Table 2: Studies compared the sealing ability of MTA to other materials used in perforation repair of permanent teeth.

First author + year Description of study Subjects/ teeth Methods of assessment Results
Holland et al., (2001) [52] In vitro study
Assess  healing of intentional lateral root perforation repaired with (MTA)
root canal of 4 mongrel dogs teeth
-Endodontic treatment
-Clinical examination
-Radiologic examination
MTA allowed healing and deposition of cementum without inflammation better than Sealapex that exhibited chronic inflamation
Yazdi et al., (2006)[49] In vitro study
Compare tissue reaction of pulp chamber perforations with MTA, light-cured GIC and amalgam
54 lower premolar teeth of 9
Dogs  with perforation in floor of pulp chamber
-Access cavity preparation
-Histologic evaluation.
MTA and GI were more suitable materials for perforation repair, as both showed bone regeneration and less inflammation than amalgam.
Broon et al., (2006)[55] In vitro study
Investigate  healing of root perforations treated with Pro RootMTA, MTA-Angeleus and portland cement
15 teeth of 4 young adult dogs perforated at cervical third of root -Endodontic cleaning and shaping
-Microscopic evaluation
white Portland cement(WPC) and MTA-Angelus(grey MTA) showed more teeth inflammation than the ProRoot MTA (white MTA)
 Morais et al., (2006)[56] In vivo study
Evaluation of tissue response to MTA and portland cement with iodoform.
18 Wistar albino rats
Devided into 3 groups
(n = 6).
- Microscopic examination
- Histologic processing
There were no significant differences regarding inflammatory responses between MTA and portland cement with iodoform.
Hamad et al., (2006)[57 In vitro dye extraction study
Compare furcation perforation repair with gray and white MTA
76 human extracted mandibular molars with furcation perforations - Dye extraction study
- Spectrophotometer measurement
No statistically significant difference in leakage was found
between gray and white MTA
De-Deus et al., (2007)[58] In vitro study
Investigate the ability of portland cement, MTA and MTA bio to prevent through fluid movement in repaired furcal perforations
55 human mandibular first molar
teeth with furcation perforation
-Fluid filtration evaluation
-Measurements  of air bubble movement
MTA Bio has superior handling and fast setting than MTA and Portland cement plus the freedom of Arsenic and lead that present in Portland cement.
The three materials had the same sealing ability as they could prevent through-and-through fluid movement.
Ghanbari et al., (2008) [51] In vitro study
To compare between amalgam and MTA in repairing furcal perforations.
Molar   teeth from 4 cats with furcation perforations
Microscopic evaluation MTA showed better sealing than amalgam for perforation repair, particularly when used immediately after perforation.
Abdul Hamed et al., ( 2011) [50] In vitro study
Repair   root canal perforation by different materials
30 fresh extracted lower premolar teeth obtained from orthodontic treatment with root perforations
divided into 3 groups( N=10)
Dye leakage measurement
Stereomicroscope Magnification
MTA showed the lowest dye leakage and best sealing ability than Glass ionomer followed by Epiphany obturation system that showed the highest dye leakage when used to seal root perforations in extracted human teeth
Bayram et al., (2015) [54] In vitro study
Determination of the Apical Sealing Abilities of Mineral Trioxide Aggregate, Portland Cement, and Bioaggregate After Irrigation with Different Solutions
130 extracted single canal teeth computerized fluid filtration method Bioaggregate (BA) (new bioceramic- based material) showed better perforation repair and biocompatibility than MTA and Portland cement when used as root end filling and perforation repair materials.
Sinkar et al., (2015) [42] An ultraviolet spectrophotometric analysis
Comparison of sealing ability of ProRoot MTA, RetroMTA, and Biodentine as furcation repair materials:
35 extracted intact human mandibular molars with non –fused well developed roots with furcation perforations. Dye extraction method Biodentine has the best sealing ability and least microleakage than RetroMTA and ProRoot MTA