THE ROLE OF MINERAL TRIOXIDE AGGREGATE (MTA) IN CONTEMPORARY ENDODONTIC PRACTICE: INDICATIONS, PROPERTIES, AND CLINICAL EFFECTIVENESS

Background. Mineral trioxide aggregate (MTA) remains one of the most extensively studied hydraulic calciumsilicate cements in modern endodontics. Despite the emergence of next-generation bioceramic materials — including Biodentine, TotalFill, and EndoSequence — offering improved handling characteristics and colour stability, the comparative long-term clinical evidence remains heterogeneous. This review was conducted to systematically appraise and synthesise current evidence on the physicochemical properties, key clinical indications, and comparative effectiveness of MTA versus contemporary calcium-silicate bioceramics across major endodontic applications. 

Materials and Methods. A structured literature search was performed in PubMed (MEDLINE), Scopus, and Google Scholar for publications from January 2010 to February 2026. Eligible study designs included systematic reviews, meta-analyses, and randomised controlled trials (RCTs) reporting on MTA use in vital pulp therapy, apexification/apical barrier formation, root perforation repair, or retrograde filling, with direct comparison to at least one bioceramic alternative. Methodological quality was assessed using AMSTAR-2 for systematic reviews and the Cochrane Risk of Bias tool for RCTs. Evidence was synthesised narratively owing to clinical and methodological heterogeneity. Results. Of 487 screened records, 28 higher-evidence studies met inclusion criteria (12 meta-analyses; 16 RCTs). MTA consistently demonstrated bioactivity through calcium-ion release and sustained alkalinity (pH 11–12), supporting hydroxyapatite deposition and hard-tissue barrier formation across all evaluated indications. Contemporary bioceramics showed advantages in setting time, delivery convenience, and colour stability; however, long-term clinical outcomes (≥24 months) were largely comparable to MTA. The overall certainty of comparative evidence was rated moderate, constrained by variability in protocols, outcome definitions, and follow-up reporting. 

Conclusions. MTA retains its status as the benchmark material in operative endodontics, supported by the most extensive long-term clinical evidence base among calcium-silicate cements. Next-generation bioceramics represent an evolutionary refinement rather than a replacement, offering ergonomic advantages without yet demonstrating superiority in long-term outcomes. Material selection should be indication-driven, weighing immediate handling benefits against established predictability. Adequately powered, standardised long-term RCTs are essential to clarify the comparative performance of newer bioceramic systems.