[Ingredient] What are the differences between ProRoot MTA and OrthoMTA?

- Particale size : 2 ㎛. Because it contains no coarse particles, OrthoMTA flows well into the narrow canal system and will seal the dentinal tubules effectively.

- Expansion coefficient : 0.08, there is no expansion or shrinkage after hardening.
Over expansion of canal grafting material will elevate the possibility of root fracture.

- Flow rate : OrthoMTA is the first hydraulic orthograde canal grafting material satisfying the ISO 6876 standard

- Film thickness : OrthoMTA is the first and the only hydraulic canal grafting material satisfying the ISO 6876 standard

- Appilication : OrthoMTA is an orthograde canal grafting material

- Instruction : OrthoMTA is individually packed in 0.2g vial so it is very convenient and there is no waste.
Hydraulic mixing and de-bubbling proceed simultaneously in a small centrifuge

- Basic materials : The basic materials of OrthoMTA are highly purified reagents so that impurities are excluded. The Basic material of Pro-rootMTA is white portland cement according to manufacturer's catalog.

OrthoMTA is the first and the only patented hydraulic orthograde canal grafting material in the world. Its physiochemical properties, stability, handling and price are definitely superior to Proroot MTA.

[Ingredient] What is the difference between OrthoMTA and white Portland cement?

- The expansion coefficient rate of white portland cement is more than 2%.
Over expansion of canal filling material will increase the possibility of root fracture.

- Industrial waste is used in the manufacturing process for white portland cement. So carcinogenic heavy metal contents such as Cr6+(chronium ion) cyanide compound cannot be excluded.
White portland cement contains coarse particles so it can cause abrupt canal obturation in the narrow canal system during the root canal filling. The basic material of Pro-rootMTA is white Portland cement according to the manufacturer’s catalog? Any materials containing industrial waste should not be used!

[Setting reaction] Are the setting reactions of OrthoMTA affected by acidic conditions?

If the apical condition is acidic resulting from inflammation, OrthoMTA will not set. so thorough irrigation with saline or calcium hydroxide solution is needed to ensure a neutral or alkaline condition in canal system. EDTA must be washed out completely by thorough irrigation because it is an acidic reagent.
Routine application of EDTA may cause root weakening and prevent MTA from hardening.

[Setting reaction] Does an acidic condition after hardening affect OrthoMTA?

Apical inflammation will not affect the setting of OrthoMTA.
Recurrent inflammation of a treated tooth cannot dissolve OrthoMTA which has already set.
As a result of in vitro experiments, it was revealed that sulfuric or hydrochloric acid could not dissolve hardened
OrthoMTA in tube.

[Setting reaction] What is the setting time for OrthoMTA?

Physical Properties of New MTA The setting process has two phases:
The first phase is an initial incomplete setting and the second phase is final setting which means a complete chemical setting. The initial setting time of OrthoMTA is 180 mins and the final setting time is 360 mins.
A short setting time is not good for orthograde filling but is desirable for retrograde filling.
Currently BioMTA is developing a RetroMTA which has a short setting time of within 3 min.

[Hardening reaction] Does OrthoMTA make a chemical bonding with the dentinal wall?

There are two kinds of bonding:
1.Mechanical bonding between the irregular dentinal wall and interfacial layer of OrthoMTA.
2.Chemical bonding between the interfacial layer and the dentinal tubules.

In many research papers show that a hydroxyapatite interfacial layer forms between dentin and MTA surface.
A. SEM view shows that there is an interfacial layer forming between MTA and the dentinal wall, and also the growing hydroxyapatite tags into the dentinal tubules. B.C. SEM. The bonding between the interfacial layer and the dentinal wall is stronger than bonding between MTA and the interfacial layer D. x50 magnitude. showing bonding between MTA and dentinal tubule

[Grafting method] What is the grafting method with existing instruments?

You can carry out orthograde grafting with existing instruments, but the new instrument is needed for shortening grafting time and better sealing in the apical 5mm area.
It is very easy with existing instruments, an amalgam carrier can be used to deliver hydrated MTA into the canal chamber, and a #15 spreader can be used to condense MTA into the MAF length. However,it takes too long to fill and increases the possibility of saliva contamination. Some research results show mucoplysaccaride in saliva prevents MTA from setting.

[Grafting method] Is it possible to graft the root canal if there is a significant exudate?

It is important to diagnose if the exudates is of an inflammatory or infective nature.
In case of white yellowish and foul smelling exudate, a thorough calcium hydroxide irrigation and follow-up check will be required.

[Grafting method] Are there any problems in case of overfilling?

There are no special problems. In fact overfilling with MTA will the change acidity
of the apical region and it will establish a more desirable micro-environment for periodontal
apparatus regeneration.

Pictures show the forming of cementum and new bone in the contact region with MTA
MTA is a material having bioactive properties. It will induce peridotium regeneration.
Recently many researchers conclude that MTA is a Bioactive material.

[Grafting method] Are there any problems in case of underfilling?

Any filling material cannot produce a good result in case of underfilling.
Unsealed gaps or spaces provide a bacterial growth environment and results in the failure of endodontic treatment.

[Grafting method] What is the advantage of canal enlargement of apical areas when the orthograde grafting method is pr

The 5mm distance from the apex is the critical area of endodontic treatment because it affects the success rate. Thorough debridement and irrigation leads to perfect sealing.

Lateral and vertical condensing technique cannot guarantee the perfect apical sealing because gutta-percha will shrink after sealing and degradation of it will follow. Also, apical areas cannot be thoroughly irrigated through a conventional enlargement technique.

A cylindrical space formation in the apical 5mm area(diameter: 0.30~0.35mm) provides a complete debridement. A 0.29 diameter needle reaches more effectively to the apex and it makes thorough irrigation in apical areas. In addition, a cylindrical space in the apical 5mm area allows a jamming effect more easily.

[Grafting method] How can a canal more than MAF #40 or open apex be filled?

The OrthoMTA condensor #35 is recommended.
A slight overfilling is acceptable, however, it requires care,
because it is diffcult to remove the overfilled MTA if a periapical lesion is extended
to the inferior alveolar nerve canal.

[Grafting method] what is the recommended water/power ratio?

First, OrthoMTA should be fully hydrated keeping water/power ratio(=1/3) and excessive water should be removed.
After grafting the canal completely, the oral environment supplies sufficient water required to set OrthoMTA.

[Grafting method] Can the left over OrthoMTA be re-used?

Yes (although not recommended) but Sterilization with an autoclave is recommended to re-use the left over OrthoMTA.

[Grafting method] How can OrthoMTA be mixed with water?

A small centrifuge is recommended to mix OrthoMTA with water, but a mixing pad is an alternative to a centrifuge.

[Grafting method] Is it possible to completely graft the curved canal with OrthoMTA?

Yes, it is possible, keeping the OrthoMTA condenser #25 to the definitive working length
ensures complete grafting.

[Grafting method] It seems possibility that the dentin walls are removed by using OrthoMTA compactor.

OrthoMTA compacter is straight and smooth type having no cutting edge on axial surface.
That is the point differentiated OrthoMTA compacter from other instruments made by Dentsply or Sybron Endo company.
Therefore, canal preparation at apex 5mm area can be achieved efficiently not removing the dentin walls.

[Grafting method] It seems there is a possibility that the dentin walls are removed by using the OrthoMTA compactor.

The OrthoMTA compacter is a straight and smooth type having no cutting edge on its axial surface.
That is the point which differentiates the OrthoMTA compacter from other instruments made by Dentsply or
the Sybron Endo company.
Therefore, canal preparation at apical 5mm area can be achieved efficiently without removing the dentin walls.

[Grafting method] Doesn't the modified technique by using guttapercha cause a problem?

No problem, fill the canal with OrthoMTA from apex to the apical 5mm area and then fill the
unfilled area with gutterpercha.

[Grafting method] How many times can the OrthoMTA spreader and condensor be used to

We recommend 10 or 15 times to avoid the risk of instrument breakage.

[Obturation] What is the difference between using condensing and compacting obturation devices?

It is your preference, the difference is:
- When using an OrthoMTA Condenser, you have to use a low-speed hand piece.
- When using an OrthoMTA Compacter, you have to use a vertical vibrating hand piece.

[Obturation] What is the role of blood when setting OrthoMTA?

Based on the research, there's no particular influence.

[Obturation] When the dentinal of the root is perforated, what is optimum grafting thickness of OrthoMTA ?

First of all you should remove the moisture from the perforated area,
then condense OrthoMTA with a depth more than 1mm.
But, because the masticatory force is not applied to the perforated area, this means that the thickness is not important.

[Obturation] How can I overcome the problem if the OrthoMTA sets abruptly during obturation procedure?

Using an ultrasonic endodontic tip, set OrthoMTA can be removed, then try obturating again.
If you don't have an ultrasonic endodontic tip, an endodontic file can be used as an alternative.
Grasp the file with the needle holder, and vibrate it with an ultrasonic scaler.

[Obturation] What is the cause of postoperative pain and what is the solution for it?

The cause of post-obturating pain is the elevated pressure on the apical area.
So, you have to administer anesthesia first, remove the moisture from the root canal with a paper point,
and then perform the obturation procedure.

[Obturation] How long it will take to obturate a canal?

Initially it will take about 5 minutes for each canal, with practice it will become less.

[Obturation] What is the optimum time for obturation?

It's same as for general obturation.

[Obturation] Is it essential to dry moisture in the root canal?

You should dry the canal with a paper point before obturation.
Operation time will be reduced in dry root canal conditions.

[Obturation] Is it possible to use OrthoMTA as a retrograde grafting material?

Indications of OrthoMTA include retrograde grafting during apical surgery.

[Obturation] Are there any particular devices to use when retrograde grafting?

No, you can use the general tools. But using the OrthoMTA carrier will help you to graft the canal more easily.

[Endodontic retreatment] Is it sufficient to perform an apicoectomy without retrograde after orthgrade MTA grafting?

It is sufficicient to remove 3mm of the apical portion of the root.

[Endodontic retreatment] Why is the radiopacity of OrthoMTA sometimes not clear.

If there is over 20% of contrast material, radiopacity will be increased.
However, Ortho-MTA will show enough radiopaque image when it is well compacted.
Native ortho-MTA itself is not radiopaque at all (it does not contain contrast materials).
The radiolucent region on a radiograph does not mean a void that is not filled in the canal,
it may just be that OrthoMTA has not been mixed homogeneously.
When resected root slices are being observed through a microscope, the canal is completely filled with ortho-MTA but it may present a few radiolucent area on radographic images.

[Radiography] Is there a method to detect underfilling?

We can increase X-ray dosage or control the image by software.

[Radiography] What is the influence of an acidic solution?

When there are reminants of acidic solution, a delay in the setting of OrthoMTA will occur.
Thus, you should remove all remnants of acidic material by thorough irrigation.

[Radiography] What is the appropriate timing for post preparation?

The optimum time is just after Orthograde grafting, because, set OrthoMTA is difficult to remove.

[Radiography] What's the minimum grafting length of OrthoMTA needed for post preparation?

The effect of apical sealing is remarkably better than guttapewrcha.
Actually, researchers have found that MTA showed excellent apical sealing properties.
Thus it is sufficient to fill the remainder of the apical 5mm.

[Radiography] What's the appropriate timing for post and core preparation?

It is appropriate just after obturation.

[Radiography] Will intra-canal moisture interfere with the resin bonding in the case of resin core?

The mechanism of bonding to dentin is Wet bonding, thus drying with a 3-way air syringe is not detrimental
to wet bonding after Orthograde grafting with OrthoMTA.

[Radiography] How much will patients have to pay for OrthoMTA grafting?

OrthoMTA is a material which is not covered by medical insurance. So, it is reasonable to demand a fee from the patient for OrthoMTA grafting. In addition, we have obtained a patent for treatment with OrthoMTA. A patented treatment
technology is protected in the USA and Japan but not in Korea unless it is specifically protected by the law of the patent. MTA grafting is already proven for its healing effect, so we judge it to be within the boundary of legal basis.
We have a very unreasonable medical pricing system for endodontic treatment in Korea, which makes the endodontic treatment environment worse. A dental doctor should save patients teeth wherever possible, but this pricing environment makes it very difficult. Unless this unreasonable medical pricing system for endodontic treatment is corrected, patients will have to chose expensive dental treatment ie. Implant surgery. It is time for a change in the medical pricing system as it relates to endodontic treatment, we expect OrthoMTA to be an huge advance in endodontic treatment in the way that implants have been. Considering the price of conventional root canal grafting materials and the difficulties of endodontic treatment, the medical pricing system should be changed for both dentist and patient.

[Radiography] Do dentists have an obligation to notify patients that OrthoMTA will be used in their root grafting

A patient who is not covered by medical insurance should definitely be notified that OrthoMTA will be used. However, if we can charge the same price as the insurance price, notification of patients will not be necessary. Usually, patients are not advised about which material will be used in their endodontic treatment. We feel that once you have used OrthoMTA you will be convinced of its benefits, both for the patient and the Dentist.

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