ProRoot MTA, MTA-Angelus and IRM Used to Repair Large Furcation Perforations: Sealability Study Ahmed Abdel Rahman Hashem, BDS, MSc, PhD, and Ehab E Hassanien, BDS, MSc, PhD Abstract The ability of two mineral trioxide aggregate (MTA) compounds and Intermediate Restorative Material (IRM) to seal large furcation perforations were evalu- ated using a dye-extraction leakage method. The fur- cation perforations were repaired with and without the use of internal matrix before placement of repair ma- terial. Eighty extracted human mandibular first molars were divided into positive (n = 10), negative (n = 10), and three experimental groups (n = 20) according to the repair material used. Each experimental group was divided into two subgroups (n = 10) according to whether internal matrix was used or not. Dye leakage was tested from an orthograde direction, and dye ex- traction was performed using full concentration nitric acid. Dye absorbance was measured at 550 nm using spectrophotometer. ProRoot MTA (Maillfer, Dentsply, Switzerland) with and without internal matrix and MTA-Angelus (Angelus, Londrina, PR, Brazil) with in- ternal matrix showed the least dye absorbance. IRM (Caulk, Dentsply, Milford, DE) without internal matrix showed the highest dye absorbance. IRM with internal matrix and MTA-Angelus without internal matrix had insignificant difference and came at intermediate level between the other groups. (J Endod 2008;34:59 – 61) Key Words Dye extraction, furcation perforation, IRM, MTA-Ange- lus, root MTA P erforations can be defined as mechanical or pathologic communications between the root canal system and the external tooth surface (1). Seltzer et al. (2) in their in vivo histologic study on monkeys found that the repair of perforations was dependent on the location of perforation and the time lapsed before sealing the defect. Sinai (3) stated that middle third and apically situated perforations were less serious than those that occurred in the coronal third of the canal, including furcal perforations. Several materials have been used to repair furcation perforations, including zinc oxide-eugenol cements (IRM and Super-EBA), glass ionomer cement, composite res- ins, resin-glass ionomer hybrids, and mineral trioxide aggregate (MTA) (4). MTA was developed at Loma Linda University in the 1990s as a root-end–filling material. Lee et al. (5) compared the sealing ability of MTA with that of amalgam and IRM in experimentally induced lateral perforations. They found that MTA had significantly less leakage. Tor- abinejad et al. (6) compared the sealing ability of MTA with that of amalgam and Super-EBA when used as root-end fillings. They showed that most of the MTA samples had no dye penetration. Pitt Ford et al. (7) evaluated the histologic tissue response to experimentally induced furcation perforations in dog teeth repaired by either MTA or amalgam. They found that most MTA samples showed no inflammation and cementum deposition, whereas Amalgam sam- ples showed moderate to severe inflammation with no cementum deposition. The chemical composition of MTA was determined by Torabinejad et al. (8). The material consisted of fine hydrophilic particles, and the main components were trical- cium silicate, tricalcium aluminate, tricalcium oxide, and silicate oxide. Bismuth oxide acted as a radioopacifier. They declared that calcium and phosphorus were the main ions in MTA. Arens and Torabinejad (9) reported two cases of large furcation perfora- tion that were repaired by MTA. They stated that MTA was an ideal material for such cases. It did not need a barrier. The extruded material showed no adverse side effects, indicating its biocompatibility. Cemental deposition had been noted also. Sluyk et al. (10) evaluated the effect of time and moisture on setting, retention, and adaptability of MTA when used to repair furcation perforations. The authors noted that the presence of moisture in perforations during the placement of MTA increased its adaptation to perforation walls. They concluded that a moistened matrix can be used under MTA to prevent over- or underfilling of the material. Bryan et al. (11) reviewed the etiology, diag- nosis, prognosis, and material selection of nonsurgical repair of furcation perforation. They stated that furcal perforations had a bad prognosis. To improve it, they should be sealed immediately with a biocompatible and sealable material. MTA showed promise in this re- spect and could enhance the treatment modality for furcation perforation repair. Holland et al. (12) evaluated the healing process of intentional lateral perforations in dog teeth after repair with either MTA or Sealapex. Histologic evaluation showed new cementum deposition and absence of inflammation in most samples sealed by MTA. They concluded that hard tissue deposition, which was seen with both MTA and Seala- pex, meant that they have similar properties. They speculated that calcium oxide present in MTA might undergo a reaction with tissue fluids and form calcium hydroxide. Studies comparing MTA with Portland cement showed their similarity in compo- sition, properties, and tissue reactions (13–16). Until recently, two commercial forms of MTA have been available; ProRoot MTA (Maillfer, Dentsply, Switzerland) is available in either the gray or white form. According to the information supplied in the material safety datasheet, ProRoot MTA consists of 75% Portland cement, 20% bismuth oxide, and 5% calcium sulfate dehydrate. Recently, MTA-Angelus (Angelus, Londrina, PR, Brazil) has also become available as an alternative to ProRoot MTA. MTA-Angelus From the Faculty of Dentistry, Ain Shams University, Cairo, Egypt. Address requests for reprints to Dr Ahmed Abdel Rahman Hashem, 45 Mohamed Fared Abo Haded, Seventh Area, Nasr City, Cairo, Egypt. E-mail address: ahmedhashem1968@yahoo. com 0099-2399/$0 - see front matter Copyright © 2008 by the American Association of Endodontists. doi:10.1016/j.joen.2007.09.007 Basic Research—Technology JOE — Volume 34, Number 1, January 2008 ProRoot MTA, MTA-Angelus and IRM for Large Furcation Perforations 59