MTA-Fillapex is an bioceramic endodontic sealer based on MTA, developed by Angelus (Londrina/Parana/Brazil) and launched commercially in 2010. It is a new product that combines the proven advantages of MTA with a superior canal obturation product. Its formulation in the paste/paste system allows a complete filling of the entire root canal, including accessory and lateral canals. MTA, present in the composition of MTA-Fillapex, is more stable than calcium hydroxide, providing constant release of calcium ions for the tissues and maintaining a pH which elicits antibacterial effects. The tissue recovery and the lack of inflammatory response are optimized by the use of MTA and disalicylate resin. The product is eugenol free and will not interfere with adhesive procedures inside the root canal. Also, it does not cause discoloration of the tooth structure.
- Presence of MTA in the formula: allows the formation of new tissue, including root cementum
- Biocompatibility: rapid recovery of tissues without causing inflammatory reaction.
- Does not stain tooth structure as it is free of eugenol and bismuth oxide
- Excellent Flow: the flowable consistency of MTA-Fillapex is engineered to penetrate and also to fill lateral canals
- Setting expansion: provides excellent sealing of the root canal, avoiding the penetration of tissue fluids and/or bacterial recontamination
- Calcium ion release: induces rapid tissue regeneration in sites with bone lesion and microbial activity
- System paste x paste: easy handling and insertion
- Working time: allows adequate working time to be used by specialists and/or general practitioners
- Easy removal: allows easy removal for retreatment, particularly when used wit
- MTA-Fillapex is indicated for filling root canals of permanent teeth. It can be inserted with the gutta-percha points or with Lentulo drills.
- It can also be used with thermal condensation techniques (heated gutta percha) because the boiling point of MTA-Fillapex is 150°C.
- In patients with hypersensitivity against the resins or other components of the product.
- In perforations, resorption sites and apical plugs (these cases must be filled with MTA Reparative Cement (Angelus MTA))
Manipulation and insertion: The MTA-Fillapex is paste/paste material presented in automix double syringes or tubes which provide an adequate consistency for the cement insertion in the root canal. The presence of nanoparticles enables a homogeneous mixture and better flow of the product.
- Sealing of root canals
- MTA-Fillapex shows an optimized flow due to the nanoparticles. It provides excellent filling and sealing of the canals, main and lateral, as shown below.
- The two pastes of MTA-Fillapex were measured in equal volumes and dispensed in a glass plate.
- After complete homogenization (±30 s), a volume of 0.05 ml of the mixture was dispensed on the center of a glass plate. At 180±5 s after mixing, a second plate was placed centrally on the top of the sealer, with a 100 g weight on it (total mass on the plate of 120±2 g).
- Ten minutes after mixing the weight was removed and the maximum and minimum diameters of the compressed disc of MTA-Fillapex were measured.
- Initially we measured the thickness of two glass plates together, using a Mitutoyo Digital micrometer
- Then, a portion of the MTA-Fillapex previously handled was dispensed in the center of one of the glass plates, covering it with another glass plate
- Finally, a weight of 150 N (15 Kg) was applied on the center of the plate
- The sealant filled completely the space between the glass plates
- After 10 minutes, the thickness of the two glass plates plus the sealing thickness were measured with the aid of a Mitutoyo Digital micrometer.
Dimensional Change: The MTA-Fillapex, unlike resin cements, presents an important characteristic required by the sealing materials, which is the setting expansion.
- 2g of MTA-Fillapex were prepared with 0.02 ml of water and dispensed into a mold to obtain three samples
- Two glass plates were pressed up on both surfaces of the mold containing the material. The glass plates were fixed with the aid of a device for stabilization
- After 5 minutes, the mold was taken to a relative humidity chamber of 95 % to 100% and later placed in dry heat at 37°C to reach the setting time (2h 20min);
- Setting was confirmed by surface indentation with a Gilmore needle until the sample did not present any visible marks
- The samples were polished with 600 grit sandpaper
- The samples were measured
- These samples were placed in distilled water and in dry heat at 37°C
- Thirty days later, the samples were measured again
Antimicrobial Action: The use of materials that provide high alkalinity favors hard tissue mineralization as well as offers good antimicrobial activity. MTA-based sealers present alkaline pH and high calcium ion releasing
Ease of removal
- MTA-Fillapex can be removed with chemical or mechanical intervention or a combination of both.
- Solvents based on citrus oils and chloroform substances can be used.
- Research on removal of lateral condensation root canal fillings with files and eucalyptol has shown that MTA-Fillapex is easier to remove than other cements
Biocompatibility: The biological properties inherent to conventional MTA used for treatment of root perforations replicates in MTA-Fillapex. When in contact with water, CaO can be converted into Ca(OH)2 and dissociated into Ca+2 and OH. The diffusion of hydroxyl ions from the root canal increases the pH at the surface of the root adjacent to the periodontal tissues, possibly interfering with osteoclastic activity and promoting alkalinization in the adjacent tissues, which favors healing. Calcium ions participate in the activation of calcium-dependent adenosine triphosphatase and react with carbonic gas to form calcium carbonate crystals (birefringent to polarized light), which serve as a nucleus for calcification and favor mineralization. A rich extracellular network of fibronectin in close contact with these crystals strongly supports the role of calcite crystals and fibronectin as an initiating step in the formation of a hard tissue. Calcium is also needed for cell migration and differentiation. Because MTA-Fillapex and MTA have similar chemical composition and elicit similar tissue reactions, it is expected that MTAFillapex will act similarly to MTA when used in clinical situations, but be easier to handle because of its paste/paste presentation. MTA-Fillapex is considered a great material for root canal treatment, considering its bioactive potential. MTA-Fillapex clearly shows the ability to stimulate nucleation sites for the formation of apatite crystals in human osteoblast-like cell culture.