Title

No Difference between MTA Vs. IRM as Retrofill Material

Clinical Question

Does a patient undergoing apical surgery on a single rooted tooth have more healing and lack of clinical symptoms if MTA is used as a retrofill material than if IRM is used?

Clinical Bottom Line

IRM and MTA are equivalent as retrofill materials in single-rooted teeth. (See Comments on the CAT below)

Best Evidence

PubMed ID	Author / Year	Patient Group	Study type (level of evidence)
16301160	Chong / 2005	221 adults referred for apical surgery	Randomized Controlled Trial
Key results	There was no difference in post-operative pain between MTA- treated or IRM-treated patients at any of the three time points, regardless of whether patients took or did not take analgesics.
12887380	Chong / 2003	221 adults referred for apical surgery	Randomized Controlled Trial
Key results	There was no difference in radiographic success rate between MTA-treated and IRM-treated patients at 12 months post-operatively (84% success for MTA, 76% for IRM, p>0.05). There continued to be no difference at 24 months.
16200680	Lindeboom / 2005	100 patients 17 - 64 years old referred for apical surgery	Randomlized Controlled Trial
Key results	There was no difference between MTA and IRM at 1 year post-operatively (86% success for IRM, 92% success for MTA, p.0.05).

Evidence Search

"Retrograde Obturation"[Mesh] AND "mineral trioxide aggregate" [Supplementary Concept] AND "IRM cement" [Supplementary Concept]

Comments on
The Evidence

In the Chong study (radiographic endpoint reported in 2003, pain endpoint reported in 2005) for analysis of post-operative pain, patients measured post-operative pain by visual analog scale at 3 to 5 hours, 24 hours, and 48 hours post-operatively. Patients were allowed to take analgesics prn. Of 198 surgeries, only 183 were eligible for final inclusion, and only 100 questionnaires were available for analysis. This very high dropout rate threatens the validity of this evidence. In the same Chong study analyzed for radiographic analysis of success of treatment, of 198 surgeries performed, 122 returned for 12-month review, and 86 returned for 24 month review. Again, the relatively high dropout rate threatens validity here. Authors did not report a randomization method.
In the Lindenboom study, the randomization method was reported. Endpoint was assessed according to a published categorical 4-point scale of radiographic features by 2 independent assessors at 1 week, 3 months, and 1 year post-operatively. Analysis was by intention-to-treat. Patient mean age was 43.4 years SD 11.1. Apparently all 100 patients who started the study completed it.

Applicability

Both IRM and MTA may provide radiographic success in appropriate cases.

Specialty

(Endodontics)

Keywords

MTA mineral trioxide aggregate, IRM

ID#

874

Date of submission

05/05/2011

E-mail

browned@livemail.uthscsa.edu

Author

Eric Brown

Co-author(s)

Co-author(s) e-mail

Faculty mentor

S. Thomas Deahl, II, DMD, PhD

Faculty mentor e-mail

DEAHL@uthscsa.edu

Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)

None available

Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)

by Kelly Ramey and Lorena Ray (San Antonio, TX) on 10/10/2014
PubMed and TRIP searches were conducted in September 2014. A systematic review of the topic (Tang, 2010, PubMed: 20614042) evaluated two high-quality RCTs; it concluded MTA and IRM had similar performance results. In contrast, a meta-analysis (Fernandez-Yanez, 2008, PubMed: 18305439) evaluated 30 articles with limited in vivo studies, which concluded MTA was better than IRM and other materials in terms of success, marginal leakage, and biocompatibility. Weighing the high-quality evidence currently available, the conclusion of this CAT is confirmed.