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GLASS IONOMER CEMENTS

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INTRODUCTION HISTORY CLASSIFICATION DEFINITION COMPOSITION SETTING REACTION PROPERTIES CLINICAL PROCEDURES DISPENSING AND MIXING FINISHING AND POLISHING CLINICAL USES CONCLUSION

Introduction:
Necessity is the mother of invention It was the late 1960s. History had already witnessed a host of restorative materials includin amal am! com"osite! cast alloys etc. #ut all had fallen short of that certain

"erfection that the dental researches and clinician yearned for$..that of a material that would #e esthetic! adhesive! #iocom"ati#le! anticario enic and relatively economical. It was durin this time that a cement came into the "icture and created %uite a sensation #y not only "ossessin a ma&ority of the desira#le "ro"erties #ut also "rovidin much sco"e for modification and im"rovement. 'his was the (lass Ionomer )ement.

History
'he study of this versatile material would #e incom"lete without e*"lorin a little #it into its "ast to a""reciate the (I) as we +now today. 'he history of tooth coloured restorative material #e an with the introduction of silic t! c!"!nt #y T$ Fl!tc%!r &'()'*. ,nfortunately! it radually lost its "o"ularity due to its hi h de ree of acidity and solu#ility It was in '+,' that a certain -wiss chemist! Dr$ Osc r H --!r! first demonstrated the adhesion of a resin to the tooth which was a""ro"riately ca"itali.ed on #y .uonoc r! in '+,, to define the "rinci"les of the acid/ etch techni%ue to #e later utili.ed #y .o/!n in '+,( to develo" the co"0osit! restoration. 'hus! the conce"t of adhesion to the tooth was finally a reality. 'he first ma&or #rea+ throu h in the conce"t of dentin adhesive via ion e*chan e was made #y D$C s"it% who develo"ed the 0olyc r#o1yl t! c!"!nt usin "olyacrylic acid and 0n1 In '+2+! .$ E$ 3!nt discovered a %i-% 4luorid! cont inin- -l ss leadin to the invention of the 1st ancestor of (I) / the ASPA I$ 'his was not free from its share of "ro#lems which included / / / -lu ish set 2inimal wor+in time 3ow de ree of o"acity

In '+)56 ASPA II was concocted usin t rt ric cid in the "revious formulation. 'his enhanced :

/ / /

4' 2ani"ulation -ettin rate elation of 566 #y addin "!t%yl

'his was the 1st "ractical (I). In '+)7 8ilson nd Cris0 tried to control the lco%ol and came u" with ASPA III #ut this formulation tended to stain. -o! in '+),! #oth of them discovered ASPA I9 which contained co :0oly"!rs o4 crylic nd it conic cid. 'his formulation did not el. 6-56 I7 is the "recursor of the modern (I). 6 4in! -r in!d ;!rsion 4or lutin- was develo"ed in '+)) so was a hi hly translucent version called ASPA X #y Cris06 A#!l < 8ilson$ In '+(7! Pross!r develo"ed the first n%ydrous GIC called ASPA 9$ 'his contained 566 in a dry "owder form #lended with lass "owder! which was then mi*ed with water or tartaric acid. 6dvanta e included: / / -ufficient mi*in %ualities Hi her stren th

In '+(,! Mc L! n nd G ss!r develo"ed the C!r!"!t ionomer cement #y fusin silver "articles to the lass "articles for #etter #urnisha#ility 2ost of the later develo"ments was done #y individual dental material com"anies. 6 whole new s"ectrum of (I)s ran in from a conventional (I) at one end to a modified com"osite at the other side is now availa#le . Newer and newer varieties are comin into the mar+et and awaitin clinical trials.

Cl ssi4ic tion
I. 6ccordin to 5hili"s: 'y"e I 8 3utin 'y"e II 8 9estorative 'y"e III 8 3iner and #ase

II. 6ccordin to :avidson and 2&or: 1. )onventional; 'raditional a. #. c. d. e. f. (lass Ionomer for direct restorations 2etal reinforced (I) Hi h viscosity (I) 3ow viscosity (I) <ase;3iner 3utin

=. 9esin modified (I) a. #. c. d. e. 9estorative <ase;3iner 5it > fissure sealant 3utin 1rthodontic cementation material

?. 5olyacid modified resin )om"osites;)om"omers

III 6ccordin to (@ 2ount: 1. (lass ionomer cements: a. AiB (lass 5olyal+eonates AiiB (lass "oly"hos"honates #. 9ein modified (I) c. 5olyacid modified com"osite resin =. a. 6uto/cure #. :ual )ure d. 'ri cure ?. a. 'y"e I 8 3utin #. 'y"e II 8 9estorative 'y"e II.1. 9estorative aesthetic

'y"e II.=. 9estorative reinforced c. 'y"e III 8 3inin or <ase I7 6ccordin to -turdvent: 1. 'raditional or conventional =. 2etal modified (I) a. )eremets #. 2iracle 2i* ?. 3i ht cured (I) C. Hy#rid A9esin modified (I)B D. 5olyacid modified resin com"osites or )om"omer 7. 6ccordin to 4ilson > 2c3ean A199EB 1. 'y"e I 3utin =. 'y"e II a. 6esthetic fillin material #. <is/reinforced fillin material Aincludes ceremetsB ?. 'y"e III 8 3inin ! #ase and fissure sealant 7I: <ased on chemical constituents of cement: 1. )onventional =. 2etal reinforced a. 2iracle mi* #. )eremets ?. 9esin modified 7II. 6ccordin to intended a""lications: 1. 'y"e I =. 'y"e II ?. 'y"e III C. 'y"e I7 / / / / 3utin 9estorative Fast settin linin Fissure sealants

D. 'y"e 7 6. 'y"e 7I G. 'y"e 7II E. 'y"e 7III 9. 'y"e IH

/ / / / /

1rthodontic cements )ore #uild u" material Hi h fluoride releasin command set (I) (I) for 6traumatic 9estorative 'reatment A69'B (eriatric and 5aediatric (I)

7III. 6ccordin to 2c3ean! Nicholson > 4ilson A199CB: 1. (lass Ionomer cement a. (lass "olyal+eonates #. (lass 5oly"hos"honates =. 9esin modified (I) ?. 5olyacid modified (I)

Con;!ntion l GIC
D!4inition: (lass ionomer is a com#ination of I(lass"owder and Iionomer/ic acid (I) can #e defined as a water/ #ased material that hardens followin an acid/#ase reaction #etween the #asic fluoro aluminosilicate lass "owder and an acidic solution of "olyacrylic acid. Co"0osition

Po/d!r J Is #asically an acid solu#le calcium aluminosilicate

lass containin

fluoride. It is formed #y fusin silica K alumina K calcium fluorite! metal o*ides and metal "hos"hates at 11000/1D000 ) and then "ourin the melt onto a metal "late ; into water. 'he lass formed is crushed! milled and round to a form "owder of =0 8 D0 si.e de"endin on what its oin to #e used for. 'hey et decom"osed #y acids due to the "resence 6l
K?

ions which can easily enter the silica networ+. It this "ro"erty

that ena#les cement formation. Functions of com"onents: Alumina A6l= 1?B / / / / / / / / / -+eletal structure Increase o"acity -+eletal structure Increase 'ranslucency :ecrease fusion t1 6nticario enecity Increase translucency Increase wor+in time Increase stren th

Silica A-i1=B

Fluoride: Its has D functions

Calcium fluoride A)a F=B / / / / / / / Increase o"acity 6cts as flu* :ecrease meltin to Increase translucency Increase translucency 6cts as flu* Include hi h reactivity of lass with "olyacid.

Aluminium phosphates

Cryolite ANa? 6l F6B

Na+, K+, Ca+2, Sr+3

6l= 1? : -i1= ratio is crucial and should #e L 1:= for cement formation to occur. )ement formation will occur only when there will there #e sufficient re"lacement of -i #y 6l to render the networ+ susce"ti#le to acid attac+. 'he lass can #e modified #y several ways to enhance the "hysical "ro"erties of the cement. 1. )a can #e re"laced #y -r! <a or 3a to ive a 9;1 lass =. 4ashin lasses with or anic acids to remove surface concentration of )a which will hel" "rolon 4' ?. )orundum! 9utile! <addelyte dis"erse "hases can #e added to increase fle*ural stren th C. 2etals! resins! fi#ers are added to increase the stren th. Li=uid: 1ri inally! the li%uid for (I) was an a%ueous solution of 566 in a concentration of a#out D0M. 'his was %uite viscous and tended to el over time. 'hus! 566 was co/ "olymeri.ed with other acids such as itaconic! maleic and tricar#o*ylic acids. 'his "olyelectrolytic li%uid of (I) is! thus! also called as "olyal+enoic acids. 9ecently "olyvinyl "hos"horic acid has also #een introduced to this system. 6 ty"ical li%uid of (I) contains C0/DDM of =:1 "olyacrylic : itaconic acid co/ "olymer and water. 'he #asic functions of these co8"olymers include: / the co/ "olymeric acids are more irre ularly arran ed than the homo "olymer. 'his reduces H/ #ondin #etween acid molecules and reduces de ree of ellin / / / decrease the viscosity reduce tendency for elation!hence! im"roves stora e. Increase the reactivity of li%uid

'he rest of the li%uid com"rises of water! which is an im"ortant constituent of (I). It is the reaction medium and hel"s in hydratin the matri*. Additi;!s> 1.'artaric acid

/ Increases 4' / Increases translucency / Im"roves mani"u#ality / Increases stren th D/1DM of o"tically active isomer of '6 is added. =.5oly"hos"hates: e*tends 4' ?.2etal o*ides: accelerates -' 'he reactivity of the "olyacid de"ends on: / in redientsJ malec acid is a more reactive acid than 566 / 2ol .wt and concentrationJ increase reactivity 'here are some other effects of these co/"olymers: / / decrease adhesion. 6ccordin to 6#oush > @en+ins A19E6B cements #ased on co 8"olymer #ond less stron ly than those #ased on 566 decrease resistant to acid attac+: -etchell > coA19EDB

Note: 'o e*tend 4'! 566 can #e free.e dried; vacuum dried and incor"orated with the lass "owder. 'he li%uid here is either water or an a%ueous solution of tartaric acid. 4hen mi*ed! the acid dissolves to reconstitute the li%uid acid and the reaction "roceeds in the normal manner. 'hese cements have a relatively low density and are "articularly suita#le for lutin and as liners. 'hese (I) are termed / t!r s!tt #l! GIC?s or erroneously as n%ydrous GIC?s .

SETTING REACTION>
6n understandin of the settin reaction is needed to a""reciate the scientific technolo y of (I) and their correct clinical usa e. 'he settin reaction can #e descri#ed in several sta es. 1. D!@co"0osition:

4hen the 5 and 3 are mi*ed! the surface of the (I "articles are attac+ed #y the HK ion of the acid. 'his results in decom"osition of the a#out =0/?0M of the lass and the leachin of )aK=! 6lK?! NaK! F/ ions into the a%ueous medium. =. Mi-r tion: 6cid attac+ occurs "referentially at )a/rich sites and these metal ions mi rate into the a%ueous "hase of the cement towards the 566 chains. ?. G!l tion: 5olyacrylic acid chain entan lement! ionic #onds and H/#ondin are all involved in matri* formation. )hains et initially cross lin+ed with the more readily availa#le )a ions leadin to "reci"itation of calcium "olyacrylate and elation. 6 clinically Ihard surface forms within C/10mins from start of mi*in . 'his initial clinical set is achieved #y )a K= ions. C. Post S!t H rd!nin-: 1ccurs when the less mo#ile 6lK? ions #ecome increasin ly #ound to the "olyacid and "reci"itate as the more ri id aluminium "olyacrylate. D.Furt%!r " tur tion: 1ccurs over the ne*t =C hrs as the cement develo"s resistance to desiccation and acid attac+. 'he cross lin+ed "hase ets hydrated in this sta e which causes im"roved "hysical "ro"erties. 'he NaK ion contri#utes to the formation of orthosilicic acid on the surface of the "articles. 6s the "H rises this converts to a silica el around the un/ reacted lass "articles which aids in #indin the "owder to the matri*. NaK and F ions do not "artici"ate in the cross/lin+in . NaK ion may re"lace HK ion of the car#o*ylic rou" while the rest com#ine with F ion to form Na F. F ions lie free within the matri* and are a#le to move in and out of the cement. 'hus! the cement structure can #e descri#ed as an 0o/d!r 0 rticl!s surround!d #y C nd Al 0olys lts --lo"!r tion o4 un@r! ct!d

silic -!l in n "or0%ous " tri1 o4 %ydr t!d

Rol! o4 8 t!r: (I)s are water #ased cements and water "lays an im"ortant role in their settin and structure. Its functions include:

It is the cement formin medium into which cations are leached and et carried towards the 566 chains. It serves to hydrate the silica el and metal salts > causes increase in stren th It is an essential "art of the cement structure and if lost while settin ! the cement formin reaction will sto". 4ater "resent in the set cement can #e ar#itrarily classified as: / loos!ly #ound / t!r which can et readily removed #y dessication. 'his is associated with )aK= durin the initial reaction / ti-%tly #ound / t!r is the one which hydrates the matri* as settin continuous and cannot #e removed #y dessication. 'his is associated with 6lK? and is critical in yieldin a sta#le el structure and #uildin the stren th of the cement. Prot!ction: 4ater is easily ained and lost #y the cement. :essication can cause cra.in and crac+s on the surface. 6ny water contamination at this sta e leads to dissolution of the matri* formers resultin in wea+ and solu#le cement. Narly contact with water causes hy rosco"ic e*"ansion! disru"tion of cement surface and surface rou hness. -o! "rotect (I) from the = e*tremes /dessication and a%ueous fluids/ usin suita#le #arriers li+e vaseline! :<6 etc. F ctors !44!ctin- s!ttin-: 1. )hemical )onstituents: aB 6lumina: -ilica ratio J If hi her the ratio! faster the set #B FJ delays elation and "rolon s 4' cB 'artaric acidJ Faster the set. =. 5article -i.eJ Finer the "owder faster the set and shorter the 4' ?. 5: 3 J 2ore the 5: 3 /faster the set C. t0 of mi*in J 2ore t0 /faster the set

Pro0!rti!s o4 GIC

(I) show a variety of "ro"erties and are clearly very diverse materials

ADHESION:
(I) have the im"ortant "ro"erty of adherin to untreated N and :. It adheres to the smear layer on cut : and also to reactive "olar su#strates li+e #ase metals. <ondin #ein chemical! #ond stren th develo"s in the first 1D mins of "lacement 6dhesion of (I) hel"s in: / / 5rovidin a conservative a""roach to restorations 5rovidin a "erfect seal ested the chelatin of calcium ions of the H6 with the

7arious s"eculation have #een made on the mechanism of adhesion 1. -mith A196EB: -u car#o*yl rou" of the 566. =. <eech A19G?B: said that interaction #etween the H6 and 566 "roduced "oly acrylate ions which formed stron ionic #onds with surface )aK= ions of N and : ?. 4ilson A19GCB: 5ostulated that wettin and initial adhesion is #y H/#ondin "rovided #y free car#o*yl rou"s. 6s the cement a es! the H/#ond is re"laced #y ionic #onds. C. 4ilson! 5rosser and 5owis A19E?B:6ccordin to them! 566 enters molecular surface of the H6 and dis"laces the )aK= and 51/? ions leadin the interface #etween the cement and H6. D. 6+inmade and Nicholson A199?B termed the a#ove theory Idiffusion #ased adhesion system 4hile there is eneral a reement that #ondin to enamel results from ionic and "olar forces! o"inions differ on #ondin with dentin. <eech A19G?B and @ac+son A19E6B said that #ondin to dentin occurred to its H6 "art with no colla en involvement #ut a study #y 6+inmade A199CB revealed that a de ree of adhesion to colla en of dentin via H/#ondin #etween car#o*yl rou"s and colla en molecule did occur. to the formation an intermediate layer of )a and 6l "hos"hates and "olyacrylates at

6dhesion to enamel is #etter than to dentin due to the hi h inor anic content and reater homo eneous nature of enamel. <ond stren th to enamel is =6/96 25a while that to dentin is 11/C.D 25a. If a restoration fails! the failure is usually cohesive within the cement rather than adhesive at the interface. 6dhesion can #e im"roved #y usa e of sur4 c! condition!rs! which hel"s to eliminate the wide variation found after cuttin . <etter wettin and interfacial contact will occur if a smooth surface is attained. )onditioners hel" to: / / / 9emove the smear layer Increase surface ener y of tooth Increase wetta#ility and therefore decrease contact an le.

:ifferent )onditioners used are : 1. 566 : Is the conditioner of choice as it is a "art of the cement formin acid. It alters the surface ener y! e*"osin 10secB =. D0M citric acid! D sec ?. =DM tannic acid! ?0 s C. =M Ferric chloride D. NaF 6. N:'6 G. 2ineralisin solution 8I'- solution! 3evine solution hi hly minerali.ed tooth surface to diffusion of acid and ion e*chan e. 'his enhances ada"tation of cement A10M!

.IOCOMPATI.ILITY:
6dverse affect of (I) on livin tissues are minimal. 6ny inflammatory res"onse of "ul" towards (I) due to its hi h initial "H of 0.9 to 1.6 resolves within =0/?0 days. No ill effects are caused #y 566 #ecause: / 566 is a wea+ acid! which #ecomes wea+er when "artly neutrali.ed

/ / /

Its diffusion into the tu#ular dentin is unli+ely due to its hi h molecular wei ht and heavy chain entan lement It ets readily "reci"itated #y the calcium ions in the tu#ules. :issociated HK ions remain near the chain due to electrostatic attraction

'he occasional "ost insertions sensitivity encountered on lutin full crowns is due to / / / / / / / 'he hi h initial "H O=.?? A566B li%uid and 1.G6 Awater setta#leBPwhich "ersists for a#out D mins. 3ower 5: 3 ratio 5re/e*istin "ul"itis 2inimal : thic+ness to "revent this! certain "recautions should #e ta+en. :ont remove smear layer 5rotect dee" areas of cavities with )a A1HB= 6""ly :<6 #efore crown insertion.

ANTICARIOGENECITY:
(I) has the uni%ue "ro"erty of #ein cariostatic due to the sustained release of fluoride! which confers resistance to caries not only on the restored tooth #ut also on the ad&acent tooth. 'he influence of fluoride is found in a .one of resistance to deminerali.ation! which is at least ?mm thic+ around a (I) restoration AQidd! Hic+s! Hot.B. Fluoride contri#utes to carious inhi#ition in the oral environment #y means of #oth / 5hysicochemical mechanism / <iolo ic mechanism

5hysiochemical: 'he F ions #ecome incor"orated in the H6 crystals to form fluora"atite which is resistant to acid mediated decalcification. 'he ions decrease the surface ener y of the a"atite ma+in it difficult for "la%ue to adhere.

'he ionic fluoride shifts the e%uili#rium towards re/minerali.ation. F acts as a catalyst for u"ta+e of )a and 51C ions. )arious enamel #ein more "orous! allows reater "enetration of F and thus more u"ta+e of )a and 51 C occurs leadin to formation of acid resistant crystals and the lesions treated with fluoride are more acid resistant than intact N

<iolo ic: F inhi#its car#ohydrate meta#olism #y acido enic "la%ue flora leadin decreased acido enecity It alters the "roduction of e*tra/cellular! insolu#le "olysaccharide which hel"s in formin adhesins of #acteria and thus inhi#it adhesion. It also alters the acid tolerance of -. mutans to "roduce a less acido enic "la%ue flora. In hi her concentration! F is #actericidal to sensitive #acterial "o"ulations efficacy of fluoride addition to the restorative to

'wo "rinci"al concerns re ardin material / /

4hat is the amount and lon evity of F releaseR 6s it ets released! will material "ro"erties et de radedR

F release is diffusion limited and affected #y concentrations in #oth matri* and "articles. 'he initial hi h #urst of F release is due to hi h concentration of F that e*ists in the matri* immediately after settin when the acid dissolves the "owder "article ed es. In the ne*t ? months! decline in the release occur when F from reater distance in the matri* away from the surface et slowly released. 6 slow diffusion follows when F from the "articles et released at a much slower rate. 'his may occur for many years. 6 to"ical F a""lication will increase the release for a short term. 6 (I) can thus #e re arded a 4luorid! r!s!r;oir. 'he second concern was re ardin de radation of material "ro"erties. Fluoride and its salt NaF are #oth not matri* formin s"ecies and thus the cement is not wea+ened #y the loss of F.

AESTHETICS:
6 de ree of translucency e*ists for (I) due to the lass fillers. Its translucency de"ends on its formation. It is im"ortant to note that #ecause of slow hydration reactions! (lass ionomer ta+es at least =Chrs to fully mature and develo" translucency. 'ranslucency increases as the cement a es. 9esistance to stain is lar ely de"endent on o#tainin a ood surface finish. 'he colour seems to #e unaffected #y oral fluids as com"ared to com"osites which tend to stain.

DIMENSIONAL STA.ILITY>
6 correctly mani"ulated and "rotected (I) shows a volumetric settin contraction of S ?M. 6t hi her humidities! the cement tends to a#sor# water and e*"and so much so that a net e*"ansion occurs while at lower humidities! a low shrin+a e occur.

DISSOLUTION AND DISINTEGRATION>


'he loss of solu#le matri* formin s"ecies from the cement can lead to disinte ration of the cement. 'his can #e caused #y: / / / Narly water contamination )hemical attac+ such as "la%ue acids ; 65F el a""lication 2echanical wear

It is mandatory to "rotect the (I) in its first T hour of life. 6 solu#ility of only 0.CM AwtB is seen as com"ared to other cements

DURA.ILITY AND LONGE9ITY>


6ccordin to one study! the (I) restoration evaluated in erosion/a#rasion lesions! E?M showed retention even after 10yrs. Failure rate ran es from 0/G0M! which is more of a measure of the clinicians s+ill than of the inherent %uality of the material

STRENGTH:
1ne of the ma&or limitations of (I) is their susce"ti#ility to #rittle fracture. 6s com"ared to com"osite and amal am! (I)s are wea+ and lac+ ri idity. 'he wea+ness a""ears to #e in the matri*! which is "rone to crac+ "ro"a ation. 6 certain

de ree of "orosity also develo"s as it is a = "art material! which needs to #e mi*ed "rior to "lacement

RADIOPACITY:
(I) are fairly 9;1 due to inclusion of radio o"acifies li+e <a-1 C. 2ost (I)s are sli htly more radio"a%ue than dentin and can #e differentiated in radio ra"h.

Clinic l Proc!dur!>
'o ensure the successful use of (I)! ? "arameters to #e controlled include / / / )onditionin of tooth surface 5ro"er mani"ulation 5rotection of cement durin settin -elect the a""ro"riate shade Isolate tooth with cotton rolls or ru##er dam if there is a chance of in ival see"a e ; #leedin 5re"are the cavity For erosion ; a#rasion: sli ht rou hnin ; cleanin with "umice slurry )arious lesion e*cavation via conventional instrumentation If 2.:.' is U 0.Dmm! line the cavity with )aA1HB= liner 6""ly surface conditioner to im"rove adhesion. 4ash thorou hly with water for ?0s :is"ense the cement on a cooled lass sla#; "a"er "ad and %uic+ly incor"orate into li%uid and mi* #y foldin techni%ue in CD/60 secs. with a ate s"atula. In hi her humidities the lass sla# should not #e cooled as this causes condensation and incor"oration of water into the mi*. 'he "ro"er 5:3 ratio should #e followed 6 lossy mi* should #e attained as this indicates the "resence of "oly acid! which will ta+e "art in adhesion

5rocedure:

'he surface should #e dried #ut not desiccated 'he cement is "laced and a "re/contoured matri* is "laced to "rovide: o )ontour o Nnsure surface inte rity o 5rotect settin cement

6llow the cement to set ACminsB 9emove the matri* and immediately a""ly varnish ; <6. 'his is the most critical ste". 'rim e*cess e*ternal to cavity with scal"el #lade. :ont use rotary instruments as it causes ditchin 9ea""ly varnish Final "olishin delayed for at least =C hrs

Dis0!nsin- nd Mi1in->
(I)s are availa#le in = forms / / 5 and 3 se"arately in = forms Nnca"sulated for mechanical mi*in

6dvanta es of ca"sule A1H5B

Finis%in- nd 0olis%in->
'he #est surface o#tained is when cement sets a ainst a matri*

Clinic l us!s>
Lutin- c!"!nts &TYPE '*
'he ideal "ro"erties of a lutin cement accordin to 2c 3ean and 4ilson are :

3ow viscosity and film thic+ness 3on wor+in time and ra"id set at mouth tem"erature (ood resistance to a%ueous acid attac+ Hi h com"ression and tensile stren th 9esistance to "lastic 6dhesion to tooth structure )ariostatic "ro"erties <iolo ical com"ati#ility with the "ul" 'ranslucency 9adio"acity

'he first commercial water hardenin cement was Qetac cem. It had many "ro"erties similar to the modern lutin (I)s 6ll the "ro"erties chartered out are ood e*ce"t for the elastic modulus! which is %uite hi h. (I) has a tendency towards "lastic deformation as it is less stiff. In this re ard! it is not "referred to cement all ceramic crowns as reater stresses will develo" under occlusal loadin . It is #etter to use 0n51 C in this case. Nven the film thic+ness! solu#ility is more than 0n 51C. 5:3 ratio is 1:=D / 1.D : 1ml -ome "oints to #e +e"t in mind: / / / / No conditionin is re%uired or rather should not #e done as acid may et forced into the dentinal tu#ules due to the increase hydraulic "ressure. N*cess cement should #e removed only after it has set. 7arnish should #e a""lied at the mar ins. It is unnecessary to maintain "ressure as the freshly mi*ed cement has sufficient thi*otro"ic "ro"erties. Follow correct 5:3 ratio as increase in 3 will cause an increase in sensitivity and increased solu#ility and an increase in 5 will cause a decrease in a#ility to achieve com"lete seatin ! alterin fit and occlusion.

R!stor ti;! C!"!nt &Ty0! II*


Indications: o 'he erosion;a#rasion lesion

o )lass 7 lesion o 9estoration of "rimary teeth o )lass III lesion o 3aminate restoration o 2icrocavity "re"aration J #o*!slot!tunnel o 69' o 5atients "rone to ram"ant caries o -mall medium si.ed class I lesion o 9e"air of o"en mar ins around crowns and inlays. 'he 5:3 J ?:1 6s mentioned #efore! correct surface treatment! mani"ulation and "rotection are essential for a lon lastin restoration.

Lin!r nd # s!>
6 linin cement is #asically used to "rotect the "ul" from tem"erature chan e! #y sealin dentinal tu#ules. It needs to #e only 0.Dmm thic+. 'hey have low "hysical "ro"erties and are used to fill voids in cavity "re"aration. 'he 5:3 J 1.D : 1 6 #ase is used as a dentin su#stitute. 6ccordin to 2ount! the entire cavity should #e filled with (I) and then cut #ac+ to ma+e room for amal am ;com"osite. L "in tion /it% co"0osit!;-6N:4I)H 'N)HNIV,N: 'he use of (I) for re"lacement of carious dentin "rior to attachment of com"osite to acid etched enamel was first descried #y 2c3ean and 4ilson in 19GG. <oth the cement and the enamel are etched for #etter #ondin and decreased microlea+a e 'he "rocedure involves: / / / / / 5lacin (I) at #ase of cavity Ntchin with ?GM "hos"horic acid for 1min. 'his results in a rou h surface suita#le for mechanical loc+in :<6 is a""lied )om"osite is "laced. (I) acts as a dentin su#stitute

6dvanta es included:

/ / /

'he hi h contraction stresses "roduced A=.E 8 ?.9 2"aB #y the "olymeri.ation shrin+a e are reduced as the amount of com"osite is reduced 2icrolea+a e is reduced 2inimi.ation of num#er of com"osite increments! therefore time is saved

L "in tion /it% " l- "> 'here are = techni%ues: 1. (I) is "laced and allowed to set. It is then cut #ac+ to ma+e s"ace for amal am. CDM 566 can #e wi"ed over the set cement &ust #efore amal am condensation to attain a de ree of clinical union =. (I) is "laced and amal am is condensed when (I) is still in the early set sta e with moderate flow. 6mal am intermin les with the (I) and a mechanical interloc+in contains -n and 6 o#tained. occurs. 6 de ree of chemical #ondin is also e*"ected as (I) can #ond to metal o*ides li+e -n1 and 6 1 and amal am mainly. <ond stren th of u" to ?/C 2"a has #een

Pit nd 4issur! s! l nt>


6 cariostatic action is essential for a caries "reventive material. (I) is recommended as a 5 and F sealant where the orifices of the fissure are "atent. 'he si.e of the fissure should allow a shar" e*"lorer ti" to enter the crevice which should #e L 100 wide. 1therwise! (I) can et lost throu h erosion due to its low wear resistance and solu#ility.

Ort%odontic lutin- c!"!nts>


3utin cements are needed to effect a sta#le attachment of #ands and #rac+ets durin tooth movement. 6 common clinical "ro#lem is o deminerali.ation and caries under #rac+ets and #ands o detachment causin schedule disru"tion and 9* delay. <oth these "ro#lems can #e solved #y usin (I) as F release reduces

deminerali.ation under #rac+ets and #ands. )onventional (I) has shown "roven

#enefit over 0n 51C for #and cementation with re ard to retention and decreased deminerali.ation.

Cor! #uild u0>


'he construction of a core is often necessary "rior to crown "re"aration in order to ive the final crown a""ro"riate resistance and retention. 'raditional (I) lac+ the necessary tensile and fle*ural stren ths for anythin other than small core #uild u"s or #loc+in out under cuts in "re"arations.

GIC in !ndodontics>
'hey are used for: o -ealin root canals ortho radely and retro radely o 9estorin "ul"s cham#er o 5erforation re"air o -ometimes for re"airin vertical fracture. (I) was used #ecause of : Its ca"acity to #ond which enhances seal and reinforces the tooth Its ood #iocom"ati#ility! which would minimi.e irritation to "eriradicular tissues Its F release! which im"arts an anti/ micro#ial effect to com#at root canal infection

Pr!;!nti;! r!stor tions>


ART 6 hi hly viscous (I) was desi ned as on alternative to amal am for "osterior "reventive restorations to #e used mainly under conditions of minimal instrumentation. 'he hi h F release would hel" in caries sta#ili.ation. 'his is the atraumatic restorative techni%ues or 69' which use these "ac+a#le! hi h F releasin (I)s to control caries. 5$ Hi-% 4luorid! r!l! sin- co"" nd s!t GIC

'his ty"e of li ht/cured (I) is used for surface "rotection! caries sta#ili.ation and as an intermediate restoration. 'he fluoride released is hi her than the usual (I) and is "in+ in colour to serve as a reminder of its tem"orary nature and identification of mar ins. Newly e*"osed tooth surfaces which are at hi h ris+ of deminerali.ation can #e a""lied with a coat of this cement to ma+e it more stron er and more acid resistant

Conclusion>
In s"ite of su#stantial im"rovement conventional (I)s have short comin s with re ard to moisture sensitivity! wear resistance! fle*ural stren th and final finish. Nven thou h chemical adhesion and fluoride release are ma&or #enefits! conventional (I)s are restricted to s"ecial indications li+e class III or class 7 cavities. 6dvancements have occurred to overcome these "ro#lems #ut most are still awaitin clinical trials.

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