Glass ionomer cement

CONTENTS
INTRODUCTION
COMPOSITION
CLASSIFICATION
MANIPULATION OF THE MATERIAL
SETTING MECHANISM
APPLICATION OF MATERIAL & USES
ADVANTAGES & DISADVANTAGES
PROPERTIES
MODIFICATIONS & ADVANCEMENT IN MATERIAL
CONCLUSION
REFERENCES

your name
1955
1952
1968
1972
KVAMER
MC LEAN
BUONOCORE
SMITH
WILSON &
KENT

your name
What is unusual of GIC???
It is neither purely organic nor purely
inorganic
It is neither a polymer nor a hydraulic
cement but set by chemical gelation
It is a kind of composite but where the
filler has taken part in the reaction
Has porcelain like translucency, adhere to
tooth structure
Shown promise as bone cement

Evolved asahybrid from silicate& Polycarboxylatecement
DEFINITION:DEFINITION: A cement that consists of a basic glass & an acidic polymer which setsA cement that consists of a basic glass & an acidic polymer which sets
by an acid-base reaction between these components.by an acid-base reaction between these components. Mclean & Wilson 1994)Mclean & Wilson 1994)
Glass Ionomer: "glass" refers to the glassy ceramic particles and the
glassy matrix (non-crystalline) of the set material, while "ionomer" refers to
ion crosslinked polymer.
2. Polyalkenoic or Polyalkenoate: refers to polymer chain which
incorporates alkenoic monomers such as acrylic acid, tartartic acid, maleic
acid, etc.

Powder (Ion leachable glass) includes :
Silica (SiO2) – 35-50%
Alumina (Al2O3) – 20-30%
Aluminium flouride – (AlF3) 1.5 – 2.5
Calcium fluoride (CaF2) – 15-20
Sodium Fluoride (NaF) – 3.0-6.0
Aluminium phosphate (AlPO4) – 4.0 – 12
Lanthanum, Strontium, Barium in traces (for
radio capacity)
(Fluorides act as ceramic flux)

Liquid :
Polyacrylaic acid – 45%
Itaconic acid – 5%
Maleic acid – 5%
Tricarballylic acid – 5%
Tartaric acid – Traces (increases working
time and decreases setting time)
Water – 50% (Hydrates reaction product)

MODIFICATIONS IN POWDERMODIFICATIONS IN POWDER
A)Anhydrous GIC - dried polyacrylic acid
B)Miracle mix – Silver tin alloy
C)Silver-palladium / Titanium alloy – CERMET cement
D)Light, Dual, Tricure GIC – BisGMA, TEGDMA and HEMA
MODIFICATIONS IN LIQUIDMODIFICATIONS IN LIQUID
A)Anhydrous cement – only water and tartaric acid
B)Light cure composite – HEMA
C)Amino-acid modified

1. Powder and liquid (with different shades)
2. Pre-proportioned capsule (for mixing with mechanical mixers)
3. Powder (anhydrous GIC which can be mixed with water)
4. Two pastes (mixed and light cured)
5. Single Paste (Compomers) as tubes or compules (Cavifils)
Microsyringe for
dispensing liquid
DISPENSING

A) According to Wilson and McLean in 1988
1. Type I – Luting cements
2. Type II – Restorative cements
a. Restorative aesthetic
b. Restorative reinforced
B) According to application
1. 1.Type I – Luting cements
2. 2. Type II – Restorative cements
• Aesthetic filling materials
• Reinforced materials
3. 3. Type III – Lining cement
4. 4. Type IV – Fissure sealant
5. 5. Type V – Orthodontic cement
6. 6. Type VI – Core build up cement
7. Type VII- Intermediate Restorations
8. Type VIII- ART(ANT. restoration)
9. Type IX –ART( POST. restoration )

C. Newer Classification
1.Traditional Glass Ionomer
a.Type I – Luting cement
b. Type II – Restorative Cements
c. Type III – Liners and Bases
2. Metal Modified Glass Ionomer
a. Miracle mix
b. Cermet cement
3. Light cure glass ionomer
HEMA added to liquid
4. Hybrid Glass Ionomer
a. Pre-cured glasses blended into composites
D. According to McLean et al in 1994
1.Glass Ionomer Cements (Traditional)
2. Resin Modified Glass Ionomer Cements.
3. Poly Acid Modified Composite Resins.

E. According to manufactures GC fuji
Fuji I - Luting
Fuji II - Restorative
Fuji III - Fissure protection
Fuji lining - Liner
Fuji Ortho - Ortho bonding
Fuji 8 - Ant. Esthetic ART
Fuji IX - ART (high strength)
Fuji IX GP - Condensable G.I.C.
GC Miracle MIX

(Phillips(Phillips, Science of Dental Materials, 9th edition, 9th edition))
Type I - Luting AgentsType I - Luting Agents
 ConventionalConventional
 Ketac-CemKetac-Cem®® Radiopaque (handmixed)(ESPE)Radiopaque (handmixed)(ESPE)
 Ketac-CemKetac-Cem®® Aplicap® (handmixed)(also radiopaque)(ESPE)Aplicap® (handmixed)(also radiopaque)(ESPE)
 GC Fuji IGC Fuji I®® (GC America)(GC America)
 CX-Plus GlasIonomer® Cement (Shofu)CX-Plus GlasIonomer® Cement (Shofu)
 Vivaglass™Cem (Vivadent)Vivaglass™Cem (Vivadent)
 Ketac-Endo® Aplicap®Ketac-Endo® Aplicap®
 Resin-modified (hybrid, resin reinforced)Resin-modified (hybrid, resin reinforced)
 AdvanceAdvance™™ (Caulk)(Caulk)
 FujiFuji®® PlusPlus™™ (GC America)(GC America)
 Fuji Ortho™ LC (GC America)Fuji Ortho™ LC (GC America)
 Fuji Ortho™ Self-Cure (GC America)Fuji Ortho™ Self-Cure (GC America)
 VitremerVitremer™™ Luting Cement(3MLuting Cement(3M™™)) →→ RelyX™RelyX™
 Photac-CemPhotac-Cem®® (ESPE)(ESPE)
 Pro Tec Cem (Vivadent)Pro Tec Cem (Vivadent)

 Type II – Restorative MaterialsType II – Restorative Materials
 ConventionalConventional
 Ketac-FilKetac-Fil®® (ESPE)(ESPE)
 GC Fuji IIGC Fuji II™™ (GC America)(GC America)
 GlasIonomer® Cement (Shofu)GlasIonomer® Cement (Shofu)
 Resin-ModifiedResin-Modified
 GC Fuji IIGC Fuji II™™ LC (GC America)LC (GC America)
 PhotacPhotac®®-Fil Quick Aplicap-Fil Quick Aplicap®® (ESPE)(ESPE)
 VitremerVitremer™™ Tri-Cure Glass Ionomer System (3MTri-Cure Glass Ionomer System (3M™™))
 Metal Modified Glass IonomerMetal Modified Glass Ionomer
 Silver alloy admix – Miracle MixSilver alloy admix – Miracle Mix®® (GC America)(GC America)
 Cermet (Chelon-SilverCermet (Chelon-Silver®®, Ketac-Silver, Ketac-Silver®®) (ESPE)) (ESPE)
 ““High Strength,” “Packable,” “High Viscosity” Glass IonomerHigh Strength,” “Packable,” “High Viscosity” Glass Ionomer
(conventional GI’s)(conventional GI’s)
 GC Fuji IXGC Fuji IX™™ GP (GC America)GP (GC America)
 KetacKetac®®-Molar Aplicap-Molar Aplicap®® (ESPE)(ESPE)
 Core Build-up Materials (Glass ionomers as core materials haveCore Build-up Materials (Glass ionomers as core materials have
limitations!!)limitations!!)
 Fuji IIFuji II™™ LC Core (GC America)LC Core (GC America)
 CoreshadeCoreshade®® (Shofu)(Shofu)
 VitremerVitremer™™ Core Build-up (3MCore Build-up (3M™™))
 metal modified materials listed abovemetal modified materials listed above

 Type III – Liners and BasesType III – Liners and Bases
 Conventional (self-cure)Conventional (self-cure)
 KetacKetac®®-Bond (ESPE)-Bond (ESPE)
 GlasIonomer® Base Cement (Shofu)GlasIonomer® Base Cement (Shofu)
 GC Lining Cement (GC America)GC Lining Cement (GC America)
 Dentin Cement (GC America)Dentin Cement (GC America)
 Resin-ModifiedResin-Modified
 VitrebondVitrebond™™ (3M(3M™™))
 Fuji BondFuji Bond™™ LC (more recent version)(GC America)LC (more recent version)(GC America)
 Fuji LiningFuji Lining™™ LC (earlier version)(GC America)LC (earlier version)(GC America)

 The most accepted classification -The most accepted classification - Graham Mount inGraham Mount in
1994.1994.
 based on the composition,based on the composition,
powder/liquid ratiopowder/liquid ratio
clinical applications of the material.clinical applications of the material.
Type IType I -- Luting GICLuting GIC
fine powderfine powder particle sizeparticle size
 used forused for luting crowns,luting crowns,
bridges, inlays andbridges, inlays and
orthodontic appliancesorthodontic appliances

 Low Powder/Liquid ratio - 1.5 : 1Low Powder/Liquid ratio - 1.5 : 1
 Film thickness - < 20 micro mmFilm thickness - < 20 micro mm

Type I GIC’s - CementationType I GIC’s - Cementation
 Ketac-CemKetac-Cem
 Fuji IFuji I

Type II - Restorative glass ionomerType II - Restorative glass ionomer cementcement
 Type II.1 -Type II.1 - RestorativeRestorative estheticesthetic glass ionomer cement –glass ionomer cement –
 used for esthetic restorations.used for esthetic restorations.
 high powder/liquidhigh powder/liquid ratio,ratio, 3:1 or3:1 or greatergreater
 has superior physical properties and good translucency.has superior physical properties and good translucency.
 autocuredautocured
 resin-modified cementsresin-modified cements

Restorative esthetic glass ionomerRestorative esthetic glass ionomer
cementcement

Type II.2 -Type II.2 - RestorativeRestorative reinforcedreinforced glass ionomerglass ionomer
cement –cement –
 have metallic inclusions for reinforcement.have metallic inclusions for reinforcement.
 superior strength but lack esthetics.superior strength but lack esthetics.
 used where improved physical propertiesused where improved physical properties
are required but esthetics is not important.are required but esthetics is not important.
 Powder/Liquid ratio -Powder/Liquid ratio - 3: 13: 1 or greater.or greater.
 Core buildupCore buildup
 rootcariesrootcaries
 tunnel restoratointunnel restoratoin
 deciduous restorationdeciduous restoration

Type II GIC’s – Restoratives
• Ketac-Fil
• Chem-Fil

Type III -Type III -Lining or base glass ionomer cementLining or base glass ionomer cement
 In low powder liquid ratio as lining;In low powder liquid ratio as lining;
 in high powder liquid ratio as base beneath amalgam,in high powder liquid ratio as base beneath amalgam,
composite restorations.composite restorations.
Powder/Liquid ratio -Powder/Liquid ratio - 1.5:1 (lining).1.5:1 (lining).
3:1 or greater (base).3:1 or greater (base).
Auto curedAuto cured
or resin-modifiedor resin-modified..

DISPENSING AND MANIPULATIONDISPENSING AND MANIPULATION
 Available commercially in two forms:Available commercially in two forms:
1) Powder and liquid for1) Powder and liquid for hand mixing.hand mixing.
2) Pre-proportioned capsules for2) Pre-proportioned capsules for mechanical mixing.mechanical mixing.

1) Hand mixing:1) Hand mixing:
 Great care required -Great care required - proper powder-liquid ratioproper powder-liquid ratio..
 manufacturer's instructions - followedmanufacturer's instructions - followed
 Mixing - on a cool, dry glasss lab or a paper pad using a thin-Mixing - on a cool, dry glasss lab or a paper pad using a thin-
bladed plastic spatula.bladed plastic spatula.
 main objective of mixing -main objective of mixing - wet the surface of each glasswet the surface of each glass
particle with the liquidparticle with the liquid, without dissolving the powder, without dissolving the powder
completely in the liquid.completely in the liquid.

Glass ionomer powder
and liquid dispensed
Powder divided into two halves
Incorporation of the first
increment of the powder gently butgently but
rapidly rolling the powder into therapidly rolling the powder into the
liquidliquid
Completed mix

 first half- within 10 secondsfirst half- within 10 seconds
 second half- within 15 secondssecond half- within 15 seconds
 Mixing- within 25-30 secondsMixing- within 25-30 seconds
 finished mix 'glossy wet' on the surfacefinished mix 'glossy wet' on the surface
 working time for the mixed cement - 1-2 minutes.working time for the mixed cement - 1-2 minutes.

2) Mechanical mixing:2) Mechanical mixing:
pre-proportioned capsules - consistent powder-liquid ratio,pre-proportioned capsules - consistent powder-liquid ratio,
mechanical mixing in an amalgamator ensuresmechanical mixing in an amalgamator ensures
- standardized mixing and setting times.- standardized mixing and setting times.
The material - syringed into the cavity and exhibitsThe material - syringed into the cavity and exhibits
optimum physical properties.optimum physical properties.
Check the efficiency of your machineCheck the efficiency of your machine
by Assessing theby Assessing the 'loss of gloss'loss of gloss''
of a freshly mixed capsule.of a freshly mixed capsule.

Determining the loss of glossDetermining the loss of gloss/ SLUMP TEST/ SLUMP TEST

SETTINGSETTING
REACTIONREACTION
ACID-BASE REACTIONACID-BASE REACTION
It occurs between the glass powder and ionic polymerIt occurs between the glass powder and ionic polymer
The setting reaction of Glass ionomer cements involves threeThe setting reaction of Glass ionomer cements involves three
overlapping stages.overlapping stages.
Stage1:Stage1: DissolutionDissolution
Stage2:Stage2: Precipitation of salt, gelation and hardeningPrecipitation of salt, gelation and hardening
Stage3:Stage3: Hydration of salts.Hydration of salts.
GIC is formed by reaction of 3 materialGIC is formed by reaction of 3 material
1.1. Fluoro alumino silicate glass powderFluoro alumino silicate glass powder
2.2. An ionic polymer of polyacrylic acidAn ionic polymer of polyacrylic acid
3.3. WaterWater

It can be set by acid base reaction or light cure polymerisation

DECOMPOSITION-
f the glass & release of cement
forming metal ions
MIGRATION
of these metal ions
in to the aqueous phase.
GELATION
Of the polyacid by the
metal ions leading to set
POST SET HARDENING
1 hr -24 hrs
FURTHER SLOW
MATURATION
>24 hrs
Crisp et al(1974) & Barry et al (1979)
Cook (1982)

 Glasses - fusing the components betweenGlasses - fusing the components between 11001100°°C to 1500C to 1500°°CC
pouring the melt onto a metal plate or into waterpouring the melt onto a metal plate or into water
then ground to a fine powder for mixing with polyacid.then ground to a fine powder for mixing with polyacid.

 Glasses - silica -Glasses - silica - transparenttransparent
 glasses - CaF2 or alumina -glasses - CaF2 or alumina - opaque.opaque.
Calcium fluoride (CaF2)Calcium fluoride (CaF2) andand Cryolite (Na3AlF6) -Cryolite (Na3AlF6) -
flux.flux.
 lower the temperature of fusionlower the temperature of fusion
 improve the working characteristicsimprove the working characteristics
 increases the strengthincreases the strength

contributes to therapeutic value of cement (F releasecontributes to therapeutic value of cement (F release))

Aluminium Phosphate (AlPO4)Aluminium Phosphate (AlPO4)
 improves translucencyimproves translucency
 adds body to the cement paste.adds body to the cement paste.
Strontium / Barium / LanthanumStrontium / Barium / Lanthanum
 may wholly or partly replace calcium to give amay wholly or partly replace calcium to give a radiopaqueradiopaque
glass.glass.

Polyelectrolytes –Polyelectrolytes –
as the name implies are bothas the name implies are both electrolytes and polymers.electrolytes and polymers.
 The more important carboxylic acids in the ionomer systemThe more important carboxylic acids in the ionomer system
includeinclude
ACRYLIC ACID,ACRYLIC ACID,
MALEIC ACIDMALEIC ACID
ITACONIC ACIDITACONIC ACID
 either in the form of aeither in the form of a conc. aqueous solution (40% to 50% byconc. aqueous solution (40% to 50% by
mass)mass) or blended dry with either water or an aqueous solutionor blended dry with either water or an aqueous solution
of tartaric acidof tartaric acid. [Mclean et al, 1984]. [Mclean et al, 1984]

 WaterWater - the REACTION MEDIUM and also plays a role in- the REACTION MEDIUM and also plays a role in
hydrating reaction products.hydrating reaction products.
Tartaric acidTartaric acid
 DECREASES viscosity & DELAYING gelationDECREASES viscosity & DELAYING gelation
 greater the concentration greater is the delay.greater the concentration greater is the delay.
[Cook, 1983; Hill and Wilson; 1986].[Cook, 1983; Hill and Wilson; 1986].
 Prolongs W.T of mixProlongs W.T of mix
 Decrase S.TDecrase S.T
 INCREASES handling charactersticsINCREASES handling characterstics
MOAMOA ::
 Temporary suppresionTemporary suppresion of ionization of polyacidof ionization of polyacid
 Enhances extraction of Al fromEnhances extraction of Al from Glass.Glass.

 Fully hardened GIC -Fully hardened GIC - all ions in an insoluble formall ions in an insoluble form..
 no longer vulnerable to attack by moisture.no longer vulnerable to attack by moisture.
 Hardening continues for about 24 hoursHardening continues for about 24 hours, during which time, during which time
translucency develops as the chemical reaction proceedstranslucency develops as the chemical reaction proceeds
 SLOW MATURATION Continues even after 24 hours;SLOW MATURATION Continues even after 24 hours;
 in the first few daysin the first few days
-translucency develops further;-translucency develops further;
-increase resistance to dessication-increase resistance to dessication
-increase resistance to acid attack-increase resistance to acid attack
- cement becomes more rigid and gathers strength- cement becomes more rigid and gathers strength

THE ROLE OF WATER
The GIC are water-based cements.The GIC are water-based cements.
FUNCTIONSFUNCTIONS
 It is reaction medium.It is reaction medium.
 It serves to hydrate the siliceous hydrogel and the metal salts formed.It serves to hydrate the siliceous hydrogel and the metal salts formed.
 It is essential part of the cement structure. If water is lost from the cement byIt is essential part of the cement structure. If water is lost from the cement by
desiccation while it is setting, the cement-forming reactions will stop.desiccation while it is setting, the cement-forming reactions will stop.
 As a plasticizerAs a plasticizer
Water content in set cementWater content in set cement  11-24%11-24%
Cement is stable only in an atmosphere ofCement is stable only in an atmosphere of 80%80% relative humidityrelative humidity
(Hornsby 1980)(Hornsby 1980)

Water present in set cement can be classified
into two forms:
(1) Loosely bound water (readily removed by
dessication)
(2) Tightly bound water (Cannot be removed)
[Wilson and Crisp, 1975; Elliot et
al,1975; Wilson et al, 1981]

 As the cement ages, degree of hydration (ratio ofAs the cement ages, degree of hydration (ratio of
tightly bound to loosely bound water) increases. Thistightly bound to loosely bound water) increases. This
is accompanied by an increase in strength andis accompanied by an increase in strength and
modulus and a decrease in plasticity.modulus and a decrease in plasticity.
[Paddoson and Wilson, 1976; Wilson et al, 1981][Paddoson and Wilson, 1976; Wilson et al, 1981]

 When subjected to dessication : Loss of waterWhen subjected to dessication : Loss of water
(1) Shrinking and crazing(1) Shrinking and crazing
(2) Retardation of cement formation(2) Retardation of cement formation
(3) Weaker cement(3) Weaker cement

 When subjected to moisture : Absorption ofWhen subjected to moisture : Absorption of
waterwater
(1) Disruption of surface by swelling(1) Disruption of surface by swelling
(2) Loss of substance to oral environment(2) Loss of substance to oral environment
[Wilson et al, 1981;[Wilson et al, 1981;
Causton, 1981; Roulet and Walti, 1984; Phillips andCauston, 1981; Roulet and Walti, 1984; Phillips and
Bishop; 1984]Bishop; 1984]

 This problem does not arise ---This problem does not arise ---
 if GIC -- protected forif GIC -- protected for between 10 and 30 minutesbetween 10 and 30 minutes..

 MOST EFFECTIVE MATERIALS FORMOST EFFECTIVE MATERIALS FOR
PROTECTING GICSPROTECTING GICS
 Low viscosity, light curing bonding agentsLow viscosity, light curing bonding agents..
 Proprietary varnishesProprietary varnishes supplied by manufacturerssupplied by manufacturers
 Wax / petroleum jellyWax / petroleum jelly
only afford brief protectiononly afford brief protection
(as they are Easily Washed(as they are Easily Washed
Off by tongue movements)Off by tongue movements)
[Earl & Coworkers, 1985][Earl & Coworkers, 1985]

GIC after 30 min without protection

ISOLATION.
TOOTH PREPARATION .
MECHANICAL PREPARATION
CHEMICAL PREPARATION.
CEMENT PLACEMENT .
MIXING OF THE CEMENT.
RESTORATION.
SURFACE PROTECTION .
FINISHING & POLISHING .

CLINICAL PROCEDURES FOR PLACEMENT:
To ensure the successful use of glass ionomers 3
parameters that must be controlled are:
- Conditioning of the tooth surface
- Proper manipulation
- Protection of the cement during setting

ISOLATIONISOLATION
SHADE SELECTION
Excessive dehydration is unnecessary
Cotton rolls and retraction cord are enough

TOOTH PREPARATION
CONDITIONING OF THE SURFACECONDITIONING OF THE SURFACE
WITH 25% POLYACRYLIC ACIDWITH 25% POLYACRYLIC ACID
CLEANING WITH SLURRY OFCLEANING WITH SLURRY OF
PUMICE AND WATERPUMICE AND WATER

Mouldable soft cervical
bands
Matrix is tucked under the
gingival margin GIC is injected
under the matrix
Matrix burnished closely to the
cavity margins to avoid excess
cement.
Light – curing bonding resin
applied immediately after
lifting the matrix .

Scalers / excavators are used to trim the
margin. Avoid using rotary instruments.
Do not destroy the bulk of the filling ,
but confine the finishing to the margins.
At a later visits these surfaces can
polished with soft abrasive rubber cups
and a slurry of fine – grained alumina.

PRE OPERATIVE
VIEW
POST OPERATIVE
VIEW

Polishing cups and points,
Finishing and polishing discs
Graded fine diamond
polishing stone
GIC POLISHING KIT

Dr. Shashikiran N. D, Nisha Madhavan and Subba Reddy V. V
Compared and evaluated, the rise in pulpal temperature during the
finishing and polishing of composite resin.RmGIC and
Compomer restoration at 4 different speeds (10,000 and 20,000 rpm)
with coolant and (5,000 and 6,000 rpm) without coolant
Concluded that
1.It is not advisable to do dry polishing for any restoration materials
2. If needed it should be done with intermittent pressure and at low
speeds less than 5,000 rpm
3. Polishing done with high speed above 5,000rpm can be done using
coolant and with intermittent pressure

RUBBER DAM
I) Useful in protecting the unset cement from moisture
II) Damaging effect once the cement has set
MATRICES
Varnish
Petroleum jelly
Copal varnish or clear nail varnish
Light cured bonding agent - best solution
PROTECTION of GIC RESTORATION

INSTRUCTIONS
Powder or liquid supplied by different manufacturers
Should never be interchanged – results in altering the
physical properties
Both powder and liquid bottles should firmly closed at
all times and stoppers should be replaced immediately
after dispensing.
Clean up procedure
Liquid should never stored in refrigerator
Make sure mixing slab is not below dew point before dispensing powder

 1) Restoration of permanent teeth :
 Class V and Class III cavities
 Abrasion / Erosion lesion
 Root caries
 2) Restoration of deciduous teeth
 Class I cavities
 Rampant caries, nursing bottle caries
 3) Luting or cementing
 Metal restorations - inlays, onlays, crowns
 Non-metal restorations - composite inlays and onlays
 Veneers
 Pins and posts
 Orthodontic bands and brackets
 4) Preventive restorations
 Tunnel preparation
 Pit and fissure sealant

5) Protective liner under composite and amalgam
6) Core build up
7) Splinting of periodontally weak teeth
8) Other restorative technique
 Layered restorations/ Laminated restorations /
Bilayered restorations
 Atraumatic restorative treatment (Fuji VIII and Fuji
IX).
 Bonded restorations
9) Endodontics
10) Temporizing a broken tooth - J Am Dent Assoc – 2000;131(2)

ApplicationsApplications
EROSION / ABRASION LESIONSEROSION / ABRASION LESIONS
CLASS III CARIESCLASS III CARIES
MINIMAL CAVITY PREPARATIONSMINIMAL CAVITY PREPARATIONS
CLASS V CARIOUS LESIONSCLASS V CARIOUS LESIONS

Pits and fissures (Fuji III)Pits and fissures (Fuji III)
Bracket BondingBracket Bonding

GLASS IONOMER AS LINER AND BASEGLASS IONOMER AS LINER AND BASE
Glass-ionomer cement as a lining.
Glass-ionomer cement as a base.

Primary TeethPrimary Teeth
RestorationsRestorations
Criteria :
TUNNEL PREPARATION
RAMPANT CARIES

Restoration of root caries in Geriatic patientsRestoration of root caries in Geriatic patients

USE IN ENDODONTICSUSE IN ENDODONTICS
 WHY used in endodonticsWHY used in endodontics
1. Capacity to bond to dental tissues- enhance the seal &1. Capacity to bond to dental tissues- enhance the seal &
reinforce the toothreinforce the tooth
2. Long term F- release- impart an antimicrobial effect2. Long term F- release- impart an antimicrobial effect
to combat root canal infectionto combat root canal infection
3. Biocompatible – minimise irritation of periradicular3. Biocompatible – minimise irritation of periradicular
tissuetissue

 ROOT CANAL SEALINGROOT CANAL SEALING
 RETROGRADE ROOT CANAL FILLINGRETROGRADE ROOT CANAL FILLING
 PERFORATION REPAIRPERFORATION REPAIR
 TREATMENT OF VERTICAL FRACTURESTREATMENT OF VERTICAL FRACTURES
 CORONAL SEALING AFTER ROOT CANALCORONAL SEALING AFTER ROOT CANAL
TREATMENTTREATMENT
V. V Subba reddy, Rafi Ahmed Tagoo
Conducted a study to assess the retrograde root sealing ability of 3 GIC
Ie., cermet, conventional, Light cure GIC
Concluded- Light cured GIC showed better apical seal than other two
GLASS IONOMER CEMENTS IN ENDODONTICS

(1). Ketac-endo strengthens endodontically treated roots(1). Ketac-endo strengthens endodontically treated roots
and may be used for weaker roots which are likely toand may be used for weaker roots which are likely to
be susceptible to vertical root #.be susceptible to vertical root #.
[J. Endod; 2002; Mar ; 28 (3); 217-9][J. Endod; 2002; Mar ; 28 (3); 217-9]
(2) While comparing apical leakage between ketac endo(2) While comparing apical leakage between ketac endo
and grossman sealer, the best results were noted whenand grossman sealer, the best results were noted when
ketac endo sealers were used with lateralketac endo sealers were used with lateral
condensation.condensation.
[Oral Surg oral Med Oral Pathol; 1994 : Dec; 78)[Oral Surg oral Med Oral Pathol; 1994 : Dec; 78)

(3) Vitrebond has a potential as root-end filling material as the(3) Vitrebond has a potential as root-end filling material as the
tissue response is more favourable than that to amalgamtissue response is more favourable than that to amalgam ..
[ Int. Endod J. 1997, Mar, 30 (2); 102-14][ Int. Endod J. 1997, Mar, 30 (2); 102-14]
(4) Teeth without intraorifice barrier leaked significantly more(4) Teeth without intraorifice barrier leaked significantly more
than teeth with vitrebond intraorifice barriersthan teeth with vitrebond intraorifice barriers..
[J. Endod; 1999 Sep; 25(9)][J. Endod; 1999 Sep; 25(9)]
(5) MTA alone or vitremer in combination with collagen(5) MTA alone or vitremer in combination with collagen
sponge can be used effectively in the treatment ofsponge can be used effectively in the treatment of
perforations in a furcation areaperforations in a furcation area..
[Int. Dent. J. ; 2005 Jun; 55 (3)][Int. Dent. J. ; 2005 Jun; 55 (3)]

 Biocompatibility of furcal perforation repair materialBiocompatibility of furcal perforation repair material
using cell culture technique: Ketac Molar versususing cell culture technique: Ketac Molar versus
ProRoot MTA.ProRoot MTA.
 percent of cell viability in the Ketac Molar group waspercent of cell viability in the Ketac Molar group was
lower than in the ProRoot MTAlower than in the ProRoot MTA
 more cytotoxic to the PDL cells than MTAmore cytotoxic to the PDL cells than MTA
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Dec;102(6):e48-50.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Dec;102(6):e48-50.
Epub 2006 Sep 26.Epub 2006 Sep 26.

 comparison of sealing capabilities of amalgam, GICcomparison of sealing capabilities of amalgam, GIC
and zinc oxide eugenol cement when used as retroand zinc oxide eugenol cement when used as retro
grade filling materials (in vitro study).grade filling materials (in vitro study).
 GIC is just as effective as Amalgam as a retro-sealerGIC is just as effective as Amalgam as a retro-sealer
 ZnO2E cement showed poor sealing abilitiesZnO2E cement showed poor sealing abilities
J Ayub Med Coll Abbottabad. 2003 Jul-Sep;15(3):43-6.J Ayub Med Coll Abbottabad. 2003 Jul-Sep;15(3):43-6.

BILAYERED / SANDWICH TECHNIQUE

BILAYERED / SANDWICH
TECHNIQUE
COMPOSITE
TOOTH
GIC

Sandwich TechniqueSandwich Technique
 DOUBLE – LAMINATED TECNIQUE or BILAYEREDDOUBLE – LAMINATED TECNIQUE or BILAYERED
TECHNIQUETECHNIQUE
 Bonding composite resins to GICs.Bonding composite resins to GICs.
 First described byFirst described by McLean and Wilson (1977).McLean and Wilson (1977).
 GIC - replace carious dentin prior to attachment of compositeGIC - replace carious dentin prior to attachment of composite
resins to etched enamel.resins to etched enamel.
 The laminate restoration - decrease microleakage compared toThe laminate restoration - decrease microleakage compared to
simple composite restoration.simple composite restoration.
 clinically employed while restoring large Class III, Class IV,clinically employed while restoring large Class III, Class IV,
Class V, Class I and Class II cavities with direct compositeClass V, Class I and Class II cavities with direct composite
resinsresins

TYPES:-TYPES:-
1.1. Open sandwich techniqueOpen sandwich technique- proximal box is first filled with- proximal box is first filled with
GIC and the occlusal restoration is completed with compositeGIC and the occlusal restoration is completed with composite
resin.resin.

2.2.Closed sandwich techniqueClosed sandwich technique- in this the cavity is first- in this the cavity is first
completely filled with GIC. The restored tooth is thencompletely filled with GIC. The restored tooth is then
reprepared ,leaving a thick glass ionomer base and creatingreprepared ,leaving a thick glass ionomer base and creating
sufficient space to make a resin compositesufficient space to make a resin composite
 DELAYED SANDWICH TECHNIQUE OR CERVICALDELAYED SANDWICH TECHNIQUE OR CERVICAL
LINING TECHNIQUELINING TECHNIQUE

THIN TRANSPARENT LAYER OF COMPOSITE IS
APPLIED TOWARD THE PROXIMAL SURFACE OF
MATRIX TO MODIFY THE ORIGINAL CLASSII
CAVITY TO CLASSI

A. Introduction:A. Introduction:
1.1. Historical DevelopmentHistorical Development
a. ART materials designed as temporary restorations fora. ART materials designed as temporary restorations for
3rd world countries3rd world countries
b. Goals = caries control, replacing missing toothb. Goals = caries control, replacing missing tooth
structure, functionstructure, function
c. First tested in central African countriesc. First tested in central African countries
d. Currently used in SE Asia, India, and Africa --- butd. Currently used in SE Asia, India, and Africa --- but
also in 1st and 2nd worldalso in 1st and 2nd world
ATRAUMATIC RESTORATIVE
TECHNIQUE (A.R.T. or ART)

2. Definition:2. Definition:
ART = approach includes both prevention and treatment ofART = approach includes both prevention and treatment of
dental caries.dental caries.
 based on excavating and removing caries using handbased on excavating and removing caries using hand
instruments only and then restoring the tooth with aninstruments only and then restoring the tooth with an
adhesive filling material (glass - ionomer).adhesive filling material (glass - ionomer).
3. Excellent success as a temporary restorative material3. Excellent success as a temporary restorative material

Commercial Examples:Commercial Examples:
 Fuji IX (GC)Fuji IX (GC)
 Fuji VIII(GC)Fuji VIII(GC)

Occlusal pit and
fissure caries in
mandibular first
molar
Caries
excavation
using spoon
excavator
Completed caries excavation

Cement placed
and protected with gloved finger
Excess cement
removed using carver
Completed restoration

GEFFERY KNIGHT CO-CURINGGEFFERY KNIGHT CO-CURING
TECHNIQUETECHNIQUE
 simultaneous curing of unpolymerised composite resin andsimultaneous curing of unpolymerised composite resin and
inactivated LC GIC.inactivated LC GIC.
 Composite resin cures before the GIC.Composite resin cures before the GIC.
 Polymerisation shrinkage of the resinPolymerisation shrinkage of the resin may be taken up by themay be taken up by the
uncured GIC,uncured GIC,
reducing the internal stress of restoration.reducing the internal stress of restoration.
(Quintessence international 1994; 25-2; 97-100)(Quintessence international 1994; 25-2; 97-100)

 The co-cured RMGIC bonding system eliminates severalThe co-cured RMGIC bonding system eliminates several
placement steps and produces a significantly strongerplacement steps and produces a significantly stronger
chemical bond between GIC and composite resin than the 'etchchemical bond between GIC and composite resin than the 'etch
and bond' technique.and bond' technique.
 RMGIC bond and composite resin may be co-cured to GICRMGIC bond and composite resin may be co-cured to GIC
either before or after initial set has occurred.either before or after initial set has occurred.
Aust Dent J. 2006 Jun;51(2):175-9Aust Dent J. 2006 Jun;51(2):175-9..

CONTRAINDICATIONCONTRAINDICATION
1) In stress bearing areas1) In stress bearing areas - in stress bearing areas like- in stress bearing areas like
Class I, Class II and Class IV cavities as they lackClass I, Class II and Class IV cavities as they lack
fracture toughness.fracture toughness.
2) Labial buildups2) Labial buildups - When large areas of labial enamel- When large areas of labial enamel
in anterior teeth to replacedin anterior teeth to replaced
- discolouration, abrasion or fractures- discolouration, abrasion or fractures,,

3) Cuspal coverage3) Cuspal coverage - not suited for cuspal replacement- not suited for cuspal replacement
lack of strength, rigidity and fracture toughness.lack of strength, rigidity and fracture toughness.
4) In mouth-breathers4) In mouth-breathers - avoided in mouth-breathers and- avoided in mouth-breathers and
patients with xerostomiapatients with xerostomia
as the restorations become opaque, brittle andas the restorations become opaque, brittle and
disintegrate over a short period of time.disintegrate over a short period of time.

Adhesive propertyAdhesive property
No retention features areNo retention features are
requiredrequired
Esthetic restorative materialEsthetic restorative material
Liberates fluoride that isLiberates fluoride that is
anticariogenicanticariogenic
BiocompatibleBiocompatible
Low oral solubilityLow oral solubility
Easy to manipulateEasy to manipulate
Easily availableEasily available
Permanent restorativePermanent restorative
materialmaterial

1) Low fracture resistance -
weak and lack rigidity than composite resins
and amalgam.
have a low modulus of elasticity.
2) Low wear resistance - exhibit low resistance to
wear when compared to composite resins.
3) Colour – Autocured glass ionomer cements not
as esthetic as composite resins.
4) Sensitivity to moisture soon after setting-

STRENGTH :STRENGTH :
a)a) COMPRESSIVE STRENGTH :COMPRESSIVE STRENGTH : 150 – 200 MPa. Increased by150 – 200 MPa. Increased by
increasing alumina content but at the expense of translucency.increasing alumina content but at the expense of translucency.
b)b) TENSILE STRENGTH :TENSILE STRENGTH : 6.5 - 17.4 MPa . Higher tensile strength6.5 - 17.4 MPa . Higher tensile strength
compared to silicates.compared to silicates.
c)c) FLEXURAL STRENGTH :FLEXURAL STRENGTH : 15 - 20 MPa .15 - 20 MPa .
HARDNESS :HARDNESS : 48 KHN.48 KHN.
FRACTURE TOUGHNESS :FRACTURE TOUGHNESS : MUCH INFERIOR TO COMPOSITE.MUCH INFERIOR TO COMPOSITE.
WORKING TIME: 45-60 secWORKING TIME: 45-60 sec
SETTING TIME : 3-5 minSETTING TIME : 3-5 min
MECHANICAL PROPERTIES

Properties of Glass Ionomer Cement
Glass ionomer
(type II)
Metal modified
GIC
Resin Modified
GIC
C.S(24 hrs)
MPa
150 150 105
T.S(24 hrs)
MPa
6.6 6.7 20
Hardness
(KHN)
48 39 40
Pulp response Mild Mild Mild
Anticariogenic Yes Yes Yes
Solubility 0.4 0.1 0.08

ADHESION
 Important property of GICImportant property of GIC
 Allows conservative approachAllows conservative approach
 Provide a perfect sealProvide a perfect seal
 It bond chemically to enamelIt bond chemically to enamel
and dentinand dentin
General requirement for adhesionGeneral requirement for adhesion
1.1. Good substrate wettingGood substrate wetting
2.2. Low contact angleLow contact angle
3.3. Clean substrateClean substrate
4.4. Surface tension of liquid must be less than enamel.Surface tension of liquid must be less than enamel.
Mount 1991, Ngo 1997:Mount 1991, Ngo 1997:
PHYSICAL PROPERTIES

MECHANISM OF ADHESION TO ENAMEL & DENTINMECHANISM OF ADHESION TO ENAMEL & DENTIN
 Bonding of GIC to tooth structure - CHEMICAL one and not aBonding of GIC to tooth structure - CHEMICAL one and not a
MECHANICAL one.MECHANICAL one.
 The PRINCIPAL mode of adhesion being BONDING TOThe PRINCIPAL mode of adhesion being BONDING TO
HYDROXYAPATITEHYDROXYAPATITE
VARIOUS THEORIES PROPOSEDVARIOUS THEORIES PROPOSED ::
(1)(1) Chelation of Ca2+ contained in hydroxyapatite isChelation of Ca2+ contained in hydroxyapatite is
responsible for adhesion.responsible for adhesion.
[Smith, 1968].[Smith, 1968].
(2) Hydroxyapatite + Polyacrylic acid(2) Hydroxyapatite + Polyacrylic acid  POLYACRYLATE IONSPOLYACRYLATE IONS
made strong ionic bonds with Ca2+ of hydroxyapatite in enamel andmade strong ionic bonds with Ca2+ of hydroxyapatite in enamel and
dentin.dentin. [Beech, 1973][Beech, 1973]

The polyalkenoic acid component of the glass ionomer - attack theThe polyalkenoic acid component of the glass ionomer - attack the
tooth surfacetooth surface
releasing calcium andreleasing calcium and
phosphate ions.phosphate ions.
ions are then combined into the surface layer of the glass ionomerions are then combined into the surface layer of the glass ionomer
 to form an intermediate layer described as theto form an intermediate layer described as the
'interdiffusion zone', ion-enriched layer'interdiffusion zone', ion-enriched layer..
which is firmly attached to both the tooth surface and the glasswhich is firmly attached to both the tooth surface and the glass
ionomerionomer

 The chemical bonding- calcium phosphate-poly acrylateThe chemical bonding- calcium phosphate-poly acrylate
crystalline structure formed at the interface between enamel orcrystalline structure formed at the interface between enamel or
dentin and the set cementdentin and the set cement
diffusion based adhesiondiffusion based adhesion
This zone forms the basis of an extremely strongThis zone forms the basis of an extremely strong
adhesive bond between glass ionomer and theadhesive bond between glass ionomer and the
tooth.tooth.
 This bond - dynamic as a reversible breaking and reformingThis bond - dynamic as a reversible breaking and reforming
of calcium carboxyl complexes occurs in the presence ofof calcium carboxyl complexes occurs in the presence of
water.water.

BARRIERS TO ADHESIONBARRIERS TO ADHESION
(1)(1) WaterWater- DENTINAL FLUID and loosely and tightly- DENTINAL FLUID and loosely and tightly
bound water in the surface of enamel.bound water in the surface of enamel.
2)2) Dynamic nature of toothDynamic nature of tooth -Because enamel is an ion-Because enamel is an ion
exchanger and dentine is a living material subject toexchanger and dentine is a living material subject to
changechange

IMPROVING ADHESIONIMPROVING ADHESION
 surface conditioners improve BOND STRENGTH.surface conditioners improve BOND STRENGTH.
 main mechanismmain mechanism - to smoothen both enamel and- to smoothen both enamel and
dentin irregularitiesdentin irregularities
to prevent air entrapment and to minimise sites whereto prevent air entrapment and to minimise sites where
stress concentration can occur.stress concentration can occur.

Ideal requirementsIdeal requirements of surface conditioners (MOUNT1984)of surface conditioners (MOUNT1984)
(1) Isotonic(1) Isotonic
(2) pH : 5.5 to 8.0(2) pH : 5.5 to 8.0
(3) Non-toxic(3) Non-toxic
(4) Compatible with cement(4) Compatible with cement
(5) Water soluble & Easily removable(5) Water soluble & Easily removable
(6) Not deplete enamel / dentin chemically(6) Not deplete enamel / dentin chemically
(7) Enhance the surface chemically to increase bonding.(7) Enhance the surface chemically to increase bonding.

 Various agentsVarious agents used :used :
(1) Surface active microbicidal solution(1) Surface active microbicidal solution
(2) Poly (acrylic) acid 10%(2) Poly (acrylic) acid 10%
(3) Tannic acid 25%(3) Tannic acid 25%
(4) FeCl2(4) FeCl2
(5) NaF(5) NaF
(6) Mineralising solution-((6) Mineralising solution-(developed by both Causton anddeveloped by both Causton and
JohnsonJohnson1979, 1982)1979, 1982)
(7) EDTA 10%(7) EDTA 10%
(8) 10% Citric acid(8) 10% Citric acid
(9) 3% Hydrogen peroxide.(9) 3% Hydrogen peroxide.

 pretreatment of the surface -pretreatment of the surface -McLean and WilsonMcLean and Wilson (1977)(1977)
first used the term surfacefirst used the term surface conditioning for this treatmentconditioning for this treatment
 Rough tooth surfaces areRough tooth surfaces are contraindicated.contraindicated.
In general, “the smoother the surface the stronger the bond",In general, “the smoother the surface the stronger the bond",
(Powis et aI., 1982; Aboush and Jenkins, 1986)(Powis et aI., 1982; Aboush and Jenkins, 1986)

 Recommended use :Recommended use :
25% solution of poly (acrylic acid) – 10 secs for surface25% solution of poly (acrylic acid) – 10 secs for surface
conditioning of cavities (conditioning of cavities ( Powis et al. (1982)Powis et al. (1982)
Currently 10% PAA FOR 10 SEC – MOSTCurrently 10% PAA FOR 10 SEC – MOST
WIDELY ACCEPTEDWIDELY ACCEPTED
(b) 25% tannic acid – 30 sec ; for preparation with large areas of(b) 25% tannic acid – 30 sec ; for preparation with large areas of
dentindentin

 The most common mode of failure in theThe most common mode of failure in the adhesionadhesion
between a GIC and the dentinbetween a GIC and the dentin during microtensileduring microtensile
bond strength tests isbond strength tests is cohesive failurecohesive failure within the GICwithin the GIC
((TanumiharjaTanumiharja et al.,et al., 20002000

 microtensile bond strengths of a GIC and an RMGICmicrotensile bond strengths of a GIC and an RMGIC
toto carious dentin were significantly lowercarious dentin were significantly lower than thosethan those
to sound dentinto sound dentin
 the mean microtensile bond strengths of RMGIC tothe mean microtensile bond strengths of RMGIC to
both sound and carious dentin were significantlyboth sound and carious dentin were significantly
higher than those of GIChigher than those of GIC
 In sound dentinIn sound dentin -- cohesivecohesive failure in GIC pre-failure in GIC pre-
dominant;dominant;
 in carious dentin-in carious dentin- mixed failuremixed failure predominantpredominant
Oper Dent. 2006 Sep-Oct;31(5):590-7Oper Dent. 2006 Sep-Oct;31(5):590-7

AdvantagesAdvantages
 lowers the surface energy of the toothlowers the surface energy of the tooth
 increasing the wettability ion exchange adhesion byincreasing the wettability ion exchange adhesion by
GICGIC
 removes the smear layer while retaining the smearremoves the smear layer while retaining the smear
plugs. .plugs. .
 Being part of the glass ionomer system any residuesBeing part of the glass ionomer system any residues
left over will not interfere with the setting reaction ofleft over will not interfere with the setting reaction of
the cement.the cement.

“ANTICARIOGENIC PROPERTY”
FLOURIDE
FLOURIDE
FLOURIDE
FLOURIDE
FLOURIDE
FLOURIDE FLOURIDE

 Fluoride content in cementFluoride content in cement
 Forsten (1993)Forsten (1993)
 What does fluoride do???What does fluoride do???
 Increased enamel resistance/ reduction in enamelIncreased enamel resistance/ reduction in enamel
solubilitysolubility
 Increased rate of posteruptive maturationIncreased rate of posteruptive maturation
 Remineralisation of incipient lesions/ caries inhibitionRemineralisation of incipient lesions/ caries inhibition
zoneszones
 Fluoride as an inhibitor of demineralizationFluoride as an inhibitor of demineralization
 Interference with microorganismsInterference with microorganisms
ANTICARIOGENICITY

FlourideFlouride ReleaseRelease ::
GICs> RMGICs>PMGICs>CompositesGICs> RMGICs>PMGICs>Composites
-DCNA 2002-DCNA 2002
Flouride Recharge:Flouride Recharge:
RMGICs> GICs -DCNA 2002RMGICs> GICs -DCNA 2002

FLUORIDE RELEASE ANDFLUORIDE RELEASE AND
RECHARGEABILITRECHARGEABILITYY
 GIC have a cariostatic action.GIC have a cariostatic action.
 spread of caries is arrested at restoration / cavity wall marginspread of caries is arrested at restoration / cavity wall margin
 F- originates from the fluoride used in preparingF- originates from the fluoride used in preparing
aluminosilicate glasses (CaF, Na3AlF6aluminosilicate glasses (CaF, Na3AlF6) [Kent et al 1976]) [Kent et al 1976]
 This F- is released as NaF [Wilson and Coworkers, 1985]This F- is released as NaF [Wilson and Coworkers, 1985]
and also as CaF2and also as CaF2
[Powis and Wilson, 1987[Powis and Wilson, 1987

 F- is mainly leached as a sodium salt, which is not aF- is mainly leached as a sodium salt, which is not a
matrix-forming species. Thus, loss of F- does notmatrix-forming species. Thus, loss of F- does not
weaken the cementweaken the cement
 F- is released by DIFFUSION MECHANISM whereF- is released by DIFFUSION MECHANISM where
the rate of release is proportional to the square root ofthe rate of release is proportional to the square root of
timetime ..[Wilson et al 1985; Kuhn and Wilson, 1985][Wilson et al 1985; Kuhn and Wilson, 1985]
 is released for a sustained period of time – at leastis released for a sustained period of time – at least
18 months.18 months.
 Thickly mixed cements release more F- than thinlyThickly mixed cements release more F- than thinly
mixedmixed. [Meryon and Smith, 1984]. [Meryon and Smith, 1984]

 MECHANISM OF ACTION OF F-MECHANISM OF ACTION OF F-
 (1) F- is taken up by enamel apatite to form(1) F- is taken up by enamel apatite to form
flurohydroxyapatite at enamel surface. Thisflurohydroxyapatite at enamel surface. This ↑↑ resistance toresistance to
plaque acidsplaque acids. [Brundevold et al, 1967; McLundie and Murray, 1972; Muhler. [Brundevold et al, 1967; McLundie and Murray, 1972; Muhler
1956; Moreno et al, 1977].1956; Moreno et al, 1977].

 2) F-2) F- ↓↓ surface energy of apatite therebysurface energy of apatite thereby ↓↓ thethe
adherence of dental plaque to tooth surface.adherence of dental plaque to tooth surface.
[Glantz 1969][Glantz 1969]
 (3) F- aids in remineralisation of damaged enamel(3) F- aids in remineralisation of damaged enamel
[Silverstone, 1978][Silverstone, 1978]
 (4) F- changes the composition of bacterial plaque(4) F- changes the composition of bacterial plaque
which alters the carbohydrate metabolism of dentalwhich alters the carbohydrate metabolism of dental
plaqueplaque [Horowitz et al, 1977; Silverstone, 1978; Mellberg, 1977;[Horowitz et al, 1977; Silverstone, 1978; Mellberg, 1977;
Ingram and Nash, 1980].Ingram and Nash, 1980].
 A fluoride enriched tooth surface has a critical pH ofA fluoride enriched tooth surface has a critical pH of
4.5.4.5.

Fluoride ReleaseFluoride Release
a. Decreases dramatically after 24-72 hrsa. Decreases dramatically after 24-72 hrs
b. Decreasing release for first month; Lowb. Decreasing release for first month; Low
release for 1-6 monthsrelease for 1-6 months

Re-charging strategies:Re-charging strategies:
1. Use daily fluoride rinses to provide F source for re-1. Use daily fluoride rinses to provide F source for re-
chargingcharging
2. Use F toothpastes for re-charging2. Use F toothpastes for re-charging
3. Use topical fluorides for re-charging3. Use topical fluorides for re-charging
 coating of 10% AgF on GICs and a resin modified GIC greatlycoating of 10% AgF on GICs and a resin modified GIC greatly
enhanced the concentration of fluoride released from theseenhanced the concentration of fluoride released from these
materialmaterial
Aust Dent J. 2006 Dec;51(4):328-32Aust Dent J. 2006 Dec;51(4):328-32..

Properties:Properties:
1. High F concentration produces immediate increase in1. High F concentration produces immediate increase in
F levels of restorationsF levels of restorations
2. Once re-charging source is removed, re-release2. Once re-charging source is removed, re-release
immediately beingsimmediately beings
3. High F release occurs for short period of time and3. High F release occurs for short period of time and
quickly goes back to original levelquickly goes back to original level
(Typically release to normal levels in 1-2 days)(Typically release to normal levels in 1-2 days)
4. Value of F re-charging has never been demonstrated4. Value of F re-charging has never been demonstrated
clinicallyclinically

ANTIBACTERIALACTIVITY OF GICANTIBACTERIALACTIVITY OF GIC
 Glass ionomer cements have got antibacterial action which hasGlass ionomer cements have got antibacterial action which has
been attributed to the release of fluoride. They are effectivebeen attributed to the release of fluoride. They are effective
against S.mutans , S.sobrinus, L.acidophillus and A. viscosusagainst S.mutans , S.sobrinus, L.acidophillus and A. viscosus
.The best activity is shown by Vitremer (RMGIC.The best activity is shown by Vitremer (RMGIC ).).
(Oper Dent 2005;30-5,636-640 )(Oper Dent 2005;30-5,636-640 )

GICs containing CHX are effective in inhibiting bacteriaGICs containing CHX are effective in inhibiting bacteria
associated with caries, and incorporation of 1% CHX diacetate isassociated with caries, and incorporation of 1% CHX diacetate is
optimal to give appropriate physical and bonding propertiesoptimal to give appropriate physical and bonding properties
Dental Materials, 2006 Volume 22, Issue 7, Pages 647-652Dental Materials, 2006 Volume 22, Issue 7, Pages 647-652

Do they really prevent recurrentDo they really prevent recurrent
caries?caries?
 Despite the release of fluoride ions, in some studiesDespite the release of fluoride ions, in some studies
secondary caries has been found to be the mainsecondary caries has been found to be the main
reason for clinical failure of GIC restorationsreason for clinical failure of GIC restorations
Burke et al., 1999
Hasselrot, 1998
Mjör, 1997

 GIC’s are anti-cariogenic in the laboratory whenGIC’s are anti-cariogenic in the laboratory when
applied to a chemical model (caries formed only byapplied to a chemical model (caries formed only by
acids). In the presence of S.mutans and L. casei, GICacids). In the presence of S.mutans and L. casei, GIC
materials may not be anti-cariogenicmaterials may not be anti-cariogenic
Sa et al., Oper Dent 2004

BIOCOMPATIBILITYBIOCOMPATIBILITY
 Freshly mixed- very acidic (.9 -1.6)Freshly mixed- very acidic (.9 -1.6)
 Ph rises rapidly with in first 20 minPh rises rapidly with in first 20 min
EFFECT ON PULP AND CELLS :EFFECT ON PULP AND CELLS :
 Freshly mixedFreshly mixed GICs - cytotoxicGICs - cytotoxic
[Dahl and Tronstad, 1976; Meryon and Coworkers, 1983].[Dahl and Tronstad, 1976; Meryon and Coworkers, 1983].
 Although freshly mixed GICs inhibited cellularAlthough freshly mixed GICs inhibited cellular
proliferation, it was not cytotoxic.proliferation, it was not cytotoxic.
[Kawahara and cowkers, 1979][Kawahara and cowkers, 1979]
 GICs cause greater inflammatory response than Zn-EGICs cause greater inflammatory response than Zn-E
cement but less than ZnPO4 cement and related dentalcement but less than ZnPO4 cement and related dental
silicate cements.silicate cements. [Plant et al, 1984][Plant et al, 1984]

 This inflammatory response resolves within 30 days and thereThis inflammatory response resolves within 30 days and there
is no enhancement of reparative or secondary dentinis no enhancement of reparative or secondary dentin
formation.formation.
 The response of gingival tissues towards the cement in class VThe response of gingival tissues towards the cement in class V
cavities is minimal. (resistance to plaque)cavities is minimal. (resistance to plaque)
( Garcia( Garcia et al, 1981)et al, 1981)
 Possible reasons for BLANDNESS of polyacrylic acidPossible reasons for BLANDNESS of polyacrylic acid
((McLean and Wilson, 1974)McLean and Wilson, 1974)

 Poly (acrylic) acid - weak acidPoly (acrylic) acid - weak acid
 Ph rises rapidly towards neutralityPh rises rapidly towards neutrality
 Diffusion of the polyacid into the dentinal tubules isDiffusion of the polyacid into the dentinal tubules is
unlikely due to its high mol. wt. and chainunlikely due to its high mol. wt. and chain
entanglement.entanglement.
 Thinnest layer of dentin is sufficient to bind polyThinnest layer of dentin is sufficient to bind poly
(acrylic acid) as insoluble salts as it is readily(acrylic acid) as insoluble salts as it is readily
precipitated by Ca2+ in the tubules.precipitated by Ca2+ in the tubules.
 Tendency to form complex with protein that limitsTendency to form complex with protein that limits
diffusion of PAAdiffusion of PAA

 Citric acid when used as SURFACE CONDITIONERCitric acid when used as SURFACE CONDITIONER
on cut tubules causeson cut tubules causes ↑↑ inflammatory response.inflammatory response.
[Cotton & Siegel, 1978][Cotton & Siegel, 1978]
 Linings of ZnOE or Ca(OH)2 cement are requiredLinings of ZnOE or Ca(OH)2 cement are required
where < 1 mm of sound dentin remains over the pulp.where < 1 mm of sound dentin remains over the pulp.
[McLean and Wilson, 1978][McLean and Wilson, 1978]

 FACTORS RESPONSIBLE FORFACTORS RESPONSIBLE FOR
BIOCOMPATIBILITY OF GIC :BIOCOMPATIBILITY OF GIC :
(1) Minimal exotherm on setting(1) Minimal exotherm on setting
(2) Rapid neutralization on mixing powder and liquid(2) Rapid neutralization on mixing powder and liquid
(3) Slow release of ions which are generally beneficial.(3) Slow release of ions which are generally beneficial.
[J. Biomater Sci Polym Ed. 1991; 2(4); 277-85][J. Biomater Sci Polym Ed. 1991; 2(4); 277-85]
 On the contrary:On the contrary:
 (1) Resin modified GICs (ComPoglass, Fuji II LC,(1) Resin modified GICs (ComPoglass, Fuji II LC,
Protec Cem) and GC lining cements are more toxic toProtec Cem) and GC lining cements are more toxic to
pulp than conventional GIC.pulp than conventional GIC.
 RM GICs should not be applied directly onto pulpRM GICs should not be applied directly onto pulp
cells.cells.
[Oper Dent; July / Aug; 28 (4)]; 2003[Oper Dent; July / Aug; 28 (4)]; 2003

(2) The principal compounds responsible for(2) The principal compounds responsible for
cytotoxicity of RMGIC – unpolymerised resincytotoxicity of RMGIC – unpolymerised resin
monomer (HEMA) and for MGIC – Cu2+, Ag+.monomer (HEMA) and for MGIC – Cu2+, Ag+.
[Biomed Mater Res; 48; 277-88; 1999][Biomed Mater Res; 48; 277-88; 1999]

ROLE OF GIC IN DIRECT PULP CAPPING:-ROLE OF GIC IN DIRECT PULP CAPPING:-
 According to a study,Vitremer has shown pulpal healingAccording to a study,Vitremer has shown pulpal healing
associated with calcified barrier formation in 60 days.There wasassociated with calcified barrier formation in 60 days.There was
a large zone of cell rich fibrodentine matrix deposition on thea large zone of cell rich fibrodentine matrix deposition on the
pulp horn related to the exposure site.Tertiary dentine under thepulp horn related to the exposure site.Tertiary dentine under the
fibrodentine matrix was deposited by a layer of elongated pulpfibrodentine matrix was deposited by a layer of elongated pulp
cells.The remaining pulpal tissue exhibited normal histologicalcells.The remaining pulpal tissue exhibited normal histological
characteristics.characteristics.
(Int Endond Journal;vol 36;pg 831;Dec 2003 )(Int Endond Journal;vol 36;pg 831;Dec 2003 )

ESTHETICSESTHETICS
 an esthetic filling materialan esthetic filling material
 has a degree of translucencyhas a degree of translucency
 because its filler - a glassbecause its filler - a glass
 Reported an experimental glass-ionomer cement-Reported an experimental glass-ionomer cement-
ASPA XASPA X
as translucent as tooth materialas translucent as tooth material
 because of slow hydration reactions,because of slow hydration reactions,
 GIC take at least 24 hours to fully mature and to develop fullGIC take at least 24 hours to fully mature and to develop full
translucency;translucency;

 have long-term aesthetic advantages because, unlikehave long-term aesthetic advantages because, unlike
composite resins which stain and lose their colour match in thecomposite resins which stain and lose their colour match in the
mouth, the colour of GIC remains unaffected by oral fluidmouth, the colour of GIC remains unaffected by oral fluid
Poor translucency
Good tranceluncy

 The translucency of dark shades is less than that of the lightThe translucency of dark shades is less than that of the light
shadeshade
(Crispet aI., 1979;Asmussen, 1983)(Crispet aI., 1979;Asmussen, 1983)
 Also, early Contamination of the cement surface with moistureAlso, early Contamination of the cement surface with moisture
adversely affects translucencyadversely affects translucency
(Asmussen, 1983)(Asmussen, 1983)
 The clinical use of Listerine as an antiseptic solution for aThe clinical use of Listerine as an antiseptic solution for a
short period of time may interfere less intensively with theshort period of time may interfere less intensively with the
translucence of the restorative material Chelon Fil.translucence of the restorative material Chelon Fil.
Braz Dent J (2001) 12(2): 91-94Braz Dent J (2001) 12(2): 91-94

 Stains penetrate into the glass-ionomer cement to aStains penetrate into the glass-ionomer cement to a
much lesser extent than is the case with compositemuch lesser extent than is the case with composite
resinresin
(Lingard et aI., 1978(Lingard et aI., 1978))
 However, resistance to stainHowever, resistance to stain
largely dependent on obtaining a good surface finish.largely dependent on obtaining a good surface finish.
 resin modified glass ionomer cements demonstrateresin modified glass ionomer cements demonstrate
excellent colour match and translucency soon afterexcellent colour match and translucency soon after
light curing.light curing.

Dissolution and erosionDissolution and erosion
 Wilson and coworkers (1986)Wilson and coworkers (1986)
found that the acid-erosion of the various types of water-basedfound that the acid-erosion of the various types of water-based
dental cements increased in this order:dental cements increased in this order:
glass ionomer < silicate < zinc phosphateglass ionomer < silicate < zinc phosphate
< polycarboxylate< polycarboxylate
 Once the glass-ionomer - fully matured,Once the glass-ionomer - fully matured,
only nonmatrix elements are leached, (sodium, fluoride, andonly nonmatrix elements are leached, (sodium, fluoride, and
silica).silica).
not matrix-forming speciesnot matrix-forming species

DURABILTYDURABILTY
the most important factor - the care devoted to it during the firstthe most important factor - the care devoted to it during the first
few minutes of its lifefew minutes of its life
Durability is affected by a number of factors:Durability is affected by a number of factors:
 inadequate preparation of the cementinadequate preparation of the cement
 inadequate protection of the restoration,inadequate protection of the restoration,
 the variable conditions of the mouth.the variable conditions of the mouth.
Cervical erosion lesions-Class VCervical erosion lesions-Class V
Tyas and Beech (1985) compared all the properties of glass-Tyas and Beech (1985) compared all the properties of glass-
ionomer cement with those of alternative materials andionomer cement with those of alternative materials and
concluded that it remains the material of choice for Class Vconcluded that it remains the material of choice for Class V
restorations.restorations.

Thermal expansion and diffusivity
• a linear coefficient of thermal expansion
similar to that of tooth structure.
• thermal diffusivity is also close to that of
tooth structure

IMPROVED TRADITIONAL GLASS IONOMERS
HIGHLY VISCOUS GLASS IONOMER/ CONDENSABLE GIC
These were developed early in 1990
It is designed as an alternative to amalgam
Particularly used for ART technique
Other uses:
•Intermediate restoration
•Replacing amalgams
•For core buildup procedure

LOW VISCOUS GLASS IONOMER CEMENT
Have been developed as liners, fissure protection material
Sealing material for hypersensitive cervical areas
Endodontic materials
Low P:L ratio, material decreases dissolution from occlusal surfaces
and causes increased fluoride release which strengthens the tooth
structure, suitable for fissure protection

INTRODUCED BY SIMMONS IN 1983.
11
Addition of spherical silver alloy powder to type II
Restorative glass cement = Miracle mix
Improved properties
Compressive strength
Tensile strength
Creep resistance
It showed less microleakage than the three other GIC
Increased flexural strength
Increased fluoride release
But:
Brittle
Low fracture toughness
Metal modified
GIC
150 C.S
6.7 T.S
39 KHN
Mild (PR)
Yes (AC)
0.1

THIS WAS INTRODUCED BY MCLEAN & GASSER
IN 1985 .
High wear resistance

 Core build up .
 Restoration of primary teeth.
 Restoration of approximal lesions [ tunnel
preparation ] .
 Treatment of root caries
 Repair of defective margins in restorations.
 Retrograde root fillings.

IN 1988 THE FIRST LIGHT CURABALE GIC WAS INTRODUCEDIN 1988 THE FIRST LIGHT CURABALE GIC WAS INTRODUCED
COMPOSITIONCOMPOSITION
Powder componentPowder component contains ion – leachablecontains ion – leachable
fluoroaluminosilicate glass particles & initiators for light curingfluoroaluminosilicate glass particles & initiators for light curing
& / or chemical curing.& / or chemical curing.
Initiator / ActivatorInitiator / Activator
 Liquid componentLiquid component contains water & polyacrylic acid modifiedcontains water & polyacrylic acid modified
with methacrylate & hydroxy ethyl methacrylate [ HEMA ]with methacrylate & hydroxy ethyl methacrylate [ HEMA ]
monomers for polymerization.monomers for polymerization.
Chemical
polymerization
Initiator : Hydrogen peroxide
Activator : Ascorbic acid
Co activator: Cupric sulphate..
light activated
Initiator: Camphoroquinone
Activator: Sodium p toluene sulphinate.
Photo activator: 4-NN dimethyl amino
benzonate.

Two distinct types of curing / setting reactions occurTwo distinct types of curing / setting reactions occur
in this type of glass ionomer.in this type of glass ionomer.
Acid - Base reaction.Acid - Base reaction.
Free radical methacrylate cure.Free radical methacrylate cure.
The relationship between these 2 reactions may takeThe relationship between these 2 reactions may take
one of two forms.one of two forms.
SETTING REACTION ;
Formation of 2 separate matrix
An ionomer salt hydrogel &
Poly HEMA matrix
Multiple cross linking – Methacrylate
group replaces small fractions
Carboxylate groups of PAA

CLASSIFICATION ;
I ) DUAL CURE ;
II ) TRI - CURE ;
1. Visible light free radical methacrylateVisible light free radical methacrylate
polymerization ,polymerization ,
2.2. Conventional acid base reactionConventional acid base reaction
3.3. Chemical cure of free radical methacrylateChemical cure of free radical methacrylate
polymerisation of the resin eg ; Vitremerpolymerisation of the resin eg ; Vitremer
1. Visible light cure free – radical polymerizationVisible light cure free – radical polymerization
2.2. Glass ionomer setting mechanism ( acid – baseGlass ionomer setting mechanism ( acid – base
reaction) e.g Geristorereaction) e.g Geristore ..

CHARACTERISTICS OF HYBRID IONOMER CEMENTS.
Translucency is improved because of the inclusion of the
monomer.
Tensile strength are higher than conventional GIC.
Bond strength to tooth structure is higher than conventional
GIC.
Polymerization results in greater degree of shrinkage upon
setting, increases MICROLEAKAGE compared to conventional
GIC
Decreased water sensitivity

 Long working time controlled by photo curing.
 Improved setting characteristics.
 Early strength
 Can be finished & polished immediately after
set .
 Repairs are carried out, as the bond between old
& new material is strong.
 Increased adhesion to composite.

Restoration of deciduous teeth
Minimal cavity preparation / tunnel
preparation
Liner
Fissure sealant
Adhesive for ortho brackets
Core – build up.
Repair of defective margins in restorations.
Restoration of Class III , Class V carious
lesions.

This material is defined by Mc clean &
Nicholson as “Materials that may
contain either or both of the essential
components of GIC but at levels
insufficient to promote the acid base
curing reaction in the dark ’’.
Products:Products: I Gen: Dyract
Dyract AP
II Gen: Compoglass
F 2000
Hytac Aplicap
Compoglass F

A . RESIN MATRIX .
1)1) UDMAUDMA
2)2) TCB RESIN [ TETRA CARBOXYLIC ACID + HEMA AS SIDE CHAIN ].TCB RESIN [ TETRA CARBOXYLIC ACID + HEMA AS SIDE CHAIN ].
3)3) FILLERS - STRONTIUM FLUORO SILICATE GLASS & DEHYDRATEDFILLERS - STRONTIUM FLUORO SILICATE GLASS & DEHYDRATED
PAA ACIDPAA ACID
4)4) STRONTIUM FLUORIDE..STRONTIUM FLUORIDE..
B . PRIMER / ADHESIVE SYSTEM.
1)1) PENTA - This is an acidic monomer made up of phosphoricPENTA - This is an acidic monomer made up of phosphoric
acidacid
2)2) TEGDMA - Provides elasticity to the cured primer / adhesive.TEGDMA - Provides elasticity to the cured primer / adhesive.
3)3) ACETONE - Acts as a solvent which carries the resin & helpsACETONE - Acts as a solvent which carries the resin & helps
to wet the tooth surface & assist the penetration of resin into wet the tooth surface & assist the penetration of resin in
the dentin surface.the dentin surface.

Advantages
 Sup working characteristics
 Ease of use
 Esthetics
 F- release( but less than rmgic)
 C.T $ T.S

Restoration of deciduous teeth
Minimal cavity preparation / tunnel
preparation
Lining of all types of cavities where a
biological seal & cariostatic action is required.
Core – build up.
Repair of defective margins in restorations.
Restoration of Class III , Class V carious
lesions.
Provisional restoration where future veneer
crowns are contemplated.

Conventiona
l Glass
Ionomer
Resin-
Modified
Glass
Ionomer
Compomers Fluoride
Releasing
Resin
Composite
Resin
Typical Products Ketac-fil
Fuji II, Fuji
IX, *Ketac-
silver,
Miracle
Mix
Fuji II LC,
Photac-fil
Quik,
Vitremer
Dyract AP,
Elan,
F2000,
Compogla
ss F
GeriStore,
Variglass,
Resinomer,
Hytac
Herculite XRV,
Prisma
TPH,
Heliomolar,
Tetric
Ceram,
Solitaire,
SureFil
Fluoride Release High
(*Ketac-
silver
medium)
High Medium Low Lowest
Fluoride
Recharge
High High Some Very Low None
Thermal
Expansion
Lowest Medium Highest
Translucency Lowest Highest
Tensile Strength
& Fracture
Toughness
Lowest Highest

SMART MATERIALSSMART MATERIALS
 Materials that restore and prevent dental cariesMaterials that restore and prevent dental caries
 The prophylactic role of F- in dental caries wasThe prophylactic role of F- in dental caries was
reported by ERHARBT as early as 1874reported by ERHARBT as early as 1874
 Smart materials apart from releasing F- also act as aSmart materials apart from releasing F- also act as a
reservoir of F-. They exist in a dynamic equilibriumreservoir of F-. They exist in a dynamic equilibrium
with the surrounding controlling the leach of F- bywith the surrounding controlling the leach of F- by
their ability to recharge.their ability to recharge.

GIOMERSGIOMERS
 New class of materialsNew class of materials
 the hybridisation of Glass-lonomer andthe hybridisation of Glass-lonomer and
Composite ResinComposite Resin
 to develop a new family of fluoride releasingto develop a new family of fluoride releasing
direct aesthetic restoratives and adhesivesdirect aesthetic restoratives and adhesives
called "GIOMER" characterized by Pre-called "GIOMER" characterized by Pre-
Reacted Glass-Ionomer (PRG) technology.Reacted Glass-Ionomer (PRG) technology.

Pre-Reacted Glass-Ionomer (PGR) technologyPre-Reacted Glass-Ionomer (PGR) technology
 Resin-based; contain pre-reacted glass ionomerResin-based; contain pre-reacted glass ionomer
particles (PRG).particles (PRG).
 Fluoroaluminosilicate glass is pre-reacted withFluoroaluminosilicate glass is pre-reacted with
polyacrylic acid prior to being incorporated intopolyacrylic acid prior to being incorporated into
resin.resin.
 This technology can be classified into twoThis technology can be classified into two
categoriescategories
F-PRG Technology - Used fully reacted glass filler.F-PRG Technology - Used fully reacted glass filler.
S-PRG Technology - Used surface reacted glass filler.S-PRG Technology - Used surface reacted glass filler.

PROPERTIES :PROPERTIES :
** F- releaseF- release
* F- recharge* F- recharge
* Excellent esthetics* Excellent esthetics
* Easy polishability* Easy polishability
* Biocompatibility* Biocompatibility
*Light activated and require use of BONDING AGENT*Light activated and require use of BONDING AGENT
to adhere to tooth structureto adhere to tooth structure

STUDIES :STUDIES :
(1) Release F- but do not have an initial “burst” type of(1) Release F- but do not have an initial “burst” type of
release like GI and long term (28 days) release isrelease like GI and long term (28 days) release is
decreasedecrease
[Oper Dent : 2002; 27 ; 259-65][Oper Dent : 2002; 27 ; 259-65]
(2) When polished with sof-lex disks, they have a(2) When polished with sof-lex disks, they have a
smoother surface than a GI. Comparable to compomersmoother surface than a GI. Comparable to compomer
and resin composite.and resin composite.
[Oper Dent; 2002; 27 ; 161-66][Oper Dent; 2002; 27 ; 161-66]

INDICATIONS :INDICATIONS :
 Root cariesRoot caries
 Non carious cervicalNon carious cervical
lesionslesions
 Class V cervical lesionsClass V cervical lesions
 Primary tooth cariesPrimary tooth caries
CONTRAINDICATIONS:CONTRAINDICATIONS:
 Class I lesions (decrease wear resistance)Class I lesions (decrease wear resistance)
Shofu Reactmer (GIOMER)
-- Restorations

AMALGOMERAMALGOMER
 These are restoratives with :These are restoratives with :
(1) GIC with the strength of(1) GIC with the strength of
amalgamamalgam
(2) Ceramic reinforcement(2) Ceramic reinforcement
 Available as ‘anterior’ asAvailable as ‘anterior’ as
well as ‘posterior’ restorativewell as ‘posterior’ restorative
materials.materials.

The Anterior ChoiceThe Anterior Choice
 Amalgomer Technology - latest innovation in restorativeAmalgomer Technology - latest innovation in restorative
dentistry.dentistry.
 For the first time the strength of a classic amalgamFor the first time the strength of a classic amalgam
restorative has been combined with the aesthetics and therestorative has been combined with the aesthetics and the
many other advantages of Glass Ionomers.many other advantages of Glass Ionomers.

FEATURES:-FEATURES:-
 Designed to match the strength and durability of amalgamDesigned to match the strength and durability of amalgam
 Sustained high level of Fluoride releaseSustained high level of Fluoride release
 Superb aesthetics, Industry standard shadingSuperb aesthetics, Industry standard shading
 Minimal cavity preparationMinimal cavity preparation
 Natural adhesion to tooth structure, Good biocompatibilityNatural adhesion to tooth structure, Good biocompatibility
 Hard, snappy chemical set with good working timeHard, snappy chemical set with good working time
 Water mix and Powder/Liquid versions availableWater mix and Powder/Liquid versions available
 No shrinkage, corrosion, expansion or thermal conductivityNo shrinkage, corrosion, expansion or thermal conductivity
problems associated with other filling materialsproblems associated with other filling materials

The Posterior ChoiceThe Posterior Choice
 AMALGOMER CR - Ceramic Reinforced Posterior GIC.AMALGOMER CR - Ceramic Reinforced Posterior GIC.
 stronger compressive, flexural and tensile strengths.stronger compressive, flexural and tensile strengths.
Features :-Features :-
 Exceptional wear characteristicsExceptional wear characteristics
 Superior radiopacitySuperior radiopacity
 Excellent for core build upsExcellent for core build ups
 Excellent for Posterior RestorationsExcellent for Posterior Restorations
 Available in White and a Universal tooth shadeAvailable in White and a Universal tooth shade
 Designed to match the strength and durability of amalgamDesigned to match the strength and durability of amalgam
 Sustained high level of Fluoride releaseSustained high level of Fluoride release
 Good biocompatibility, natural adhesion to tooth structureGood biocompatibility, natural adhesion to tooth structure
 Water mix and Powder/Liquid versions availableWater mix and Powder/Liquid versions available

 new bioactive material: HAIonomer cementsnew bioactive material: HAIonomer cements
(hydroxyapatite-ionomer )(hydroxyapatite-ionomer )
 lack of exotherm during setting, absence of monomerlack of exotherm during setting, absence of monomer
and improved release of incorporated therapeuticand improved release of incorporated therapeutic
agentsagents
 Potential uses ofPotential uses of
bone cementsbone cements
performed implants for hard tissue replacement in theperformed implants for hard tissue replacement in the
field of otological, oral-maxillofacial and orthopedicfield of otological, oral-maxillofacial and orthopedic
surgerysurgery
Biomaterials. 2002 Feb;23(3):955-62Biomaterials. 2002 Feb;23(3):955-62

What is the position of GIC???What is the position of GIC???
 Pulp Compatibility:Pulp Compatibility: Bioactive & OsteoinductiveBioactive & Osteoinductive - Dent Mater 2005- Dent Mater 2005
 Secondary CariesSecondary Caries - DCNA 2002- DCNA 2002
 GICs < Composites < AmalgamGICs < Composites < Amalgam
13% 15% 28%13% 15% 28%
 Fluoride Release & RechargeFluoride Release & Recharge - DCNA 2001- DCNA 2001
GICs > Compomers > CompositesGICs > Compomers > Composites
 Volumetric contractionVolumetric contraction - Aust Dent Journal 2007- Aust Dent Journal 2007
 GICs < Composites < CompomersGICs < Composites < Compomers
 WearWear - Am J Dent 1997- Am J Dent 1997
Compomers > GICs > CompositesCompomers > GICs > Composites
 Tensile StrengthTensile Strength - J Adhes Dent 2002- J Adhes Dent 2002
GICs < Compomers < CompositesGICs < Compomers < Composites

TO A DENTIST
Esthetic is what I am gentle, friendly in
any situation these two I am
Handle me with care as I can be the next
best thing to what a tooth can ever have
Pamper me, protect me in my childhood
years.
I shall be grateful and benefit you till
death do us apart.
Yours sincerely
GIC

REFERENCESREFERENCES
 GLASS IONOMER CEMENT – Wilson / McLean.GLASS IONOMER CEMENT – Wilson / McLean.
 AN ATLAS OF GLASS IONOMER CEMENT – AAN ATLAS OF GLASS IONOMER CEMENT – A
CLINICIAN’S GUIDE – G.J. MOUNTCLINICIAN’S GUIDE – G.J. MOUNT
 ADVANCES IN GLASS IONOMER CEMENT-ADVANCES IN GLASS IONOMER CEMENT-
DAVIDSON AND MJORDAVIDSON AND MJOR
 PHILLIP’S SCIENCE OF DENTAL MATERIALSPHILLIP’S SCIENCE OF DENTAL MATERIALS
 STURDEVENT’S ART & SCIENCE OF OPERATIVESTURDEVENT’S ART & SCIENCE OF OPERATIVE
DENTISTRYDENTISTRY
 RESTORATIVE MATERIALS – CRAIGRESTORATIVE MATERIALS – CRAIG
 ENDODONTICS – INGLEENDODONTICS – INGLE

 Mount G.J, Hume W.R : Preservation and restorationMount G.J, Hume W.R : Preservation and restoration
of tooth structure, Mosby, 1998.of tooth structure, Mosby, 1998.
 An update on glass ionomerc ements, Dent Update,An update on glass ionomerc ements, Dent Update,
Sep 1995Sep 1995
 Dent Update, Nov. 1990.Dent Update, Nov. 1990.
 Aus. Dent J, Vol.44(1),1999.Aus. Dent J, Vol.44(1),1999.
 Aus Dent J, Vol. 49 (3),2004.Aus Dent J, Vol. 49 (3),2004.
 Dent Update Dec 1995Dent Update Dec 1995
 Dent UpdateDec 1995.8.Dent UpdateDec 1995.8.
 Dent Update Jan/Feb,1996.9.Dent Update Jan/Feb,1996.9.

 Oper Dent. 2006 Sep-Oct;31(5):590-7Oper Dent. 2006 Sep-Oct;31(5):590-7
 Aust Dent J. 2006 Jun;51(2):175-9.Aust Dent J. 2006 Jun;51(2):175-9.
 Dental Materials, Volume 22, Issue 7, Pages 647-652Dental Materials, Volume 22, Issue 7, Pages 647-652
 J Dent ResJ Dent Res 82(11): 914-918, 200382(11): 914-918, 2003
 Aust Dent J. 2006 Dec;51(4):328-32.Aust Dent J. 2006 Dec;51(4):328-32.
 J Endod. 2001 Jan;27(1):36-9.J Endod. 2001 Jan;27(1):36-9.
 Quintessence Int. 2000 Apr;31(4):261-6Quintessence Int. 2000 Apr;31(4):261-6
 Biomaterials. 2005 Mar;26(7):713-20Biomaterials. 2005 Mar;26(7):713-20
 Biomaterials. 2002 Feb;23(3):955-62Biomaterials. 2002 Feb;23(3):955-62

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