During this year’s IDS in Cologne, Ultradent Products invited interested dentists to attend specific exclusive expert sessions. The sessions covered topics of special interest, clinical discussions, treatment protocols as well as tips and tricks around the latest product innovations. In a relaxed atmosphere with tasty finger foods and drinks, the guests also had the opportunity to get answers to all their professional questions and to gain hands-on experience with the corresponding products.

Professor Carlos Spironelli Ramos, DDS, MS, PhD from Brazil was the expert speaker in the session about „MTA with the properties that the clinician has always dreamed of: Endo-Eze™ MTAFlow™“. Professor Spironelli Ramos holds a master of science and a PhD in endodontics. He has been a professor and international lecturer for more than 20 years and also wrote multiple books and publications. Additionally, he was granted three international patents, which have brought different devices to the world market that use these patented technologies.

Explaining the general advantages of MTA, Professor Spironelli Ramos emphasized that any MTA has the ability to release great amounts of calcium hydroxide, which in turn forms Hydroxyapatite. In combination with a very high PH value, an antibacterial effect can be achieved. However, instead of being resorbed like calcium hydroxide, MTA is entirely stable and remains in place as a permanent material.

In the past, the mixing procedure of MTA has been a common issue, as the particles of the first MTA on the market, for example, have a size of 200 μm. This is far too big, since the size of the particles is essential for the mixing procedure. The smaller the particles, the better the mixing conditions, as the external contact surface will be much higher for the liquid. Bearing this in mind, Ultradent Products started to apply MTA. The result of this research and development convention is an innovative product, called Endo-Eze ^TM MTAFlow ^TM.

In addition to significantly smaller particles, Endo-Eze MTAFlow contains a hydro-gel instead of water. The gel provides for a better texture, which is considerably smoother and more consistent. Using other products on the market, the little grains and particles can literally be felt on the spatula. However, this is not the case with Endo-Eze MTAFlow. The gel includes a thickener and a texture-improving ingredient, which can also be found in other medical products, for example. Various additional components in the gel help to achieve of ideal mixing properties.

With an external gel layer, the Endo-Eze MTAFlow gel grants protections against water. It keeps the water in contact with the material, but at the same time protects from outside excess of water. This is very important, for example, when doing for a direct pulp capping. In this case, other materials would be washed out while Endo-Eze MTAFlow remains reliably in place.

Finding the foramen is one of the major problems in endodontics. It means removing calcifications and finding the canal and the entrance in a proper and safe way. During this process, the risk of perforation is quite high. In former times, calcium hydroxide was used, but with unsatisfying results. Endo-Eze MTAFlow is much better suited in this regard.

In addition, the proper MTA mixing procedure of MTA used to be a challenge. Endo-Eze MTAFlow can be mixed individually in every required consistency - according to the desires of the dentist.

Likewise, the application is easy and unique with a skinny syringe and a 29 ga NaviTip ^TM, which provides for ideal control. Using bigger syringes and cannulas would reduce the pressure inside and thus lead to an inadequate application process. Plus, a lot of material would remain unused in the syringe.

Hands-on:

Dr. Carlos Ramos showed the participants how to mix different consistencies during the hands-on session.

When opening the Endo-Eze MTAFlow packaging, a technique guide with some suggestions for using the product can be found. However, users may feel free to follow or to modify the powder and liquid ratio according to the clinical situation. The dedicated Endo-Eze MTAFlow spoon, with a small spoon on one end and a bigger spoon on the other end, is very convenient as it helps to get the right dosage out of the bottle.

Firstly, the appropriate amount of powder is taken out of the bottle and then put onto a mixing pad. Secondly, the gel bottle shall be shaken in order to remove the bubbles. Thirdly, three little drops are taken out of the bottle plus a bit of spare material, which is also placed on the mixing pad.

It is important to use a metal spatula for the mixing procedure instead of a plastic spatula. The material should be mixed gently, as the powder is very thin. This way, the consistency will become very nice and flowable. After having achieved an even consistency, the material can be back-filled into a syringe by the means of a metal spatula. The ready-mixed material will be good to use for 15 minutes after filling it into the syringe. Ultimately, the material can easily be squeezed out of the skinny syringe and the NaviTip in small portions.

Due to the hydraulic pressure in the syringe, the material is flowable but equally stackable when it is brought out. This enables users to shape and sculpt the material quite easily. Putting the material into cavities, will initiate the dehydration and setting process. Depending on the consistency, the setting time will vary. As soon as Endo-Eze MTAFlow lost its shiny appearance, the dentist can start the process of restoration.

Compared with others water/powder MTA products, which will vanish and dissolve in combination with water,Endo-Eze MTAFlow is water wash out resistant and will not be diluted by water. Consequently, no washout effect will occur.

User Tip/Example 1 - Liner:

A clinical case requires removing a big and deep caries lesion, which will cause a certain exposure. However, the pulp tissue can be preserved. In this situation, Dr. Ramos recommends to put some Endo-Eze MTAFlow in contact with the exposure and the pulp tissue. After around 5 minutes, it should be covered it with a liner, e. g. Ultra-Blend^TM plus, Permaflo^TM or any other flowable composite. Endo-Eze MTAFlow will release calcium hydroxide and react with the pulp tissue. After light curing the liner or flowable composite with VALO^TM, the etching and washing process takes place. The material will neither dissolve nor washout. Equally, the bespoke procedure will avoid the staining of the tooth.

User Tip/Example 2 - Apexification:

Another case Dr. Ramos was faced with was a child with a trauma. It was possible to clean the root canal very well with different methods and devices. In the past calcium hydroxide would have been used as temporary inserts, which had to be changed every 6 weeks. What can easily be done today is to use UltraCal^TM, which in turn creates a calcium hydroxide layer. Next, place a layer of Endo-Eze MTAFlow and the kid can be sent home immediately. After 24 hours the obturation can be done - even with a thermoplastic technique, if preferred. Alternatively, a single-cone technique could be applied. And that’s it!

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Questions & Answers:

Q: How can Endo-Eze MTAFlow interact with the tissue on the apex or the perforation?

A: The interaction between Endo-Eze MTAFlow  and the tissue is characterized by the release of calcium as well as by the increase of the pH value.

Q: What can be done, if Endo-Eze MTAFlow is used in case of a perforation, but instantly keeps flowing?

A: The solution is simple: Try to find the right consistency. If the material flows away, adapt the consistency and make it a bit thicker. Endo-Eze MTAFlow offers all options in this regard.

Q: When treating an apexification, can Endo-Eze MTAFlow be used directly or is it necessary to apply UltraCal before?

A: Endo-Eze MTAFlow can be used in combination with UltraCal or also directly without UltraCal. However, if UltraCal is used first, the extrusion of Endo-Eze MTAFlow will be avoided to a certain extend.

Q: In terms of the price, how can Endo-Eze MTAFlow be evaluated?

A: Considering the use per portion, it is quite competitive. Especially, when buying a kit, it is very interesting.

Learn more about Endo-Eze MTAFlow here.