Glass Ionomer Cement-2022.pdf

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D E N T A L S E R I E S
P R E S E N T S

Y A S S E R A L I A L M O R T A D A A L W A S I F I
B D S , M S C , D D S , P H D
C L I N I C A L O P E R A T I V E D E N T I S T R Y
D I R E C T T O O T H C O L O R E D R E S T O R A T I O N S
GLASS IONOMER CEMENT
C O P Y R I G H T © 2 0 2 2 , A L W A S I F I , Y . A . A L L R I G H T S R E S E R V E D

D I R E C T T O O T C O L O R E D R E S T O R A T I O N S - G L A S S I O N O M E R C E M E N T - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 4
- Egyptian dentist
- Researcher, Educator & International Lecturer
- Founder of LEARN - DENTAL SERIES @ YouTube
- Presentation skills coach
- Painter
- Life long learner -

D I S C L A I M E R
S T A T E M E N T I don’t receive fees, compensation or royalties from the sales of any of the
products shown or discussed. Also, I declare that I haven't any conflict of interest
with any of the discussed products and techniques.
All products, equipment and techniques presented are those most commonly
used in professional restorative clinical practice. Finally, this presentation has not
been sponsored by any company, agency or organization and is only prepared for
educational purposes.
Yasser Alwasifi

C O P Y R I G H T
Copyright © 2022. All rights reserved. No part of this presentation may be
reproduced, distributed, or transmitted in any form or by any means, including
copying, recording, or other electronic or mechanical methods, without the prior
written permission of the author.
Yasser Alwasifi

E X C E P E C T E D
O U T C O M E S By the end of this presentation, you are expected to:
1. Correlate between different setting reaction stages and the manipulative
precautions of the material
2. Interpret the properties of glass ionomer material in terms of advantages and
disadvantages
3. Conclude the indications and contraindications based on the properties of
the material
4. Differentiate the clinical use of different types of glass ionomer cement
5. Rationalize the cavity design and manipulation of glass ionomer cement to its
properties

C O N T E N T S PART I: MATERIAL REVIEW 10
I.A. HISTORY & DEVELOPMENT 11
I.B. TERMINOLOGY & DEFINITIONS 14
I.C. COMPOSITION 16
I.D. SETTING REACTION
I.D.1. ACID ATTACK
I.D.2. GELATION
I.D.3. MATURATION
22
24
27
30
I.E. PROPERTIES 40
I.F. TYPES & CLASSIFICATIONS 58
I.G. ADVANTAGES & DISADVANTAGES 80
I.H. INDICATIONS & CONTRAINDICATIONS 83
Expected Time: 60 Min

C O N T E N T S PART II: CAVITY PREPARATION 102
II.A. CAVITY PREPARATION 103
PART III: MANIPULATION 104
III.A. MANIPULATIVE STEPS
III.A.1. DISPENSING & MIXING
III.A.2. PLACEMENT
III.A.3. CONTOURING & FINISHING
105
105
109
112
III.B. CASE REPORTS
III.B.1. CASE REPORT 1
114
114
117
Expected Time: 60 Min

MATERIAL REVIEW
PART I:

I. M A T E R I A L
R E V I E W
I.A. HISTORY & DEVELOPMENT
I.B. TERMINOLOGY & DEFINITIONS
I.C. COMPOSITION
I.E. PROPERTIES
I.G. ADVANTAGES & DISADVANTAGES
I.H. INDICATIONS & CONTRAINDICATIONS
I.F. TYPES & CLASSIFICATIONS
I.D.1. ACID ATTACK
I.D.2. GELATION
I.D.3. MATURATION

D I R E C T T O O T C O L O R E D R E S T O R A T I O N S - G L A S S I O N O M E R C E M E N T - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A .
• 1965: Dr. Alan Wilson and Dr. Brian Kent at the
British Laboratory of the Government Chemist,
experimenting mixing silicate glass with poly-acrylic
acid
• 1969: The first synthesized Glass Ionomers by
Wilson & Kent
• 1971: The first GIC product, ASPA (Alumino –
Silicate – Poly – Acrylate), was introduced and
marketed
• 1972: Due to its adhesion to enamel and dentin
and fluoride release for anticariogenic effect, it
gained popularity widely in dental profession
• 1975: Dr. John McLean was the first to develop
clinical techniques and to demonstrate the
material’s resistance to caries
• 1983: To improve the abrasive resistance, GIC was
modified by addition of silver to develop miracle
mix or silver cermet by Simmons
12

• 1985: McLean and Gasser introduced Glass
Cermet by sintered glass and metal powders to
improve wear resistance and flexural strength
• Early 90s: Resin-modified glass ionomer cement
was developed by addition of a hydroxyethyl
methacrylate monomer in the polyacrylic acid and
their polymerization is initiated along the
methacrylate group after exposure of light
• Late 90s: Highly viscous GIC
• Early 2000s: Nano-ionomers
• Over the years, improvements were made to the
original formulations, to speed up the set, allow
immediate shaping, improve mechanical quality and
increase its bioactivity
• More advancements and modifications in the
composite and glass ionomer restorative materials
aided more benefits in the field of esthetic dentistry
13

I. M A T E R I A L
R E V I E W
I.C. COMPOSITION
I.E. PROPERTIES
I.D.1. ACID ATTACK
I.D.2. GELATION
I.D.3. MATURATION

• ISO standard defines GIC as a Polyalkenoate
Cement as its poly-acids liquid contains
unsaturated double bonds
• Termed Glass Ionomer as it is formed of ionizable
silicate glass powder and polyacrylic acid co-
polymers
• It could be defined as:
• A water-based material, which is formed as a
product of an acid-base reaction between calcium-
fluoro-alumino-silicate glass powder and an
aqueous solution of poly-acids
• A water-based material is a material that
precipitated from an aqueous reaction whose
reaction medium is water
15

I. M A T E R I A L
R E V I E W
I.C. COMPOSITION
I.E. PROPERTIES
I.D.1. ACID ATTACK
I.D.2. GELATION
I.D.3. MATURATION

• GIC composed of two main components:
1. Glass Powder
2. Poly-Acid Liquid
17
I.C. COMPOSITION

GLASS POWDER COMPOSITION:
• Is basically an acid soluble calcium alumino-silicate
glass containing fluoride
• It is formed by fusing silica + alumina + calcium
fluoride, metal oxides and metal phosphates at
1100-1500 ○C and then pouring the melt onto a metal
plate
• The glass formed is crushed, milled and ground to a
form powder of 20 – 50 µm size depending on what it’s
going to be used for
• They get decomposed by acids due to the presence
Al+3 ions which can easily enter the silica network
enabling cement formation
18
I.C.1. GLASS POWDER
- Silica (SiO2) 35 - 50%
- Alumina (Al2O3) 20 - 30%
- Aluminum Fluoride (AlF3) 1.5 - 2.5%
- Calcium Fluoride (CaF2) 15 - 20%
- Sodium Fluoride (NaF) 3 - 6%
- Aluminum Phosphate 4 - 12%
- Radio-opacifiers (Lanthanum”La”,
Strontium “Sr” and barium “Ba”
Traces
- Fluoride (F) as ceramic flux Traces

GLASS POWDER COMPOSITION:
• The essential ingredients are Silica (SiO2) and
Alumina (Al2O3)
• Also Sodium (Na+), Potassium (K+), Calcium (Ca++)
and Strontium (Sr++) are added in order to:
1. Maintain electric neutrality
2. Modify the cement properties
3. Decrease the molecular weight of silicate
structure
4. Increase reactivity of the glass with poly-acids
• Phosphates (P+4) and Fluorides (F+) are added to
decrease the melting temperature of the glass in the
production process and incorporated into the glass
composition to modify the setting characteristics
• Fluorides are not incorporated into the skeletal
structure of glass, so it can diffuse freely in and out
of the glass core
19
I.C.1. GLASS POWDER

POLY-ACID LIQUID COMPOSITION:
• These acids are:
1. Organic: Weak and contain (OH) group with high
binding capacity
2. Ionomeric: Partially ionizable in aqueous media
3. Carboxylic: Contain carboxyl group (COOH)
4. Alkenoic: Contain unsaturated double bond
(C=C)
20
I.C.2. POLY-ACID LIQUID
- Polyacrylic Acid 45%
- Itaconic Acid
5%
- Maleic Acid
- Tricaballylic Acid
- Tartaric Acid
- Water 50%

POLY-ACID LIQUID COMPOSITION:
• These acids are:
1. Maleic: Reduces moisture sensitivity as it fasten
cross-linking and hardening
2. Itaconic: Prevents gelation of the liquid
3. Tricarballylic: Reaction controller
4. Tartaric: Increases reactivity
21
I.C.2. POLY-ACID LIQUID

I. M A T E R I A L
R E V I E W
I.C. COMPOSITION
I.E. PROPERTIES
I.D.1. ACID ATTACK
I.D.2. GELATION
I.D.3. MATURATION

• GIC has an acid base setting reaction which runs in
“3” basic phases:
23
ACID BASE REACTION
1. ACID ATTACK
2. GELATION
(Initial Setting)
3. MATURATION & HARDENING
(Final Setting)

I. M A T E R I A L
R E V I E W
I.C. COMPOSITION
I.E. PROPERTIES
I.D.1. ACID ATTACK
I.D.2. GELATION
I.D.3. MATURATION

• Upon mixing, the acid dissociates in aqueous
solution into:
1. Negatively charged carboxylate anions (RCOO-)
2. Positively charged hydrogen protons (H+)
• H+ ions attack the surface of calcium-alumino-
silicate glass particles releasing the cement forming
metal ions, Ca++ and Al+++
25
I.D.1. ACID ATTACK

H +
H +
H +
H +
H +
H +
H +
H +
H +
RCOO -
H +
H +
attacks calcium
alumino-silicate particles
Ca++ Ca++ Ca++ Ca++
Al+++ Al+++ Al+++
Na +
Fl -
1 . A C I D A T T A C K

I. M A T E R I A L
R E V I E W
I.C. COMPOSITION
I.E. PROPERTIES
I.D.1. ACID ATTACK
I.D.2. GELATION
I.D.3. MATURATION

• The surface layer of glass powder reacts with acid
and changed into a silica hydrogel
• The surface layer of the glass powder reacts with
acid, whereas the glass core remaining intact and
exists as filler in the cement matrix
• Ca++ ions react with the carboxylate anions forming
a matrix of water soluble calcium polysalts
• At this stage, the ions are present in aqueous
solution, meaning that they are susceptible to be
washed out by moisture contamination, which limits
the supply of ions needed for the setting reaction
• Also, dehydration at this time will deny the setting
reaction from the required aqueous medium to
proceed
• So, GIC should be protected by a layer of varnish to
prevent moisture contamination during setting
• Also, should never be finished until final setting and
hardening to avoid dehydration
28
I.D.2. GELATION

RCOO -
H +
Al+++ Al+++ Al+++
Na +
Fl -
1st Calcium Polysalt Matrix
(Water Soluble)
H +
attacks calcium
Silica Hydrogel
Ca++ Ca++ Ca++ Ca++
2 . G E L A T I O N

I. M A T E R I A L
R E V I E W
I.C. COMPOSITION
I.E. PROPERTIES
I.D.1. ACID ATTACK
I.D.2. GELATION
I.D.3. MATURATION

• In the presence of aqueous reaction medium, H+
ions continually attack the silicate glass leading to
release of Al+++
• The incorporation of Al+++ into the preformed
matrix leads to the formation of water-insoluble
calcium-aluminum-carboxylate gel, that no longer
susceptible to hydration or dehydration
31
I.D.3. MATURATION & HARDENING

RCOO -
H +
Al+++ Al+++ Al+++
Na +
Fl -
2nd Calcium Aluminium Polysalt Matrix
(Water Insoluble)
H +
attacks calcium
Al+++ Al+++ Al+++
3 . M A T U R A T I O N

AGAIN

H +
H +
H +
H +
H +
H +
H +
H +
H +
RCOO -
H +
H +
attacks calcium
Ca++ Ca++ Ca++ Ca++
Al+++ Al+++ Al+++
Na +
Fl -
1 . A C I D A T T A C K

RCOO -
H +
Al+++ Al+++ Al+++
Na +
Fl -
1st Calcium Polysalt Matrix
(Water Soluble)
H +
attacks calcium
Silica Hydrogel
Ca++ Ca++ Ca++ Ca++
2 . G E L A T I O N

RCOO -
H +
Al+++ Al+++ Al+++
Na +
Fl -
2nd Calcium Aluminium Polysalt Matrix
(Water Insoluble)
H +
attacks calcium
Al+++ Al+++ Al+++
3 . M A T U R A T I O N

T A K E A N O T E
• The final set and harden glass ionomer cement mass composed of:
1. Unreacted remaining alumino-silicate glass particles
2. Coated with silica Hydro-gel
3. Dispersed in a matrix of water insoluble calcium-aluminum polycarboxylate
• Sodium and fluoride ions remain in the ionized form and didn’t share in the crystalline
pattern of the set material

MATURATION
24 Hours - 1 Year
WORKING TIME
3 - 6 Min
SOLID STATE
Maturation
Insoluble matrix
Water addition is required
(to prevent dehydration)
LIQUID STATE
Gelation
Silica hydrogel formation
Water protection is required
(to prevent dissolution)
MIXING
Acid Attack
38
LIQUID
POWDER
MIXING TIME
45 - 60 Sec

ROLE OF WATER:
• The GIC is a water-based cement
• Water functions are:
1. It is the reaction medium that allows dissociation
of the polyacid liquid
2. Allows ionization and release of metal salts that
form the matrix
3. Continues the ionization until maturation
4. Act as a plasticizer during manipulation
5. Allow cement to age with increase in its strength,
modulus of elasticity and decrease plasticity
• Water content in the final set cement is about:
11 – 24%
39

I. M A T E R I A L
R E V I E W
I.C. COMPOSITION
I.E. PROPERTIES
I.D.1. ACID ATTACK
I.D.2. GELATION
I.D.3. MATURATION

1. Hydration & Dehydration
2. Biocompatibility
3. Bonding to Tooth Structures
4. Setting Shrinkage
5. Wear
6. Fluoride Release & Uptake
7. Esthetics
8. Strength
9. Radio-Opacity
41
I.E. PROPERTIES

I.E.1. HYDRATION & DEHYDRATION
1. Dissolution of poly-salts
2. Loss of adhesive potential
3. Decrease strength
4. Loss of translucency
5. Disintegration
6. Surface erosion
• A water proof seal should be maintained during the
initial phases of the setting reaction by application
of special seal
HYDRATION
1. Surface micro-cracks
2. Increased opacity
3. Ability to staining and leakage
4. Poor esthetic
5. Weakened restoration
• Early finishing should be avoided
DEHYDRATION

I . E . P R O P E R T I E S
1. HYDRATION & DEHYDRATION
HYDRATION DEHYDRATION

I.E.2. BIOCOMPATIBILITY
RESISTANCE TO PLAQUE:
• Bacterial plaque fails to thrive on the surface of GIC
due to the fluoride contents
PULP RESPONSE:
• GIC is considered biologically compatible with the
pulp due to:
1. Its compositional poly-acids are weak organic
acids
2. Its high molecular weight limits its diffusion
through the dentinal tubules to the pulp
3. Shows minimal temperature rise during setting
compared to other cements

I.E.3. BONDING TO TOOTH STRUCTURE
BOND TO MINERALIZED TISSUES:
• Polyalkenoic acid when attacking the tooth structure
will result in displacement of phosphate ions from
the apatite by carboxyl groups, and each phosphate
ion taking a calcium ion with it to retain electric
equilibrium
• A chemical bonding is now achieved by calcium-
phosphate-polyalkenoate crystalline structure
BOND TO COLLAGEN:
• Hydrogen bonding or metallic ion bridging
between carboxyl groups and collagen of dentin

I.E.4. SETTING SHRINKAGE
• Minimal shrinkage stresses (2 MPa) compared to
that of composite (17 - 18 MPa)
• This is may be due to:
1. The rubbery stage during setting, which allow
the cement to flow at the free surface
2. Also, hygroscopic expansion that occurs due to
water sorption counteract the setting shrinkage

I.E.5. WEAR
• Low wear resistance immediately after placement
due to low initial strength
• By aging, the wear resistance improved up to
acceptable levels
• Still its wear resistance is low when compared to
other restorative materials

5 . W E A R
GIC WEAR: Clinical aging after 2-years

5 . W E A R
GIC WEAR: SEM at different aging intervals

I.E.6. FLUORIDE RELEASE & UPTAKE
ROLE OF FLUORIDE:
• Decrease the fusion temperature of the glass
• Improves the handling properties of the mixed
cement
• Increases strength and translucency

FLUORIDE RELEASE:
51
I.E.6. FLUORIDE RELEASE & UPTAKE
• High fluoride release during the post-setting
maturation stage in the first few days
• It is the responsibility of total fluoride contents of
the powder
A) SHORT-TERM RELEASE B) LONG-TERM RELEASE
• Low fluoride release through-out the cement life as
a result of an equilibrium diffusion process
• The released fluoride is mostly in the form of NaFl
which is not a matrix forming salt
• So, no weakening effects or loss of desired
properties occurs
• It’s the responsibility of sodium ions

6. FLUORIDE RELEASE & UPTAKE
FLUORIDE RELEASE & UPTAKE CYCLE
F -
F -
F -
F -
Fluoride application
Only internal Fluoride
Leaches in oral fluids
After a few months
Original GIC placement
F -
F -
F -
F -
a) leaching Phase b) Equilibrium c) Depleting d) Depleted e) Recharging

Fluoride
recharge into
GIC
Fluoride
release from
GIC

RATE OF FLUORIDE RELEASE & UPTAKE IN GIC
24 hours
3 - 6
months
Topical
application
TIME
A
MOUNT
OF
F
LUORIDE

I.E.7. ESTHETICS
• Initial adequate color matching
• Translucency takes several days to develop
• Opacity is a major shortcoming

I.E.8. STRENGTH
• Brittle, weak and lack of rigidity
• Strength increases whenever the P/L ratio increases

I.E.9. RADIO-OPACITY
• Radio-opaque because of the incorporation of
radio-opacifiers such as Lanthanum (La), Strontium
(Sr) and Barium (Ba) in powder

I. M A T E R I A L
R E V I E W
I.C. COMPOSITION
I.E. PROPERTIES
I.D.1. ACID ATTACK
I.D.2. GELATION
I.D.3. MATURATION

• GIC COULD BE CLASSIFIED ACCORDING TO:
59
GIC
1. COMPOSITIONAL FORM
2. CHEMISTRY
3. CLINICAL USE

I.F.1. COMPOSITIONAL FORM
• The poly-acid is presented as an
aqueous solution forming the liquid of
the cement
• This cement is more viscous upon mixing
and its liquid may gel by time due to
hydrogen bonding
POLY-ACID MIXABLE
• The poly-acid is freeze-dried and added
to the powder
• The liquid is distilled water or aqueous
solution of tartaric acid in which the poly-
acid powder dissolves upon mixing to
reconstitute the poly-acid liquid
• It is less viscous upon mixing with longer
working time, shorter setting time and
extended shelf life
• It is also called “water-settable” or
“anhydrous” cement
• Part of the poly-acid is freeze-dried and
the other in an aqueous solution
• Has intermediate properties between the
two types
WATER MIXABLE MIXED

61
GIC
2. CHEMISTRY
3. CLINICAL USE

I.F.2. CHEMISTRY
available chemical forms of GIC:
a) Conventional GIC
b) Resin Modified GIC
c) Poly-acid Modified Composite Resin (Compomer)
d) Giomer
4

I.F.2. CHEMISTRY
A) CONVENTIONAL GIC:
• Acid-base setting reaction
• Sensitive to hydration and dehydration
• Short working time and extended setting time
• Should be sealed against moisture contamination
• Should not be finished immediately after placement
• Special forms are metal-reinforced by adding silver
alloy or sintering glass with silver (Cermet cement)
• FORMS & CLINICAL USES:
1. GIC for direct restoration
2. Metal reinforced GIC
3. Highly viscous GIC
4. Low viscosity GIC
5. GIC liner & base
6. GIC luting cement

I.F.2. CHEMISTRY
1. GIC for direct restoration
- Used for pedodontic applications and for the
restoration of Class III and Class V cavities
- They are not recommended for permanent filling of
occlusal surfaces in adults where there is excessive
load because of insufficient resistance to abrasion
2. Metal reinforced GIC
- The powder contains fluoro-alumino-silicate glass
and a silver alloy or the glass is sintered with silver
and called cermet cement aiming to reinforce the
GIC
- Due to the admixing of metals, these materials are
no more tooth colored than other glass-ionomer
cements
- It is recommended to be used as a core-build up
material and as a temporary posterior restoration

I.F.2. CHEMISTRY
3. Highly viscous GIC
- The highly viscous GIC were designed as an
alternative to amalgam as posterior restoration
- They are particularly helpful for Atraumatic
Restorative Technique (ART)
- This technique based on excavating carious dentin
using hand instruments and restoration with
adhesive restorative material
4. Low viscosity GIC
- The low-viscosity glass-ionomers have been
developed as liners, fissure protection materials,
sealing materials for hypersensitive cervical areas,
and endodontic materials
- Such materials are designed with low powder-
liquid ratios and are highly flowable

I.F.2. CHEMISTRY
5. GIC liner & Base
- Some glass-ionomers have been developed for
lining and base applications
- These materials are used for the "sandwich"
technique in which they are applied as a dentin
substitute and composite resin is applied as an
enamel substitute
6. GIC luting cement
- The glass-ionomer cements for luting are widely
used for cementing metal inlays, crowns, and
bridges
- They are considered the most suitable luting
cements, because of their ease of manipulation,
bonding ability, fluoride release, and low solubility
in the oral environment

I . F . T Y P E S &
C L A S S I F I C A T I O N S
2 . C H E M I S T R Y
A) CONVENTIONAL GIC
MATURATION
24 Hours - 1 Year
GELATION
24 Hours
ACID ATTACK
Few minutes
Working Time &
Placement
Varnish
Protection
Finishing
ACID-BASE REACTION

I.F.2. CHEMISTRY
B) RESIN MODIFIED GIC:
• Incorporating water-soluble resin monomers (2-
Hydroxyethyl-Methacrylate “HEMA”) into an
aqueous solution of polyacrylic acid
• Two types of setting reactions:
1. Acid-base reaction
2. Resin-base reaction
• This provides the following advantages:
1. Decreased moisture sensitivity
2. No need to provide water-proof seal after
placement
3. Ability to be immediately finished

I.F.2. CHEMISTRY
1. Restorative
- Showed “4” major improvements in GIC as a
restorative filling material
1. Decreased water sensitivity
2. Improved mechanical properties
3. Improved handling and manipulation
4. Improved translucency
2. Liner & Base
- The quick set with photo polymerization of RMGIC
compared to the slow set of conventional GIC allow
it to be more suitable as a liner and base material

I.F.2. CHEMISTRY
3. Fissure protection
- Although conventional GIC offer several
advantages as pits and fissures sealant including
short and long term fluoride release and adhesion
to tooth structure but its retention rate is not as high
as that for RMGIC
- Also, conventional GIC requires prevention of
moisture contamination at the early stages of
setting while the RMGIC don’t require that
protection
4. Luting cement
- The bond strength of conventional glass-ionomer
cement for luting is not as high as that of resin
cement
- Also, the bond strength of the material to the tooth
structure has been improved with the incorporation
of monomers

I . F . T Y P E S &
B) RESIN MODIFIED GIC
MATURATION
24 Hours - 1 Year
GELATION
24 Hours
ACID ATTACK
Few minutes
Working Time &
Placement
No Varnish Protection
Immediate Finishing
ACID-BASE REACTION
RESIN-BASE REACTION
20 - 40 SEC

I.F.2. CHEMISTRY
C) POLY-ACID MODIFIED COMPOSITE RESIN:
• It basically has a similar nature and physical
properties to composite resin
• It is a resin composite with a fluoride releasing
potential as it contains fluoro-alumino-silicate glass
powder as a filler
• Does not contain water and does not self-adhere to
the tooth structure
• The main setting reaction is resin-base reaction
• Acid-base reaction was thought to take place when
it comes in contact with water from saliva in acidic
medium due to drop in oral pH
• It is not considered as a true GIC because of:
1. It doesn’t contain water
2. It doesn’t start setting reaction primarily with
acid-base reaction

I.F.2. CHEMISTRY
C) POLY-ACID MODIFIED COMPOSITE RESIN:
1. Restorative
- The main clinical application for compomers is
restorative filling, because they are not adhesive
and require a separate bonding agent

I . F . T Y P E S &
C) COMPOMER
FINISHED RESTORATIONN
UNLIMITED
WORKING TIME
Immediate Finishing & Polishing
ACID-BASE
REACTION
RESIN-BASE REACTION
20 - 40 SEC

I.F.2. CHEMISTRY
D) GIOMER:
• Resin-based material that contains pre-reacted glass
ionomer particles incorporated into the resin
• It is similar to compomer in being light activated
and requiring the use of bonding agent to adhere
to the tooth structure
• Available clinically as a restoration only

A) CONVENTIONAL GIC B) RESIN MODIFIED GIC C) COMPOMER D) GIOMER
6
FORMS
4
FORMS
1
FORM
1
FORM
1. Restorative filling
2. Metal Reinforced
3. Highly Viscous
4. Low Viscous
5. Liner & Base
6. Luting Cement
1. Restorative filling
2. Liner & Base
3. Fissure Protection
4. Luting Cement
1. Restorative filling only 1. Restorative filling only
76
I.F.2. CHEMISTRY

I . F . T Y P E S &
CONVENTIONAL GIC
RESIN MODIFIED GIC
GIOMER
COMPOMER
COMPOSITE RESIN
INCREASING
• Compressive Strength
• Fracture Toughness
• Esthetic
INCREASING
• Fluoride release
• Fluoride recharge
• Water contents

78
GIC
2. CHEMISTRY
3. CLINICAL USE

I.F.3. CLINICAL USE
TYPE I: LUTING CEMENT • Crown, bridges, inlays and orthodontic
• Fast setting
• P/L = 1.5/1
TYPE II: RESTORATIVE 1. Esthetic • Resin modified GIC
• Fast setting
• P/L = 3/1
• Resistant to water uptake
2. Reinforced • Cermet cement
• Fast setting
• P/L = 3/1
TYPE III: LINER & BASE • Liners: Thin, Fast setting, P/L = 1.5/1
• Bases: Thick, Fast setting, P/L = 3/1

I. M A T E R I A L
R E V I E W
I.C. COMPOSITION
I.E. PROPERTIES
I.D.1. ACID ATTACK
I.D.2. GELATION
I.D.3. MATURATION

ADVANTAGES:
1. Cariostatic due to sustained release of fluoride
2. Adhesive potential
3. Low setting contraction
4. Biocompatibility, as a result of its weak acid contents
and high molecular weight
5. Thermal insulating capacity
6. Low coefficient of thermal expansion
7. Satisfactory optical properties
8. Multiple clinical applications
9. Ease of manipulation and reasonable coast
81

DISADVANTAGES:
1. Poor mechanical properties, its wear resistance
preclude its use at stress bearing areas
2. Very sensitive to hydration and dehydration
3. Short working time and long setting time
82

I. M A T E R I A L
R E V I E W
I.C. COMPOSITION
I.E. PROPERTIES
I.D.1. ACID ATTACK
I.D.2. GELATION
I.D.3. MATURATION

INDICATIONS
1. Class V carious, erosive or abrasive lesions
2. Class III carious lesions
3. Pits and fissures sealant
4. Classes I & II restorations in primary teeth
5. Luting cement
6. Liner and base under direct (Sandwich technique)
and indirect tooth-colored restorations
7. Root surface caries
8. Core and build ups
84

I.H. IN D I C AT I O N S &
CO N T R A I N D I C AT I O N S
I N D I C A T I O N S
Class V carious, erosive or abrasive lesions

Class III carious lesions

Pits and fissures sealant

Classes I & II restorations in primary teeth

Luting cement

Liner and base under direct (Sandwich technique) and indirect tooth-colored restorations

INDICATIONS
SANDWICH TECHNIQUE:
• Double-laminated technique or Bi-layered
technique
• Bonding composite resins to GICs
• First described by McLean and Wilson (1977)
• GIC - replace carious dentin prior to attachment of
composite resins to etched enamel
• The laminate restoration decrease micro-leakage
compared to simple composite restoration
• Clinically employed while restoring large Class III,
Class IV, Class V, Class I and Class II cavities with
direct composite resins
93

INDICATIONS
SANDWICH TECHNIQUE:
94
• Proximal box is first filled with GIC and the occlusal
restoration is completed with composite resin
• Indicated mainly when the gingival margins of the
prepared cavity are deep sub-gingivally that impairs
placement of composite resin and bonding
procedures
A) OPEN SANDWICH TECHNIQUE B) CLOSED SANDWICH TECHNIQUE
• The cavity is first completely filled with GIC after
excavation and removal of all carious dentin
• The restored tooth is then re-prepared, leaving a
thick glass ionomer base and creating sufficient
space to make a resin composite

Sandwich Technique
OPEN CLOSED

Open Sandwich Technique

Closed Sandwich Technique

Root surface caries

Core and build ups

CONTRINDICATIONS
• The low tensile strength, brittleness and low
resistance to wear should preclude the use of glass
ionomer for Class I and II restorations
• Metal reinforced glass ionomer exhibits improved
wear resistance compared to glass ionomer, but the
strength was found to be inadequate for use in
areas of high stresses
101

PART II: CAVITY PREPARATION

• The adhesive potential of the cement precludes any
necessity for retentive features, while its potent
cariostatic influence similarly precludes any
extension beyond elimination of caries
• Deep cavities need first to be lined with a thin
continuous film of calcium hydroxide for pulp
protection before application of glass ionomer
cement
103
II. CAVITY PREPARATION

MANIPULATION
PART III:

III.MANIPULATION III.A. MANIPULATIVE STEPS
III.B. CASE REPORTS
III.A.2. PLACEMENT
III.B.1. CASE 1
III.B.2. CASE 2

• Glass ionomer cements are available
commercially in two forms:
106
• For mechanical mixing
• The capsule provides a consistent and satisfactory
powder/liquid ratio and ensures optimum physical
properties
1. CAPSULES
• Powder and liquid supplied separately for hand mixing
• The powder/liquid ratio is significant in hand mixing
• For convenience, the mixed material should be
transferred to a disposable syringe for accurate and
positive placement into the cavity
2. POWDER & LIQUID

III.A. MANIPULATIVE
STEPS
1. DISPENSING & MIXING
GIC Capsules

III.A. MANIPULATIVE
STEPS
1. DISPENSING & MIXING
GIC Powder & Liquid

III.B. CASE REPORTS
III.A.2. PLACEMENT
III.B.1. CASE 1
III.B.2. CASE 2

• The cavity requires conditioning prior to placement
of the cement
• The preferred conditioner is 10-15% polyacrylic acid
for 10-15 seconds
• The cavity should be then washed thoroughly and
dried lightly without dehydration
• Complete isolation is recommended, but if the
cavity is re-contaminated then reconditioning is
needed
• If the cement is hand mixed rather than capsulated
then it will be easier to handle if the mixed cement
is transferred into a centrix-type syringe for
placement into the cavity
• This is because it improves adaptation and reduces
porosity
110
III.A.2. PLACEMENT

• Syringe carried the cement into the depth of the
cavity firstly and continues to expel the cement
whilst withdrawing the syringe
• Then applying a matrix for the final positive
placement and allow the cement to set
• Immediately after the removal of the matrix cover
the cement with a layer of sealant
• Whilst the sealant is still liquid, trim the excess
cement with a sharp blade or a slowly rotating mild
steel bur, cutting from the cement towards the tooth
so as not to stress the developing union
• If the sealant has been disturbed during contouring
then apply a second layer
• Now, either light activates a resin bonding agent or
gently blow – dry a varnish
• Trim any excess sealant, which may be present
111
III.A.2. PLACEMENT

III.B. CASE REPORTS
III.A.2. PLACEMENT
III.B.1. CASE 1
III.B.2. CASE 2

• Contouring and polishing should always be
performed under an air/water spray, using very fine
diamonds to begin with and finishing with
aluminum oxide discs
• Contouring and polishing should not be carried out
less than a week after placement, after which the
physical properties have achieved a reasonable
level and translucency will not be lost
• Most RMGIC can be contoured and finished
immediately after light curing
113

III.B. CASE REPORTS
III.A.2. PLACEMENT
III.B.1. CASE 1
III.B.2. CASE 2

S U G G E S T E D
R E A D I N G S
Customer Book Title Stage Supplier Date
OUP Pickard’s Guide to Minimally Invasive Operative Dentistry Revise 2 Thomson Digital 28 April 2015

S U G G E S T E D
R E A D I N G S
Alperstein, K. S., Graver, H. T., & Herold, R. C. B. (1983). Marginal leakage of glass-ionomer cement restorations. The Journal of
Prosthetic Dentistry, 50(6), 803–807.

Bansal, R. K., Tewari, U. S., Singh, P., & Murthy, D. V. S. (1995). Modified polyalkenoate (glass-ionomer) cement – a study. Journal
of Oral Rehabilitation, 22(7), 533–537.
Billington, R. W., Williams, J. A., & Pearson, G. J. (2006). Ion processes in glass ionomer cements. Journal of Dentistry, 34(8), 544–
555.

Brantley, W. A., & Kerby, R. E. (1993). Thermal diffusivity of glass ionomer cement systems. J Oral Rehabil, 20(1), 61–68.
Cheng, H., Liu, H., & Zhang, G. (2005). Setting chemistry of glass ionomer cement. Journal Wuhan University of Technology,
Materials Science Edition, 20(4), 110–112.
Christensen, G. J. (1994). Why is glass ionomer cement so popular? Journal of the American Dental Association (1939), 125(9),
1257–1258.
Crisp, S., Ferner, A. J., Lewis, B. G., & Wilson, A. D. (1975). Properties of improved glass-ionomer cement formulations. Journal of
Dentistry, 3(3), 125–130.
Davidson, C. L. (1998). Glass ionomer cement, an intelligent material. Int Rech Sci Stomatol Odontol, 40(1), 38–42.

S U G G E S T E D
R E A D I N G S
Davidson, C. L. (2006). Advances in glass-ionomer cements. Journal of Applied Oral Science : Revista FOB, 14 Suppl(1), 3–9.
De Caluwé, T., Vercruysse, C. W. J., Fraeyman, S., & Verbeeck, R. M. H. (2014). The influence of particle size and fluorine content
of aluminosilicate glass on the glass ionomer cement properties. Dental Materials, 30(9), 1029–1038.
Forsten, L. (1977). Fluoride release from a glass ionomer cement. Scandinavian Journal of Dental Research, 85(6), 503–504.
Freire, W. P., Fook, M. V. L., Barbosa, E. F., Araújo, C. S., Barbosa, R. C., & de Sousa, W. J. B. (2014). Glass Ionomer Cement –
Development and Characterization Microstructural. Materials Science Forum, 805, 12–18.
Hadley, P. C., Milella, E., Gerardi, C., Hill, R. G., & Billington, R. W. (2001). Distribution of fluoride in glass ionomer cement
determined using SIMS. Biomaterials, 22(12), 1563–1569.
Kawahara, H., Imanishi, Y., & Oshima, H. (1979). Biological Evaluation on Glass Ionomer Cement. Journal of Dental Research,
58(3), 1080–1086.
Kent, B. E., Lewis, B. G., & Wilson, A. D. (1973). The properties of a glass ionomer cement. British Dental Journal, 135(7), 322–326.
Liebenberg, W. (2006). Return to the resin-modified glass-ionomer cement sandwich technique. British Dental Journal, 200(5),
297.

S U G G E S T E D
R E A D I N G S
McCabe, J. F., Jones, P. A., & Wilson, H. J. (1979). Some properties of a glass ionomer cement. British Dental Journal, 146(9), 279–
281.
McLean, J. W. (1992). Clinical applications of glass-ionomer cements. Operative Dentistry, Suppl 5, 184–90.
Mjör, I. (1996). glass-ionomer cement restorations and secondary caries: A preliminary report. Quintessence International, 27(3),
171–174.
Nagaraja Upadhya P, K. G. (2005). Glass Ionomer Cement–The Different Generations. Trends Biomater Artif Organs, 18(2), 158–65.
Neelakantan, P., John, S., Anand, S., Sureshbabu, N., & Subbarao, C. (2011). Fluoride Release From a New Glass-ionomer
Cement. Operative Dentistry, 36(1), 80–85.
Nicholson, J. W. (1998). Chemistry of glass-ionomer cements: A review. In Biomaterials (Vol. 19, pp. 485–494).
Oliveira, S. R. . R., Rosenbach, G. ., Brunhard, I. H. V. P., Almeida, M. A., & Chevitarese, O. (2004). A clinical study of glass
ionomer cement. European Journal of Orthodontics, 26(2), 185–189.
Quackenbush, B. M., Donly, K. J., & Croll, T. P. (1998). Solubility of a resin-modified glass ionomer cement. ASDC Journal of
Dentistry for Children, 65(5), 310–312.

S U G G E S T E D
R E A D I N G S
Sakal, E., Ono, K., Asaga, K., & Dalman, M. (1992). Mechanism of glass-ionomer cement hardening. In 9th International Congress
on the Chemistry of Cement Vol 3 (pp. 413–418).
Serra, M. C., Navarro, M. F., Freitas, S. F., Carvalho, R. M., Cury, J. A., & Retief, D. H. (1994). Glass ionomer cement surface
protection. American Journal of Dentistry, 7(4), 203–206.
Sidhu, S. K. (2011). Glass-ionomer cement restorative materials: A sticky subject? Australian Dental Journal, 56(SUPPL. 1), 23–30.
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ionomer cement. Acta Biomaterialia, 8(8), 3153–3160.
Wilson, A. D. (1991). Glass-ionomer cement origins, development and future. Clinical Materials, 7(4), 275–282.
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Chemistry and Biotechnology, 21(11), 313–313.
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132(4), 133–135.

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