THE EFFECT OF ACCELERATOR AND BLOOD CONTAMINATION

ON CALCIUM IONS RELEASE OF MINERAL TRIOXIDE

AGGREGATE AS A RETROGRADE FILLING MATERIAL
Azizah Arifati*, Wignyo Hadriyanto**, Tri Endra Untara**
*Post Graduate Student of Conservative Dentistry Specialistic, Faculty of Dentistry, Universitas Gadjah Mada
**Departement of Conservative Dentistry, Faculty of Dentistry, Universitas Gadjah Mada

Jl. Denta No.1 Sekip Utara, Yogyakarta, Indonesia; correspondence e-mail: aarifati@yahoo.com

ABSTRACT
Mineral Trioxide Aggregate (MTA) is calcium silicate-based cement materials for endodontic applications that had bioactivity properties, such as calcium ions release which supports
the formation of new periapical bone tissue post-surgical endodontics. The long setting time (±165 minutes) was one of the drawbacks of MTA. Accelerator was used to accelerate
the process of setting and facilitate easy handling of applications. This study aims to determine the effect of accelerator and blood contamination on the release of calcium ions from
MTA as a retrograd filling material. The study used 32 sampling immersions fluids from 4 treatment groups i.e (1) MTA without blood contamination, (2) MTA with blood
contamination, (3) MTA with accelerator but without blood contamination and (4) MTA with accelerator and blood contamination. Calcium ions were measured using Atomic
Absorptions Spectroscopy (AAS) and stereoscopic microscope for clinical examinations. The result of two way ANOVA showed that accelerator had significant effect to the release
of calcium ions (p <0.05). On the other hand, the blood contamination had no significant effect (p> 0.05) and there was no significant interactions between the accelerator and the
blood contamination to the release of calcium ions from MTA (p> 0.05 ).
This study conclude that an accelerator can increase calcium ions release whereas blood contamination did not affect the release of calcium ions of MTA.

Keywords : accelerator, calcium ions, blood contamination, MTA

INTRODUCTION RESULT
Retrograde fillers such as MTA, is used in parts that contact with blood, bone Calcium ions of MTA and MTA with
Calcium ions of MTA and MTA with
Accelerator With Blood
tissue or with vital pulp so that the material must have specific properties such as Accelerator Without Blood
Contamination Release
Contamination Release
biocompatibility, biointeractivity and bioactivity. The release of calcium ions will 80

70
47.71
70

60
43.27

support the physical and chemical properties in the formation of calcium hydroxide 60
50
50
deposit and amorphous calcium phosphate then forming apatite carbonate as the 40
40
18.3
formation of new periapical bone tissue (apatite forming) on ​the material surface.
19.84 30
30 21.28
21.45
12.04 20 10.56
20
The formation of apatite layers is an ideal environment for differentiation, 10
8.86
5.11 10
8.94
5.08

colonization and cell growth and also supports new bone formation1,2. 0
Day 1 Day 7 Day 28
0
Day 1 Day 7 . Day 28

MTA MTA+Accelerator MTA MTA+Accelerator

Several studies have shown that the addition of calcium chloride (CaCl2)
Picture 1. Graphic showed average calcium ions release on MTA material on days 1, 7 and 28.
materials to MTA materials as accelerators can improve the manipulation but Average number of highest calcium ion release seen in the MTA group with accelerator
research on MTA’s bioactivity of ion release is limited.

OBJECTIVE
8x 8x 8x 8x
This study aims to determine the effect of accelerator and blood contamination on
the release of calcium ions from MTA as a retrograde filling material.

50x 50x 50x 50x

METHODS Group 1 Group 2 Group 3 Group 4
Picture 2. Surface samples of MTAs (groups 1 and 2) and MTAs with accelerators (groups 3 and
4) after a 28-day PBS immersion with stereoscopic microscope (8x and 50x). Calcium ions that
release from material reacted and formed calcium hydroxide and calcium phosphate layers on
material surface.

Tabel 1. The 2-Way-ANOVA test to determine the average difference of MTA calcium ions
release among the four groups
Df Mean Square p
Sample MTA without accelerator (ProRoot, Denstply) liquid mixed with powder by stirred on a glass plate using a plastic Accelerator added 1 13085,941 .000
spatula, while MTA with accelerator capsule (Biodentine, Septodont) mixed with amalgamator based on fabrication Blood contamination 1 111,333 .261
instructions.
Accelerator *Blood contamination 1 102,166 .281
. Total 32

CONCLUSIONS
Sample MTA and MTA+accelerator
after setting
At group with blood contamination, 0,025 Mixed MTA put in to
1. Accelerators can increase the release of calcium ions of MTA
ml blood was dropped in to the mold fiber glass mold 2. Blood contamination does not affect the release of calcium ion
MTA
3. There is no effect interaction between the addition of accelerator
and blood contamination to the release of calcium ions of MTA as
a retrograde filling.

Sample placed in to
glass tube contain 20 ml
of phospate buffered
saline (PBS) and store it
to incubator
Stereo microscope
was used to view
The immersion liquids of each sample group were References
inserted into a propylene tube using a micropipette and
MTA surface after 1 Priyanka, S.R., Veronica, 2013. A Literature Review of Root-End Filling Materials 9, Journal of
average concentration of calcium ion element measured
immersion.
by Atomic Absorption Spectroscopy (AAS) Dental and Medical Sciences, 20–25.
2 Gandolfi, M.G., Iezzi, G., Piattelli, A., Prati, C., Scarano, 2017. Osteoinductive potential and

bone-bonding ability of ProRoot MTA, MTA Plus and Biodentine in rabbit intramedullary model:
Microchemical characterization and histological analysis. Dent. Mater. 1–18
DISCUSSION 3 Nekoofar, M.H., Davies, T.E., Stone, D., Basturk, F.B., Dummer, 2011. Microstructure and

The high number of calcium ions in the MTA group with the accelerator due to
the presence of an accelerator (CaCl2) reduced the volume of water during
hydration process and accelerated the dispersion of water during wetting of the
powder particles. In this study the blood does not affect the release of calcium
ions, this can be caused by the influence of the variable state of the blood base
and the amount of calcium in the blood of probandus itself. The ion release
process is affected by saturation and the solubility following the equilibrium
reaction. Measurement of ion release should be performed when the reaction
has not reached the equilibrium value so it is necessary to measure in more
detailed time period in future research3,4,5.
chemical analysis of blood-contaminated mineral trioxide aggregate. Int. Endod. J. 44, 1011–
1018.
4 Wismayer, P.S., Lung, C.Y.K., Rappa, F., Cappello, F., Camilleri, J., 2016. Assessment of the
interaction of Portland cement-based materials with blood and tissue fluids using an animal
model. Nat. Publ. Gr. 1–9.
5 Guyton, A.C., Hall, J.E., 2006. Textbook of Medical Physiology, 11th ed. Elsevier Saunders,
Philadelphia
Acknowledgements
The researcher greatest appreciation to Dr. Mohammad Hossein Nekoofar, Associate
Professor School of Dentistry, Cardiff University for crucial contribution in discussing of this
research