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Original Research

Open Access

Evaluation of the biological effect of mineral trioxide aggregate in inflamed pulp—in vivo analysis

  • Yin Zou1,†
  • Bingting Shao1,†
  • Xiaodan Li1
  • Xianyin Xu1,*,

1Department of Stomatology, Wuxi Children’s Hospital Affiliated to Jiangnan University, 214023 Wuxi, Jiangsu, China

DOI: 10.22514/jocpd.2023.057 Vol.47,Issue 5,September 2023 pp.88-95

Submitted: 30 December 2022 Accepted: 21 April 2023

Published: 03 September 2023

*Corresponding Author(s): Xianyin Xu E-mail:

† These authors contributed equally.


The health of dental pulp tissue is critical to maintaining normal tooth function from the eruption of permanent teeth to the formation of the apex. The study evaluated the inflamed pulp response to the mineral trioxide aggregate (MTA) after direct pulp capping with the mechanical pulp exposure in rats’ incisor. Forty-eight mandibular central incisors of twenty-four Sprague-Dawley rats which were prepared with the cavities of one mm diameter, and the pulp exposures were randomly assigned into two groups: MTA group and calcium hydroxide (Ca(OH)2) group. The direct pulp capping was performed after three days and samples histological observations conduction within eight weeks. In both MTA and Ca(OH)2 groups, dentin -like structures were observed in the pulp tissues of some teeth. The number of teeth with reparative tissue in MTA group was statistically significantly higher than that in Ca(OH)2 group (p = 0.041). Inflammatory cell infiltration was found in the crown pulp tissues in two groups, and no statistical difference was observed between the two groups (p = 0.243). Pulp necrosis occurred in both groups, and there was no statistical difference between the two groups (p = 0.622). The results in this paper suggest that MTA promotes direct pulp capping and hence has certain potential clinical applications value in the treatments for the preservation of inflamed pulp.


Pulpal tissue; Inflammation; Direct pulp capping; Mineral trioxide aggregate; Calcium hydroxide

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Yin Zou,Bingting Shao,Xiaodan Li,Xianyin Xu. Evaluation of the biological effect of mineral trioxide aggregate in inflamed pulp—in vivo analysis. Journal of Clinical Pediatric Dentistry. 2023. 47(5);88-95.


[1] Zhang YQ, Li H, Wu HH, Zong XN. Timing of permanent tooth emergence and its association with physical growth among children aged from four to seven years in nine cities of China. Zhonghua Er Ke Za Zhi. 2020; 58: 206–212. (In Chinese)

[2] Shevchenko MA, Alpatova VG, Kiselnikova LP, Lezhnev DA, Vasiliyev AY. Comparative characteristics of root formation and mineralization features in the permanent teeth according to cone beam computed tomography data. Stomatologiia. 2021; 100: 19–24. (In Russian)

[3] Lawrence SM, McTigue DJ, Wilson S, Odom JG, Waggoner WF, Fields HW Jr. Parental attitudes toward behavior management techniques used in pediatric dentistry. Pediatric Dentistry. 1991; 13: 151–155.

[4] Zhu L, Li J, Dong Y. Effect of mesoporous bioactive glass on odontogenic differentiation of human dental pulp stem cells. PeerJ. 2021; 9: e12421.

[5] Malikaew P, Watt R G, Sheiham A. Prevalence and factors associated with traumatic dental injuries (TDI) to anterior teeth of 11–13 year old Thai children. Community Dental Health. 2006; 23: 222–227.

[6] Marcenes W, Zabot NE, Traebert J. Socio-economic correlates of traumatic injuries to the permanent incisors in schoolchildren aged 12 years in Blumenau, Brazil. Dental Traumatology. 2001; 17: 218–222.

[7] Wang G, Wang C, Qin M. Pulp prognosis following conservative pulp treatment in teeth with complicated crown fractures—a retrospective study. Dental Traumatology. 2017; 33: 255–260.

[8] Ojeda-Gutierrez F, Martinez-Marquez B, Arteaga-Larios S, Ruiz-Rodriguez MS, Pozos-Guillen A. Management and followup of compli-cated crown fractures in young patients treated with partial pulpotomy. Case Reports in Dentistry. 2013; 2013: 1–5.

[9] Tewari N, Bansal K, Mathur VP. Dental trauma in children: a quick overview on management. Indian Journal of Pediatrics. 2019; 86: 1043–1047.

[10] Yang X, Sun W, Wang Z, Ji AP, Bai J. Clinical analysis of children and adolescents emergency dental trauma cases. Beijing Da Xue Xue Bao Yi Xue Ban. 2021; 53: 384–389. (In Chinese)

[11] Krastl G, Filippi A, Weiger R. Initial management of dental trauma: musts, shoulds, and cans. Quintessence International. 2020; 51: 763–774.

[12] Xie Z, Shen Z, Zhan P, Yang J, Huang Q, Huang S, Chen L, Lin Z. Functional dental pulp regeneration: basic research and clinical translation. International Journal of Molecular Sciences. 2021; 22: 8991.

[13] Bimstein E, Rotstein I. Cvek pulpotomy—revisited. Dental Traumatology. 2016; 32: 438–442.

[14] Caprioglio A, Conti V, Caprioglio C, Caprioglio D. A long-term retrospective clinical study on MTA pulpotomies in immature permanent incisors with complicated crown fractures. European Journal of Paediatric Dentistry. 2014; 15: 29–34.

[15] Gronthos S, Mankani M, Brahim J, Robey PG, Shi S. Postnatal human dental pulp stem cells (DPSCs) in vitro and in vivo. Proceedings of the National Academy of Sciences of the United States of America. 2000; 97: 13625–13630.

[16] Liu N, Shi S, Deng M, Tang L, Zhang G, Liu N, et al. High levels of β-catenin signaling reduce osteogenic differentiation of stem cells in inflammatory microenvironments through inhibition of the noncanonical Wnt pathway. Journal of Bone and Mineral Research. 2011; 26: 2082–2095.

[17] Alongi DJ, Yamaza T, Song Y, Fouad AF, Romberg EE, Shi S, et al. Stem/progenitor cells from inflamed human dental pulp retain tissue regeneration potential. Regenerative Medicine. 2010; 5: 617–631.

[18] Wang Z, Pan J, Wright J T. Putative stem cell in human dental pulp with irreversible pulpitis: an exploratory study. Journal of Endodontics. 2010; 36: 820–825.

[19] Olsson H, Petersson K, Rohlin M. Formation of a hard tissue barrier after pulp cappings in humans. A systematic review. International Endodontic Journal. 2006; 39: 429–442.

[20] de Souza Costa CA, Lopes do Nascimento AB, Teixeira HM, Fontana UF. Response of human pulps capped with a self-etching adhesive system. Dental Materials. 2001; 17: 230–240.

[21] Hilton TJ. Keys to clinical success with pulp capping: a review of the literature. Operative Dentistry. 2009; 34: 615–625.

[22] Cox CF, Hafez AA, Akimoto N, Otsuki M, Suzuki S, Tarim B. Biocompatibility of primer; adhesive and resin composite systems on non-exposed and exposed pulps of non-human primate teeth. American Journal of Dentistry. 1998; 11: S55–S63.

[23] Lee S, Monsef M, Torabinejad M. Sealing ability of a mineral trioxide aggregate for repair of lateral root perforations. Journal of Endodontics. 1993; 19: 541–544.

[24] Saeed Asgary, Mahta Fazlyab. Management of complicated crown fracture with miniature pulpotomy: a case report. Iranian Endodontic Journal. 2014; 9: 233–234.

[25] Rustem Kemal Subay, Banu Ilhan, Hasmet Ulukapi. Mineral trioxide aggregate as a pulpotomy agent in immature teeth: long-term case report. European Journal of Dentistry. 2013; 7: 133–8.

[26] Paranjpe A, Smoot T, Zhang H, Johnson JD. Direct contact with mineral trioxide aggregate activates and differentiates human dental pulp cells. Journal of Endodontics. 2011; 37: 1691–1695.

[27] Kim D, Jang J, Lee B, Chang H, Hwang I, Oh W, et al. Anti-inflammatory and mineralization effects of ProRoot MTA and Endocem MTA in studies of human and rat dental pulps in vitro and in vivo. Journal of Endodontics. 2018; 44: 1534–1541.

[28] McNamara RP, Henry MA, Schindler WG, Hargreaves KM. Biocompat-ibility of accelerated mineral trioxide aggregate in a rat model. Journal of Endodontics. 2010; 36: 1851–1855.

[29] Watts A, Paterson RC, Cohen BD, Combe EC. Pulp response to a novel adhesive calcium hydroxide based cement. European Journal of Prosthodontics and Restorative Dentistry. 1994; 3: 27–33.

[30] Liu S, Wang S, Dong Y. Evaluation of a bioceramic as a pulp capping agent in vitro and in vivo. Journal of Endodontics. 2015; 41: 652–657.

[31] Yamada M, Nagayama M, Miyamoto Y, Kawano S, Takitani Y, Tanaka M, et al. Mineral trioxide aggregate (MTA) upregulates the expression of DMP1 in direct pulp capping in the rat molar. Materials. 2021; 14: 4640.

[32] Abdul MM, Murali N, Rai P, Mirza M, Salim S, Aparna M, et al. Clinico-histological evaluation of dentino-pulpal complex of direct pulp capping agents: a clinical study. Journal of Pharmacy and Bioallied Sciences. 2021; 13: 194.

[33] Samiei M, Shahi S, Ghasemi N, Dastmalchi S, Bargahi N, Asgary S. Effect of different additives on genotoxicity of mineral trioxide aggregate. Iranian Endodontic Journal. 2018; 13: 37–41.

[34] Rajasekharan S, Martens LC, Cauwels RGEC, Anthonappa RP. Bioden-tine™ material characteristics and clinical applications: a 3 year literature review and update. European Archives of Paediatric Dentistry. 2018; 19: 1–22.

[35] Mente J, Hufnagel S, Leo M, Michel A, Gehrig H, Panagidis D, et al. Treatment outcome of mineral trioxide aggregate or calcium hydroxide direct pulp capping: long-term results. Journal of Endodontics. 2014; 40: 1746–1751.

[36] Suhag K, Duhan J, Tewari S, Sangwan P. Success of direct pulp capping using mineral trioxide aggregate and calcium hydroxide in mature permanent molars with pulps exposed during carious tissue removal: 1-year follow-up. Journal of Endodontics. 2019; 45: 840–847.

[37] Nawaz Khan T, Yawar Ali Abidi S. Comparison of retrograde, primary and secondary bonding materials with tooth substance. Journal of College of Physicians and Surgeons Pakistan. 2018; 28: 9–12.

[38] Katge FA, Patil DP. Comparative analysis of 2 calcium silicate–based cements (Biodentine and mineral trioxide aggregate) as direct pulp-capping agent in young permanent molars: a split mouth study. Journal of Endodontics. 2017; 43: 507–513.

[39] Parirokh M, Asgary S, Eghbal MJ, Stowe S, Eslami B, Eskandarizade A, et al. A comparative study of white and grey mineral trioxide aggregate as pulp capping agents in dog’s teeth. Dental Traumatology. 2005; 21: 150–154.

[40] Iwasaki K, Komaki M, Akazawa K, Nagata M, Yokoyama N, Watabe T, et al. Spontaneous differentiation of periodontal ligament stem cells into myofibroblast during ex vivo expansion. Journal of Cellular Physiology. 2019; 234: 20377–20391.

[41] Monea A, Stoica A. Histological evaluation of indirect pulp capping procedures with calcium hydroxide and mineral trioxide aggregate. European Scientific Journal. 2014; 10: 1–10.

[42] Modaresi J, Almodaresi Z, Mousavi R, Mirzaeeian A, Hosseini SAS. Successful management of a tooth with canal obstruction using “cold ceramic”. Journal of Dental Research. 2021; 18: 77.

[43] Goldberg M, Smith AJ, Nagai N. Cells and extracellular matrices of dentin and pulp: a biological basis for repair and tissue engineering. Journal of Hard Tissue Biology. 2004; 13: 55–72.

[44] MacDougall M, Simmons D, Luan X, Nydegger J, Feng J, Gu TT. Dentin phosphoprotein and dentin sialoprotein are cleavage products expressed from a single transcript coded by a gene on human chromosome 4. Journal of Biological Chemistry. 1997; 272: 835–842.

[45] Shaik I, Dasari B, Kolichala R, Doos M, Qadri F, Arokiyasamy J, et al. Comparison of the success rate of mineral trioxide aggregate, endosequence bioceramic root repair material, and calcium hydroxide for apexification of immature permanent teeth: systematic review and meta-analysis. Journal of Pharmacy and Bioallied Sciences. 2021; 13: 43.

[46] de Oliveira NG, de Souza Araújo PR, da Silveira MT, Sobral APV, Carvalho MDV. Comparison of the biocompatibility of calcium silicate-based materials to mineral trioxide aggregate: systematic review. European Journal of Dentistry. 2018; 12: 317–326.

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