Australian Dental Journal, April, 1977

120

Volume 22,
No. 2

The clinical development of the glass-ionomer cement. II.

Some clinical applications*

J. W. McLean, M.D.S., L.D.S., R.C.S.

Clinical Consultant, Laboratory of the Governnient Chemist, London

AND

A. D. Wilson, D.Sc., C.Chem., F.R.I.C.

Senior Principal Scientific Officer, Laboratory of the Governnient Chemist, London

ABSTRACT-A description is given of the varied clinical applications of this cement; these
applications include its use as a filling material, as a sealant and as a luting agent.

(Received for publication June, 1976)

Introduction

The first part of this series discussed the formulation, development and properties of glassionomer cements. The most practical version of
this cement was designated ASPA IV. The hydrophilic nature of this material, its good mechanical
strength and excellent adhesion to tooth structure
and certain metals are properties which can be
utilized to the maximum in several clinical applications. The recommended applications fo? ASPA IV
filling material are listed below
1. Sealing of occlusal pits and fissures.
2. Filling of occlusal fissures showing early
signs of caries.

* From a lecture, 21st Australian Dental Congress, Adelaide, February, 1976.

3. Restoration of deciduous teeth.

4. Restoration of lingually placed Class I11

cavities.
5. Restoration of Class V cavities not involving
large areas of labial enamel.
6. Repair of defective margins in restorations.
7. Restoration of erosion lesions without cavity
preparation.
A fine grained version of ASPA IV, ASPA IVA,
has been made available for further evaluation
as a luting agent. The only difference in formulation between this material and ASPA 1V filling
material being in the particle size distribution of
the powder. ASPA luting (ASPA IVA) has been
used for the following clinical applications.
1. Translucent luting cement.
2. Lining cement.
3. Sealing of occlusal pits and fissures.

121

Australian Dental Journal, April, 1977

Contra-indications for use

Glass-ionomer cements, in their present stage
of development, are brittle materials with a low
tensile strength and must therefore be used in
bulk. They also have insufficient transluency for
restoring large areas of visible labial or buccal
enamel. They are not recommended for the following clinical applications:1. Restoration of Class IV cavities.
2. Restoration of large areas of labially exposed enamel.
3. Class TI cavities.
4. Restoring large cusp areas.
Biological compatibility
The glass-ionomer cement is based on a polycarboxylic acid2J and pulpal studies by Plant4 and
Rowes indicate that its irritant action towards
tissue is probably similar to the polycarboxylate
cement of Smith6. Evidence is accumulating that
the zinc polycarboxylates do not produce very
much pulpal reaction. Four recent studies stated
that the response is essentially the same as that
of zinc oxide and eugenol cement 7-10.
The blandness of poly(acry1ic acid) compared
with phosphoric acid, as observed by Peters and
his co-workersll, may be attributed to several
causes:
(1) Poly(acry1ic acid) and related polyacids are
weak acids;
(2) diffusion of polyacids down dentinal tubules
is restricted by their high molecular weight
and the entanglement of polymer chains;
(3) even when dissociated, H+ ions tend to be
confined to the locality of the polyanion
chain by electrostatic forces and will be less
readily exchanged by cations than those
associated with simple anions such as phosphates.
1 McLean,

J. W., and Wilson, A. D.-The clinical deve!opment of the glass-ionomer cements. 1. Formulations
and properties. Austral. D. J., 221, 31-37 (Feb.) 1977.
2 Wilson
A D. and Kent B E.-The
glass-ionomer
cem'ent. * a n;w translucent ciental filline material. J.
Appl b e m . Biotechnol. 21: 313 1971.8 Wilson.'A.
D., and Kent. 'B. E.-S;rgical
cement. Brit.
Pat. No. 1 316 129 1973.
4 Plant. S. C.--'Personal
'communication. 1972.
5 Rowe, R. H. W.-Personal
communication, 1972.
BSmith. D. C.-A
new dental cement. Brit. D. J.. 125:5,
?Xi-384 (Nov. 5 ) 1968.
7 Smith
D C-A
review of the zinc polycarboxylate
cehents. J.' Canada. D. A., 37:1, 22-29 (Jan.) 1971.
BBeagrie, G. S.. Main, J. H., and Smith, D. C.-Inflammatory reaction evoked by zinc polyacrylate and zinc
eugenate cements. A comparison. Brit. D. J., 132:9,
351-357 (May 2) 1972.
OSafer, D. S Avery, J. K., and Cox, C. F.-Pulpal
responses t 6 newly formulated restorative cements, liners,
sealers. International Association for Dental Research
49th General Session, Chicago, paper No. 830, 1971.
1oTruelove E L Mitchell D. F and Phillips R. W.Biologic &al;8tion of a'carbox'slate cement. i. D. Res.,
50:1 166 (Jan.-Feb.) 1971.
11Peters.' W. J., Jackson, R. W., Iwano, .K.,and Smith,
D. C.-The biological response to zinc polyacrylate
cement. Clin. Orthop., 88: 228-233, 1927.

For the above reasons, in nearly all the clinical

studies carried out on the glass-ionomer cement
the material was used without lining cement. This
was of particular importance when adhesion to
dentine was required. In cases where a near exposure of the pulp was observed a lining of Dycal
calcium hydroxide was inserted.

1
~

Radial c o n g c r r l o n
Tangential rmrbn
Ln composite
resin matrix

Aromatlc Dlrncthwrylare Resin

I
Fig. 1.-The filler matrix interface in a composite resin
material and in the glass-ionomer cement. In the latter
material a laver of siliceous hydrogel connects the filler
core to the matfix.

Fissure filling and sealing

A fissure sealant must form a firm attachment
to the enamel substrate if it is to be effective. Its
bond strength to enamel and its resistance to abrasion govern the permanence of the seal. In addition, a fissure sealant should be both thermally
and chemically stable in the oral environment.
The glass-ionomcr cement is probably the first
restorative material to fulfil most of the above
requirements. Its bond strength to enamel exceeds
11

Hotz P. McLean J . W Sced I and Wilson A . D.Thk bbnding oi glass-'ionomdr 'dements to metal and
tooth substrates. Brit. D.J., 142:2, 41-47 (Jan. 18)
1977.

13Kent B. E., Lewis, B G. and Wilson, A. D.-The

properties of a glass-ionbmer cement. Brit. D. J.,
135:7 322-326 (OCt. 2) 1973.
'
1 McLeaG, J. W., and Wilson A D.-Fissure
sealing and
filling with an adhesive 'glakionomer cement. Brit.
D. J., 136:7, 269-276 (Apl. 2 ) 1974.
*Levine R. S.-The
action of fluoride in caries prevention.' A review of current concepts. Brit. D. J., 140:1,
9-14 (Jan. 6) 1976.

122

Australian Dental Journal, April, 1977

its cohesive strengthl2; the cement is not easily

attacked by weak acids13 and it is resistant to
clinical abrasionl4. Unlike a composite resin there
is a graded structure between filler particle and
matrix with no precise interfaces, which gives this
cement more of the character of a monolith. More-

that even if it releases fluoride, ion-exchange

would be hindercd.
T h e rationale behind the clinical technique for
occlusal fissure filling and scaling with the glassionomer cement has already been givenlt However, in the light of further clinical experience a

TABLE 1

Elution of fluoride from a glass-ionotner cement

Period'

Fluoride eluted,
mg/cernent

0.75
1.22
0.29
0.14
0.08

1st day
1st week
2nd week
5th week
13th week

* Following

preparation.

over, any stresses between filler and matrix will

have been dissipated during the course of the
cement-forming reaction, in which the filler is a
reactant and the matrix polysalt a product. Thermal
cycling will have less deleterious effect than on
composites where radial and tangential stresses
can be set up at the filler-matrix interface because
of mis-match between the thermal expansion of
filler and matrix (Fig. 1). In the glass-ionomer
cement it is considered that the interfacial layer
of siliceous hydrogel coating each particle acts as
a stress reliever.
A cariostatic action on the tooth is another
essential property which a caries preventive material should possess. One way in which this
favourable result may be achieved is by topical
release of fluoride, although the mechanism is not
fully understood. It has been variously suggested
that fluoride converts hydroxyapatite to the less
soluble fluorapatite, by ion-exchange; promotes
formation of well ordered crystals of apatite; and
inhibits glycolysis and thus the corresponding conversion of sugars to acidsls. T h e matrix of the
glass-ionomer cement contains sheathed droplets of
calcium fluoride16 and so the hardened cement
paste continually releases fluoride ions17 (Table 1).
Because the cement becomes attached via ionic
and polar bonds to the enamel and dentine, the
intimate molecular contact facilitates fluoride ionexchange with the hydroxyl ions in the apatite of
the surrounding enamel. By contrast a filling material that does not adhere by molecular interactions
would leave gaps between the filling and tooth, so

Barry T I Miller K P. and Wilson A. D-Dental

cem'entk b'ased on 'ion'learhable glassei. XI Cbnference
on the silicate industry Budapest, 1973 (pp. 881-893).
17 Crisp S., Lewis B. G.: and Wilson, A
D.-Glassionbmer cemeAts: chemistry of erosion. ' J. D. Res.,
55:6, 10321041 (Nov.-Dec.) 1976.
18

Fig. 2.-a,
Tracing of a cross section through a molar
fissure which is easily detectable with a probe. These fissures will always exceed lOOpm in width. b, Fissure filled
with cement.

Fig 3.-a
Tracing of a cross section through a molar
fisshe of 'less than lOOpm in width. The base of these
fissures is difficult to fill with glass-ionomer cement as
shown in Fig. 2b.

reiteration of the most successful techniques together with certain modifications will be given.
Fissure sealing
The glass-ionorner ccment is only suitable for
sealing fissures in depth where the pit or fissure
orifice exceeds lOOpm14 (Fig. 2a,b). This size of
fissure should allow n sharp probe to enter the
crevice and is easily detectable. Fissures or pits
below lOOprn in size can only be treated if the
cement is over-built above the orifice (Fig. 3a,
b).
Recommended clinical technique:1. Isolate the tooth or teeth in one quadrant
with cotton rolls and dry the surface. Swab a solution of 50 per cent citric acid into the fissures and
work the acid into the depth of the crevices with
a sharp probe. Debris may be scraped out with
the probe. This treatment should not exceed one
minute.
2. Clean off the debris and acid with air/water
spray and dry thc tooth with warm air.
3. Dispense two drops of the polyacid liquid
onto a refrigerated glass slab. Sufficient powder is
then placed on one side of the liquid to provide
the required mix.
Note: refrigeration of the slab increases the
working time.

123

Australian Dental Journal, April, 1977

Fig. 4.-Two
mixes of cement powder are shown on the
left of the slab. The lower mix is made first at n thin
consistency of approximately 1.5g/ml. Further powder is
now drawn in to the top mix on the left lo give a plastic
consistency (P/L proportion of 3.0g/ml).

Fig. 5.-Thin

Fig. 6.-Thicker mix applied over the mix in fissures and

pressed firmly to position with a ball-ended burnisher.

Fig. 7.-A

4. Draw in a small quantity of powder and mix

with the liquid using an agate or stellite spatula.
This mix should be of a thin consistency (P/L
proportion of 1.5g/ml). Divide this mix into two
and, thicken half the mix with more powder until
it reaches a plastic consistency (P/L proportion of
3.0g/ml) (Fig. 4).
5. Pick up some of the thin mix on the end
of a probe and work it vigorously into the fissures
(Fig. 5). Then at once apply the thicker mix to
the fissure and ram it into position with a ballended burnisher (Fig. 6). The cement should now
be over-built above the orifice.
6. Apply a sheet of thin wax* over the filling
and burnish it tightly into position. This technique
will provide a very effective seal which is necessary since any contamination of the cement by
moisture during setting is detrimental. The patient
can now be allowed to relax and thereby avoid
the discomfort of muscle fatigue.

7. Allow the glass-ionomer cement to set for at

least five minutes prior to removing the wax and
then lightly scrape away the exccss cement with
spoon excavators until the filling is slightly above
the fissure orifice but without impeding occlusion.
Apply a cavity varnish immediately after trimming
to protect thc polysalt matrix from degradation
by moisture (N.B. the strength of the matrix increases with time as the aluminium ions build
up in the gel). A glass-ionomer cement sealant,
age 18 months, is illustrated (in Fig. 7) and may
be compared with an old amalgam filling in the
first molar.
Fissure filling
Prophylactic odontotomy has been practised for
many years and materials such as amalgam and
silico-phosphate cements have been used on quite
an extensive scale.
It is not recommended that the glass-ionomer
cement should be used in this way since retention
in the fissures is achieved by molecular interactions to enamel and does not require mechanical

Kerrs Green occlusal indicator wax.

cement should be worked well into fissures

prior to applying thicker mix.

completed glass-ionomer cement sealant after 18

months in service in the second molar.

124
retention. However, the treatment of early carious
fissures does present an entirely different problem.
An investigation of the potential of glass-ionomer
cement as a n occlusal fissure filling proved very
promising. A two-year study revealed that in only
a few cases was anatomical form lost and in n o

Fig. S.-Tracing of a typical filled fissure in an upper premolar where the dental caries has not mushroomed into the
dentine.

case was dentine exposed. There was evidence of

some marginal staining but no cases of secondary
caries were recorded in the 96 restorations examinedlt A cross-section of a fissure filling is
shown in Fig. 8.
Glass-ionomer cement occlusal fillings appeared
abrasion resistant and able to form strong and
long lasting physico-chemical bonds with tooth
structure. Their fluoride release also appeared to
give protection to the tooth. For these reasons it
may be preferable to use glass-ionomer cement as
a n alternative to amalgam in restoring early carious
fissures. I n these cases only minimal cavity preparation is required and undercuts are not necessary
to obtain retention. T h e prime object of the tooth
preparation is t o remove any carious material and
generally this can be done with small round burs
or even a No. 1 plain tungsten-carbide fissure bur.
Cavity toilet should only consist of cleaning with
hydrogen peroxide and an air/water spray;
under no circumstances should citric acid cavity
cleansers be used on large areas of exposed dentine.
The glass-ionomer cement, mixed a t a P/L ratio
of 3.0g/ml should be packed into the fissure. Trimming and finishing of the filling may then be done
in the same way as described for the fissure sealant technique, but in the event of any gross excess
being present it is often easier to trim this with
round tungsten or finishing burs. Protection by
cavity varnish after final trimming of the filling is
essential.

Restoration of deciduous teeth

The adhesive nature and biological compatibility
of the glass-ionomer cement makes it a very useful material for restoring children's teeth. Cavities
may be restored with minimal preparation and
unlike amalgam fillings, key-ways are not required.
It is suggested that standard cavities are prepared
for Class I lesions but in the case of the Class I1
cavity the essential feature should be to provide

Australian Dental Journal, April, 1977

bulk for the filling. Glass-ionomer cement is strong
in compression but weak in tension, therefore
narrow isthmuses and shallow key-ways are to be
avoided. I n large restorations some mechanical
retention should be provided by lightly grooving
the dentine walls. Failure t o provide mechanical
retention may result in early failure since the cohesive bond strength o the glass-ionomer cement
is not sufficient to resist strong occlusal forces
which produce shearing stresses. The basic aim of
all deciduous cavity preparation for the glassionomer cement should be t o preserve the maximum amount of enamel subject t o access for caries
removal. Nylon matrix strips should be used for
containing the filling in preference to metal and
during the initial set (five minutes) the filling
should be protected with thin sheet wax over the
surface of the restoration. Final finishing may then
be done as described for the fissure filling techniques. Immediately on completion of finishing
the restoration, a coat of varnish must be applied.
Class 111 and V cavities
The glass-ionomer cement would have fulfilled
the role of a universal anterior filling material but
for having a translucency lower than that found
in most coniposite resin materials. This lower
translucency restricts the aesthetic use of the present glass-ionomer cement on the anterior teeth.
However, apart from this deficiency, this cement
is superior, in many properties, to the composite
resin filling material. It is biologically compatible
with the pulp and generally requires no lining, it
releases fluoride ions, and is adhesive to enamel
and dentine. As a result all cavity preparation on
the anterior teeth can be very conservative in
nature, since no mechanical retention is required
in the Class TI1 or V cavities, and space need not
be provided for a lining cement.
In the case of an early Class IT1 lesion the glassionomer cement is probably the most effective material for restoration. Providing the operator makes
a lingual approach, the finest diamond point will
penetrate the enamel and reach the carious zone.
After this it is a very simple operation to use a
slow running round bur t o gently excavate the
caries. The enamel should only be removed just
over the lesion and no attempt made to extend
into self cleansing areas labially. In essence, the
final cavity could resemble a small cup shaped
depression in the proximal wall of the affected
tooth, with access for packing the cement via the
lingual surface. The glass-ionomer cement may
then be inserted or contained using a standard silicate cement technique. Cavity toilet should consist only of light irrigation with hydrogen peroxide. Citric acid should not be used.

Australian Dental Jocrnal, April, 1977

Repair material

Another important application for the glassionomer cement would appear to be the repair of
faulty margins around restorations. Most clinicians
have faced the dilemma of what to do with extensive crown and bridgework where gingival erosion
has occurred or where marginal fit may not be acceptable around one or two units of metal/ceramic
work in an extensive splint. Remaking such restorations is not only expensive but removal of the
restoration after a short period of service undermines the patient's confidence.
Previous methods of repair generally involved
some sort of cavity preparation, with the subsequent insertion of a composite resin or similar
material. Phosphate bonded cements were unsatisfactory because of their rapid breakdown under
acid conditions.
Providing the margins are thoroughly cleaned
out, and the micro-leakage has not extended into
the depths of the restoration, then the sealing of
defective margins around crowns or inlays with
glass-ionomer cement is a practical proposition.
Generally, a radiograph combined with an examination with a sharp cxplorer will establish the
integrity of the internal surfaces of the tooth preparation. The cement should be firmly packed into
the crevice or eroded area and covered with a
cervical matrix in the same way as for the erosion
lesion. I t is then very convenient t o trim the set
material with sharp knives, since in this way, subgingival bleeding is avoided, which might contaminate the set cement. At the present time, no
signs of dissolution of these cement margins have
been observed during a three-year trial. The ability
of the glass-ionomer cement to retain its surface
in a potentially acid-producing stagnation area once
again supports the in vitro studies in the laboratory.

Luting cements

Although the polysalt gel stage of a freshly prepared glass-ionomer cement is susceptible to water
contamination, a very useful clinical property
appears to be in sight of achievement. By controlling the rate of ion-exchange it is possible to make
luting cements with a gel-like initial set that allows
the operator to remove the restoration within the
first five minutes of cementation. For example, if
dissatisfied with the fit of the restoration, or too
thick a mix has caused failure of seating, then
the operator is given the opportunity of starting
again. Glass-ionomer cements can be formulated
having the characteristics of a temporary cement,
such as Kerr's Temp-Bond, for the first five to

125
ten minutes, and then developing after one hour
properties characteristic of a silico-phosphate
cement such as high strength and ability to liberate
fluoride ions as a cariostatic measure. Such a
cement will also have the favourable qualities of a
polycarboxylate, including good wetting ability
combined with comparative inertness and, as previously illustrated, good resistance to acid attack.
A specially prepared glass-ionomer powder of
vcry fine grade, termed ASPA IVA, luting material
has now been used for over two years for the
cementation of all types of restorations. Further
studies are now in progress to assess its commercial
viability. The only clinical disadvantage observed
with this ncw cement is in the early stages of set.
As explained previously the cement sets in two
stages, the first gel-like set is due to calcium ioncxchange and the second stagc, where a rockhardness is achieved, is due to aluminium ionexchange. During the initial gel-stagc the salt
matrix is very susceptible t o attack by moisture,
so that if saliva contacts the luting cement the
material can be seriously weakened. Attack by
moisture will obviously be more severe a t low P/L
ratios so that at luting consistencies of 1.5g/ml it
is essential to protect the margins of the restoration from moisture for at least five minutes after
cementation. Providing the cement is protected
during calcium ion-exchange and a firm gel salt is
allowed to form, then the final result provides a
strong fluoride leachable glass cement with good
physico-chemical bonding.
This latter property is of great significance
since current work by Hotz and co-workers12 has
shown that ASPA IV cement will stick to tin or
tin oxide coated gold or platinum surfaces as described in Part I of these papers. The mechanism
for adhesive bonding is illustrated in Fig. 9 and
is particularly applicable to the construction of
bonded alumina crowns, or attachment of gold
inlays to tooth structure.
The bonding scheme postulated in Fig. 9 shows
how the glass-ionomer cement bonds dentine to the
tinned surface of platinum, and how tinned
platinum adheres to porcelain. The cssential bond
is the ionic one between oxygen anions and metal
cations. At the glass-ionomer cement/dentine interface oxygen anions at the surface of the dentine
and those contained in the cement carboxylate
groups are ionically linkcd by, most probably,
Ca'+ ions. At the glass-ionomer cement/treated
platinum intcrface oxygen anions a t the surface
of the tinncd and oxidized platinum are ionically
linked to those contained in thc cemcnt matrix
by Sn?+ ions. A similar ionic mechanism applies
to the porcelain/treated platinum surface where
oxygen atoms at the surface of both materials are

Australian Dental Journal, April, 1977

126
ionically linked by Sn'+ ions. Although the adhesive bonds at the various interfaccs differ, a
common feature to all is the bridging of oxygen
atoms by an ionic metal link.

respects, such as adhesion, low thermal expansion

and hydrophilic qualities, the glass-ionomer
cements are superior and reflect the good qualities
of the polycarboxylate cements. I t is also probable
that they will have similar biological propertie~4~5.
Two qualities are therefore required in the glassionomer cements before they can be considered

CM'

Fig. 9.-Schematic drawing of the bonding of porcelain to

tin-plated platinum foil at the attachment of glass-ionomer
cement to the tin oxide surface. Attachment of the cement
to dentine i.; shown on the right of the drawing. Thlr
system provides molecular bonding of the restoration to
tooth structure.

Lining material

The glass-ionomer cement is particularly well

suited as a lining cement. Because it does not form
transient elastomers it does not tend t o 'cobweb'
like the polycarboxylate and is therefore easy to
insert. After an initial set of five minutes the glassionomer cement can also be easily carved with
sharp spoon excavators or chisels.
One particularly useful clinical application may
be found in lining composite fillings. The translucent glass-ionomer lining cement of appropriate
colour is packed into the cavity and trimmed level
with the amelo-dentinal junction. After setting the
enamel may then be acid-etched with 37 per cent
phosphoric acid and a composite filling inserted
by standard technique. In this way the advantages
of ASPA, its molecular seal to dentine combined
with the aesthetic appeal and strong mechanical
retention of the composite fillings, can be fully
realized (Fig. 10).
Erosion-lesions

The detailed clinical technique for restoring

erosion-lesions will be dealt with in Part I11 of
this series.
Discussion

Within the limitations of this five-year development programme, the glass-ionomer cements would
appear t o have the abrasion resistance and low
thermal expansion of the silicate cement without
its liability to disintegrate rapidly in weak acids.
In addition, the glass-ionomer cements contain
leachable calcium fluoride which provides a cariostatic property in the material. It has not yet been
found possible t o produce a glass-ionomer cement
with the translucency of the composite resins or
with the latter's higher flexural strength. In other

Fig. 10.-Diagram showing sealing of dentine with a glassionomer cement and the attachment of a composite filling
over it using acid etching techniques.

as a universal restorative-improved
toughness for
posterior situations and a higher translucency or
lessened opacity for anterior fillings.
Another property which has been found important in cements based on poly(acrylic acid) is the
shelf life of the liquids. Some of the problems
encountered by clinicians with these materials can
be related to the increase in viscosity of the poly(acrylic acid) liquids during storage. Increases in
viscosity lead to difficulties in mixing, shorter
working time and lower P/L ratios, all of these
undesirable features producing lower strengths.
The cause of this phenomenon is as yet unknown:
it may be inherent.due to chain entanglement or
could be the result of slight contamination from
the containing vessel. It is important, therefore, to
avoid using liquids which have gelled or have a
high viscosity like glues. Crisp, Lewis and Wilson18
have described an acrylic/itaconic acid co-polymer
which, in 50 per cent m / m aqueous solution, has
a low viscosity (10 poise) compared with that of
similar solutions of poly(acrylic acid) 50 poise.

18

Crisp S., Lewis, B. G., and Wilson, A. D.-Gelation of

poiyacrylic acid aqueous solutions and the measurement of viscosity. J. D. Res., 54:6, 1173-1175 (Nov.Dec.) 1975.

127

Australian Dental Journal, April, 1977

This material has a minimum two-year shelf life
and is now available commercially*.
The most promising area of clinical use for the
glass-ionomer cement would appear to be in the
field of preventive dentistry. The sealing of erosionlesions (without cavity preparation) and fissure
sealing are but two major possibilities. The
clinical author considers that in the light of this
five-year trial the use of glass-ionomer cements
as small fissure fillings could eliminate much of
the present amalgam filling work in the typical
Class I cavity. In addition, the cariostatic action
of this material may also play a major role in
arresting occlusal caries.
Other areas of great potential may lie in the
restoring of deciduous teeth, since these new
cements are very bland and ideal for placement

in cavities with poor access. Providing they are

not directly contaminated by saliva they are very
tolerant of moist environments which again makes
them attractive for very young patients.
Acknowledgement

The authors thank the Government Chemist,

Dr. H. Egan, for permission to contribute this
paper. Crown Copyright, reproduced by permission
of the Controller of Her Britannic Majestys
Stationery Office.

Department of Industry,
Laboratory of the Government Chemist,
Cornwall House,
Stamford Street,
London, SE1 9NQ,
England.