Copy of gic 7/ dental implant courses

INTRODUCTION
INDIAN DENTAL ACADEMY
Leader in continuing Dental
Education
Glass Ionomer Cement
www.indiandentalacademy.com

HISTORICAL DEVELOPMENT
Modern dental cements are based on inventions
made in the middle of the 19th century. As early
as in 1856, Sorel presented a formulation for a
magnesium chloride cement.
The ensuing search for improved materials initiated
numerous developments, such that by the 1920s
three main categories of cements had become
established: zinc phosphate cements, zinc oxide
eugenol cements, and silicate cements.

In 1966, D.C. Smith introduced yet another class of
cement, in which the liquid of the zinc phosphate
cement was replaced by aqueous polyacrylic acid.
This so-called carboxylate cement opened up new
prospects for self-adhesive dental materials.
On the basis of these developments, Wilson et al.
introduced glass ionomer cementing materials in
1969, a material class which remains very
successful today.
The first glass ionomer cement product, ASPA
(Alumino-Silicate-Poly-Acrylate), introduced in
the 1970s, was formulated by adding polyacrylic
acid as the liquid component to finely ground
silicate powder. www.indiandentalacademy.com

 Invention of glass ionomer cement inInvention of glass ionomer cement in 19691969
Wilson & KentWilson & Kent
 Term to glass ionomer cement wasTerm to glass ionomer cement was
coined by B.E. Kent.coined by B.E. Kent.
 1972 Wilson & Crisp found that tartaric1972 Wilson & Crisp found that tartaric
acid improves manipulative propertiesacid improves manipulative properties
 1974 Mc. Lean & Wilson proposed1974 Mc. Lean & Wilson proposed
clinical use of GICclinical use of GIC

CLASSIFICATION
According to Wilson and McLean inAccording to Wilson and McLean in
19881988
1.1. Type I – Luting CementType I – Luting Cement
2.2. Type II – Restorative cementsType II – Restorative cements
a.a. Restorative estheticRestorative esthetic
b. Restorative reinforced.b. Restorative reinforced.

According to McLean etal in 1994According to McLean etal in 1994
1.1. Glass Ionomer Cements ( Traditional)Glass Ionomer Cements ( Traditional)
2. Resin modified glass Ionomer2. Resin modified glass Ionomer
CementCement
3.3. Poly acid modified composite ResinPoly acid modified composite Resin

 According to the characteristics specifiedAccording to the characteristics specified
by the manufacturer.by the manufacturer.
 Type I – Luting cement e.g. Fuji ketakType I – Luting cement e.g. Fuji ketak
Cement.Cement.
 Type II – Restorative material eg. Ketac Fil,Type II – Restorative material eg. Ketac Fil,
Fuji II, Fuji IXFuji II, Fuji IX
 Type III –Type III – Bases & Liners -Bases & Liners -
 Type IV. Admixture eg. Ketac silver miracleType IV. Admixture eg. Ketac silver miracle
mix.mix.

Newer Classification
I.I. Traditional Glass IonomerTraditional Glass Ionomer
A.A. Type I – LutingType I – Luting
B.B. Type II – RestorativeType II – Restorative
C.C. Type III – Liner & basesType III – Liner & bases
II.II. Metal Modified glass Ionomer.Metal Modified glass Ionomer.
A.A. Miracle mixMiracle mix
B.B. CementCement
III.III. Light cure glass Ionomer Cement HEMA added to liquidLight cure glass Ionomer Cement HEMA added to liquid
IV.IV. Hybrid glass Ionomer / Resin modified GICHybrid glass Ionomer / Resin modified GIC
A.A. Composite resin in which fillers are substituted with GICComposite resin in which fillers are substituted with GIC
particles.particles.
B.B. Precured glasses blended into composite.Precured glasses blended into composite.

According to Application
Type I – LutingType I – Luting
Type II – RestorativeType II – Restorative
 Aesthetic RestorativeAesthetic Restorative
 Reinforced materialReinforced material
Type III – Lining cementType III – Lining cement
Type IV – Fissure SealantType IV – Fissure Sealant
Type V – Orthodontic cementType V – Orthodontic cement
Type VI – Corebuild up cementType VI – Corebuild up cement

COMPOSITION - POWDER
Compound Composition A ( % Wt) Composition B (Wt %)
Sio2
41.9 35.2
A1203 28.6 20.1
A1 F3 1.6 2.4
Ca F2 15.7 20.1
NaF 9.3 3.6
Alpo4 3.8 12.0

LIQUID
Originally was 40 to 50% aqueous solution ofOriginally was 40 to 50% aqueous solution of
polyacrylic acid.polyacrylic acid.
Current cements the acid is in the form ofCurrent cements the acid is in the form of
copolymer withcopolymer with
Maleic, Increase the reactivity of liquidMaleic, Increase the reactivity of liquid
Itaconic, Decrease the viscosityItaconic, Decrease the viscosity
Tricarboxylic Reduce the tendency for gelatinTricarboxylic Reduce the tendency for gelatin
AcidsAcids
Tartaric acid improves the handlingTartaric acid improves the handling
characteristics & increase working time, butcharacteristics & increase working time, butwww.indiandentalacademy.com

DISPENSING
 Traditionally as powder & liquid bottlesTraditionally as powder & liquid bottles
 Various shades ( 2-3) were providedVarious shades ( 2-3) were provided
 Convenient preproportioned capsules forConvenient preproportioned capsules for
mechanical mixing are provided. They comemechanical mixing are provided. They come
with a nozzle for dispensing the cementwith a nozzle for dispensing the cement
directly in the cavity from a gun by injection.directly in the cavity from a gun by injection.
 Water settable cements were powder & liquidWater settable cements were powder & liquid
having either water or water & tartaric acidhaving either water or water & tartaric acid
 Compomers – Are polyacid modified resins. TheyCompomers – Are polyacid modified resins. They
are provided as single pastes in bulk as tubes orare provided as single pastes in bulk as tubes or
compules for single use.compules for single use.www.indiandentalacademy.com

CHEMISTRY OF THE SETTING
On mixing powder and liquid, the acid attacks
the glass resulting in surface degradation of
the glass and release of metal ions (e.g.,
strontium, calcium,
aluminium), fluoride ions and silicic acid.
The metal ions react with the carboxyl (COO-)
groups to form a polyacid salt, which
becomes the cement matrix, and the surface
of the glass becomes a silica hydrogel.
The unreacted cores of the glass particles
remain as a filler.www.indiandentalacademy.com

Although the clinical set is completed within a
few minutes, a continuing ‘maturation’ phase
occurs over subsequent months.
This is predominantly due to the slow reaction
of the aluminium ions, and is the cause of the
set material’s sensitivity to water balance.
The set material needs to be protected from
salivary contamination for several hours,
otherwise the surface becomes weak and
opaque.
From water loss for several months, otherwise
the material shrinks and cracks and may
debond.

THE ROLE OF WATER
It is an essential part of the cement structure.It is an essential part of the cement structure.
Water forms the reaction medium into which theWater forms the reaction medium into which the
cement forming cations – calcium & aluminumcement forming cations – calcium & aluminum
are leached & in which they are transported toare leached & in which they are transported to
react with the polyacid to form a polyacrylatereact with the polyacid to form a polyacrylate
matrix.matrix.
Water also serves to hydrate the siliceous hydrogelWater also serves to hydrate the siliceous hydrogel
& the metal polyacrylate salts formed.& the metal polyacrylate salts formed.
If water is lost from the cement by desiccation whileIf water is lost from the cement by desiccation while
it is setting, the cement forming reaction willit is setting, the cement forming reaction will
stop.stop.

Water present in the set cement has been classifiedWater present in the set cement has been classified
into two forms.into two forms.
1.1. Loosely bound waterLoosely bound water, which is readily, which is readily
removed by desiccationremoved by desiccation
2.2. Tightly boundTightly bound watewater, which cannot be removed.r, which cannot be removed.
Tightly bound water is associated with hydrationTightly bound water is associated with hydration
shell of the cation-polyacrylate bond,shell of the cation-polyacrylate bond,
particularly that of aluminum & some silica gelparticularly that of aluminum & some silica gel
water.water.
As the cement ages the ratio of tightly bound toAs the cement ages the ratio of tightly bound to
loosely bound water increases.loosely bound water increases.
This is accompanied by an increase in strength & aThis is accompanied by an increase in strength & a
decrease in plasticitydecrease in plasticity

SURFACE PROTECTION
Certain materials are applied on the GICCertain materials are applied on the GIC
restoration surface immediately after removalrestoration surface immediately after removal
of matrix in order to prevent excessiveof matrix in order to prevent excessive
imbibition or desiccation of the cement, theseimbibition or desiccation of the cement, these
areare
 Petroleum JellyPetroleum Jelly
 Cocoa ButterCocoa Butter
 Dentin Bonding agentsDentin Bonding agents
 Dental Varnish.Dental Varnish.

PROPERTIES OF GLASS
IONOMER CEMENTS
COMPRESSIVE STRENGTH :COMPRESSIVE STRENGTH :
DENTAL MATERIAL COMPRESSIVE STRENGTH (MPA)
1. Silicate cement 180
2. Glass Ionomer Cement (Type II) 150
3. Cement 150
4. Hybrid Ionomer 105
5. Unfilled resins 70
6. Traditional composite 250-300
7. Hybrid Composite 350-400
8. Dental Amalgam 300-550www.indiandentalacademy.com

TENSILE STRENGTH
Dental Material Tensile Strength ( MPa)
Silicate 3.5
GIC (type II ) 6.6
Cement 6.7
Hybrid Inomer 20
Unfilled resins 24
Traditional composite 50-65
Hybrid Composite 75-90
Dental Amalgam 45-65

HARDNESS
Material KHN
Silicate Cement 70
GIC type II 48
Cement 39
Hybrid Ionomer 40
Zinc Phosphate 50-60

WEAR
These materials exhibit a greater wear as compared to otherThese materials exhibit a greater wear as compared to other
restorative materials like composites.restorative materials like composites.
The limited wear resistance of GIC on chewing surfaces isThe limited wear resistance of GIC on chewing surfaces is
thought to be due to insufficient strength directly afterthought to be due to insufficient strength directly after
placement.placement.
It may require few weeks or even months to achieve itsIt may require few weeks or even months to achieve its
maximal strength. Another mechanism that affects wear ofmaximal strength. Another mechanism that affects wear of
GIC is action of dietary acids on GIC which directly attackGIC is action of dietary acids on GIC which directly attack
the surface of GIC.the surface of GIC.
Unlike Composite resins setting reaction of GIC continuesUnlike Composite resins setting reaction of GIC continues
over a period of several months.over a period of several months.
This continuing improvement in mechanical properties isThis continuing improvement in mechanical properties is
probably the result of the slow displacement of calciumprobably the result of the slow displacement of calcium
ions by aluminum ions, which further enhances theions by aluminum ions, which further enhances the
cohesion of the matrix.cohesion of the matrix.

ADHESION
 An ionic bond occurs between the carboxyl
(COO-) ions in the cement acid and the calcium
(Ca++) ions in enamel and dentine.
 Phosphate ions (negatively charged) and calcium
ions (positively charged) are displaced from the
hydroxyapatite, and are absorbed into the unset
cement.
 This results in an intermediate layer between the
‘pure’ GIC and the ‘pure’ hydroxyapatite; the so
called ‘ion-exchange’ layer

The ion-exchange
layer appears to
consist of calcium
and phosphate ions
from the tooth, and
aluminium, silicic,
fluoride and calcium
and/or strontium
ions (depending on
glass composition)
from the GIC.

Ionic bonding between the carboxyl ions from
the
cement acid and the calcium ions from the
tooth
structure has been confirmed using X-ray
photon
spectrometry, and ionic bonding to the collagen
of dentine has been proposed but not
investigated.

FLUORIDE IN GIC - ( UPTO 28%)
Incorporation of fluoride is useful in all stages.Incorporation of fluoride is useful in all stages.
1.1. It acts as a flux during sintering of powderIt acts as a flux during sintering of powder
particles, alsoparticles, also
2.2. increases cement strength & translucency.increases cement strength & translucency.
3.3. During setting the fluoride ions produced fromDuring setting the fluoride ions produced from
strong soluble aluminofluoride complexes likestrong soluble aluminofluoride complexes like
A1 FA1 F2+2+
prevent premature gelation of polyions byprevent premature gelation of polyions by
aluminium ions.aluminium ions.
4.4. Prolongs working time.Prolongs working time.

The initial high burst of fluoride release is dueThe initial high burst of fluoride release is due
to the high concentration of fluoride that existsto the high concentration of fluoride that exists
in the matrix immediately after the cementin the matrix immediately after the cement
placement.placement.
Most of the fluoride is released as sodium fluoride,
which is not critical to the cement matrix, and thus
does not result in weakening or disintegration of
the set cement.

BIOCOMPATIBILITY
‘The ability of a material to elicit an
appropriate biological response in a specific
application.’
Therefore, in the context of restorative
materials it is important to identify the tissues
with
which the material may come into contact.
For GIC, these tissues are:
Dentine (and therefore pulp),
Gingivae and www.indiandentalacademy.com

Hydroxethylmethacrylate (HEMA) is released
from
RM-GICs induce allergic and toxic responses.
Ph:
As the reaction proceeds, the pHAs the reaction proceeds, the pHincreases from initialincreases from initial
values near 1 to a range of 4 to 5. As the setting reactionvalues near 1 to a range of 4 to 5. As the setting reaction
nears completion the final PH value reaches 6.7 to 7.nears completion the final PH value reaches 6.7 to 7.
Because the acid groups are attached to polymerBecause the acid groups are attached to polymer
molecules that have limited diffusibility, the potentialmolecules that have limited diffusibility, the potential
pulp effects of the low initial PH are limited to areaspulp effects of the low initial PH are limited to areas
immediately adjacent to the material.immediately adjacent to the material.

If the remaining dentine thickness is less than 0.5If the remaining dentine thickness is less than 0.5
mm, it may be necessary to protect dentinmm, it may be necessary to protect dentin
surfaces from direct contact with unset GIC bysurfaces from direct contact with unset GIC by
using a calcium hydroxide liner.using a calcium hydroxide liner.
Once the setting reaction is complete theOnce the setting reaction is complete the
cement ph becomes 6.7 to 7 & cementcement ph becomes 6.7 to 7 & cement
causes very less inflammation or irritationcauses very less inflammation or irritation
as compared to other restorative cements.as compared to other restorative cements.

MANIPULATION CONSIDERATION
FOR GIC
To achieve long lasting restorations, the followingTo achieve long lasting restorations, the following
conditions must be satisfiedconditions must be satisfied::
 Surface of the tooth must be clean & drySurface of the tooth must be clean & dry
 Consistency of the cement must allow completeConsistency of the cement must allow complete
coating of the surfaces irregularitiescoating of the surfaces irregularities
 Surface must be finished without excessiveSurface must be finished without excessive
dryingdrying
 Surface protection must be done properly.Surface protection must be done properly.

SURFACE PREPARATION
 Tooth surface cleanedTooth surface cleaned – With pumice slurry– With pumice slurry
 ConditioningConditioning – With (34% to 37%) phosphoric– With (34% to 37%) phosphoric
acid or an organic acid like polyacrylic acidacid or an organic acid like polyacrylic acid
(10 to 20%) for 10 to 20 seconds, followed by(10 to 20%) for 10 to 20 seconds, followed by
a 20 to 30 sec of water rinsing.a 20 to 30 sec of water rinsing.
 Drying by gentle air blowDrying by gentle air blow
 Excessive air blow causing desiccationExcessive air blow causing desiccation
should be avoided.should be avoided.
 Any further contamination with saliva or bloodAny further contamination with saliva or blood
impairs bonding.impairs bonding.

PREPARATION OF THE
MATERIAL
 P/L ratio recommended by the manufacturerP/L ratio recommended by the manufacturer
should be followedshould be followed
( usually 4 :1)( usually 4 :1)

Mixing is usually done on plastic
crafted paper pad.

Plastic spatula is most commonly
used.

Powder incorporated rapidly in the
liquid.
Mixing done for 45 to 60 Seconds

 Mix should be glossy at this time which indicatesMix should be glossy at this time which indicates
unreacted polyacid on the surface. This residual acidunreacted polyacid on the surface. This residual acid
on the surface is critical for bonding to the tooth.on the surface is critical for bonding to the tooth.
 A dull appearance indicates inadequacy of free acid forA dull appearance indicates inadequacy of free acid for
bonding.bonding.
 Preproportioned capsule of GIC are also available.Preproportioned capsule of GIC are also available.
 They are used with amalgamators or specialy designedThey are used with amalgamators or specialy designed
triturators.triturators.
 The preproportioned capsules have nozzles so that theThe preproportioned capsules have nozzles so that the
mixed material can directly be injected in the preparedmixed material can directly be injected in the prepared
cavity.cavity.
 Advantages of mechanical mixing areAdvantages of mechanical mixing are
ConvenienceConvenience
Consistent control over P/L ratioConsistent control over P/L ratio
Elimination of variation associated withElimination of variation associated with
hand spatulation.hand spatulation.

PLACEMENT OF RESTORATION
& REMOVAL OF EXCESS
 Cement is placed using a plastic instrumentCement is placed using a plastic instrument
or injected into cavityor injected into cavity
 Cavities are slightly overfilled & surfaceCavities are slightly overfilled & surface
immediately covered by using plastic matriximmediately covered by using plastic matrix
at least for 5 minutes.at least for 5 minutes.
 Excess is trimmed off.Excess is trimmed off.
 Surface protection is done immediately.Surface protection is done immediately.
 Further finishing procedure if needed shouldFurther finishing procedure if needed should
be delayed for at least 24 hrs.be delayed for at least 24 hrs.

METAL REINFORCED GICS
The main shortcoming of GIC that limitsThe main shortcoming of GIC that limits
its use in stress bearing areas is itsits use in stress bearing areas is its
lack of fracture toughness. To improvelack of fracture toughness. To improve
upon it metal reinforced GICs wereupon it metal reinforced GICs were
developed.developed.
They are mainly of two types:They are mainly of two types:
1.1. Miracle MixMiracle Mix
2.2. CermetsCermets

MIRACLE MIX
This was introduced by Simmons in the year 1983.This was introduced by Simmons in the year 1983.
Initially it was prepared by incorporation of silver tinInitially it was prepared by incorporation of silver tin
alloy into GIC powder. Glass is generally brittle &alloy into GIC powder. Glass is generally brittle &
silver was expected to improve the toughness of thesilver was expected to improve the toughness of the
cement by acting as a stress absorber.cement by acting as a stress absorber.
Most properties of the cement including the compressiveMost properties of the cement including the compressive
strength, flexural strength, solubility & abrasivestrength, flexural strength, solubility & abrasive
resistance remained without improvement.resistance remained without improvement.
In fact it gave a grey or blackish color to the cementIn fact it gave a grey or blackish color to the cement
which was aesthetically unacceptable.which was aesthetically unacceptable.
Advantage of this material slight increase in the fluorideAdvantage of this material slight increase in the fluoride
release because of increase surface area of the matrixrelease because of increase surface area of the matrix
for ion exchange due to incorporation of mutualfor ion exchange due to incorporation of mutual
particlesparticles

CERMETS
This was introduced by Mc Lean & Gaser in theThis was introduced by Mc Lean & Gaser in the
year 1985. Glass & metal powders are sintered atyear 1985. Glass & metal powders are sintered at
a high temperature.a high temperature.
This could be made to react with polyacrylic acid toThis could be made to react with polyacrylic acid to
form improved GIC.form improved GIC.
This was attempted to improve the wear resistanceThis was attempted to improve the wear resistance
& Flexural strength at the same time maintain the& Flexural strength at the same time maintain the
aesthetics. Sometimes other metals like titaniumaesthetics. Sometimes other metals like titanium
oxide is added in small proportions (5%) asoxide is added in small proportions (5%) as
whitening agent.whitening agent.
Fluoride release with cement is less as comparedFluoride release with cement is less as compared
to miracle mix because a portion of glass particleto miracle mix because a portion of glass particle
is metal coated which decreased the effectiveis metal coated which decreased the effective
surface area for ionic exchange.surface area for ionic exchange.

CLINICAL CONSIDERATIONS
OF METAL MODIFIED GICS
 Presence of metal filler makes the material radiopaque.Presence of metal filler makes the material radiopaque.
 They have been suggested for limited use as an alternativeThey have been suggested for limited use as an alternative
to amalgam for posterior restorations.to amalgam for posterior restorations.
 However clinical data indicated that these materials fallHowever clinical data indicated that these materials fall
short of expectations.short of expectations.
 They exhibit frequent fractures when used for Class IIThey exhibit frequent fractures when used for Class II
restorations, as to the Conventional GICS.restorations, as to the Conventional GICS.
 They are used as core build up materials, Because of theirThey are used as core build up materials, Because of their
high fracture toughness & low brittleness, they are nothigh fracture toughness & low brittleness, they are not
recommended in cases where the cement will constituterecommended in cases where the cement will constitute
greater than 40% of total core build ups.greater than 40% of total core build ups.

RESIN MODIFIED GICS
(HYBRID IONOMERS)
In order to overcome the disadvantages of traditional GICsIn order to overcome the disadvantages of traditional GICs
 Moisture sensitivity &Moisture sensitivity &
 Low early strength along withLow early strength along with
 Less fracture toughnessLess fracture toughness
 Solubility.Solubility.
The goal was achieved by incorporating water soluble resinThe goal was achieved by incorporating water soluble resin
monomers into an aqueous solution of polyacrylic acid.monomers into an aqueous solution of polyacrylic acid.
In this way the system undergoes early activatedIn this way the system undergoes early activated
polymerization of resin monomer, while the acid basepolymerization of resin monomer, while the acid base
reaction continues to take its own course & time.reaction continues to take its own course & time.

COMPOSITION
PowderPowder – Same as traditional GICS i.e. ion– Same as traditional GICS i.e. ion
reachable fluoroaluminosilicate glass particles.reachable fluoroaluminosilicate glass particles.
Initiators of light curing – e.g. Visible light cureInitiators of light curing – e.g. Visible light cure
camphoroquione or chemical curing e.g. amine.camphoroquione or chemical curing e.g. amine.
LiquidLiquid – Same as traditional GIC modified with– Same as traditional GIC modified with
methacrylate or Hydroxyethymethacrylatemethacrylate or Hydroxyethymethacrylate
monomers (HEMA)monomers (HEMA)

SETTING REACTION
Initial setting reaction of the material occurs by theInitial setting reaction of the material occurs by the
polymerization of methacrylate groups which willpolymerization of methacrylate groups which will
eliminate all problems related to traditional GICs likeeliminate all problems related to traditional GICs like
low early strength, high solubility, of setting waterlow early strength, high solubility, of setting water
inhibition, loss of translucency & color instability etc.inhibition, loss of translucency & color instability etc.
The slow acid base reaction will ultimately be responsibleThe slow acid base reaction will ultimately be responsible
for the unique maturing process & final strength.for the unique maturing process & final strength.
These materials are considered dual cure only if oneThese materials are considered dual cure only if one
polymerization mechanism is used if both mechanismspolymerization mechanism is used if both mechanisms
are used they are considered tricured materials.are used they are considered tricured materials.

ADVANTAGES OF HYBRID
IONOMERS
 Improvement of translucency because theImprovement of translucency because the
inclusion of monomer brings the refractiveinclusion of monomer brings the refractive
index of the liquid close to that of the particles.index of the liquid close to that of the particles.
 Fluoride release is similar to that of theFluoride release is similar to that of the
particles.particles.
 Tensile strength more than conventional GICsTensile strength more than conventional GICs
(conventional – 6.6MPA, Hybrid-20MPA). This(conventional – 6.6MPA, Hybrid-20MPA). This
increase in strength is mainly attributed toincrease in strength is mainly attributed to
addition of resins which permit the greateraddition of resins which permit the greater
amount of plastic deformation that can beamount of plastic deformation that can be
sustained before fracture occurs.sustained before fracture occurs.

ADHESION TO TOOTH
STRUCTURES
The mechanism for bonding to tooth structure isThe mechanism for bonding to tooth structure is
the same as that for conventional GICs.the same as that for conventional GICs.
Less ionic activity is expected because of theLess ionic activity is expected because of the
reduction in carboxylic acid in the liquid ofreduction in carboxylic acid in the liquid of
resin modified GICsresin modified GICs
These material exhibits higher bond strength toThese material exhibits higher bond strength to
resin based composites, which is governed theresin based composites, which is governed the
residual nonpolymerized functional groupsresidual nonpolymerized functional groups
within them.within them.

TYPES OF RESIN MODIFIED GICS
Restorative Hybrid IonomersRestorative Hybrid Ionomers
Fissure Sealant ApplicationsFissure Sealant Applications
Base & LinerBase & Liner
LutingLuting
Orthodontic Cementing materialOrthodontic Cementing material

RESTORATIVE HYBRID
IONOMERS
Famous Brands are, Fuji II LC, Vitremer, photacFamous Brands are, Fuji II LC, Vitremer, photac
fil.fil.
There have four major improvements overThere have four major improvements over
traditional GICs such as:traditional GICs such as:
 Decreased water sensitivityDecreased water sensitivity
 Improved mechanical propertiesImproved mechanical properties
 ManipulabilityManipulability
 TranslucencyTranslucency

FISSURE SEALANT
APPLICATIONS
Glass ionomers when used as pit & fissureGlass ionomers when used as pit & fissure
sealants offer advantages of chemically bondingsealants offer advantages of chemically bonding
to tooth structure & fluoride release to preventto tooth structure & fluoride release to prevent
caries.caries.
Resin modified glass ionomers fissure protectionResin modified glass ionomers fissure protection
material (FUJI III LC) have high fluidity &material (FUJI III LC) have high fluidity &
ability to penetrate into fissures.ability to penetrate into fissures.
It also exhibits better mechanical & handlingIt also exhibits better mechanical & handling
properties.properties.

BASE & LINER
First use of hybrid ionomers after theirFirst use of hybrid ionomers after their
development was as a base & liner.development was as a base & liner.
Thin coating of the material is applied in theThin coating of the material is applied in the
cavity with a brush (10 to 40 μm) allowing thecavity with a brush (10 to 40 μm) allowing the
cement to work as both a bonding agent & acement to work as both a bonding agent & a
lining material.lining material.
The monomers penetrate into the demineralizedThe monomers penetrate into the demineralized
dentin, forming a hybrid layer which isdentin, forming a hybrid layer which is
expected to contribute to long term stable bondexpected to contribute to long term stable bond
of the cement to the tooth.of the cement to the tooth.

LUTING
Monomers added to hybrid ionomers impartMonomers added to hybrid ionomers impart
good early strength & improved overallgood early strength & improved overall
mechanical properties.mechanical properties.
They also enhance better bonding to toothThey also enhance better bonding to tooth
structure by penetration of monomers into thestructure by penetration of monomers into the
conditioned dentine to form strong hybridconditioned dentine to form strong hybrid
layer.layer.
Fuji plus & vitremeter luting cements areFuji plus & vitremeter luting cements are
popular products in this category.popular products in this category.

COMPOMERS
The search for a material that has the fluorideThe search for a material that has the fluoride
releasing capability of conventional GIC & thereleasing capability of conventional GIC & the
durability of composites has led to thedurability of composites has led to the
introduction of polyacid modified compositesintroduction of polyacid modified composites
or compomers.or compomers.
This material has a structure & physicalThis material has a structure & physical
properties similar to those of composites.properties similar to those of composites.
It also has ability to release fluoride, and itIt also has ability to release fluoride, and it
undergoes an acid-base reaction in presence ofundergoes an acid-base reaction in presence of
saliva (i.e. reaction between acidic monomer &saliva (i.e. reaction between acidic monomer &
basic glass filler).basic glass filler).

COMPOSITION & CHEMISTRY
Compomers is usually provided as a one-paste, light –Compomers is usually provided as a one-paste, light –
curable material for restorative applications.curable material for restorative applications.
It consists of silicate glass particles, sodium fluoride &It consists of silicate glass particles, sodium fluoride &
polyacid modified monomer without any water.polyacid modified monomer without any water.
It is sensitive to moisture so it is often packaged in aIt is sensitive to moisture so it is often packaged in a
moisture proof pouch.moisture proof pouch.
Setting is initiated by photo polymerization of the acidicSetting is initiated by photo polymerization of the acidic
monomer that yields a rigid material. During themonomer that yields a rigid material. During the
service life of restoration, the set material begins toservice life of restoration, the set material begins to
absorb water in the saliva that contributes the acidabsorb water in the saliva that contributes the acid
base reaction between the acidic functional groupsbase reaction between the acidic functional groups
within the matrix & silicate glass particles, thiswithin the matrix & silicate glass particles, this
reaction is responsible for fluoride release.reaction is responsible for fluoride release.www.indiandentalacademy.com

CHARACTERISTICS OF
COMPOMERS
One paste compomers used as a restorativeOne paste compomers used as a restorative
material release less fluoride than domaterial release less fluoride than do
conventionals & hybrids.conventionals & hybrids.
This is because limited occurrence of acid baseThis is because limited occurrence of acid base
reaction in this system.reaction in this system.
Bond strength to the tooth is in the same rangeBond strength to the tooth is in the same range
of traditional GIC & hybrid because of use ofof traditional GIC & hybrid because of use of
dentin bonding agents.dentin bonding agents.

CLINICAL USES OF GICS
 Restoration of erosion / abrasion lesionsRestoration of erosion / abrasion lesions
without cavity preparationwithout cavity preparation
 Sealing & filling of occlusal pits & fissures.Sealing & filling of occlusal pits & fissures.
 Restoration of deciduous teethRestoration of deciduous teeth
 Restoration of Class V carious lesions.Restoration of Class V carious lesions.
 Restoration of Class III carious lesionsRestoration of Class III carious lesions
preferably using lingual approach.preferably using lingual approach.
 Conservative cavities like, tunnel preparationsConservative cavities like, tunnel preparations
etc.etc.

 Restoration of root caries.Restoration of root caries.
 Repair of defective margins in restorations.Repair of defective margins in restorations.
 Core build up in few cases where sufficientCore build up in few cases where sufficient
dentine supports the material.dentine supports the material.
 Sandwich technique with composites.Sandwich technique with composites.
 Atraumatic Restorative Technique.Atraumatic Restorative Technique.
 Co cure technique.Co cure technique.
 Endodontic root perforations.Endodontic root perforations.
 Retrograde root filling in endodonticsRetrograde root filling in endodontics..

TUNNEL PREPARATION
The “tunnel” concept, which accesses proximalThe “tunnel” concept, which accesses proximal
dentinal cariesdentinal caries through a sound mesial or distalthrough a sound mesial or distal
occlusal pit, was describedocclusal pit, was described in 1984 (Hunt) toin 1984 (Hunt) to
preserve the overlying proximalpreserve the overlying proximal marginal ridgemarginal ridge
and maintain greater tooth integrity.and maintain greater tooth integrity.
This access has the potential to preserveThis access has the potential to preserve not only thenot only the
structural transverse marginal ridge, whichstructural transverse marginal ridge, which
maintains bucco-lingual tooth integrity, but alsomaintains bucco-lingual tooth integrity, but also
much of the outer proximal tooth surface.much of the outer proximal tooth surface.

 IT has been promoted for use in conjunction with
fluoride-releasing glass ionomer cements, in order
to provide compensatory caries-inhibition.
 A further possible advantage is less risk of
iatrogenic damage to the adjacent tooth.
 Two types of completed tunnel preparations are
possible
 1) the “partial” tunnel with little or no external
perforation, sometimes sparing removal of surface
demineralised enamel and
 2) the “total” tunnel” where the proximal enamel
has been perforated, with or without residual
demineralised enamel

STUDIES ON TUNNEL PREPARATION
Table 1. The Proximal “Tunnel” Restoration. Clinical Studies.
Year Author Study
Design
Country,
Sample
Sampling Study
Period
Subjects Restorations
1992 Svanberg I
(small)
Sweden
Public
Health
Clinic
Volunteers
(caries-
active)
3yrs 18
(13-
16yrs)
18 tunnel
(Ketac
Silver)
18 amalgam
1995 Lumley
et al
II-1 UK
Dental
Faculty
Any
suitable
patients
5yrs 25
(19-
45yrs)
33 tunnel
(GI + KS)
14 amalgam
proximal
slots
1999 Pilebro
et al
II-3 Sweden
Mixed,
PHS plus
Faculty
Multicentre
All
tunnels
1992-93
3yrs 272
(10-
74yrs)
Mean
19yr
374
(Ketac
Silver)
1999 Pyk
et al
II-3 Sweden
P.Health
Clinic
All
tunnels
1987-93
2yrs 142
Mean
19yr
242 tunnel
(87%
K.Silver,
13% GI)

Cont…
1998 Hasselrot
et al
II-
3
Sweden.
General
Practice
All
tunnels
1988-90
7yrs 193
young
adult
267
tunnel
(Ketac
Silver)
1998 Holst
et al
II-
3
Sweden
P.Health
Service
Any
suitable
patients
3yrs Not
given
322
(Ketac
Silver)
170
molars
145
bicuspid
1997 Nordbro
et al
II-
3
Norway
P.Health
Service
Any
suitable
patients
3-
4yr
Not
given
302
tunnel
(Ketac
Silver)
1996 Strand
et al
II-
3
Norway.
General
practive
Any
outer
third
dent.
caries
3yrs 117
(10-
30yrs)
230
tunnel
(Ketac
Silver)
1993 Wilkie
et al
II-
3
Australia
Dental
Faculty
Volunteer
patients
2yr 26
23 ‹
40yrs
3 ›
40yrs
42
tunnel
(Ketac
Silver)
44 Class
2
amalgam

Table 1. The Proximal “Tunnel” Restoration. Clinical Studies.
Year Author Study
Design
Country,
Sample
Sampling Study
Period
Subjects Restorations
1992 Svanberg I
(small)
Sweden
Public
Health
Clinic
Volunteers
(caries-
active)
3yrs 18
(13-
16yrs)
18 tunnel
(Ketac
Silver)
18 amalgam
1995 Lumley
et al
II-1 UK
Dental
Faculty
Any
suitable
patients
5yrs 25
(19-
45yrs)
33 tunnel
(GI + KS)
14 amalgam
proximal
slots
1999 Pilebro
et al
II-3 Sweden
Mixed,
PHS plus
Faculty
Multicentre
All tunnels
1992-93
3yrs 272
(10-
74yrs)
Mean
19yr
374
(Ketac
Silver)
1999 Pyk
et al
II-3 Sweden
P.Health
Clinic
All tunnels
1987-93
2yrs 142
Mean
19yr
242 tunnel
(87%
K.Silver,
13% GI)

1998 Hasselrot
et al
II-
3
Sweden.
General
Practice
All tunnels
1988-90
7yrs 193
young
adult
267 tunnel
(Ketac Silver)
1998 Holst
et al
II-
3
Sweden
P.Health
Service
Any suitable
patients
3yrs Not
given
322
(Ketac Silver)
170 molars
145 bicuspid
1997 Nordbro
et al
II-
3
Norway
P.Health
Service
Any suitable
patients
3-
4yr
Not
given
302 tunnel
(Ketac Silver)
1996 Strand
et al
II-
3
Norway.
General
practive
Any outer
third dent.
caries
3yrs 117
(10-
30yrs)
230 tunnel
(Ketac Silver)
1993 Wilkie
et al
II-
3
Australia
Dental
Faculty
Volunteer
patients
2yr 26
23 ‹
40yrs
3 › 40yrs
42 tunnel
(Ketac Silver)
44 Class 2
amalgam

Table 1 (cont.) The Proximal “Tunnel” Restoration. Clinical Studies.
Year Author Criteria Examiners Other Nos.
Lost
Findings
1992 Svanberg Clinical
Radiographic
Stone casts
1 dentist
No details
Not
stated
Tunnel - 5.5% marg.fracture,
0% rec.caries. Sig. reduced
adjacent proximal caries.
Amalgam 17% rec. caries
1995 Lumley
et al
Clinical
Radiographic
2 authors
No details
Bicuspids,
mes. 1st
molar only
None 3yrs, all satisfactory. 5yrs:
Tunnel - 21% failure (15%
rec.caries, 6% fractured ridge)
Amalgam - 0% failure
1999 Pilebro
et al
Clinical
radiographic
Clinical:
Each dentist.
Radiographic:
2 examiners
12 dentists 18.4% 8% residual caries
20% replacements at 3 yrs
(41% untreated progression,
14% ridge fract, 3% rec.caries
1999 Pyk
et al
Clinical
Radiographic
Life-table
method
Not
given
15.7% failures
(9.5% rec. caries, 4.2%
ridge fracture.)
1998 Hasselrot
et al
Clinical
Radiographic
1 dentist/
examiner.
No details
Tunnels:
Partial 87%
Total 13%
57% 50% failure at 6yrs.
(41% ridge fracture, 40% rec.
caries, 19% enamel cavitation.

1998 Holst
et al
USPHS
Radiographic
Clinicians
Trained &
calibrated
Partial &
total tunnels
16% 15.7% failures
(7.3% 1yr, 3.2% 2yr,
5.2% 3yr)
Rec. caries 8%, fracture 6%
1997 Nordbro
et al
Clinical
Radiographic
Not given Tunnels:
Partial 215
Total 87
Not
given
28% ridge fracture. 45% of res
rec. caries. Total tunnel better
than partial tunnel
1996 Strand
et al
Clinical
Radiographic
2 clinical +
2 radiographic
Consensus
30% 54% failures: 16% rec.caries,
14% ridge fracture, 24%
progression of residual demin.
enamel.
1993 Wilkie
et al
Clinical
radiographic
Colour photo
Replica casts
Clinical - 2
dentists.
Indirect - 1
Kappa .48-.86
Rubber
dam.
55% partial
tunnel
Not
given
KS material problems 48%
(voids, defects, wear)
Rec caries & ridge fracture 0%
Am 100% Comp 91% success

SANDWITCH TECHNIQUE
It is the use of glass ionomer cement as a linerIt is the use of glass ionomer cement as a liner
below the composite resin restorationsbelow the composite resin restorations
AdvantagesAdvantages
GIC bonds to both tooth and compositeGIC bonds to both tooth and composite
increasing the retentionincreasing the retention
Fluoride content reduces the cariesFluoride content reduces the caries
GIC gives a better seal as it bonds with theGIC gives a better seal as it bonds with the
toothtooth

ATRAUMATIC RESTORATIVE
TREATMENT
Since its development as part of a community-based primary oral healthSince its development as part of a community-based primary oral health
program carried out in Tanzania in the mid-1980s, the Atraumaticprogram carried out in Tanzania in the mid-1980s, the Atraumatic
Restorative Treatment (ART) technique has been used around theRestorative Treatment (ART) technique has been used around the
world.world.
Such approach consists of caries removal using hand instruments only,Such approach consists of caries removal using hand instruments only,
followed by restoration of the prepared cavity with adhesive fillingfollowed by restoration of the prepared cavity with adhesive filling
material, currently a glass-ionomer cement (GIC).material, currently a glass-ionomer cement (GIC).
The advantages of ART includeThe advantages of ART include
 the use of easily available and inexpensive hand instruments rather thanthe use of easily available and inexpensive hand instruments rather than
the more expensive electrically-driven dental equipment,the more expensive electrically-driven dental equipment,
 sound tooth tissue conservation due to the chemical adhesion of glass-sound tooth tissue conservation due to the chemical adhesion of glass-
ionomers,ionomers,
 limitation of pain, minimizing the use of local anesthesia, andlimitation of pain, minimizing the use of local anesthesia, and
low cost.low cost.
 Due to these features, many people living in less developed areas canDue to these features, many people living in less developed areas can
receive oral care through ART.receive oral care through ART.
 In addition, it is also suitable for patient with permanent or temporaryIn addition, it is also suitable for patient with permanent or temporary
physical disabilitiesphysical disabilities44
..

CLINICAL CASES
PREOPERATIVE

POST OPERATIVE

PREOPERATIVE

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