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Glass Ionomers & Compomers

Overview
Glass ionomers
composition
properties
classification

Compomers
composition
properties

Giomers
Click here for text briefing on Glass Ionomers (PDF)

Traditional Cements
Phosphoric acid

Zinc Oxide
Aluminosilicate
Glass

Polyacrylic acid

Zinc Phosphate Polycarboxylate

Silicate

Glass Ionomer

Van Meerbeek Fund Oper Dent 2001

Glass Ionomer Development


United Kingdom
Wilson and Kent
1972

ASPA
first commercial product
alumino-silicate polyacrylic acid
combined benefits
silicates
translucency, fluoride release

polycarboxylates
adhesion, biocompatibility
Tyas J Adhes Dent 2003

Early Glass Ionomers


Poor esthetics
rough surface

Prolonged setting reaction


Poor wear resistance
Vulnerable to hydration extremes
Handling difficulties
Van Meerbeek Fund Oper Dent 2001

Modifications
Refined formulation
addition of tartaric acid
more reactive acids

Improved packaging
Metal modification
Addition of resin

Van Meerbeek Fund Oper Dent 2001

Advantages
Inherent (chemical) adhesion to tooth
structure
Fluoride release
Coefficient of thermal expansion (CTE)
similar to tooth structure
Biocompatible

Van Meerbeek Fund Oper Dent 2001

Disadvantages

Sensitive to moisture and desiccation


Low fracture toughness
Low flexure strength
Low wear resistance
Relatively poor esthetics

Van Meerbeek Fund Oper Dent 2001

Indications
Direct restorative
Class 5
Root caries
Class 3
Pediatric dentistry
resin-modified version

Tunnel preparations
Atraumatic restorative treatment (ART)
Van Meerbeek Fund Oper Dent 2001

Indications

Luting agents
Liners
Caries control
Core block-out
Occlusal sealant

Van Meerbeek Fund Oper Dent 2001

Contraindications
Stress-bearing areas in permanent teeth
Class 1, 2 and 4

Basic Glass Ionomer Types


Conventional GI
traditional acid-base reaction

Resin-modified (RMGI)
acid-base reaction
light and/or chemical cure

Conventional Glass Ionomer


Composition
powder
ion-leachable calcium
aluminofluorosilicate glass

liquid
copolymers of acrylic acid
and/or
water
copolymers freeze-dried, placed in powder
maximize shelf-life

Phillips Science of Dental Materials 2003

Conventional Glass Ionomer


Ion-leachable glass
silicon dioxide
aluminum oxide
calcium fluoride
aluminum phosphate
sodium fluoride
aluminum fluoride

Phillips Science of Dental Materials 2003

Conventional Glass Ionomer


Polyacids
acrylic
maleic
itaconic
tricarboxylic acid

Tartaric acid
improves handling
extends working time
sharpens set
increases strength
Phillips Science of Dental Materials 2003

Resin-Modified Glass Ionomers


First developed as liners
Modified light- and/or
chemically-activated
methacrylate side chains
on polyacrylic-acid molecules
free in solution
HEMA

Total set resin 4.5 - 6%

Resin-Modified Glass Ionomer


Attempt to combine
benefits
glass ionomer
fluoride release
adhesion

composite resin

glass ionomer
hydration sensitivities
delayed set
poor early strength

composite
polymerization shrinkage
microleakage
recurrent caries

strength
esthetics

Glass Ionomers

Attempt to reduce

RMGI

Compomers

Composites

Resin-Modified Glass Ionomer


Composition
powder
ion-leachable glass

liquid
initiators
copolymers of acrylic acid
methacrylate groups grafted
and/or HEMA

and/or
water
copolymers freeze-dried, placed in powder
maximize shelf-life
Phillips Science of Dental Materials 2003

Material-Related Variables

Fluoride release
Adhesion
Pulpal response
Physical Properties

Flouride
Elevated in saliva
Enhancement of remineralization
incorporated into tooth structure
effective zone around restorative margin
up to 7.5 mm in enamel

Bacterial effects
metabolism
reduced acid production
reduced growth
Seppa Eur J Oral Sci 1995
Tantbirojn D Caries Res 1997
Hatibovic-Kofman Swed Dent J 1991
Retief DH Caries Res 1984

Clinical Efficacy of
Fluoride-Releasing Materials
Equivocal
review of 28 clinical studies
no conclusive, overall evidence of caries reduction
Randall JDR 1999
click here for abstract

Recent studies suggest caries reduction


xerostomic patients
McComb Oper Dent 2002
click here for details

Haveman JADA 2003


click here for details

Adhesion to Tooth Structure


COO-

Conventional GI
ion exchange
GI tooth substrate

carboxyl groups of GIC

COOCOO-

Tooth

M3+ COO

COOCOO-

bond with Ca+2 of hydroxyapatite

Resin-modified GI

Ca2+

Ca2+

COOCOOH

ion exchange similar to conventional GI


resin-impregnated hybrid layer?
equivocal
Wilson JDR 1983
Yoshida J Dent Res 2000
Tyas J Adhes Dent 2003

Pulpal Response
Favorable
large molecules
limited tubule ingress

buffering of dentinal fluid


relatively weak acid
initial high acidity

chemical adhesion
minimizes microleakage

antimicrobial activity
Burgess Fund Oper Dent 2001

Properties
Property
Flexural Strength (MPa)
Compressive Strength (MPa)
Diametral Tensile Strength (MPa)
Fluoride Release
Fluoride Recharge

Glass Ionomers

RMGI

GI

RMGI

Compomer

Composite

15-25
170-200
22-25
High
High

35-70
180-210
35-40
High
High

60-94
190-250
45-47
Moderate
Moderate

85-97
230-270
40-60

Compomers

Minimal - None

Minimal - None

Composites

Strength
Polishability
Fluoride Release
Burgess Fund Oper Dent 2001

Classifications
Applications
Type 1: luting cements
Type 2: restorative cements
esthetic restoratives
reinforced restoratives
condensable
metal-modified

Type 3: liners/sealants

Chemistry
conventional GI
traditional acid-base reaction

resin-modified (RMGI)
acid-base reaction
light and/or chemical cure

Applications
Type 1: luting cements
Type 2: restorative cements
esthetic restoratives
reinforced restoratives
condensable
metal-modified

Type 3: liners/sealants

Luting Cements
(Type 1)
Conventional
examples
Ketac-Cem (3M ESPE)
Fuji 1 (GC)

Resin-modified (RMGI)
greater strength
less moisture sensitivity
less soluble
examples
Fuji Plus and FujiCem (GC)
Rely X (3M ESPE)
Click here for cements evaluated by DECS

Post-Op Sensitivity
(Luting Cements)
Initial reports of sensitivity
when cements were first introduced
due to low initial acidity and improper handling?

Clinical studies show no increase in sensitivity


when properly used

Conventional GI vs. Zinc Phosphate


no difference
Johnson JADA 1993
Kern JPD 1996

Conventional GI vs. RMGI


no difference
Hilton Oper Dent 2004
click here for more information

RMGI Luting Cements


Hydroscopic Expansion
Contraindications
non-reinforced
all-ceramic restorations
Sindel J Dent 1999
click here for abstract

follow manufacturers
recommendations

Percent Linear Expansion


5
4.5
4
3.5
3

1 Hr

2.5
2

1 Day

1.5

2 Mos

1
0.5
0
-0.5

Zn Phos

GI

Resin

RMGI

CRA 1997

Orthodontic Luting Agents


Fluoride releasing
reduced incidence of white spot lesions
Benson J Ortho 2005
click here for abstract

Bonds in moist environment


Condition surface
etch optional

Only light-leveling wires first 24 hrs


Examples
Fuji Ortho (GC)
Fuji Ortho LC (GC)

Endodontic Obturation

Fluoride releasing
Radiopaque
Short working time
More difficult to retreat
Example
Ketac-Endo (3M EPSE)

Buck Gen Dent 2002

Applications
Type 1: luting cements
Type 2: restorative cements
esthetic restoratives
reinforced restoratives
condensable
metal-modified

Type 3: liners/sealants

Esthetic Restoratives
(Type 2)
Conventional
examples
Ketac-Fil (3M ESPE)
Fuji II (GC)
Glasionomer Type II (Shofu)

RMGI
examples
Fuji II LC (GC)
Vitremer (3M ESPE)
Riva Light Cure (SDI)

Esthetic Restoratives
Case Selection

High caries risk


Areas of lower stress
permanent Class 3 & 5
esthetics not paramount

Pediatric dentistry
RMGI version
Croll JADA 2001
Click here for abstract

Esthetic Restoratives
Technique Tips

Surface must be clean


Remove smear layer
Tooth must be moist

Tyas J Adhes Dent 2003

Esthetic Restoratives
Conditioning Dentin

Conventional GI
polyacrylic-acid conditioner
removes smear layer
cleans surface
promotes adhesion

RMGI
follow manufacturers directions
polyacrylic-acid conditioner or adhesive

Esthetic Restoratives
Moisture Content

Sensitive to moisture levels


ion exchange in hydrated medium
desiccation
extracts water from cement

excess water
dilutes matrix

Esthetic Restoratives
Finishing

Conventional GI
surface coat
wait 15 minutes
minimize trauma
to surface
use blades
slow speed

Esthetic Restoratives
Finishing

RMGI
surface coat
immediate finishing
normal armamentarium
fine diamond
polishing discs

gentle technique

Esthetic Restoratives
Surface Protection
Protect setting cement
early moisture contamination
desiccation later

Unfilled resins
essential
conventional

optional
RMGI

more resistant to water loss


fills irregularities
color stability
decreased F release
Summitt Fund Oper Dent 2001

Esthetic Restoratives
RMGI Liners
Posterior composite
open-sandwich technique
dentinal gingival margins
reduced leakage
reduced gap formation

examples
Fuji II LC (GC)
Vitremer (3M ESPE)
Burgess JDR 1999
Hagge Gen Dent 2001
Friedl Oper Dent 1997

Applications
Type 1: luting cements
Type 2: restorative cements
esthetic restoratives
reinforced restoratives
condensable
metal-modified

Type 3: liners/sealants

Reinforced Restoratives
(Type 2)

Condensable
Metal-modified

Condensable
(Type 2)
Conventional GI
simplified handling

Indications
provisionalization
pediatric restorations
Atraumatic Restorative Treatment
field dentistry
hand instrumentation

Examples
Fuji IX (GC)
Ketac-Molar (3M ESPE)
Click here for DECS evaluations of
Condensable GIs

Metal-Modified Glass Ionomers


(Type 2)
Conventional GI
silver fused with powder
e.g., Ketac-Silver (3M ESPE)

amalgam alloy mixed with powder


e.g., Miracle-Mix (GC)

Improved handling
Improved radiopacity
Fluoride release
similar or slightly less than conventional

Improved wear resistance

DeSchepper Quint Int 1991

Metal-Modified Glass Ionomers


(Type 2)
Indications
non-stress bearing areas
core build-ups
low strength
minimize size
block-out

caries control
provisionals
Atraumatic Restorative Treatment

Applications
Type 1: luting cements
Type 2: restorative cements
esthetic restoratives
reinforced restoratives
condensable
metal-modified

Type 3: liners/sealants

Liners
(Type 3)

Conventional
examples
Ketac-Bond (3M ESPE)
Lining Cement (GC)

RMGI
examples
Vitrebond (3M ESPE)
Fuji Lining LC (GC)

Sealants
Glass-ionomer

(Type 3)

pre-cooperative children
partially-erupted permanent molars
examples
Riva Protect (SDI)
Fuji Triage (GC)
click here for DECS evaluation

Resin-based sealants
higher retention
similar efficacy
Simonsen Pediatr Dent 2002

proper isolation necessary

Compomers
Composite and Glass-ionomer

Polyacid-modified composite resin


Matrix
dimethacrylate monomer
carboxylic groups

Filler
ion-leachable glass

No water

H2C=CH

CH=H2C

COO-H2C-H2C-H2C-H2C

CH2-CH2-CH2-CH2-OOC
C

HOOC

C
COOH

Matrix Example

Setting reaction
Free-radical polymerization reaction
similar to resin composites
resin-based adhesives

No chemical bond to tooth structure


Low levels of fluoride release
Delayed acid-base reaction
water from tubules, absorption

Compomers in Dentistry
Direct restorations
restoratives
flowables

Cements

Advantages

Easy to place and polish


Some fluoride release
More esthetic than glass ionomer
Better mechanical properties than glass
ionomer
Glass Ionomers

RMGI

Compomers

Composites

el-Kalla Oper Dent 1999

Disadvantages
Inferior mechanical properties
compared to composite
Yap Oper Dent 2004
click here for details

Less fluoride release than glass ionomer


minimal recharge

No chemical bond to tooth structure


Glass Ionomers

RMGI

Compomers

Composites

el-Kalla Oper Dent 1999

Indications
Esthetics
Areas of lower stress
class 5, 3
pediatric
conservative class 1 and 2

Click here for more details


Folwaczny Am J Dent 2001
Van Dijken Am J Dent 1996
Gross Pediatr Dent 2001

Contraindications
Stress-bearing areas
permanent Class 1 or 2
increased wear
Wucher Am J Dent 2002
click here for details

loss of marginal integrity


Huth Am J Dent 2004
click here for details

Poor isolation
Burgess Fund Oper Dent 2001

Giomers
Resin-based restoratives
Pre-reacted glass-ionomer particles (PRG)
fillers from conventional GI reaction

Free-radical polymerization reaction


similar to light-activated resin composites

No chemical bond to tooth structure


More research needed
Example
Beautifil (Shofu)
Click here for more details

Routine Material Usage*

Civilian Practitioners
Flowable Composite
81%
Hybrid Composite
69%
Amalgam
67%
All-Purpose Composite
53%
Microfill Composite
52%
Resin-modified Glass ionomer 45%
Packable Composite
33%
Compomer
7%
Other
1%
*Multiple responses

DPR 2005