 1:1 ratio based on covariates. Efficacy was assessed using the Zurn & Seale criteria. Kaplan-Meier survival analysis and Cox proportional hazards model were performed to analyze the outcomes. PSM resulted in 266 pairs of matched teeth from 532 teeth of 291 children (mean age: 4.64 ± 1.07 years, ranging from 2 to 8 years). Long-term clinical and radiographic evaluations revealed higher success rates for iRoot BP Plus (24-month: 99.54%/97.25%; 36-month: 97.22%/95.83%) compared to MTA (24-month: 94.76%/95.29%; 36-month: 92.50%/91.25%). Survival analysis indicated a statistically significant difference between two groups (P=0.0042). Age, gender, tooth position, and decayed tooth surface showed no significant impact on pulpotomy success, whereas the choice of pulp capping materials significantly influenced the outcome (HR [95% CI]=0.3745[0.1857-0.7552], P=0.006). Clinical and radiographic evaluations support the use of iRoot BP Plus for pulpotomy in primary molars.

A Comparison of the Apical Sealing Efficacy Between Guttaflow Bioseal and Mineral Trioxide Aggregate as Root-End Filling Materials: An In Vitro Study

A Comparison of the Apical Sealing Efficacy Between Guttaflow Bioseal and Mineral Trioxide Aggregate as Root-End Filling Materials: An In Vitro Study

In Vivo and In Vitro Response to a Regenerative Dental Scaffold.

As dental pulp contains the stem cells necessary for regeneration, the tooth should hold the intrinsic capacity for self-repair. A triphasic hybrid dental biocomposite (3HB) composed of biocompatible biopolymers to provide strength, antibacterial properties and protein-based cell support could provide a conducive microenvironment for the regeneration of dental structures. 3HB was incorporated into Mineral Trioxide Aggregate (ProRoot MTA) to construct a malleable injectable implant. Human tooth pulp cells (hDPCs) significantly increased proliferation in the presence of 3HB+MTA compared to 3HB or MTA alone. Cell viability decreased with MTA alone but increased with 3HB and 3HB+MTA. 3HB+MTA was implanted into the residual tooth of drilled Wistar rat M2 molars for up to 45 days. Stereological analysis from micro-CT images showed the volume of the tooth remaining. Histologically, regenerative pulpal architecture was seen invading 3HB. A continuous odontoblastic profile lined a deposit of dentin-like material suggesting reparative dentinogenesis. Overall, no infection or encapsulation was seen. Immunohistochemically, odontoblasts were seen along the margins of the wounded tooth undergoing repair. Mesenchymal cells (MSCs) were seen at the base of the drilled tooth and by 21 days had translocated into the implant itself. Cells stimulating remineralization were highly expressed in the tooth undergoing repair. CD146-positive MSCs were seen in the center of the implant, possibly stimulating remineralization. In conclusion, behavior of 3HB+ in vitro and in vivo provided a promising start as 3HB+MTA may serve as a viable regenerative scaffold for pulp regeneration; however, this should be further studied before clinical use can be considered.

Impact of strontium added fluorophosphate glass on the physico-chemical properties of mineral trioxide aggregate

Mineral trioxide aggregate (MTA) is widely employed in the field of endodontics, extensively for root canal therapy. Despite being successful, MTA has certain limitations regarding its physico-chemical properties. The present investigation aims to enhance the physicochemical and mechanical behavior of MTA by formulating a cement paste by addition of strontium containing fluorophosphate glass (SrFP). The addition of strontium on to the fluorophosphate glass improves the mechanical strength of the glass network and also accelerates the mineralization process during implantation. In this regard, fluorophosphate glasses with 6 mol% of strontium content were synthesized by standard melt quenching technique and the glasses were ball milled to obtain fine powder. Cement paste was prepared by adding optimized 5 wt% of 6 mol% SrFP glass powder on to 95 wt% of MTA cement. Comparative analysis of conventional MTA with SrFP added MTA were evaluated for various properties such as pH variation, contact angle, radiopacity, compressive strength, push-out bond strength, setting expansion, sealing ability, tooth color change, surface morphology and ALP activity. The obtained results from the investigation exposed that the addition of strontium added fluorophosphate on to MTA impacts the physical properties which includes wettability, sealing ability, push out bond strength and ALP. These findings suggest that SrFP to be a promising additive to MTA with wide scope of applications in dentistry.

Vital pulp therapy: A bibliometric analysis of the 100 most-cited articles from 1966 to 2022

Introduction: Vital pulp therapy (VPT) aims to preserve dental pulp after injury and has gained significant popularity due to advancements in materials and understanding of pulp biology. While bibliometric analyses are common in various fields, none have been conducted specifically for the 100 most-cited articles on VPT. Materials and Methods: This bibliometric study analyzed the 100 most-cited VPT papers using data from Web of Science (WoS-CC), Scopus, and Google Scholar. Articles were manually reviewed to extract key bibliometric data, including titles, citation counts, citation density, authorship, country of origin, publication year, journal, study design, and VPT type. Results: The articles collectively received 19,782 citations, with the oldest from 1966 and the most recent from 2019, having 803 and 104 citations, respectively. Key journals included the Journal of Endodontics, International Endodontic Journal, and Dental Materials. Review articles were the predominant study design, followed by clinical, laboratory, and basic research studies. Eight of the top 20 articles focused on the properties of mineral trioxide aggregate (MTA). Torabinejad and Parirokh were notable contributors before 2010, while Duncan, Bjørndal, and Simon were prominent after 2010. VPT research has increased significantly post-2010, with a notable shift in focus from early studies on calcium hydroxide to more recent studies on MTA’s biocompatibility and its use as a pulp capping agent. Conclusion: This analysis provides a comprehensive list of the top 100 cited VPT articles, offering valuable insights for researchers, students, and clinicians. The study highlights key trends and influential contributions in the field of VPT research.

Clinical efficacy of platelet-rich fibrin, injectable platelet-rich fibrin, and advanced platelet-rich fibrin in regenerative endodontics: A case series

Background: This series investigates the efficacy of regenerative endodontic therapy (RET) using various platelet-rich fibrin (PRF) formulations in treating apical periodontitis and necrotic pulp in immature permanent teeth. Aim: This study aims to evaluate the effectiveness of different PRF formulations in RET. Materials and Methods: Three cases involving patients aged 15–16 with immature teeth and necrotic pulp were treated with RET using PRF, injectable PRF, and advanced PRF. The procedure included inducing bleeding with a Hedstrom file, applying PRF variants, and sealing with mineral trioxide aggregate and composite resin. Patients were followed up at 1, 3, 6, 12 and 18 months. Results: Radiographic evidence showed apical closure, root maturation, and healing of periapical tissues in all cases. However, pulp sensibility tests were negative. Conclusion: RET using PRF variants promotes root development and apical healing in immature teeth. Further research with larger sample sizes is needed to understand these therapies’ potential and limitations.

Nonsurgical endodontic treatment of Type II dens invaginatus by removal of the internal structure of the tooth : a case report

Dens invaginatus is a developmental anomaly that occurs when the enamel organ is invaginated into the dental papilla before the process of calcification during tooth development. Dens invaginatus exhibits various anatomical variations, and these structural changes can complicate treatment. For effective management of dens invaginatus, it is crucial to accurately understand the internal structure of the tooth and to establish an appropriate treatment plan. Cone-beam computed tomography (CBCT) has proven to be a valuable tool for three-dimensional reconstruction of the tooth. This case report presents a maxillary lateral incisor with pulpal necrosis and periapical periodontitis. The case involves dens invaginatus characterized by a separate tooth structure, diagnosed using CBCT, and a treatment plan was established accordingly. For treatment, a dental microscope was used to remove the internal structure of the tooth, followed by filling with mineral trioxide aggregate (MTA).

Impact of Acidic and Alkaline Environments on the Surface Morphology of Biodentine and White Mineral Trioxide Aggregate - An In-vitro Study.

The physical and chemical properties of calcium silicate cement might be affected due to exposure to acidic or alkaline conditions during clinical use. The present study aimed to evaluate the effect of acidic and alkaline environments on the surface morphology of biodentine (BD) and white mineral trioxide aggregate (wMTA). Disc-shaped specimens of BD (n = 30) and wMTA (n = 30) were prepared in a metal mould and wrapped in pieces of gauze. They were divided into three sub-groups according to the storage media: group A, soaked in sterile distilled water at a pH of 7.0; group B, exposed to butyric acid buffered at pH 4.0; and group C, exposed to calcium hydroxide solution buffered at pH 12.0. The specimens were incubated for 7 days at 37°C, followed by examination under scanning electron microscopy at 1000x and 5000x magnification to characterise the microstructural morphology. Definite changes were seen in the microstructure of BD and wMTA on exposure to acidic and alkaline pH. The microstructure of wMTA tends to exhibit reduced cohesion when exposed to an acidic environment, especially when compared to an alkaline pH. Acidic pH exerts a milder influence on the morphological structure of BD when contrasted with its effects on wMTA. Biodentine may emerge as a more prudent choice than wMTA for utilisation in inflamed periapical regions.

Radiographic changes in root maturation of immature dog premolars after direct pulp capping with Mineral Trioxide Aggregate (MTA) : A randomized controlled trial

Radiographic changes in root maturation of immature dog premolars after direct pulp capping with Mineral Trioxide Aggregate (MTA) : A randomized controlled trial

The Effect of Human Blood and Platelet-rich Fibrin on the Surface Microhardness of Hydraulic Calcium Silicate-based Cements

Objectives: This study aimed to compare the effect of human blood and platelet-rich fibrin (PRF) on the surface microhardness of hydraulic calcium silicate-based cements (OrthoMTA and RetroMTA). Materials and Methods: Two types of mineral trioxide aggregate, OrthoMTA and RetroMTA, were mixed and placed into cylindrical molds. The lower surfaces of all cements were exposed to saline. The upper surfaces of cements were exposed to human blood, PRF, or phosphate buffer saline (PBS). After storage for 7 days in fully saturated humidity at 37°C, the microhardness of cement surface exposed to blood, PRF, or PBS was measured using the Vickers microhardness test. The data were analyzed using two-way analysis of variance and post hoc Tamhane’s T2 test. The significance level was set at P<0.05. Results: Exposure to blood and PRF significantly decreased the surface microhardness of OrthoMTA and RetroMTA. The microhardness of PBS-contacted cements was significantly higher than that of blood or PRF groups (P<0.001). The microhardness values for OrthoMTA exposed to PRF were significantly higher than the blood group (P=0.020). There were no significant differences between RetroMTA contacted with blood or PRF groups (P=0.985). When exposed to blood or PBS, RetroMTA had a significantly higher microhardness than OrthoMTA (P<0.001 for blood, P=0.002 for PBS). Conclusion: Exposure to blood or PRF decreased the surface microhardness of both cements. Blood-contaminated RetroMTA showed significantly higher surface microhardness than OrthoMTA contacted with blood. No significant difference was found between PRF-contacted OrthoMTA and RetroMTA.

Investigation on structurally reinforced synthetic bone grafts via tricalcium silicate

AbstractTricalcium silicate (C3S) is one of the main components of mineral trioxide aggregates, which is used in dental endodontic treatment. C3S provides workable viscosity itself and fast hydration when water is added, and it is known to be nontoxic, noncarcinogenic, nongenotoxic, biocompatible, and insoluble in tissue fluids. In this study, C3S is added to synthetic bone‐graft materials from 30% to 60% to deliver viscosity to increase workability in the early stage of implant surgical procedure and to attain some degree of compressive strength after the hydration. Additionally, the porosity is not overly reduced to maintain the ability for bone regeneration. The porosity of the samples was confirmed to be 40%–50% with the formation of the C3S matrices. Simultaneously, the maximum compressive strength was ensured at 14.9 MPa within 24 h of curing time. The radiopacity required for post‐procedural diagnosis was evaluated. The radiopacity of the samples with 50% and 60% C3S was 1.0 mm Al and 1.1 mm Al, respectively. When ZrO2 was added, the radiopacity was enhanced to 1.6 mm Al. Overall, the experimental results showed that the bone‐graft added C3S would be suitable for alveolar bone support and rigid matrix formation in implant surgery.

Total Pulpotomy with MTA in Young Permanent Teeth: Case Series

Vital pulp therapy is a way to preserve the vitality and function of pulp damaged by trauma, caries or restorative procedures. Vital pulp therapy procedures include direct pulp capping, indirect pulp capping, partial and coronal pulpotomy treatments where diseased pulp tissue is removed. Over the years, the focus of vital pulp therapy has been on the preservation of the radicular pulp in immature permanent teeth to ensure the completion of root formation (apexogenesis). Today, it has been reported that vital pulp therapy can be considered as an alternative to root canal treatment, including in teeth with certain conditions that are considered to have irreversibly inflamed pulp. Coronal amputation therapy, a vital pulp treatment, involves complete removal of the coronal pulp, placement of a biologically acceptable material into the pulp chamber and restoration. The covering material must be able to relieve inflammation and initiate healing of the pulp tissue and allow new dentin tissue to form. The oldest material used in pulpotomy is calcium hydroxide. Mineral trioxide aggregate, which is a more recent material, is frequently preferred today due to its biocompatible and bioactive properties. In this case report, the results of 4 cases of coronal pulpotomy with mineral trioxide aggregate in young permanent teeth with a follow-up of 18 months are presented.

Evaluating the Restoration of External Root Resorption Under Biomechanical Stress: A Finite Element Analysis.

Root resorption is a complex problem in endodontic treatment that considerably affects the structural integrity of teeth. This study aims to assess the biomechanical efficacy of various restorative materials and approaches in treating external root resorption, emphasizing their capacity to improve stress resistance and guarantee long-term success. This research employed finite element analysis (FEA) to assess stress distribution in mandibular premolars with external root resorption. Eight models, demonstrating apical and mid-level resorption, were repaired using mineral trioxide aggregate (MTA), Biodentine, or a mixture of these materials with gutta-percha. In order to evaluate each technique's biomechanical performance, the models were exposed to both vertical and oblique stresses. The findings demonstrated that complete canal obturation with Biodentine or MTA greatly lowered stress levels, with Biodentine exhibiting a marginal advantage. The hybrid approach utilizing gutta-percha produced elevated stress concentrations, especially under oblique loading conditions. MTA and Biodentine are effective in enhancing resistance to biomechanical forces in teeth with external resorption. However, the combination of gutta-percha with these materials reduces resistance, especially under oblique forces. These findings highlight the importance of material selection in restoring resorbed teeth and improving clinical outcomes.

Effects of using different dentin conditioners on dentin regeneration.

This experiment aimed to evaluate the impact of several dentine etching and conditioning agents on growth factors (GFs) liberation from dentine slices. Eighteen dentine slices were obtained from nine premolars divided in to six groups, the slices immersed in one mL test solutions for 5 min; Group 1: white Mineral trioxide aggregate (MTA), Group 2: Phosphate buffered saline (PBS), Group 3: 37% phosphoric acid, Group 4: 17% Ethylenediaminetetraacetic Acid (EDTA), Group 5: 10% Maleic acid (MAc), and Group 6: 0.7% Fumaric acid. The solutions were removed and stored directly at for further detection and quantification of transforming GF beta 1 (TGF-b1), bone morphogenetic protein 2 (BMP2) and vascular endothelial growth factor (VEGF) by enzyme-linked immunosorbent assay (ELISA). One-way ANOVA was used to compare the mean release and standard deviation between groups (α = 0.05). Tukey's post hoc applied for multiple comparisons. After five min conditioning of dentine slices, white MTA released the highest level of TGF-b1, BMP2 and VEGF among all groups, followed by 0.7% Fumaric acid with no significant difference between them, but compared to 37% phosphoric acid and PBS groups significant difference observed, which they released the least amount of GFs amongst all groups. Based on the results of this research the detectable release of TGF-b1, BMP2 and VEGF by 0.7% fumaric acid was comparable with white MTA from dentin slices.

How Irrigants Affect Mineral Trioxide Aggregate (MTA) Sealing in Furcal Perforations: An In Vitro Study.

Objective This study aimed to evaluate the effect of 5.25% sodium hypochlorite (NaOCl) and 2% chlorhexidine (CHX) on ProRoot mineral trioxide aggregate (MTA) used for treating furcal perforations, compared to no solution application, using the dye penetration (DP) method. Materials and methods The study included 36 intact mandibular molars in the furcal area (FA) with well-spaced roots. Using dental operating microscopes, perforations were created at the FA of the molars with a 1.2 mm diameter. Subsequently, ProRoot MTA (Dentsply, Germany) was applied to seal the perforations. After 24 hours, the samples were randomly assigned to three groups: Group A (n = 12), irrigated with 5.25% NaOCl; Group B (n = 12), irrigated with 2% CHX; and Group C (n = 12), without irrigation (control group). Specimens' pulp chambers were immersed in 2% methylene blue for 24 hours. Buccal-lingual sections were performed, and the depth of marginal dye leakage was assessed using a stereomicroscope at 20x magnification. Data analysis employed the one-way analysis of variance (ANOVA) test and Bonferroni post-hoc test (α = 0.05). Results The study revealed significant differences in DP values between groups (p-value < 0.01). DP values in the control group (no irrigation) were lower than both NaOCl (p < 0.05) and CHX (p < 0.01) groups. Furthermore, DP values in the CHX group were higher than those in the NaOCl group (p < 0.01), suggesting the order: no irrigation < NaOCl < CHX (p < 0.05). Conclusions The sealing ability of MTA was compromised when irrigated with 2% CHX and 5.25% NaOCl. CHX significantly impacted the marginal leakage and sealing ability of MTA. Care should be taken when resuming endodontic treatment after the application of MTA in cases of furcal perforations as the use of CHX and NaOCl may affect the marginal leakage of MTA.

Comparative evaluation of various biomaterials as pulpotomy agents in molars with symptomatic irreversible pulpitis: A randomized single-blinded single-center control trial.

Untreated tooth decay in mature permanent dentition is a prevalent global issue, affecting 34.1% of people with 2.5 billion cases annually. Extensive decay often leads to irreversible pulpitis, characterized by pulp inflammation and pain. Pulpectomy, the standard treatment, involves complex procedures with potential complications. Modern endodontics favors minimally invasive treatment such as pulpotomy, which preserves pulp vitality. This study aims to compare the clinical as well as radiographic outcomes of different pulpotomy agents: Biodentine, mineral trioxide aggregate (MTA), Bio-C repair, and Endosequence Bio-ceramic root repair material (BCRRM) in mature permanent molars. This single-blind, single-center study involved 80 participants randomly assigned to four groups, each receiving one of the biomaterials. Ethical approval was obtained. Participants aged 14-60 years with symptomatic irreversible pulpitis were selected. Pulpotomy procedures were performed, and follow-up evaluations occurred at 24 h, 1 week, 4 weeks, 3, 6, and 12 months. Clinical success was measured by the absence of pain, sensitivity, and tenderness. Radiographic evaluation used the periapical index (PAI) scoring system. Pulpotomy significantly reduced postoperative pain in all groups. Endosequence BCRRM showed the maximum pain reduction at 24 h with a statistically significant difference from all the groups (at 1% probability level), followed by Bio-C repair, Biodentine, and MTA. At 1 week, Bio-C repair led in pain reduction with statistically nonsignificant results. All groups reported no pain at 3, 6, and 12 months. Endosequence BCRRM had the highest improvement in periapical findings at 1 year. Sensitivity to hot and cold improved significantly in all groups, with Endosequence BCRRM performing best. Endosequence BCRRM provided the best overall outcomes, emphasizing the importance of material choice in pulpotomy treatments. Further research on biomaterials' long-term clinical and radiographic outcomes is needed to enhance treatment efficacy.

The Management of Root Perforation: A Review of the Literature.

Root canal perforation is defined as an opening or communication of the root to the outer oral tissue that occurs either accidentally during root canal therapy or due to unknown pathological causes, which generally result in complications in patientsdue to the passage of microorganisms to the surrounding tissues. These complications may necessitate extraction of the affected tooth. In this literature review, 42 articles were reviewed initially; 33 of them were included in the final analysis based on exclusion and inclusion criteria. Root perforation may occur due to caries, external and internal resorption, trauma, as well as iatrogenic causes. Many studies have suggested that perforation can be identified by radiographs, unexpected bleeding and pain during instrumentation, blood on paper points, electronic apex locator, and dental operating microscope. Several materials have been used in endodontic perforation repairs, such as indium foil, super 2-ethoxybenzoic acid (super EBA), as well as bioceramic materials like mineral trioxide aggregate (MTA) and biodentine. These materials must achieve biocompatibility, bacteriostatic ability, and radio-opacity. Many studies have reported the superior properties of MTA in comparison with other materials. Based on our literature review, management of root perforation should be performed based on multiple significant factors. Clinicians must possess a comprehensive understanding of tooth anatomy to prevent perforation occurrence. Furthermore, clinical management and prognosis of root perforation have been enhanced by the availability of advanced materials and sealing techniques.