Glass ionomer cements/cosmetic dentistry courses

GLASS IONOMER
CEMENTS
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.comwww.indiandentalacademy.com

INTRODUCTION

CONTENTS
 INTRODUCTION
 DEFINITION
 HISTORY
 CLASSIFICATIONS
 COMPOSITION
 SETTING REACTION
 PROPERTIES
 CLINICAL PROCEDURES
 INDICATIONS and CONTRAINDICATIONS
 RECENT ADVANCES
 CONCLUSIONwww.indiandentalacademy.comwww.indiandentalacademy.com

DEFINITION
 Water based material that hardens following
an acid base reaction between basic
fluoroaluminosilicate glass and an aqueous
solution of polyacids. (Anusavice)
 Glass ionomer is a water- based material
that hardens following an acid base reaction
between fluroaluminosilicate glass particles
and an aqueous solution of polyacid.
(Davidson and Mjor)

HISTORICAL BACKGROUND
 Silicate Cements - Fletcher (1871)
 Adhesion of Resin Totooh Dr.Oscar
Hagger(1951)
 Acid Etching- Buonocore (1955)
 Composite Resin- Bowen (1958)
 Polycarboxylate Cements - D.C. Smith (1968)
 GIC (ASPA-I) - B.E.Kent & (1969)
 ASPA II with Tartaric Acid Wilson and Crisp
(1972)
 ASPA III with Methyl Alcohol (1974)
 ASPA IV with Co Polymer of Itaconic Acid
(1975) www.indiandentalacademy.comwww.indiandentalacademy.com

 ASPA-X with high Translucency Wilson
Crisp & Abel (1977)
 Anhydrous GIC (ASPA-V) - Prosser (1984)
 CERMET- McLean & Gasser (1985)
 Polyacid Modified Composite Resin (1994).
 2002 Giomer

CLASSIFICATIONS
 Philips
 Type I - Luting
 Type II - Restorative
 Type III - Liner & base
 Davidson / Mjor
 Conventional / Traditional GIC
 Resin Modified GIC
 Polyacid Modified Resin Composites

MOUNT:
A) Glass Ionomer Cements
(i) Glass Polyalkeonates
(ii) Glass Polyphosphates
B) Resin modified GIC
C) Polyacid modified composite resin
D)
 Auto Cure
 Dual Cure
 Triple Cure
E)
 Type I
 Type II
- Type II 1 (AESTHETIC)
- Type II 2 (RESTORATIVE)
 Type III

Sturdvent
1.Conventional or Traditional
2. Metal Modified GIC
- Miracle Mix
- Cermet
3. Light Cured GIC
4. Hybrid (resin modified) GIC
5. Polyacid Modified Resin Composites
Mc Lean and Nicholson
 Glass ionomer cements
 Poly alkeonates
 Poly phosphonates
 Resin modified GIC
 Poly acid modified GICwww.indiandentalacademy.comwww.indiandentalacademy.com

 According to clinical use as:
Type I- Luting
TYPE II- Restorative
Type III- Liner/ Base
Type IV- Pit & Fissure Sealant
Type V- Luting for Orthodontic Purpose
Type VI- Core build up material
Type VII- High fluoride releasing command
set
Type VIII- ART
Type IX- Geriatric & Paediatric GIC

COMPOSITION
POWDER (Calcium Fluroaluminosilicate)
 ALUMINA (28.6%) Alumina: Silica --> 1:2
 SILICA (41.9%)
 FLUORIDE
 CALCIUM FLUORIDE (15.7%)
 ALUMINIUM PHOSPHATE (3.8%)
 CRYOLITE
 Na+
, K+
, Ca2+
 La2O3, SrO
LIQUID
 POLYACRYLIC ACID (40 to 50%) Polyacrylic: Itaconic-- > 2:1
 ITACONIC ACID
 MALEIC ACID
 TRICARBOXYLIC ACID
 TARTARIC ACID(5-15%)
 POLYPHOSPHATES
 METAL OXIDES
 WATER
ANHYDROUS GLASS IONOMER CEMENTwww.indiandentalacademy.comwww.indiandentalacademy.com

SETTING REACTION
 Decomposition(20 -30%)
 Migration
 Gelation
 Post set hardening
 Maturation
Agglomeration of unreacted glass powder surrounded by a silica
gel in an amorphous matrix of hydrated Ca and Al polysalts.

 Role of water
 Reaction medium
 Hydrate the matrix
 Classification
 Loosely bound water
 Tightly bound water
 Protection
 Vaseline
 Dentin bonding agents

CRACK IN UNPROTECTED GIC CRACK PROPOGATION

Factors affecting setting
 Chemical constituents
- Alumina : Silica ratio
- Fluoride
- Tartaric acid
 Particle size
 Powder : liquid ratio
 Temperature of mixing

PROPERTIES
ADHESION:
Mechanism of adhesion
1. Chelation (Smith)
2. Hydrogen bonding (Wilson)
3. Hydroxyapatite & polyacrylic acid interaction
(Beech)
4. Hydrogen bonding with dentin collagen
(Akinmade)

Diffusion based adhesion
(Akinmade)

 Bond strength
 Enamel- 2.6 to 9.6 Mpa
 Dentin – 1.1 to 4.5 Mpa
 Surface conditioners
 Remove smear layer
 Increases surface energy
 Increases wettability and decreases contact
angle

 Polyacrylic acid- 10% for 15 sec
 50% citric acid for 5 sec
 25% tannic acid for 30 sec
 2% ferric chloride
 EDTA
 ITS solution, Levine solution
 Advantages
 No microleakage
 Conservative cavity form

 Biocompatibility
 High initial pH(0.9 – 1.6)
 Properties of polyacrylic acid
 high mol wt and heavy chain entanglement
 weak acid
 ppt by Ca in dentinal tubules
 electrostatic attraction of H+
ions
 Sensitivity with luting GIC
 high initial pH
 low P : W ratio
 pre existing pulpitis
 decrease dentin thickness
 Resistance to plaque

 Anticariogenicity
 Zone of resistance 3mm(Kidd, Hicks)
 Fluoride Action
 Physicochemical mechanism
 Biological mechanism
 Duration of fluoride release?
 Structural degradation?

TETRAHEDRON GLASS SKELETAL STRUCTURE
F- ION NOT IN STRUCTURE

 Aesthetics- Translucency due to glass fillers
 Dimensional Stability - ~ 3% contraction
 Dissolution and disintegration: by Dissolution of matrix
forming species
 Early water contamination
 Plaque acid/ APF gel application
 Mechanical wear
 Solubility 4 wt%
 Clinical Life of the restoration:
 83% showed retention after 10 years
 0 to 70 % failure rate
 Strength:
 Compressive strength- 150 Mpa
 Tensile strength- 6.6 Mpa
 KHN- 48
 Radiopacity:: Fairly radio opaque
 Abrasion resistance: Satisfactory if material is supported by
sound tooth structure.www.indiandentalacademy.comwww.indiandentalacademy.com

CLINICAL PROCEDURE (DISPENSING)
STANDARDIZE
POWDER IN SPOON
DISPENSE LIQUID TO
AVOID AIR BUBBLES

MIXING
MIXING POWDER AND LIQUID
USING PLASTIC SPATULA
FOLDING TECHNIQUE
FOR MIXING

MATRIX APPLICATION
PREFORMED
HAWE MATRICES
SOFT TIN MATRIX

FINISHING & POLISHING
Remove excess cement with sharp blade to
reduce gross contour
 After 24 hours, fine diamond with air/ water
spray for gross contour
 Rubber polishing points for refining
 Polishing discs for glossy finish
 Sealing with resin sealant or vaseline

INDICATIONS
LUTING CEMENT (Type 1 GIC)
 Tendency towards plastic deformation
 Particle size - 4 to 15µ
 Film thickness - 10 to 20µ
 P : W ratio – 1.5:1
 No application of pressure- GIC has thixotropic
 Fast setting, no need of protection,
 Conditioning or no conditioning ?

 RESTORATIVE CEMENT
 Erosion/ abrasion lesions
 Class III & V lesions
 Restoration on primary teeth
 Restoration in rampant caries cases
 Laminate restorations
 ART (Class I Lesions)
 Micro cavity preparation
 Small to medium size class I lesion
 Repair of open margins around crowns and
inlays

 P : W ratio – 3:1 (2.9:1 to 3.6:1) for
conventional GIC
 For anhydrous GIC – 6.8: 1
 Polishing after 24 hours

 LINER AND BASE
 As a liner to protect pulp from thermal insult
 As base to replace carious dentin
 Mount technique for base application
Sandwich technique-
 Good bonding(0.3 – 6 MPa)
 Less shrinkage
 Microlekage reduced
 Lamination with amalgam:
 GIC can bond to metal oxides
 3-4 MPa bond strength were obtained

 Pit & fissure sealant
 pit and fissure orifices are patent
 Luting of orthodontic brackets and bands
 Core build up
 In Endodontics
 Sealing the root canals
 Sealing and restoring the pulp chamber
 Repairing the perforation
 Rarely treating the vertical fracture of tooth

CONTRAINDICATIONS
 Class IV lesions and fractured incisors
 Large labial restoration where esthetic
is of prime concern
 Lost cusp area
 Class II lesions where conventional
cavities are prepared

RECENT ADVANCES
IN
GIC

HIGH VISCOSITY GIC
Developed as an alternative to amalgam.
Packable / condensable glass ionomer cements
Composition: Powder: Ca,La,Al fluorosilicate glass
Liquid: PA,TA,water and benzoic acid
INDICATIONS: Molar restoration of primary teeth
Intermediate restoration
Core build up material
For A R T
ADVANTAGES: Packable or condensable
Improved wear resistance
Easy to use
Low solubility
Rapid finishing possible
Decrease moisture sensitivity
DISADVANTAGES: Limited life
Moderately polishable
Not esthetic
. www.indiandentalacademy.comwww.indiandentalacademy.com

Commercial Products
FUJI-IX GP
FUJI-IX GP
FAST

LOW VISCOSITY GIC
1. Also called as Flowable GIC
2. Low P:L ratio thus increase flow.
3. Use for lining, pit and fisure sealer, endodontic
sealer and for sealing hyper sensitive cervical
area.
Eg fuji lining LC, Ketac – endo etc.
Fuji lining LC Ketac-Endowww.indiandentalacademy.comwww.indiandentalacademy.com

METAL MODIFIED GIC
1 Seed & Wilson (1980) invented miracle mix
2 Spherical silver amalgam alloy+Type II G I C in
ratio 7:1
3 Mc lean & Gasser (1985) invented ceremet
Glass powder sintered to metal fillers (<5%) at
800°C
4 Minimal improvement in mechanical property
- Compressive strength – 150 Mpa
- Modulus of elasticity is slightly lower
- KHN – 39
- Tensile strength – slightly more 6.7 Mpa
- Slight increase in wear resistance.
 Fluoride release
 Max for miracle mix (3350µg, 4040µg)
 And min for cermets (200µg, 300µg)

Indications: Class I cavities in primary teeth
Core build up material
Lining of class II amalgam restorations
Root caps for teeth under over dentures
As a preventive restoration
Contraindications: Anterior restoration
In areas of high occlusal loading
Advantages:
Ease for placement
Adhesion to tooth structure and anticariogenic
potential
Crown cutting can be done immediately
Increased wear resistance
Disadvantages:
Esthetically poor
Tooth discoloration
Rough surface
Reduced W.L and S.Twww.indiandentalacademy.comwww.indiandentalacademy.com

Miracle mix
COMMERCIAL PRODUCTS
Ketac Silver

RESIN MODIFIED GIC
Objective:
To overcome low early strength and moisture sensitivity
1. Defined as hybrid cement that sets partly by acid base
reaction and partly by polymerisation reaction (Mc
Lean)
2 Materials that are modified by the inclusion of resin,
generally to make the them more photo curable
(Nicholson)
3. Powder – Ion leachable glass and initiators
liquid – water, Poly acrylic acid, HEMA (15-25%),
methacrylate monomers.
4. Setting reaction: - Dual cure
- Tricurewww.indiandentalacademy.comwww.indiandentalacademy.com

PROPERTIES
 Esthetic – Superior than conventional GIC
 Fluoride release:
 Conventional
 440µgF after 14 days
 650 µgF after 30 days
 RMGIC-1200 µgF after 14 days
 1600 µgF after 30 days
 Strength: Diametral strength
 Conventional
 G I C: 6.6Mpa
 RMGIC: 20 Mpa

 Compressive strength
 Conventional G I C:150Mpa
 RMGIC: 105Mpa
 Hardness:
 Conventional GIC:48KHN
 RMGIC:40KHN
 Shear bond strength: lesser than
conventional GIC (Acc to skinner)
 Marginal adaptation: poor compare to
conventional GIC
 Biocompatibility: Transient rise in
Temperature

Advantages
 Long working time due to photo curing
 Improved setting characteristics
 Decrease sensitivity to water (but not significantly,
Journal of Conservative Dentistry, June 2005)
 Increase early strength
 Finishing & polishing can be done immediately
 Improved tensile strength.
 Better adhesion to composite restoration
 Increase fluoride release.
 Repairable.

Disadvantage
 Biocompatibility is controversial
 More setting shrinkage leading increase
microleakage and poor marginal adaptation

Uses
 As a luting cement (FUJI PLUS Ketac-cem 3M ESPE, Fuji Cem)

 As a liner and bases
(Fuji LC)
 As a pit and fissure
(Vitre Bond)
 Core build up material
(Fuji I LC)
 Retrograde filling material

POLYACID MODIFIED COMPOSITE
RESIN
 Also called as compomer
 Defined as : material that contain both the
essential components of GIC but in an
amount insufficient to carry out acid base
reaction in dark.
 They are developed to combine fluoride
release of GIC and durability of composite

 Composition: one paste system containing ion
leach able glass, sodium fluoride, polyacid
modified monomer but no water
 Recently 2 paste or powder liquid system is
introduced.
 Powder:
 Strontium aluminium flurosilicate glass particles, metal
oxides,and intiators
 Liquid:
 Polymerizable methacrylate/caboxylic acidic monomers
multi functional acrylate monomers and water ;

 Setting reaction
1. Initially light curing forms resin network
around the glass
2. After 2 to 3 month there is water uptake
which initiates slow acid base reaction and
fluoride release.

Properties
 Adhesion –Micromechanical, absence of
water thus no self adhesion
 Fluoride release minimal.
 Physical properties better than conventional
GIC but less than composite.
 Optical properties superior to conventional
GIC.

Uses
 Pit and fissure sealant
 Restoration of primary teeth
 Liners and bases
 Core build up material
 For class III & V lesions
 Cervical erosion / abrasion
 Repair of defective margins in restorations
 Sealing of root surfaces for over dentures
 Reterograde filling material.

Contraindications
 Class IV carious lesions
 Large areas of labial surfaces
 Class II cavities where conventional cavity
is prepared
 Lost cusp areas
 Under full crown or PFM crowns.

Advantages
 Ease of use
 Easy adaptation to the tooth
 Good esthetics
 More working time than RM GIC

Commercial Products
Compoglass F Principle
Compoglass Flow

Self hardening RM GIC
 Activated purely by chemical polymerisation
reaction
 Contains benzoyl peroxide and T-Amines
 Advantages
 Ease of handling
 Fluoride release
 Higher compressive strength
 No additional set up for light activation
 Uses:
 Luting of stainless steel crown, orthodontic
brackets, space maintainers.

Fluoride charged material
 To overcome the shortcomings of
conventional fluoride releasing materials.
 Consist of 2 part
 Restorative part
 Charge part
 Still under experimental stage

Low pH “Smart” Material
 Releases fluoride when pH falls below
the critical level
 Fluoride release is episodic and not
continuous

Bioactive glass
 Introduce by Hench in 1973
 Acid dissolution of glass forms calcium and
phosphate rich layers
 The glass can form bioactive bonds with bone cells
 Better than hydroxyapatite
 Can grow calcium and phosphate rich layer in
presence of calcium and phosphate saturated
saliva.
 They are less abrasive than feldspathic porcelain to
opposing teeth

Uses
 Bone cement
 Retrograde filling material
 For perforation repair
 Augmentation of resorbed alveolar ridge
 Implant cementation
 Infra bony pocket correction
 Bio glass ceramic crown.

Fiber-reinforced Glass Ionomer
Cements
 Al and Sio2 fibers added to glass powder (PRIMM)
 Diameter of fiber is 2µm.
 Advantages:
 Increased wear resistance.
 Improved handling characteristics
 Increased depth of cure
 Reduction of polymerization shrinkage
 Improved flexure strength(50Mpa)

GIOMERS
 True hybridization of GIC and composite
 Combine fluoride release and fluoride
recharge of GIC with esthetic easy
polishability and strength of composite
 Based on PRG technique.
 Two types:
 S- PRG :Reaction of entire glass
 S-PRG: Reaction with glass surface

INDICATIONS
 Class I, II, III, IV, and Class V cavities
 Restoration of cervical erosion and Root caries
 Laminates and core build up
 Restoration of primary teeth.
 Repair of fracture of porcelain and composites

Advantages
 Increase wear resistance
 Increase Radiopacity (glass filler)
 Ideal shade match (improved light diffusion and
fluorescence)
 High and sustained fluoride release and recharge
 Provide almost complete seal against bacterial
microleakage
 Little mechanical and chemical pulp irritation
 Inhibit demineralization

Example
BEAUTIFUL (SHOFU)

CONCLUSION
 GIC’s have come a long ways since its modest
beginning in 1969. Even though research can
boast of substantial improvements, certain
essential properties still seem to be wanting
and further clinical trials are warranted for a
majority of these developments. At this point of
time, we are left wondering if GIC will ever be
able to dominate tomorrow’s restorative scene
or will it go into total oblivion. Who knows?
Only the future will tell. Let us wish GIC all the
best for the coming years.

Glass ionomer cements/cosmetic dentistry courses

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (20)

Similar to Glass ionomer cements/cosmetic dentistry courses

Similar to Glass ionomer cements/cosmetic dentistry courses (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

Glass ionomer cements/cosmetic dentistry courses