Minimal intervention dentistry II: IN BRIEF

• Demonstrates the use of glass-

part 7. Minimal intervention in ionomer cement (GIC) in minimally

PRACTICE
invasive restorative techniques and
as a therapeutic coating in preventive

cariology: the role of glass-iono- dentistry.

• Highlights the chemical properties of
GICs and why they are important.

mer cements in the preservation

of tooth structures against caries
H. Ngo*1 and S. Opsahl-Vital2,3

Glass-ionomer cements (GICs) are essential materials in clinical practice because of their versatility, self-adhesion to
enamel and dentine, and good biocompatibility. In addition, being chemically cured, with no shrinkage stress, makes them
well suited for minimally invasive restorative techniques. This article looks at some of the clinical situations where the
chemical adhesion and high biocompatibility of GIC are important for clinical success: excavation of deep carious lesions,
fissure sealing and protection of root surfaces against caries.

The philosophy of minimal intervention (MI) unbalanced oral environment. MI is supported interface7 and the ensuing seal is both tech-
dentistry is gaining popularity around the by the following four pillars: individual risk nique tolerant and long lasting, even under
world; it recognises that caries is a multifac- assessment, detection and management of challenging clinical environment.
torial, life-style associated condition, which non-cavitated lesions, effective preventive They have been described as bioactive
is driven by an unhealthy oral biofilm and an care and minimally invasive restorative tech- materials due to the exchange of ions with
niques. At every stage in the management tooth structures8 and can be thought of as
of caries clinicians should aim for maximum a reservoir for fluoride and other ions in
MINIMAL INTERVENTION preservation of tooth structures. the oral cavity.9 This exchange is only pos-
DENTISTRY II This article will focus on the use of glass- sible because GICs contain both tightly and
1. Contribution of the operating microscope to ionomer cement (GIC) in minimally invasive loosely bound water in its matrix, the set
dentistry restorative techniques and as a therapeutic cement still contains between 11% to 24% of
2. Management of caries and periodontal risks coating in preventive dentistry. As a group bound water.2 The liquid contains approxi-
in general dental practice of materials, GIC is very versatile; examples mately 60% water by weight.
3. Management of non-cavitated (initial) can be found as restorative materials, cavity
occlusal caries lesions – non-invasive
liners, luting cements, fissure sealants and THE SETTING REACTION
approaches through remineralisation and
therapeutic sealants therapeutic coatings.1–3 This last terminology The setting of GICs involves complex chemi-
4. Minimal intervention techniques of is used to describe a material that can be cal reactions; in brief it can be separated into
preparation and adhesive restorations. The painted on susceptible tooth surfaces to form two distinct stages. Immediately after mixing,
contribution of the sono-abrasive techniques
a long lasting coat and provide both physical there is cross-linking of the poly-acid chains
5. Ultra-conservative approach to the treatment
of erosive and abrasive lesions and chemical protection against caries. by either free calcium or strontium ions. The
6. Microscope and microsurgical techniques in cross-linking during this stage is not stable
periodontics
BIOCOMPATIBILITY OF and can be easily affected by excessive water
7. Minimal intervention in cariology: the
GLASS-IONOMER CEMENT loss or too much moisture contamination, due
role of glass-ionomer cements in the GIC was developed in England by Wilson to poor isolation technique, during placement.
preservation of tooth structures against
and Kent in 19724 and introduced to the During the second stage, the chains of poly-
caries
dental profession in 1988.5 The first genera- acid are further cross-linked by trivalent alu-
8. Biotherapies for the dental pulp
This paper is adapted from: Ngo H, Opsahl-Vital S. Intervention
tion of GIC includes water-based cements minium ions. This later stage brings both an
minimale. La place des ciments verre ionomère. Réalités Cliniques that were formed by an acid-base reaction increase in mechanical properties, a reduction
2012; 23: 235-242.
between a calcium-based fluoroalumino- in solubility and improved aesthetic. Even at
silicate glass powder and a polyalkenoic this stage the maintenance of water balance is
1
Faculty of Dentistry, Kuwait University, PO Box 24923 acid liquid. In later versions, calcium was still critical for the long-term clinical perfor-
Safat, 13110 Kuwait; 2EA2496 Pathologies, Imaging and
Biotherapies of the Tooth, Dental School, University
replaced with strontium to impart radio- mance of the restoration. Indeed, the presence
Paris Descartes PRES Sorbonne Paris Cité, 92120 Mon- opacity.6 It is interesting to note that because of some loosely bound water molecules in the
trouge, France; 3AP-HP Service Odontologie HUPNVS of their similarity in polarity and atomic size, solidified matrix is essential for ion exchange
*Correspondence to: Professor Hien C Ngo
Email: hien.ngo@hsc.edu.kw these two  elements are interchangeable in and recharging of fluoride ions.10–12
the composition of GIC as well as hydroxya- Fluoride is an essential part of the glass
Refereed Paper patite (HAP). The major attraction of GIC because it is used to control the fusion tem-
Accepted 15 November 2013
DOI: 10.1038/sj.bdj.2014.398 is its ability to chemically bond to dentine perature and it is also a good oxide scavenger
© British Dental Journal 2014; 216: 561-565 and enamel and to form an acid resistant during the manufacturing of the glass. In the

BRITISH DENTAL JOURNAL VOLUME 216 NO. 10 MAY 23 2014 561

© 2014 Macmillan Publishers Limited. All rights reserved

 PRACTICE

a
Fig. 2a Initial situation: the patient presented Fig. 2d A high fluoride-releasing GIC liner
with a large proximal lesion and reported mild (Fuji Triage®, GC Corporation) was applied over
symptoms over a brief period the discoloured dentine as a liner for internal
remineralisation. A high-strength GIC was laid
down, in particular over the dentinal margin
(Fuji IX Extra, GC Corporation) as a base in
preparation for the composite resin restoration

Fig. 2b A clean margin of 2 mm wide was

created using a round bur and only hand
instruments were used to remove carious
dentine, in order to minimise the risk of direct
pulp exposure
c
Fig. 2e Classical composite resin restoration
Fig. 1 The clinical application of the
internal remineralisation concept is
illustrated in this case. a) A patient
presented with a proximal cavity and
reported mild symptoms consistent with
reversible pulpitis; b) Enamel removal to
gain proper access to the cavity; c) Removal
of carious dentine from the dentino-enamel
junction, while the carious dentine from
the pulpal and axial walls was left. A clean
margin of two mm wide was created to
ensure a long lasting seal, which is essential Fig. 2c The finished cavity was treated with
for the success of this therapy 10% polyacrylic acid for ten seconds. Note
that the enamel transverse ridge was retained Fig. 2f Final sandwich restoration
so not to weaken the tooth crown
set cement, fluoride does not form a physical
part of the matrix so its release does not affect Due to lower physical properties, in com-
the physical property of the cement. parison with composite resin, GICs should
not be used where the restoration is exposed
TYPES OF GIC RESTORATIONS to excessive and repeated occlusal loads and
During its 30 year history, there have been a where high level of aesthetics is required. Some
number of modifications to the original for- conventional GICs are classified as high vis-
mulation with the aim to increase its physi- cosity. These have good mechanical strength
cal properties, in particular wear resistance, and, in particular, good wear resistance.13
reduce sensitivity to early water uptake so The resin-modified-glass-ionomer
that restorations can now be placed and fin- cements (RMGIC) have similar components Fig. 2g Radiograph of final restoration:
partial excavation has preserved the integrity
ished at the same visit and to enhance trans- of conventional glass-ionomer cements
of the pulp
lucency to bring better aesthetic results.13 plus a small quantity of resin hydroxyeth-
Today, GICs can be roughly divided into ylmethacrylate (HEMA) and bisphenol A
two groups: conventional and resin-modi- glycidyl dimethacrylate (BisGMA) and both BI0ACTIVITY OF GIC
fied. The first GICs introduced on the market photo and chemical initiators. They set by Due to its ability to release and recharge
are conventional, or auto-cured, GICs with the combined effects of photo and chemi- of fluoride and exchange of strontium for
self-adhesion to dentine and enamel.13 They cal polymerisation on top of the acid-base calcium from its immediate environment
provide a long lasting seal, which is due to reaction. This means that these materials will (eg tooth structure, saliva and plaque fluid);
their adhesion property and dimensional eventually set completely even when there GIC can be considered to be a reservoir of
stability. However, these early GICs required is inadequate light activation. It has been constituents of hydroxyl-apatite (eg fluo-
careful maintenance of water balance imme- shown that their mechanical properties are ride, calcium/strontium and phosphate).15,16
diately after placement. not affected under these conditions.2,14 It has been shown that the surface hardness

562 BRITISH DENTAL JOURNAL VOLUME 216 NO. 10 MAY 23 2014

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 PRACTICE

of GIC can increase by 39% over 40-day of softened dentine left at the base of the
exposure to saliva.17 cavity; it is important to create a margin
A major advantage of GIC is its ability to on sound dentin and enamel to ensure that
act as a fluoride reservoir in the oral cavity. a seal is achievable with the final restora-
The release of fluoride is characterised by a tion (Figs 1a–c). In the early version of this
high initial peak, which decreases rapidly technique, step-wise excavation, a tempo-
to maintain a sustained level over several rary restoration was placed and a time period
months.18,19 However, there is a topping- of approximately six  months was allowed
up effect where GIC can be recharged with for the deposition of tertiary dentine before
fluoride ions from external sources such as replacing the temporary restoration with a
toothpastes, gels and varnishes.20 GIC res- final one.29 The current literature suggests
torations can be viewed as slow fluoride that for most clinical cases the re-entry step Fig. 3a Initial situation: erupting first
permanent molar. Pre-fissure-sealant with GIC
releasing devices.21 The caries preventive can be eliminated, so a final restoration can
was recommended, because the tooth has not
effect of GIC is restricted to its immediate be placed at the initial visit then the vital- yet been fully erupted and moisture control is
vicinity, this protection has been observed ity of the tooth monitored.27,37,38 The use of difficult to achieve
not only along the margin of the restoration GIC is essential in this technique, because
but also on proximal surface of the adjacent there is a suggestion that the demineralised
tooth.22,23 dentine can be remineralised through an
When GIC is placed in direct contact with ion exchange process with GIC. This process
caries affected dentine, the migration of apa- was described as ‘internal remineralisation’
tite forming elements F and Sr from the GIC (Figs 2a‑g).8,10 In addition, GIC can provide
to carious dentine can be extensive.8 a long lasting seal through chemical adhe-
sion that deprives the remaining bacteria of
DEEP CARIES externally sourced nutrients.10 As GIC can
GIC is an essential tool in the management be placed in proximity to the pulp without
of deep caries lesions in permanent teeth the risk of inducing inflammation, there
(codes 5 and 6 ICDAS II). Traditionally, we is no need for the placement of any liner
were taught that all soft and discoloured unless there is direct pulp exposure.38 It has
dentine at the base of these deep caries been shown that this conservative approach Fig. 3b A high fluoride-releasing GIC was
lesions should be completely removed in is much kinder to the tooth, reducing the chosen (Fuji Triage®, GC Corporation)
order to eradicate bacteria and to provide incidence of pulp exposure and ensuring a
good supports for the overlying restoration. better prognosis.26,27,39,40 as Fuji Triage (GC Corporation), to protect
This approach often leads to the unneces- the occlusal surface of erupting permanent
sary removal of tooth tissue and mechanical THE SANDWICH TECHNIQUE molars (Figs 3a and b).44,48,49
pulp exposures. It was reported that in young Sandwich technique is a term that has been
patients the rate of pulp exposure can be as used to describe the use of GIC as a den- PROTECTION OF ROOT SURFACES
high as 40%.24 In addition, it is now proven tine replacement material or as a base in IN ELDERLY PATIENTS
that the elimination of all microorganisms large posterior composite restorations. This Root caries lesions are commonly found on
in the lesion is not at all possible.25 technique can be further divided into either exposed root surfaces in the elderly. These
It is now well accepted that, when dealing ‘closed-sandwich’, when the GIC is entirely lesions are difficult to diagnose at an early
with deep caries lesions on teeth, without enclosed within the composite restoration, stage because, unlike enamel lesions, the first
any symptom of irreversible pulpitis, dentists or ‘open-sandwich’, when GIC is used as a changes are softening and surface rough-
should only selectively remove the infected base that is exposed to the oral cavity.41 The ening of the affected area, well before dis-
layer and to leave the affected layer behind, rationale for using a GIC base is to provide colouration sets in. In addition, these early
so to avoid pulp exposure and to preserve a seal at the gingival dentinal margin when lesions are frequently masked by plaque and
pulp vitality.26,27 This approach is based on enamel is missing and to reduce the depth of swelling of surrounding soft tissues and once
the work of Fusayama28 and Massler,29 which the proximal box so that light curing can be established they often spread subgingivally.
described the histology of these two layers reliably achieved. It also reduces the number Bacteria can penetrate through the thin
of carious dentine. However, under clinical of increments of composite resin.42,43 cementum into the underlying dentine very
conditions, the differentiation of infected quickly.50 Root caries can be arrested with
and affected dentine can be difficult, even PIT AND FISSURE SEALANT AND high fluoride and good oral hygiene; often
with the aid of caries detector dyes.30,31 In PRE-FISSURE SEALANT it is difficult to satisfactorily restore these
1992, Mertz-Fairhurst et al. confirmed, in a GIC can be used as a pit and fissure sealant, due to lack of access and adequate moisture
ten-year clinical trial, that any demineral- the key advantage is that it offers a dual, control. GIC can be used to cover and protect
ised dentine left at the base of restorations mechanical and chemical protection with the exposed root surfaces or to restore sub-
did not continue to progress nor contribute long-term fluoride release. However, it has gingival root caries lesion. Figure 4 presents
significantly to the failure of the coronal been reported that its retention rate is lower a case of a patient with an original caries
restorations, as long as a seal was estab- than those achieved with resin based seal- lesion that had been arrested for many years.
lished and maintained.32 More recently, sys- ants.44–46 It is recommended where the tooth This had been achieved with a combination
tematic reviews have confirmed the above has not yet been fully erupted and moisture of good oral hygiene, use of a high fluoride-
findings.33–36 control is still difficult to achieve.47 The term containing toothpaste, and daily application
As shown in the following case, most of pre-fissure-sealing is used to described the of a calcium and phosphate-containing paste
the outer dentine was removed and a layer use of a high fluorine releasing GIC, such to saturate the biofilm with minerals. The

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 PRACTICE

lesion displayed the three characteristics systematic review. Eur Arch Paediatr Dent 2011; 12:
5–14.
of a remineralised dentine surface; it was 24. Leksell E, Ridell K, Cvek M, Mejare I. Pulp exposure
discoloured, shiny, and hard. However, with after stepwise versus direct complete excavation of
the onset of arthritis the task of keeping the deep carious lesions in young posterior permanent
teeth. Endod Dent Traumatol 1996; 12: 192–196.
area clean became too much of a challenge 25. Lager A, Thornqvist E, Ericson D. Cultivatable bacte-
for the patient. After a period of assessment ria in dentine after caries excavation using rose-bur
it was decided that the area should be pro- or carisolv. Caries Res 2003; 37: 206–211.
26. Bjorndal L, Reit C, Bruun G et al. Treatment of deep
tected with a thin therapeutic coat of high caries lesions in adults: randomized clinical trials
fluoride-releasing GIC, (Fuji Triage®, GC comparing stepwise vs. direct complete excavation,
Corporation). and direct pulp capping vs. partial pulpotomy. Eur J
Oral Sci 2010; 118: 290–297.
27. Ricketts D N, Kidd E A, Innes N, Clarkson J. Complete
CONCLUSIONS Fig. 4a Initial situation: the original caries or ultraconservative removal of decayed tissue in
lesion had been arrested for many years, unfilled teeth. Cochrane Database Syst Rev 2006; 3:
GIC plays an important role in both pre- but with the onset of arthritis the task of CD003808.
ventive and restorative dentistry. It can be keeping the area clean became too much of 28. Fusayama T, Okuse K, Hosoda H. Relationship between
considered as a reservoir of fluoride in the a challenge for the patient. After a period hardness, discoloration, and microbial invasion in
carious dentin. J Dent Res 1966; 45: 1033–1046.
mouth. It can be used as a therapeutic coat- of assessment it was decided that the area
29. Massler M. Changing concepts in the treatment of
ing to protect tooth surfaces against caries should be protected with a thin therapeutic carious lesions. Br Dent J 1967; 123: 547–548.
and contributes to the preservation of tooth coat of high fluoride-releasing GIC, (Fuji 30. Anderson M H, Loesche W J, Charbeneau G T.
Triage®, GC Corporation) Bacteriologic study of a basic fuchsin caries-disclos-
structure by aiding the remineralisation pro- ing dye. J Prosthet Dent 1985; 54: 51–55.
cess and providing a long-term seal. 31. Kidd E A, Joyston-Bechal S, Beighton D. The use of
a caries detector dye during cavity preparation: a
The authors would like to thank Claudie Damour- microbiological assessment. Br Dent J 1993; 174:
Terrasson, publishing director of the Groupe 245–248.
Information Dentaire, Paris, France, for the 32. Mertz-Fairhurst E J, Curtis J W, Jr., Ergle J W,
authorisation of translation and publication of the Rueggeberg F A, Adair S M. Ultraconservative and
series in the BDJ; Drs Sophie Domejean and Avijit cariostatic sealed restorations: results at year 10. J
Banerjee for initiating and supporting this collabo- Am Dent Assoc 1998; 129: 55–66.
rative project. 33. Kidd E A. How ‘clean’ must a cavity be before resto-
ration? Caries Res 2004; 38: 305–313.
1. Mickenautsch S, Mount G, Yengopal V. Therapeutic 34. Alleman D S, Magne P. A systematic approach to
effect of glass-ionomers: an overview of evidence. deep caries removal end points: the peripheral seal
Aust Dent J 2011; 56: 10–15. concept in adhesive dentistry. Quintessence Int
2. Mount G J. An atlas of glass-ionomer cements: a 2012; 43: 197–208.
clinician’s guide. 3rd ed. London: Martin Dunitz, 35. Ferreira J M, Pinheiro S L, Sampaio F C, de Menezes
2002. V A. Caries removal in primary teeth‑a systematic
3. Tyas M J. Milestones in adhesion: glass-ionomer
Fig. 4b Being a conventional GIC, this low
review. Quintessence Int 2012; 43: E9–15.
cements. J Adhes Dent 2003; 5: 259–266. viscosity GIC adheres well to the root surface 36. Momoi Y, Hayashi M, Fujitani M et al. Clinical
4. Wilson A D, Kent B E. A new translucent cement for and acts as a mechanical barrier to protect guidelines for treating caries in adults following a
dentistry. The glass ionomer cement. Br Dent J 1972; the area and minimise plaque accumulation. minimal intervention policy‑evidence and consensus
132: 133–135. It releases significantly much more F than the based report. J Dent 2012; 40: 95–105.
5. Wilson A D, McLean J W. Glass ionomer cement. traditional restorative GICs and if recharged 37. Maltz M, Oliveira E F, Fontanella V, Carminatti G.
Chicago: Quintessence, 1988. Deep caries lesions after incomplete dentine caries
6. Wren A, Boyd D, Towler M R. The processing, with fluoridated toothpaste then the F release removal: 40-month follow-up study. Caries Res
mechanical properties and bioactivity of strontium can be maintained indefinitely 2007; 41: 493–496.
based glass polyalkenoate cements. J Mater Sci 38. Gruythuysen R J, van Strijp A J, Wu M K. Long-term
Mater Med 2008; 19: 1737–1743. 15. Ngo H C, Mount G, McIntyre J, Do L. An in vitro survival of indirect pulp treatment performed in pri-
7. Ngo H, Mount G J, Peters M C. A study of glass- model for the study of chemical exchange between mary and permanent teeth with clinically diagnosed
ionomer cement and its interface with enamel glass ionomer restorations and partially demineral- deep carious lesions. J Endod 2010; 36: 1490–1493.
and dentin using a low-temperature, high-reso- ized dentin using a minimally invasive restorative 39. Bjorndal L. Stepwise excavation may enhance pulp
lution scanning electron microscopic technique. technique. J Dent 2011; 39(Suppl 2): S20–26. preservation in permanent teeth affected by dental
Quintessence Int 1997; 28: 63–69. 16. Nicholson J W. Chemistry of glass-ionomer caries. J Evid Based Dent Pract 2011; 11: 175–177.
8. Ngo H C, Mount G, Mc Intyre J, Tuisuva J, Von cements: a review. Biomaterials 1998; 19: 485–494. 40. Bjorndal L. Indirect pulp therapy and stepwise
Doussa R J. Chemical exchange between glass- 17. Okada K, Tosaki S, Hirota K, Hume W R. Surface excavation. J Endod 2008; 34: S29–33.
ionomer restorations and residual carious dentine hardness change of restorative filling materials 41. Knibbs P J. The clinical performance of a glass poly-
in permanent molars: an in vivo study. J Dent 2006; stored in saliva. Dent Mater 2001; 17: 34–39. alkenoate (glass ionomer) cement used in a ‘sand-
34: 608–613. 18. Gjorgievska E, Nicholson J W, Grcev A T. Ion migra- wich’ technique with a composite resin to restore
9. Ab-Ghani Z, Ngo H, McIntyre J. Effect of reminerali- tion from fluoride-releasing dental restorative Class II cavities. Br Dent J 1992; 172: 103–107.
zation/demineralization cycles on mineral profiles of materials into dental hard tissues. J Mater Sci Mater 42. Andersson-Wenckert I E, van Dijken J W, Kieri C.
Fuji IX Fast in vitro using electron probe microanaly- Med 2012; 23: 1811–1821. Durability of extensive Class II open-sandwich resto-
sis. Aust Dent J 2007; 52: 276–281. 19. Wiegand A, Buchalla W, Attin T. Review on fluoride- rations with a resin-modified glass ionomer cement
10. Ngo H. Glass-ionomer cements as restorative and releasing restorative materials‑fluoride release and after 6 years. Am J Dent 2004; 17: 43–50.
preventive materials. Dent Clin North Am 2010; 54: uptake characteristics, antibacterial activity and 43. Andersson-Wenckert I E, van Dijken J W, Horstedt
551–563. influence on caries formation. Dent Mater 2007; 23: P. Modified Class II open sandwich restorations:
11. Mount G. Glass-ionomer materials. In Hume W R, 343–362. evaluation of interfacial adaptation and influence of
Mount G J (eds) Preservation and restoration of 20. Cranfield M, Kuhn A T, Winter G B. Factors relating different restorative techniques. Eur J Oral Sci 2002;
tooth structure. pp 163–197. Brighton: Knowledge, to the rate of fluoride-ion release from glass-iono- 110: 270–275.
Books and Software, 2005. mer cement. J Dent 1982; 10: 333–341. 44. Simonsen R J, Neal R C. A review of the clinical
12. Wilson D B. Properties of the entry and exit reac- 21. Hengtrakool C, Pearson G J, Wilson M. Interaction application and performance of pit and fissure seal-
tions of the beta-methyl galactoside transport between GIC and S. sanguis biofilms: antibacterial ants. Aust Dent J 2011; 56(Suppl 1): 45–58.
system in Escherichia coli. J Bacteriol 1976; 126: properties and changes of surface hardness. J Dent 45. Kuhnisch J, Mansmann U, Heinrich-Weltzien R,
1156–1165. 2006; 34: 588–597. Hickel R. Longevity of materials for pit and fissure
13. Attal J. Les ciments verres ionomères. In Matériaux 22. Mickenautsch S, Yengopal V. Absence of carious sealing‑results from a meta-analysis. Dent Mater
alternatifs à l’amalgame. pp 12–20. Paris: ADF, 2002. lesions at margins of glass-ionomer cement and 2012; 28: 298–303.
14. Korkmaz Y, Ozel E, Attar N, Ozge Bicer C. Influence amalgam restorations: An update of systematic 46. Beauchamp J, Caufield P W, Crall J J, Donly K J,
of different conditioning methods on the shear review evidence. BMC Res Notes 2011; 4: 58. Feigal R, Gooch B et al. Evidence-based clinical rec-
bond strength of novel light-curing nano-ionomer 23. Yengopal V, Mickenautsch S. Caries-preventive ommendations for the use of pit‑and‑fissure seal-
restorative to enamel and dentin. Lasers Med Sci effect of resin-modified glass-ionomer cement ants: a report of the American Dental Association
2010; 25: 861–866. (RM-GIC) versus composite resin: a quantitative Council on Scientific Affairs. Dent Clin North Am

564 BRITISH DENTAL JOURNAL VOLUME 216 NO. 10 MAY 23 2014

© 2014 Macmillan Publishers Limited. All rights reserved

 PRACTICE

2009; 53: 131–147. 48. Kamala B K, Hegde A M. Fuji III vs. Fuji VII glass materials used as fissure sealants. Eur J Dent 2010;
47. HAS. Appréciation du risque carieux et indications du ionomer sealants‑a clinical study. J Clin Paediatr 4: 245–250.
scellement prophylactique des sillons des premières Dent 2008; 33: 29–33. 50. Lasfargues J J. Odontologie conservatrice et res-
et deuxièmes molaires permanentes chez les sujets 49. Bayrak S, Tunc E S, Aksoy A, Ertas E, Guvenc D, Ozer tauratrice. Tome 1: une approche médicale globale.
de moins de 18 ans. 2005. S. Fluoride release and recharge from different 2010.

Erratum
Letter (BDJ 2014; 216: 488–489)
‘Oral surgery: ARONJ masterclass’
In the above letter, the author list should have read as follows:
A. Moore, S. Ruggiero, S. Rogers, T. Taylor, S. Popat, R. Coleman, S. Leyland, R. Popat, K. Sivardeen, I. Fogelman, A. Hawkesford
and T. Renton

In the original letter the first author A. Moore was omitted in error.
We apologise for any confusion caused.

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