Present status and future directions - hydraulic materials for endodontic use

Josette Camilleri, Amre R. Atmeh, X Li, Nastaran Meschi

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The first mention of the use of hydraulic cements in dentistry dates to the 19th century with Portland cement used as an additive to make a paste for endodontic use. This did not gain popularity until the mid-1990s when the first patent for the use of Portland cement for root-end surgery and perforation repair was filed by Torabinejad and White and the first material marketed by Dentsply as ProRoot MTA. Even though the term mineral trioxide aggregate (MTA) is a misnomer as MTA is neither an oxide nor an aggregate, several developments have resulted in a number of materials being created for clinical endodontics. These materials are presented in various consistencies and delivery methods. Furthermore, although composed primarily of tricalcium and dicalcium silicate, the materials also include a radiopacifier, additives and an aqueous or a non-aqueous vehicle Only materials whose primary reaction is with water can be classified as hydraulic.

The main features of hydraulic cements are the formation of calcium hydroxide on hydration and the interaction of these materials with the environment. The current review refers to a classification by Camilleri and the literature pertaining to specific uses of hydraulic cements in endodontics namely intra-coronal, intra-radicular and extra-radicular as this classification informs the clinician about the material interactions which are dependent on the environment the material is placed in. The literature was reviewed using PUBMED and for each clinical use, the in vitro properties such as physical, chemical, biological and antimicrobial characteristics and clinical data was extracted and evaluated. This provided the current status of these materials after which future trends and gaps in knowledge were identified.

The hydraulic cements have made a difference to clinical outcomes. The main shortcoming is the poor testing methodologies employed which provide very limited information and also inhibits adequate clinical translation. Furthermore, the clinical protocols need to be updated to enable the materials to be employed effectively.
Original languageEnglish
Pages (from-to)710-777
JournalInternational Endodontic Journal
Issue numberS3
Early online date15 Feb 2022
Publication statusE-pub ahead of print - 15 Feb 2022


  • antimicrobial properties
  • biological properties
  • clinical studies
  • extra-radicular
  • hydraulic calcium silicates
  • hydraulic cements
  • intra-coronal
  • intra-radicular
  • material characterization
  • physical characteristics


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