Removal Efficiency of Mineral Trioxide Aggregate: A narrative Review of Retrieval Techniques Efficiency of Mineral Trioxide Aggregate: A narrative Review
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Abstract
Regenerative endodontic procedures are designed to eliminate clinical symptoms, promote periapical healing, and restore a functional pulp–dentin complex with continued root development. However, treatment failure may occur and require retreatment. In such situations, the removal of mineral trioxide aggregate (MTA) poses a significant clinical and technical challenge. This narrative review critically appraises recent advances in MTA removal techniques following failed regenerative endodontic therapy, with particular emphasis on removal efficiency, effects on radicular dentin, and subsequent management considerations. A systematic electronic search of PubMed and Google Scholar was conducted to identify English-language articles published between 2017 and 2025 using keywords related to regenerative endodontics, MTA retrieval, chemical solvents, and assessment methods. From an initial yield of 70 articles, 10 studies met the inclusion criteria based on relevance, methodology, and scientific merit. The available evidence indicates that complete removal of set MTA from the root canal system cannot be achieved using a single technique. Mechanical methods showed limited effectiveness, while ultrasonic activation enhanced MTA retrieval but consistently left residual material. Chemical agents, particularly acidic solutions, demonstrated superior MTA softening and removal potential. However, their application was associated with reduced dentin microhardness and signs of dentinal erosion, as confirmed by micro-CT and SEM analyses. In conclusion, the findings highlight the absence of a standardized and clinically optimal protocol for MTA removal and emphasize the need for further well-designed studies to establish safe exposure times, effective concentrations, and evidence-based guidelines that balance removal efficiency with preservation of radicular dentin integrity.
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References
1. Alothman FA, Hakami LS, Alnasser A, AlGhamdi FM, Alamri AA, Almutairii BM. Recent Advances in Regenerative Endodontics: A Review of Current Techniques and Future Directions. Cureus [Internet]. 2024 Nov 20 [cited 2025 Dec 14]; Available from: https://www.cureus.com/articles/320328-recent-advances-in-regenerative-endodontics-a-review-of-current-techniques-and-future-directions
2. Pendse G, Misra R, Mandke L, Maniar H, Khose A, Basmatkar N. Comparison of Revascularization and Apexification Using Mineral Trioxide Aggregate in Young Human Immature Nonvital Teeth: A Systematic Review and Meta-Analysis. Cureus [Internet]. 2025 July 25 [cited 2025 Dec 14]; Available from: https://www.cureus.com/articles/371915-comparison-of-revascularization-and-apexification-using-mineral-trioxide-aggregate-in-young-human-immature-nonvital-teeth-a-systematic-review-and-meta-analysis
3. Wei X, Yang M, Yue L, Huang D, Zhou X, Wang X, et al. Expert consensus on regenerative endodontic procedures. Int J Oral Sci. 2022 Dec;14(1):55.
4. Almutairi W, Yassen GH, Aminoshariae A, Williams KA, Mickel A. Regenerative Endodontics: A Systematic Analysis of the Failed Cases. J Endod. 2019 May;45(5):567–77.
5. Karunakaran S, Praveen N, Selvandran KE, Leburu A, Madhuram K, Kumar ARA. Effectiveness of mineral trioxide aggregate and its modifications in inducing dentin bridge formation during pulp capping: A systematic review. J Conserv Dent Endod. 2025 Mar;28(3):222–30.
6. Buyukcolpan G, Özden İ, Sazak Öveçoğlu H. Evaluation of the Effects of Different Irrigation Solutions on MTA and Dentin Microhardness. Clin Exp Health Sci. 2025 Sept 30;15(3):524–30.
7. Bhandare RS, Mattigatti SB. Re-evaluation of Microhardness of Mineral Trioxide Aggregate and Biodentine After Removal From Root Using Different Types of Solvents: An In Vitro Study. Cureus [Internet]. 2024 Sept 22 [cited 2025 Dec 14]; Available from: https://www.cureus.com/articles/272299-re-evaluation-of-microhardness-of-mineral-trioxide-aggregate-and-biodentine-after-removal-from-root-using-different-types-of-solvents-an-in-vitro-study.
8. Cheng G, Wu X, Li W, Lv Z. Comparative Outcomes of Apical Induction Versus Pulp Revascularization in Young Permanent Anterior Teeth with Traumatic Pulp Necrosis. Ther Clin Risk Manag. 2025;21:737–45.
9. Chan S, Abbott PV. A Laboratory Investigation of the Effectiveness of Different Acids in Removing Mineral Trioxide Aggregate From Simulated Root Canals. Aust Endod J. 2025 Aug;51(2):267–74.
10. Boutsioukis C, Noula G, Lambrianidis T. Ex Vivo Study of the Efficiency of Two Techniques for the Removal of Mineral Trioxide Aggregate Used as a Root Canal Filling Material. J Endod. 2008 Oct;34(10):1239–42.
11. Hamadhi̇ F, M. Z. Evaluation the Marginal Adaptation for the Bio C Repair and Other Root end Filling Material by Using Scanning Electron Microscope (A Comparative In Vitro Study). Cumhur Dent J. 2023 Sept 29;26(3):261–7.
12. Al-Dahan ZAA, Khalaf MS, Al-Assadi AH. Apexification and Periapical Healing of Immature Teeth Using Mineral Trioxide Aggregate. J Baghdad Coll Dent. 2014 Sept;26(3):108–12.
13. Butt N, Talwar S. In-vitro evaluation of various solvents for retrieval of mineral trioxide aggregate and their effect on microhardness of dentin. J Conserv Dent JCD. 2013 May;16(3):199–202.
14. Oh S, Perinpanayagam H, Lee Y, Kum JW, Yoo YJ, Lim SM, et al. Effect of acidic solutions on the microhardness of dentin and set OrthoMTA and their cytotoxicity on murine macrophage. Restor Dent Endod. 2016;41(1):12.
15. Chhabra N, Parolia A. Effect of Various Acid Solutions as an Aid in Removing the OrthoMTA-Based Root Canal Filling. Materials. 2023 June 23;16(13):4535.
16. Pérez‐Heredia M, Ferrer‐Luque CM, González‐Rodríguez MP, Martín‐Peinado FJ, González‐López S. Decalcifying effect of 15% EDTA, 15% citric acid, 5% phosphoric acid and 2.5% sodium hypochlorite on root canal dentine. Int Endod J. 2008 May;41(5):418–23.
17. Gharechahi M, Moradi S, Nasirnia S, Peighoun M. Investigation of the effect of hydrochloric acid with different concentrations on mineral trioxide aggregate plug and dentin. Dent Res J. 2023;20:61.
18. Dawod KM, Al-Hashimi RA. Assessing Volume of Two Sealers’ Remnants after Reinstrumentation Using 3D Imaging Technology: An In Vitro Comparative Study. J Contemp Dent Pract. 2025 Oct 10;26(8):743–51.
19. Bates CF, Carnes DL, Del Rio CE. Longitudinal sealing ability of mineral trioxide aggregate as a root-end filling material. J Endod. 1996 Nov;22(11):575–8.
20. Torabinejad M, Watson TF, Pitt Ford TR. Sealing ability of a mineral trioxide aggregate when used as a root end filling material. J Endod. 1993 Dec;19(12):591–5.
21. Wikström A, Romani Vestman N, Rakhimova O, Lazaro Gimeno D, Tsilingaridis G, Brundin M. Microbiological assessment of success and failure in pulp revitalization: a randomized clinical trial using calcium hydroxide and chlorhexidine gluconate in traumatized immature necrotic teeth. J Oral Microbiol. 2024 Dec 31;16(1):2343518.
22. Al-Zubaidi AK, Al-Azzawi AKJ. The Effect of Various Endodontic Irrigants on the Sealing Ability of Biodentine and Other Root Perforation Repair Materials : In Vitro Study. J Baghdad Coll Dent. 2014 Sept;26(3):1–8.
23. Kim Y, Kim BS, Kim YM, Lee D, Kim SY. The Penetration Ability of Calcium Silicate Root Canal Sealers into Dentinal Tubules Compared to Conventional Resin-Based Sealer: A Confocal Laser Scanning Microscopy Study. Materials. 2019 Feb 11;12(3):531.
24. Alves FRF, Rôças IN, Provenzano JC, Siqueira JF. Removal of the Previous Root Canal Filling Material for Retreatment: Implications and Techniques. Appl Sci. 2022 Oct 11;12(20):10217.
25. Aksel H, Küçükkaya Eren S, Askerbeyli Örs S, Serper A, Ocak M, Çelik HH. Micro‐CT evaluation of the removal of root fillings using the ProTaper Universal Retreatment system supplemented by the XP‐Endo Finisher file. Int Endod J. 2019 July;52(7):1070–6.
26. Abdul-Hamed S. A Stereomicroscopic Analysis of Dentinal Micro Cracks after Root Canal Preparation Using Four Different Rotary Instruments. Indian J Forensic Med Toxicol [Internet]. 2020 Jan 25 [cited 2025 Dec 14]; Available from: http://medicopublication.com/index.php/ijfmt/article/view/78
27. Madarati AA, Sammani AMN, Alnazzawi AA, Alrahlah A, Pedullà E. Efficiency of reciprocating systems reciprocated at different angles in removing root-canals fillings with an MTA-type sealer: an Ex-vivo study. BMC Oral Health. 2022 Aug 17;22(1):357.
28. Yoshpe M, Einy S, Ruparel N, Lin S, Kaufman AY. Regenerative Endodontics: A Potential Solution for External Root Resorption (Case Series). J Endod. 2020 Feb;46(2):192–9.
29. Tang H, Torabinejad M, Kettering J. Leakage Evaluation of Root End Filling Materials Using Endotoxin. J Endod. 2002 Jan;28(1):5–7.
30. Lee C, Song M. Failure of Regenerative Endodontic Procedures: Case Analysis and Subsequent Treatment Options. J Endod. 2022 Sept;48(9):1137–45.
31. Baruwa AO, Martins JNR, Maravic T, Mazzitelli C, Mazzoni A, Ginjeira A. Effect of Endodontic Irrigating Solutions on Radicular Dentine Structure and Matrix Metalloproteinases—A Comprehensive Review. Dent J. 2022 Nov 23;10(12):219.
32. Cebeci GY, Almaz ME, Orhan EO, Beklen A. Evaluation of removal efficiency of capping materials used in pulp revascularization in vitro. BMC Oral Health. 2023 Sept 6;23(1):646.
33. Ari H, Erdemir A. Effects of Endodontic Irrigation Solutions on Mineral Content of Root Canal Dentin Using ICP-AES Technique. J Endod. 2005 Mar;31(3):187–9.
34. Abdulameer ZM. A Comparative Study to Evaluate the Effect of Ultrasonic Agitation on Push - Out Bond Strength of Three Root-End Filling Materials: An In Vitro Study. Indian J Forensic Med Toxicol [Internet]. 2021 Jan 7 [cited 2025 Dec 14]; Available from: http://medicopublication.com/index.php/ijfmt/article/view/13653