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GLASS IONOMERS

in Restorative Dentistry

The many faces of glass ionomers

• GI -- what are they ?


• GI categories ?
• GI setting reactions ?
• GI release of F and recharging ?
• GI applications ?
DEVELOPMENT
Timeline for “direct restorative materials” usage

First GIC in 1972 A.S. = Aluminosilicate glass


Dentsply A.S.P.A. P.A. = Polyacrylic acid in water

1970 1980 1990 2000

Dental Amalgam

Dental Composite
Glass Ionomer
TERMINOLOGY
Don’t be confused by some of the strange language.

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.

Polyalkenoic or Polyalkenoate: refers to polymer chain which


incorporates alkenoic monomers such as acrylic acid, tartaric acid,
maleic acid, etc.

F-Release: refers to release of fluoride ions but there is no implication


as to the source of the ions -- and there are many possibilities. The
confusion for current systems is, if “F” does not come from the
traditional GI matrix, then some people say that the system is not a
“true” GI (but the point is irrelevant).

Multiple-Cure: refers to multiple curing mechanisms possible with


resin-modified systems -- the terminology was first introduced in 1992
by 3M for their Vitremer product because it underwent the (1)
traditional GI chemical setting reactions, (2) a self-cured
polymerization reaction, and a (3) light-cured polymerization reaction.
GLASS IONOMERS
HYBRID = SC [Powder] and PCC [Liquid] = A.S.P.A.

Silicate Cement
Ca+2 Glass particle
Si, Na,
H2O, Al+3 Etched periphery
F, Ca, + H3PO4,
H+
F-
Al
Al, Zn Si+4

Ca, Al, Na, Zn


Phosphates and
Fluorides

REACTANTS PRODUCTS
Polycarboxylate Cement
HOOC -OOC
Zinc polyacrylate gel
-OOC Residual
ZnO
H2O ZnO + COOH COO-
Zn++ ZnO
PAA COO- COO-
COOH
-OOC Zn++ COO-
HOOC
-OOC
GLASS IONOMERS
HYBRID = SC [Powder] and PCC [Liquid] = A.S.P.A.

H2O Si+4
PAA
SiO2, in Al+3
SiO2,
Al2O3, H2O Na+
Al2O3, Ca+2
Na, Ca,
Na, Ca, F-
F
F PAA

Residual Glass Particle


SiO2,
POLYACRYLATE HYDROGEL
Al2O3, (initially Ca polyacrylate gel
Na, Ca, and later Al polyacrylate gel)
F
Si+4 , Al+3 , Ca+2 , Na+, F- Ions
GI SETTING REACTIONS
Ca+2 Al+3
H-O-H
F- Si+4
--O-Si+4(OH)2
F-Al-SiO2
¯OOC COO¯ CaF2 H-O-H
COO¯
Ca+
H-O-H
¯OOC COO¯
COO¯

¯OOC

COO¯ H-O-H
Ca++
¯OOC
Ca+ ¯OOC
COO¯
¯OOC
¯OOC
¯OOC COO¯
Al+3
COO¯
H-O-H
Hydrophobic POLYMER

GIOMER COMPOMER COMPOSITE


 VLC Composite and  VLC Composite and
 Pre-reacted GIC powder  F source
Universal
Universal
CEMENTS CEMENTS
FILLING MATERIALS FILLING MATERIALS FILLING MATERIALS

RM-GI
 GI and
 VLC Hydrophilic
monomer and polymer

CEMENTS

MM-GI GI RR-GI
 GI and  GI and
 Metallic fillers  Resin-Fillers
 Cermet fillers
A.R.T. and
CORES TEMPORARIES
HYDROGEL
FLUORIDE RELEASE
Fluoride comes from matrix and particles at different rates.
rapid early
F release
from matrix
Slow long term
F release
by diffusion
from particle

F-1 ,
Ca+2 , Al+3 , Si+4

Initial
dissolution
for
starting
reaction

FLUORO-ALUMINO-SILICATE CEMENT
PARTICLE MATRIX
20
FLUORIDE RELEASE (ppm)

15

EFFECTIVE LEVELS

10
Fluoride Toothpaste,
Topical Fluoride,
Fluoride Mouthrinse

5
MATRIX

PARTICLES

0 7 14 21 28

TIME (Days)
CARIOSTATIC EFFECTS
GI is not more effective than composite or amalgam.

Glass Ionomer

Composite

Amalgam

0 20 40 60 80 100
Replacement rate (%) for secondary caries

Mjor IA. Glass ionomer cement restorations and secondary caries: a


preliminary report. Quintessence Int 1996;27(3):171-174.
1996;
APPLICATIONS
GI have been tried for about every conceivable application.

1. Cement
2. Liner / Base
3. Restoration
4. Core / Foundation
5. (Tunnel Restoration)
6. (Sandwich Restoration)
7. Retrograde Filling Material
8. P/F Sealant
9. Root Caries Cervical Restoration
10. Temporary, or ART Restoration

Technical modifications: General Properties:


> P/L → Precapsulated > Strength
> Addition of etching and then BA > Adhesion
> Addition of different reinforcing fillers > Biocompatibility
> Finer and finer particle sizes > Fluoride release
COMMERCIAL PRODUCTS
SOME PRODUCTS

Ketac-Cem Hytac Dyract Flow

Fuji Miracle Mix Vitremer


A.R.T. RESTORATIONS
ART = Atraumatic Restorative Technique

Developed as temporary restorations for 3rd world countries.


First tested in African countries.
Now used widely in Asian countries.

Original technique = scoop, finger mix, finger insertion.


Current technique = P/L or precapsulated mixture.

Fuji IX

Now being used as permanent restoration in pedodontics.


“WHO” Global A.R.T. Project
Atraumatic Restorative Treatment (ART) = prevention and treatment of
dental cariesbased on excavating and removing caries using hand
instruments only and restoring glass ionomer.

Fuji IX GP

Minimal equipment and instrumentation


TEMPORARY RESTORATIONS
Fuji IX Dominates the Landscape