MTA is sold at a heavy price, but studies have proved that cheap portland cement can be used in place of MTA safely and with same benefits...READ PAPER
Today, it is well-established that MTA is nothing more than Portland cement plus bismuth oxide. However, due to the several classes of Portland cement It is impossible affirm that Portland cement that you will buy in the hardware shop will be the same used in the production of ProRoot MTA or MTA Angelus (see http://www.cement.org ;probably not but there are good chance that the results be quite similar even without sterilization.
The main composition of MTA is approximately 80% of Portland cement plus 20% of bismuth oxide. Taking our poor country as instance; the clinical use of raw Portland cement has been desired by many colleagues as a low-cost alternative to MTA. However, this still being a very debatable and questionable issue sinnce raw Portland cement was not controlled by the official agencies of health and don't have an approvement to its free clinical use (see attached letter by Dr. Caroline Primus). I always like to quote the wiser reply of Prof. Spangberg (2005):
'The fact responsible to exacerbate this issue is the unreasonably high price of ProRoot MTA in relationship to the inexpensive raw material for manufacturing Portland cement. Presently ProRoot sells for about $50,000 per kilogram and Portland cement for about 40 cents per kilogram. Gold is sold for about $16,000 per kilogram today ….. ProRoot MTA is a new material, but for practical purposes not much different from Portland cement. The factors responsible for the beneficial effects in ProRoot are also found in Portland cement…..'.
Moreover, his conclusion is remarkable: 'Considering the number of uncontrolled toxic materials dentists are allowed to use clinically, such as formaldehyde, cresol, mercury, phenol, eugenol, polymers to name a few, less than half a gram of Portland cement seems like an innocuous amount, even if it contained as much as 0.5µg arsenic at 10 ppm. In our litigious society, however, no one dares to try—yet'. As you could see in the attached case reported, Coutinho and I (2007) had success in the human clinical use of raw Portland cement as an apical plug in a wide-open apex tooth.
As far as I know this is the only report about the clinical employment in humans of raw Portland cement in a peer-reviewed journal. However, this case was performed protected by both the wings of the academic environment and an approval of ethical committee. So, I think that the clinical use of raw Portland cement is one of the points that still necessitate to be faced with more seriousness by our specialty. This discussion need to be advanced to conclusion...Gustavo De-Deus DDS, MS, Brasil Tweet