A practical approach to selection is to first decide which restorative, or combination, is best for the indication

In general, the starting point for choosing which restorative to use is to have a good understanding of the characteristics of each material. These should then be matched to the performance requirements demanded by the individual clinical situation, particularly depending on whether the restoration is in the posterior or anterior regions of the mouth, and the location and size of the cavity. To describe the cavity, this guide uses the standard Class I to V classification system according to 'G.V. Black'. However, this traditional approach is gradually being replaced by more modern classifications, as it was based on surgical removal of the carious lesion, followed by mechanical interlocking of a restoration such as amalgam that needs retention. By modern standards therefore, any initial lesion treated will be overextended. Nowadays, because of more advanced adhesive techniques more possibilities are available. But suitability for the indication is not the only concern; other characteristics of the material should also be taken into account. For example, it must be safe to use, so if a patient is known to be hypersensitive to certain monomers, non-resinous materials should be considered. Choosing a material which gives the right balance between performance and ease/cost in use, may also be important, particularly if restorations are a frequent procedure for the practice and patient turnover per hour is important. Using a restorative that is easy to use and can work in a moist environment may be best option here.

Consider which restorative is best for

To help you select the type of restoratives that are most appropriate for particular clinical procedures, please refer to the relevant tables in the following pages.
CLASS III

CLASS I

CLASS II

CLASS IV

CLASS V

BASE/LINING

CORE BUILD-UP

Which restorative?
Amalgam
Low price and reliable but questions over safety
Amalgam has been used for many decades and yet, even today, it remains popular among some dentists, particularly for use in areas of high occlusal loading, such as posterior teeth. Essentially made from a mix of silver alloy and mercury, amalgam is easy to use, offers proven results in larger posterior cavities, and is generally considered to be reliable and inexpensive, with good durability and wear resistance. However, amalgam does present a number of drawbacks that may be contributing to its decline. In certain situations, using amalgam may require healthy or sound tissue to be removed beyond the limits of the caries lesion. Being silvery-grey metallic in colour, amalgam is not particularly aesthetic, especially when used in the visible regions of the mouth, and its good thermal conductivity can cause problems for some patients with sensitive teeth. Nowadays, safety and environmental issues are constantly under review and this has led to the implementation of strict regulations in some countries to prevent its use and/or to reduce the risk of pollution by using amalgam separators.

Composite resins
Good aesthetics but technically demanding
Composite resins are highly popular as dental restoratives. When used correctly, they provide excellent aesthetics/colour matching from the availability of a wide range of shades and opacities as well as good physical properties. Composite resins are considered particularly suitable for all restorations where aesthetics are the most important factor. However, composites are also known for being technique sensitive. For example, they need to be applied in a moist-free environment, and require the use of multi-step bonding agents. Shrinkage of the material from cavity floors and walls may occur during and after polymerisation, and to ensure that polymerisation shrinkage is reduced the material needs to be applied in layers, especially for deep cavity restorations. If polymerisation is incomplete and since thermal expansion of composite is different from tooth structure, microleakage of the restoration may occur, as well as marginal discolouration and bacterial penetration. The majority of composites also do not release any

REMOVAL OF HEALTHY TISSUE

NEED LINING MATERIALS

TEMPERATURE SENSITIVE

POOR AESTHETICS

POTENTIAL SAFETY HAZARD

Compomers
A compromise between aesthetics and ease of use
Compomers are created from a mixture of composites and glass ionomers in an attempt to combine the advantages of both material groups, namely the aesthetics and physical properties of a composite with the ease of use of a glass ionomer. However, they still require close attention to technique. For instance, there may be insufficient chemical adherence of the compomer to the teeth so they require the application of a bonding agent. The incremental layering technique may also be required for deep cavities because of polymerisation shrinkage. All this results in longer handling times compared with glass ionomers. Being sensitive to water uptake, the material might expand in the cavities potentially affecting the performance of the restoration. And despite compomers containing glass ionomer, the majority do not release sufficient fluoride.

INSUFFICIENT CHEMICAL ADHESION

fluoride. Good aesthetics too, should not be taken for granted. Most materials need multishade techniques to

achieve excellent aesthetic results, so requiring time consuming treatment and an extensive stockholding.

NEED BONDING AGENT

MATERIAL EXPANDS IN CAVITY

MOISTURE SENSITIVE

NO CHEMICAL ADHESION

POTENTIAL SHRINKAGE

INSUFFICIENT FLUORIDE RELEASE POSSIBLE MICROLEAKAGE MARGINAL DISCOLOURATION BACTERIAL PENETRATION

MOST HAVE NO FLUORIDE RELEASE

Conventional Glass Ionomer

Easy to use, safe and effective

GC Fuji II B E N E F I T S

GC Fuji II
STRONG CHEMICAL ADHESION

The Advantages Strong, self-curing chemical adhesion to dentine and enamel. Adhesion unaffected by moisture so no need for protection such as rubber dam. No need for etching or bonding agents. Excellent, long-lasting marginal seal. High fluoride release. Good aesthetic results. Biocompatible. Good radiopacity.

GCs first glass ionomer restorative GC Fuji II, represents the epitome of this important group of restoratives. A self-curing conventional glass ionomer, it gives good aesthetic restorations that are safe and effective for Class III and V cavities in anterior adult teeth, as well as in deciduous teeth in children. It may be used in a variety of other indications also, such as the treatment of root surface caries and cervical erosions, or for a base below amalgam or composites. What sets glass ionomer like GC Fuji II apart is its ease of use. For instance it has strong, intrinsic chemical adhesion to dentin and enamel which is unaffected by moisture, so there is no need to keep the area dry and no need for etching or bonding agents. The strong adhesion also creates an extremely good, longlasting marginal seal that helps to prevent discolouration and bacterial microleakage. Glass ionomer releases high levels of fluoride, is biocompatible and the restoration becomes increasingly resistant to wear over time.
Core build-up

NOT AFFECTED BY MOISTURE

NO ETCHING OR BONDING AGENTS

EXCELLENT MARGINAL SEAL

HIGH FLUORIDE RELEASE

MAIN INDICATIONS
Class I Class II Class III Class IV Class V Lining Base

BIOCOMPATIBLE

GC Fuji II LC Improved B E N E F I T S

Resin-modified Glass Ionomer

Beautiful long-lasting aesthetic results, easily

GC Fuji II LC Improved
BEAUTIFUL AESTHETICS

STRONG CHEMICAL ADHESION

CONTROLLED SETTING TIME

As the successor of GC Fuji II LC, the worlds first light cured glass ionomer, GC Fuji II LC Improved combines all the advantages of a genuine glass ionomer with the added benefits of composite resin technology. With its superior aesthetics, ease of use and improved mechanical properties GC Fuji II LC Improved offers dentists the perfect solution for Class III and V restorations in both anterior and posterior teeth for adults as well as children. It can also be used as a lining or base material below amalgam or composites and under composite or porcelain inlays. GC Fuji II LC Improved has a wide range of shades to help create beautiful restorations which are easy to polish to a natural enamel-like translucency. Application is simple as moisture does not affect its chemical adhesion, etching or a bonding agent is not required, handling is easy, and being light curable it has a controlled setting time. It also gives an excellent marginal seal, has improved mechanical properties such as wear resistance and high fluoride release. All factors that have made GC Fuji II LC Improved a very popular choice, including for difficult areas where rubber dam is hard to use; where cavities extend into dentin; or when enamel cannot be etched.

The Advantages Beautiful aesthetic results from a wide range of shades. Strong, chemical adhesion unaffected by moisture and no need for etching or bonding agents. Light curable for a controlled setting time. Excellent, long-lasting marginal seal. Improved mechanical properties such as wear resistance. High fluoride release. Biocompatible. Good radiopacity.

EXCELLENT MARGINAL SEAL

IMPROVED MECHANICAL PROPERTIES

MAIN INDICATIONS
Class I Class II Class III Class IV Class V Lining Base Core build-up

HIGH FLUORIDE RELEASE

Packable Glass Ionomer

Over 80 million reasons to use

GC Fuji IX GP B E N E F I T S

GC Fuji IX GP and GC Fuji IX GP FAST

EASY TO PACK AND CONTOUR

The Advantages Packable and non-sticky, easy to place, easy to contour. Strong, self-curing chemical adhesion to cavity, unaffected by moisture and no need for etching or bonding agents. Tooth-conserving preparation technique, no need for undercutting. Chemical setting allows single-step placement without layering, also ideal for immediate or postponed sandwich techniques. No shrinkage during setting, same thermal expansion as tooth structure. Excellent, long-lasting marginal seal. High wear resistance. High fluoride release, biocompatible and good radiopacity.

GC Fuji IX GP is one of the world's leading glass ionomer restoratives, used in over 120 countries for more than 80 million restorations. A conventional, self-curing glass ionomer made to a packable, non-sticky consistency, GC Fuji IX GP is easy to place in the cavity and, aided by metal matrices, easy to contour. These properties, together with high wear resistance and the other advantages of glass ionomer, make GC Fuji IX GP ideal for Class I, II and V posterior restorations in both adults and children as well as for core build-up. It can be used for the immediate sandwich technique, or, when the final treatment plan has not been decided, a postponed sandwich technique with a composite material or an inlay. GC Fuji IX GP FAST 2 x faster and longer-lasting GC Fuji IX GP FAST has all the proven benefits and clinical safety of GC Fuji IX GP, but in addition has even greater strength, higher wear resistance and sets in only half the time 3 minutes from start of mix. This means a filling can be completed in less time and to an exceedingly high quality. Suitable for all indications in which GC Fuji IX GP could be used, this FAST version is particularly useful for any occasion where speed is of the essence.

STRONG CHEMICAL ADHESION

EXCELLENT MARGINAL SEAL

HIGH FLUORIDE RELEASE

GC Fuji IX GP FAST B E N E F I T S

SETS IN ONLY 3 MINUTES

MAIN INDICATIONS
Class I Class II Class III Class IV Class V Lining Base Core build-up

IMPROVED MECHANICAL PROPERTIES

GC Glass Ionomer Restoratives

A range to suit the majority of indications

GC Fuji II
Easy to use, safe and effective, GC Fuji II is a self-curing, conventional glass ionomer which gives good aesthetic results. It is ideal for Class III and V restorations or as a base.

GC Fuji II LC Improved
Beautiful, long-lasting aesthetic results and easy to use, GC Fuji II LC Improved is a light-curable, resinmodified glass ionomer which gives safe, effective and long-lasting results. It is ideal for both anterior and posterior Class III and V restorations or as a base.

GC Fuji IX GP GC Fuji IX GP FAST

Used for more than 80 million restorations throughout the world GC Fuji IX GP is a conventional, selfcuring glass ionomer which is easy to pack and contour in the cavity. It is ideal for posterior Class I, II and V restorations, or as a temporary restoration as well as for core build-up or as a base. All the benefits of GC Fuji IX GP and for the same indications, but gives longerlasting restorations in only half the time only 3 minutes from start of mixing to finish. Particularly valuable for any occasion where speed is important.

MAIN INDICATIONS
I Conventional glass ionomer GC Fuji II Resin-modified glass ionomer GC Fuji II LC Improved Packable glass ionomers GC Fuji IX GP and GP FAST II Cavity Class III IV Liner V Base Core build-up

GC Fuji II
Conventional Glass Ionomer CLINICAL TECHNIQUE Posterior Class V Restoration
POWDER AND LIQUID CAPSULE Restorative technique Avoid air bubbles during application. Form the contour and place a matrix if required during the first 2 minutes of setting. Setting time is 530" from start of mixing. Once set, remove the matrix and immediately apply GC Fuji VARNISH (blow dry) or GC Fuji COAT LC (Light Cure).

Preparation of tooth Prepare tooth using standard techniques. Extensive mechanical retention is not necessary. For pulp capping use a calcium hydroxide.

Conditioning To remove the smear layer after tooth preparation it is recommended to apply GC CAVITY CONDITIONER to the bonding surfaces for 10 seconds (or GC Dentin Conditioner for 20 seconds) using a cotton pellet or sponge.

Dispensing Dispense onto the mixing pad 1 level scoop of powder to 1 drop of liquid representing a standard powder to liquid ratio of 2.7/1.0g. For accurate dispensing of powder, lightly tap the bottle against the hand. Do not shake or invert. Hold the liquid bottle vertically and squeeze gently. Close bottles immediately after use. Mixing Using the plastic spatula, divide the powder into 2 equal parts. Mix the first portion with all of the liquid for 10 seconds. Incorporate the remaining portion and mix the whole thoroughly for 15-20 seconds (total time within 30 seconds). Working time is 1 minute 45 seconds at 23C (73.4F). Higher temperatures will shorten the working time.

Activation Before activating tap the side of the capsule on a hard surface to loosen the powder. Press the plunger in on a hard surface until it is flush with the main body. Mixing Immediately set the capsule into the mixer and mix for 10seconds (+/- 4.000 RPM)

Finishing After initial set, correct the contour WITHOUT water spray using standard techniques. Apply GC Fuji VARNISH or GC Fuji COAT LC and wait for about 15 minutes. Final finishing and polishing under water spray can now be carried out. Ideally finishing and polishing is performed 24hrs after placement.

Application Using GC Capsule Applier inject cement directly into the cavity. Protection After finishing apply a final coat of GC Fuji VARNISH or GC Fuji COAT LC to protect the GIC during the first 24hrs.

Washing and drying Rinse thoroughly with water and remove surface moisture by blotting with a cotton pellet or by gently blowing with an air syringe. Do not desiccate as this will affect the adhesion.

Application Transfer cement to the preparation using a syringe or suitable placement instrument.

End result

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