Since its introduction in 1993, Mineral Trioxide Aggregate (MTA) has been shown to be superior to others in sealing, biocompatibility, and many other aspects of clinical endodontics. MTA is primarily Portland cement with bismuth oxide as a radiopacitifier. Although some studies suggested that the reasonable-priced Portland cement could be used instead of MTA, but MTAs are different from Portland cement in its composition, especially in heavy metal contents. Therefore, clinicians should be meticulous adapting the Portland cement as a MTA substitute.