ADHESIVE RESTORATIVE

MATERIALS FOR MINIMAL

CAVITY PREPARATIONS

J
 Adhesive Materials

Adhesive restorative
materials for minimal cavity
preparations
 The arrival of adhesive restorative
materials meant that mechanical
retention was no longer necessary.
 Thus it was possible to develop
intervention techniques for caries
management that were more
conservative of tooth tissue.
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Historical development of
adhesive restorative
materials
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Adhesive dental
restorative materials:
Glass-ionomer
1

2
 A dental glass-ionomer (self - cure) is
supplied as

 a powder and liquid in separate bottles (hand-

mix version) or
 in an encapsulated form
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Adhesive dental
restorative materials:
Glass-ionomer
1  Powder
2  The powder comprises a fluoride glass that is
made up of a number of minerals, the most important
being SiO2 and Al2O3.

 Liquid
 The liquid is usually a water-soluble organic
(polyakenoic) acid, mostly polyacrylic acid.
 Some glass - ionomers are supplied with the acid
component
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Conditioning of tooth tissues

 Polyacrylic acid conditioner is

applied in the cavity prior to the
glass-ionomer filling material:
 To remove the smear layer
 To promote the adherence to the tooth
surface
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Conditioning of tooth tissues

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Setting reaction of glass-

ionomer
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Setting reaction of glass-

ionomer
1

2
 The acidic liquid decomposes the outer
layer of the ionomer glass particles.
 Ions, are freed and react with the polyacrylic
molecules.
 Chains of calcium-polyacrylate and
aluminium-polyacrylate are formed.
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Setting reaction of glass-

ionomer
1

2
 Other freed ions attach to this
network of metal-polyacrylate chains.
 The mixture hardens.
 The initial setting takes place within 5
minutes.
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The three main

characteristics of glass-
ionomers
 Bond to enamel and dentine without
acid etching
 Leach fluoride into the tooth tissues
and oral environment
 Pulp - friendly.
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The bonding of glass-ionomer

to tooth tissues
 Chemically
 Poly-acrylic
 Calcium bridges.
 Bonding to enamel > dentine
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Micro-leakage of glass-
ionomers
 Usually less often seen with glass-
ionomers than for composite resin
restorations
 Polymerization shrinkage and shrinkage
stress are low
 High adhesion values, necessary for
resin containing materials, are
therefore not so relevant.
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The bonding of glass-ionomer

to tooth tissues
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Tooth tissue - glass-ionomer

interface: interaction zone

Original magnification
* 1,936
From Ngo et al.
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Tooth tissue - glass-ionomer

interface: interaction zone
A distinct zone exists at the interface of
glass-ionomer and tooth tissues.
 This zone is more resistant to acid
attack than the surrounding glass-
ionomer material and tooth tissues.
 This is an indication of
hypermineralization of the interface.
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Tooth tissue - glass-ionomer

interface: fracture

Original magnification
* 2.215
From Ngo et al.
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Tooth tissue - glass-ionomer

interface: fracture
 Fractures occur within the material
cohesively.
 Glass-ionomer therefore remains in
contact with both dentine and enamel
at the interface.
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Tooth tissue - glass-ionomer

interface
Interaction zone
Original magnification * 1,936
From Ngo et al.

Fracture
Original magnification * 2.215
From Ngo et al.
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The function of a surface

conditioner
 The removal of outer carious dentine with either
a hand instrument or a drill results in the
production of a smear layer.
 Smear layer prevents adequate bonding of glass-
ionomer to the tooth tissues.
 Conditioner removes the smear layer
 Conditioner improves the bond strength.
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Bond strength and surface

conditioning
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Bond strength and surface

conditioning
 Surface conditioning doubles the bond
strength.
 A surface conditioner differs from a liquid
used for acid etching of tooth tissues and
they are not interchangeable.
 Acid etching is restricted for use with resin
based materials.
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The role of water in glass-

ionomer restorations
 Glass-ionomer water-based
 Water is reaction medium
 Setting process is fast and continues
 Water uptake and loss
 Initial protection of restoration/sealant
 Desiccation should be avoided
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Fluoride in glass-ionomer

 Aluminosilicate glasses can contain 26%

fluoride
 Glass-ionomer restoration and sealants
take up fluoride
 Fluoride release does not affect properties
 Fluoride continues to be released from
glass-ionomer
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Fluoride in glass-ionomer
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Pattern of fluoride release

from glass-ionomers

 Characterized by an initial burst of fluoride up to a

week.
 Followed by a gradual decrease that levels off
after some months.
 The amount of fluoride increases with increase in
number of restorations placed.
 As an indication, two restored surfaces provided
0.4 ppm fluoride in saliva after 10 weeks.
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The fade of fluoride released

from the glass-ionomers.
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Fluoride, metabolism and

S.mutans in plaque
 Plaque fluoride levels increase
 Plaque metabolic activity is reduced
 Low number of Streptococcus
mutans
 Same trend in primary dentition
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Remineralization of
carious lesions from glass-
ionomer
 Studies have been carried out
 Remineralizing potential
 Reduction in the progression of
carious lesions
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Remineralization of
carious lesions from glass-
ionomer
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Hypermineralization of
carious lesions
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Hypermineralization of
carious lesions
 Studies have been carried out
 The study reported that caries-like lesions in
tooth surfaces adjacent to glass-ionomers
became hypermineralized.
 Further demineralization occurred in caries-like
lesion adjacent to both composite resin and
amalgam restorations
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Pulp and glass-ionomer

 Acid can cause pulp irritation

 Powder/liquid ratio important: unreacted acid
 Pulp-friendly material
 In case of pulpal exposure placement of a hard
setting material is sometimes recommended
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The physical
characteristics of glass-
ionomers
 Early glass-ionomers
 Difficult
to handle
 Very water sensitive

 Improvements related to wear resistance

 Wear decreases when material matures
 Low pH is important
 Long term wear vs. early wear
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The physical
characteristics of glass-
ionomers
Wear in micron
Wear in micron
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The physical
characteristics of glass-
ionomers
 Resistance to wear lower
 Compressive strength higher
 Human factor in handling is important
 Fracture toughness need improvement
 Flexural strength need improvement
 Tensile strength need improvement
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Conclusions (glass-
ionomer)

2
 Glass-ionomers adhere chemically to
3 enamel and dentine but need a dentine
4
conditioner to remove the smear layer
5

6
and thus improve adhesion.
7
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Conclusions (glass-
ionomer)

2
 It is very important to reduce exposure of
3 a freshly placed glass-ionomer
4
restoration or sealant to saliva and water
5

6
for at least one hour. This is achieved by
7 placing a varnish, unfilled resin or
petroleum jelly over the restoration or
sealant.
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Conclusions (glass-
ionomer)

2
 Fluoride is released from the material into
3 the tooth tissues and into plaque and
4
saliva.
5

7
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Conclusions (glass-
ionomer)

2
 There is growing evidence that the
3 progression of carious lesions is reduced
4
in tooth surfaces adjacent to glass-
5

6
ionomer.
7
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Conclusions (glass-
ionomer)

2
 The compressive strength and wear
3 resistance of glass-ionomer restorative
4
material are substantial but fracture
5

6
toughness and flexural strength need
7 further improvement.
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Conclusions (glass-
ionomer)

2
 The optimal mechanical characteristics
3 are achieved if the specified
4
powder/liquid ratio is closely followed. A
5

6
thinner mixture may also irritate the pulp
7 during the early setting phase.
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Conclusions (glass-
ionomer)

2
 The use of glass-ionomers in preservative
3 oral health care is restricted to certain
4
applications.
5

7
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Other adhesive restorative

materials: Resin-modified glass-
ionomer
1  Combination of glass-ionomer and resin
2
 Mechanical properties improved
 Acid-base and polymerization reaction
 Resemble conventional glass-ionomer
 Fluoride release
 Anti bacterial effect
 Susceptibility to dehydration
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Other adhesive restorative
materials: Resin-modified
glass-ionomer
1

2
 Differences with glass-ionomer
 The mechanism of adhesion
 Bonding to enamel and dentine requires
mostly acid conditioning
 Setting is activated by light curing
 Greater mechanical strength
 More wear than conventional glass-
ionomers
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Other adhesive restorative

materials: Composite resin

1  The material is available in two systems:

2  a two-component that cures chemically and
 a one-component that requires light curing.
Composite resin materials
 High filler load and small particle size
 Fluoride has been incorporated
 Studies have shown:
 caries is not reduced
 caries progresses in dentine alongside composite resin
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Other adhesive restorative

materials: Composite resin

2
 The biocompatibility is lower
 Physical properties are the best of the
adhesive restorative materials.
 Polymerization shrinkage and shrinkage
stress remain a problem.
 micro-leakage at the tooth-filling interface
 cracks in the enamel.
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Other adhesive restorative

materials: Compomer

1  Polyacid modified composite resin ('Compomer')

2

3
 A 'Compomer' is to a composite resin as a resin-
modified glass-ionomer is to glass-ionomer.
 The main difference between a 'Compomer' and a
resin-modified glass-ionomer is the ratio of resin to
glass-ionomer filler, which is in the order of 80 to 20
per cent, respectively.
 Therefore, the behavior of compomers is
essentially that of composite resin materials.
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Other adhesive restorative

materials: Compomer

1  As compomers do not contain water, the acid

2
based setting reaction that characterizes glass-
3
ionomers does not take place.
 The setting is completed after the light curing
the material.
 The physical properties are somewhat lower
than for normal composite resins but are
generally higher than for resin-modified glass-
ionomers and conventional glass-ionomers.
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Other adhesive restorative

materials: Compomer

1  Despite the presence of fluoride -

containing glass particles, compomers do
2

not leach enough fluoride to reduce caries

progression.
 As with normal composite resins,
polymerization shrinkage and shrinkage
stress are a problem.
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Four adhesive dental
restorative materials
compared
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Four adhesive dental
restorative materials
compared
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Adhesive dental
restorative materials:
comments
1  Conventional and resin-modified glass-ionomers
2
score high on the biological but lower on the
physical requirements.

 The opposite is applicable for composite resin and

polyacid-modified composite resins (‘compomers’)
materials. They score low on the biological and
high on the physical requirements.
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Adhesive dental
restorative materials:
comments
1

2
 Conventional glass-ionomers and
chemically cured composite resins are
available in hand-mix form and can
therefore be used without electricity.

 The cost and availability of materials

vary according to country.
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Summary

1  Glass-ionomers have been explained in more

2
details than the other adhesive restorative
materials for the reason that this material has been
used in the ART studies.
 Each material has its strengths and weaknesses.
 An ideal biological restorative material has not
been manufactured.
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Summary
 The selection of material for caries preventive
1

2
and tooth restorative purposes is dependent on
a number of factors such as:

 the size of the caries lesion

 its site in the mouth
 patient’s oral health promoting or harmful behaviour
 knowledge and skills of the operator.