GLASS IONOMER

CEMENTS
http://hi-dentfinishingschool.blogspot.com/

http://apexiondental.com/
 INTRODUCTION
GIC is an adhesive tooth
coloured restorative material used
for eroded areas and now it has
been used for other areas also .

Salt formed by reaction

between poly alkenoic acid and
Calcium aluminoflurosilicate glass .
 HISTORY
developed by Wilson & Kent in 1972 .

Yogi etal - 1992 – GI cement is used as a sealent for

partially erupted permanent molars .

Groll etal – 1993 – Recommended light curable glass

polyalkeonate for amalgam replacement .

Althadaing etal - 1994 – light cured glass ionomer

for repairing furcated
areas on the pulpal floor .

Thevadans etal – 1996 – Mixing of 4 % NaF with GIC.

.
Historical evolution of GIC
 Also named as……
 polyalkeonates .
.
 ASPA (aluminosilicatepolyacrylic acid )

developed by Wilson etal 1970 .

 ADVANTAGES
 Tooth coloured material .

 It will adhere directly to both enamel and dentine

through ion exchange mechanism .

 Biologically active as it is capable of releasing

fluorides , calcium and phosphate .
CLASSIFCATIO
N
CLASSIFICATION

TYPE I - Luting

TYPE II – Resoration .

TYPE III – Liners and bases .

TYPE IV - Pit and fissure sealants .

TYPE V – Orthodontic cements .

TYPE VI – Core built up.

 CLASSIFICATION……
• TYPE I - Luting
• TYPE II - Restoration
• TYPE III - Liners & Bases
• TYPE IV - Resin modified
• TYPE V - Metal modified
• TYPE VI - Ceromers
• TYPE VII - Compomers
• TYPE VIII - Geriatric
• TYPE IX - Pediatric
CLASSIFICATION BY G J MOUNT
Based on the - water powder ratio.
physical properties .
clinical application .

TYPE I – Luting agents .

TYPE II i – Esthetic restoration .

TYPE II ii – Non esthetic restoration .

TYPE III - Liners and bases .

CLASSIFICATION NO:3
TYPE I Conventional

TYPE II Restorative

Class 1 – esthetic restorative cements .

Class 2 – reinforced restorative cements or metal
modified glass ionomer .

TYPE III
Light cured lining glass ionomer cement

( liners and bases ) .

TYPE I –CONVENTIONAL GI.

Mostly used in cementing , luting , liners and

bases .

Powder particle size – 15 micron .

Thickness of cement film – 2 micron .

Thin pulpal dentin is required to be protected

with hard Setting Ca ( OH )2 .
 TYPE II RESTORATIVE GIC

Class I esthetic restorative cement

Mostly used for anterior restorations

Class II reinforced restoration cements

Class I reinforced restoration cement
( metal modified , posterior GI)

Mostly used for posterior restorations .

A ) Amalgam alloys mixed with cements.

B ) Cermet ( ceramic metal mixture )

Glass powder is fused and sintered with Ag
particles .
 PROPERTIES

Resistance to wear as they are stronger and tougher .

Poor esthetics due metallic color

Less pulpal irritation .

Posses anticariogenic properties

 TYPE 3 a – Light cured lining glass
ionomer cements

HEMA ( hydroxy ethyl methacrylate ) added to light

component .

Reduce shrinkage .

To increase strength , powder mixed with alumino –

silicate glass.
Light cured GIC
TYPE 3 b – Light cured glass ionomer cement

COMPOSITION

POWDER - ion leachable glass .

LIQUID - Polyacrylic acid

or
Polyacrylic acid with HEMA .

SETTING REACTION

Initial set – polymerization of methacrylate gp

Final set – slow acid – base reaction

 PROPERTIES

Reduced translucency .

Increased tensile strength

Stronger adhesion to teeth surface .

Decreased marginal adaption and increased marginal

leakage due to polymerization shrinkage .
 TYPE 4 Hybrid resin modified G I

Used as restorative filling material.

HEMA added to liquid component - bonding.

Have higher resistance to wear & tear.

Used in class 1,2,5 filling with conservative cavity

preparation.

Avoid cavities in deciduous teeth.

Light cured GIC
AVAILABLE AS…
 Powder – liquid system .

 Pre – proportionate capsule .

 Light cure system .

 Dual cure system (chemical +light) .

Luting ,restorative & root canal
cements
Cement dispensing system
COMPOSITIO
N
 POWDER
acid soluble calcium fluoro aluminosilicate glass

SiO2 -35-40%

Al2O3 -20-25%

AlF3 -1.5-3 %

CaF2 -15-20 %

NaF -4-10 %

AlPO4 -1-15 %
Fluoride component - ceramic flux .

Lanthanum , strontium,barium , ZnO-

radiopacity .

Fine colloidal Ag and amalgam -

enhance the properties.
 LIQUID
40 -50% acidic solution……

Poly acrylic acid .

Tartaric acid .

Water.
 Poly acrylic acid – very viscous
Tendancy to gelation .

Poly acrylic acid co-polymerized with itaconic acid

maleic acid .

Increases the reactivity of liquid .

Decreases the viscosity .

Decreases the tendency to gelation .

TARTARIC ACID

Improve the handling character .

Decreases the viscosity .
Increases the working time .
Decreases the setting time .

WATER

Most important constituents .

Too much of water- weak cement .
Too little water – dehydration .
 SETTING REACTION
The liquid acid may be freeze dried and combined with
powder [ to have better shelf life and lower viscosity
which are important characteristics for luting agents .

Mix can be done on a disposable moisture resistant paper

pad or a glass slab .

A plastic spatula is preferred to a metal one to minimize

contamination of the mix from eroded metal .

Large increment of powder are rapidly incorporated into

the liquid and mixing should be completed within 40 sec
Working time – short , not more than 3 min from start of
mixing .
 SETTING
REACTION
Powder and liquid mixed together

Acid attacks the glass particles .

Na,Ca,Al ,F ions are leached into the

aquous solution

Ca poly salts in the beginning and later

Al – poly salts .

Two salts cross links to form polyanionic

chain.
 STRUCTURE OF SET CEMENT

Agglomerates of un reacted
powder particles surrounded by silica gel
and embedded in an amorphous matrix of
hydrated Ca-Al polysalts .

Fresh cement once

hardened is prone to cracking and crazing
due to loosely bound water which is
readily removed from mix .

Setting time – Type 1 4 – 5 min

Type 2 7 min
 STEPS IN GI
RESTORATIO
N
• Cavity preparation

• Conditioning of tooth preparation

• Proper manipulation

• Protection of cement from setting

• Finishing
 CAVITY PREPARATION

Proper adhesion → resistance →

retention is achieved by proper cavity
preparation .

Eroded rough surfaces can be

restored after acid etching alone without
proper preparation.
 CONDITIONING OF TOOTH PREPARATION

Chemical adhesion of cement with tooth

surface .

Surface should be free of saliva, blood and

completely dry .

Smear layer on the cavity should be removed .

This is done by
Pumice wash
10 % polyacrylic acid
37 % H3PO4
Time 10 to 20 sec
Surface of dentin after
application of……….

37% ortho phosphoric

acid

10% poly acrylic acid

PROPER MANIPULATION

P/L ratio - type I 3:2

type II 3:1

Hand mixing

Capsule mixing
 Hand mixing
Divide the dispersed powder into two equal
parts .

Powder is incoperated rapidly into liquid .

Mixing should be done in a folding manner in

order to preserve the gel structure .

10 sec after adding first increment , 2nd

increment is added to liquid .

The final mix should be with in 25 to 30 sec .

 CAPSULE MIXING

Amalgamator is used for mixing

Powder and liquid contained within capsule by

removing the seal separating the liquid and powder .

After mixing is completed by vibration nozzle of the

capsule is pierced and the cement is dispersed
directly on the prepared cavity .

Advantage

Control over p/l ration

Convenience
Mechanical mixing
PROTECTION OF CEMENT
DURING SETTING

Matrix placement

Matrix removal
 MATRIX PLACEMENT

Pre contoured matrix is placed over the cement in

the cavity for a period of 5 – 8 mts

ADVANTAGES

- Provide best possible surface integrity

- provide maximum contour
- prevent loose or gain of water from cement before
initial setting is completed .
 MATRIX REMOVAL

– After initial setting the matrix is removed.

Excess material is removed by sharp hand
instrument BP knife .
-Cement then coated with:

-light curable bonding agent

-Vaseline

This prevent loose or gain of water . dehydrated

restored cement become weak due to microcracks.
 FINISHING

Before dismissing the patient , apply one or

more layer of protective agents .

GIC is not advised in patient with

xerostomia , with mouth breathing habits
(restoration are susceptible to dehydration) .
Occlusal caries on mandibular 1st
molar
Caries excavation using spoon excavator
Completed caries excavation
CEMENT PLACED
Excess cement removed
Finishing done
LOSS OF GLOSS OR SLUMP TEST
USES
For luting

For restorations

Liners and bases

Fissure sealants

Orthodontic purpose

Core build up

Intermediate Restorations
Adhesive Cavity Liners (Sandwich Technique)
ART (Atraumatic Restorative Technique)
Restorations for deciduous teeth
 Luting Agents

Excellent for permanent cementation of crowns, bridges.

Releases fluoride reduces sensitivity by giving a firm

foundation for composites.

Fast setting - low film thickness & low viscosity.

P/Lratio………… 1.5:1

Typical Physical Properties:

Mixing Time: 15 seconds
Setting Time: 2 minutes
Working Time: 2 minutes
Luting agent
 Orthodontic Bracket Adhesives

 Most commonly used .

 They bond directly to tooth by the interaction of

Polyacrylate ions and hydroxyapatite crystals, thereby
avoiding acid etching.

 Anticariogenic effect -
fluoride releasing ability.
 Pit and Fissure Sealants

Cements were found to be unsuitable for

use as sealnts if the fissures were less than
100µm wide.

The material is mixed to a more fluid

consistency to allow flow into the depths of
the pits & fissure of the posterior teeth.
Carious pit & fissures on
mandibular molar
Conditioner applied
Placement of the cement
 Liners and Bases

GICs have a number of advantages as cavity

lining as they bond to dentine and enamel
and release fluoride

-prevent decay & therefore minimizing the

chances of
appearance of secondary carries
-promote the formation of secondary dentine.

They can be used as base for both

composite resin and amalgam.
GIC as a Base ( P/L ratio-3:1)
Class III cavity preparation in 32
-Liner placed for pulp prottection
( P/L ratio – 3:1 )
GIC as a lining – 0.5mm thick
 For Core Build Up

Silver containing GICs (cermet, Ketac Silver, Espe,GMbH

or 'miracle mix' of GIC &unreacted amalgam alloy have been
used.
Cermet used to fill deciduous teeth .
Addition of Ag radiopacity to diagnose secondary caries.
To protect a GIC core crown margin should completely
embrace 1-2 mm of sound tooth structure cervically.
Extension of crown margin -ferrule effect

Advantages:
to tooth Intrinsically adhessive
Fluoride release - freedom from 2° decay
Similar coefficient of thermal expansion
DEVELOPING
A CORE
 Intermediate Restorations

Due to inherent adhesive nature & brittleness

To restore loss of tooth structure from the

roots of teeth [cervical abrasion cavity-product
of over zealous tooth brushing]

Used frequently as in non-undercut cavities,

to ensure their retention
Deep caries
Temporary restoration - GIC
Adhesive Cavity Liners (Sandwich
technique)

Involves using GIC as dentin replacement and a

composite to replace enamel

Surface should be coated either with an

unfilled resin or a DBA to optimize attachment.
 ART (Atraumatic Restorative Treatment)

The technique uses simple hand instruments (such as

chisels &excavators) to break through the enamel &
remove caries

The cavity is loaded using cotton rolls.

Then residual cavity is restored using a modified GIC.

These GICs are reinforced to give increased strength

under functional loads and are radio opaque.
 Restorations for Deciduous Teeth

Due to high fluoride release ,minimal cavity

preparation & adhesion to dental hard tissue.

Restoring carious teeth is one of the major

treatment needs of young children.

And because they require a short time to fill the

cavity, Glass ionomer cements present an additional
advantage.
PROPERTIES
 Film Thickness

The film thickness of GICs is similar to or less

than that of zinc phosphate cement and is

suitable for cementation.

 MECHANICAL PROPERTIES

Compressive strength – 150 mPa

Tensile strength – 6.6 mPa

Hardness – 49 khn

The resin-modified materials have been shown to

have significantly higher tensile strengths and lower
modulus of elasticity than the conventional materials.
 ADHESION

Good adhesion to enamel and dentin.

Bonding occurs between exchange of ions .

Some degree of bond is also developed between GI

& collagen fibres of dentin.

Bond to enamel more than dentin , due to its high

inorganic content and homogenesity .
 ION EXCHANGE ADHESION
BETWEEN TOOTH & CEMENT
 AESTHETICS

Inferior to silicate and composite .

Lack translucency and have rough surfaces

texture .

Rough surface texture .

 Margin Adaptation and Leakage
The coefficient of thermal expansion of
conventional GI is close to that of dental hard
tissue- so good margin adaptation of GI
restorations.

Shear bond strength of GIC doesnt approach

that of dentin bonding agent, resin-modified GIC
exhibit microleakage .

This may be partly because their

coefficient of thermal expansion is higher than
conventional materials, though still much less than
composite
 BIOCOMPATIBLITY

High degree of compatibility to living tissue

Polyalkenoic acid with high molecular weight is

difficult to penetrate throught dentinal tubules .

Induce secondary dentin formation in mechanically

exposed pulp .

In deep cavities Ca(OH)2 should be used to

prevent post operative sensitivity .
RESISTANCE TO PLAQUE- Lack of plaque
build up relative to adjacent teeth
 ANTICARIOGENIC PROPERTIES

GIC is considered as a fluoride reservoir

Remineralisation of tooth structure due to release of Ca

, PO4 and F ions

Streptococcus mutans is unable to thrive in the presence

of F ions . so low accumulaton of plaque .

Minimize the white spotting and decalcification which is

seen around orthodontic brackets .

Orthodontic bands on posterior teeth – luting agent of

choice is GIC
FLUORIDE RELEASE
Fluoride re-uptake & release-
after recharging with NaF gel
 WATER BALANCE

Susceptible to both water loose and

water uptake.

Type 3 cement remains susceptible to

water uptake for at least one hrs to 25 hrs
after placement.

Resin modified G I were developed to

overcome this problem.
 CLINICAL IMPORTANCE

GIC susceptable to dehydration should be coated

with varnish during dental procedure .

Contraindicated in mouth breathers and xerostomia

patients due to dehydration .

Failure to protect with matrix / varnish / resin bond

agent will result in chalky / crazed surface .

Decreased P/L ratio gives chalky surface .

Liquid with PAA not to be refrigerated which

increases viscosity.
DISADVANTAGES OF CONVENTIONAL
GIC

Short working time

Sensitivity to moisture exposure

Dehydration during setting.

Lower cohesion strength.

Less resistence to abrasion and wear than composite .

MODIFICATION OF
GIC
Resin modified GIC .

Metal modified GIC .

Fast setting materials .

Water settable GIC / anhydrous .

Compomers .
 RESIN
MODIFIED
GIC
Cement are light cured by adding 5% resin
matrix to GIC .

They also retain the acid – base reaction .

RESIN MODIFIED GIC
 COMPOSITON

Ion leachable glass ( fluoro alumino silicate

glass )

Polymerisable resin.

Photo initiator or chemical initiator or

both .
 LIQUID
PAA

H2O

Methacrylate monomer .

Hydroxy ethyl methacrylate monomer (HEMA) .

The acid base raction will continue even in the

absence of light activation .
Clean lesion with pumice & water
• Condition with
10% poly acrylic
acid for 10sec
 Apply pressure during placement to
minimise porosity & good wetting of the
tooth
Trimming & contouring under air –
water spray
 PROPERTIES

Microleakage more than GIC due to

polymerization .

Good anticariogenic property due to

increased F content.

Pulpal response mild .

Good esthetics .
 USES
Class 1

Class 2

Class 5

For repair of cavities .

Class V non carious lesion
restored with RMGIC
METAL MODIFIED
GIC

Miracle mix
Cermet
 CERMET

Filler particles are added…………

To improve Strength

Fracture toughness

Resistence to wear
 CERMET REPAIR ON BUCCAL CUSP OF
BICUSPID HAS BEEN IN PLACE FOR 6years
& APPEARS STABLE
Metal modified GIC
 MIRACLE MIX

Also called silver alloy admix .

Spherical amalgam alloy powder mixed with

type II GIC .

Not used in anterior teeth – due to radio

opacity and metallic color .
Miracle mix
 CERMET

Ag particles are bonded to glass particles by

sintering ( fusion at high temp)

USES

Alternative to amalgam and composite .

In core build up in grossly destroyed

teeth .
 PROPERTIES

Excellent anticariogenic property due to F ions.

More resistance to wear than GIC.

Poor esthetics –radiopaque and gryeyish in color.

.
 FAST SETTING MATERIALS

Glass in these cements has been chemically

modified during manufacturing to decrease the Ca2+
content and thus limit the production of Ca-poly
alkeonate chains which are highly water soluble .

Faster maturation of setting reaction .

Decrease the translucency .

 WATER SETTABLE GIC (ANHYDROUS)

Polyacrylic acid co-polymer is freeze dried and

coated to powder particles.

The liquid part is water or water with tartaric acid.

When powder is mixed with water the polyacrylic acid

goes in to solution to form liquid acid.

Cements undergo chemical reaction.

Cements set faster than normal cement.

Have improved physical properties.

COPOMER (POLYACID MODIFIED RESIN )

Hybridisation of composite and glass ionomer

Composite + ionomer = copomer

Variable degree of dehydrated polyalkenoic acid

incoperated with filler .

The setting reaction is light activated .

Subsequent absorption of water from saliva into

restoration will release small amount of fluorides
 Adhesive system is based on acid
etch or resin bond system and no ion
exchange adhesion.

Used in children.

Have minimal steps in placement.

Aesthetically pleasing.
Finished case
TUNNEL RESTORATION

First discribed in 1963

Conservative alternative cavity

preparation in primary molars.

Indication
Small proximal caries with out
involvement of marginal ridges
 SANDWICH TECHNIQUE

GIC is sandwiched between tooth and composite resin.

Used in case of deep carious lesion.

ADVANTAGE
Etching avoided in deep caries- avoid pulpal
irritation.
Better strength is achieved .
Prevent recurrent caries due to F ion release .
Chemical bonding to tooth achieved by GIC .
Open sandwich
restoration

Closed sandwich
restoration
 Lamination with amalgam
• Combination of GIC with amalgam
• To with stand heavy occlusal load.
• STEP –I , A strong GI base(auto cured
or resin modified) is applied first.
• Fine layer of 45% poly acrylic acid
applied over cement – ensure chemical
bonding.
• STEP II , Pack amalgam over this.
• Mechanical interlocking occure between
two
 …………STEP I

STEP II……………
 CONCLUTION….
• No one material is universal and it is
unlikely that such an ideal material
limitations, bt each one , used to its
full potential , has aplace in
restorative dentistry.there have been
20years of close clinical observationof
GIC
 Text book of pedodontics - Shobha
Tandon

• Preservation &restoration of tooth structure -

Graham J Mount

• Text of pediatric dentistry - S.G.Damle

• Pediatric dentistry,infancy through adolescence

• - Pinkham
• Dentistry for the child & adolescent
- Mc Donald,Avery,Dean

• Sturdevant”s Art & Science of Operative Dentistry

THANK YOU