Mineral trioxide aggregate (MTA) is a calcium silicate-based cement commonly used in endodontic procedures involving pulpal regeneration and hard tissue repair, such as pulp capping, pulpotomy, apexogenesis, apexification, perforation repair, and root-end filling. Since MTA’s introduction in 1993, numerous studies have been published regarding various aspects of this material. The purpose of this paper was to review the composition, properties, biocompatibility, and to give evidence-based recommendation for the clinical use of these materials.