Resource Libraries
What Is Put Inside a Root Canal Tooth, and Is It Safe?
What MTA (mineral trioxide aggregate) does inside a root canal, why it heals bone better than older sealers, and why local healing is not systemic safety.
MTA and ROOT CANALS
A budding biological dentist in Australia asked questions recently about a material called MTA that is used in pulpotomies and root canals and appears to have good success in helping the body heal. Obviously, people know me well enough to know that when my curiosity is triggered, I go down the scientific research path, and look for the science. It was a great question! I appreciate his curiosity and balanced approach, and my aim is to do the same.
MTA does have well-documented advantages in endodontics—biocompatibility, excellent sealing ability, and the ability to stimulate odontoblast activity and hard tissue formation at the apex. He's correct in that MTA is one of the most biologically friendly materials in endodontics. It seals well and can stimulate hard-tissue formation/odontoblast-like activity at the apex—often taken as a local healing sign. In terms of longevity and success, my research has told me that root canals, done, conventionally or with MTA have the same success rate/failure rate, and the same longevity as conventionally done root canals. Which means they last about the same amount of time. From a biological dentistry lens, though, there are a few extra layers to consider.
What MTA does well (with references)
Biocompatibility & sealing (root-end use and more):
-
Torabinejad’s foundational work and subsequent reviews:
Sealing ability of MTA
J Endod reviews on MTA properties & indications:
Induction of hard-tissue/odontoblast-like responses (apex/pulp):
Review: reparative dentinogenesis with MTA, odontoblast-like differentiation
Cell work showing migration/proliferation → odontoblast-like differentiation with white MTA:
MTA promoting osteo/odontogenic differentiation via MAPK signaling:
Where endodontics (including MTA) runs into biological questions
1. Complete disinfection is unlikely.
Bacteria can persist in lateral canals/dentinal tubules post-treatment, and endotoxin (LPS) can remain even after chemo-mechanical prep and medicaments:
Siqueira & Rôças review on bacterial persistence:
Endotoxin reduction studies:
2. Longevity ≠ biological neutrality.
Functionally, root-filled teeth can last a long time—median ~11.1 years overall, with ~20 years when restored optimally—but “lasting” mechanically isn’t the same as being biologically inert. And 100% of them inevitably fail. The question is, how long will it take to fail, and what systemic health issues will have resulted from having something in the body that doesn't conduct electricity.
Real-world PBRN survival analysis (46k+ pts): median 11.1 years; 26% survive 20+ years:
Survival improves with crowns vs direct restorations:
Systematic review:
Supportive meta-analysis:
Account required
Sign in to see more
Create an account or sign in to unlock the full list.