All about

Glass Ionomer Cements

by
dr.anoop.v.nair

Introduction
Definitions & terminologies
Scientific & clinical development
Classification
Composition
Setting reaction
Water balance
Adhesion
Properties
Clinical implications
Instructions to dental assistants
Review of literature
References
Summary & conclusion

DEFINITIONS &
TERMINOLOGIES

 The word ionomer was coined by Dupont company

Describe its range of polymers containing a small proportion of

ionized or ionizable groups generally of the order of 5% to 10%.

Does not properly apply to components of GI dental cement

Therefore the term Glass polyalkenoate cement was devised.

Systematic name in Chemical Abstracts ; Official ISO terminology

Does not apply to recently developed poly(vinyl phosphonic acid)

cements ---- Glass Polyphosphonates.

Therefore the term Glass - ionomer cement is a generic one for

all glass polyacid cements.

Definition of glass ionomer cement

A cement that consists of a basic glass & an acidic polymer
which sets by an acid-base reaction between these
components.
(Mclean & Wilson 1994)

Glass : Acid-decomposable glass

Acidic polymer : Typically poly(acrylic acid)
Successful acids are water soluble &
polyelectrolytes.

Acid-base reaction : The cement forming reaction is defined

as the conversion of initially viscous paste to a hard solid, & in

a true glass-ionomer cement this reaction takes place within a
clinically acceptable time i.e, a few minutes.

The essential elements of a true glass ionomer :

Acid-base setting reaction

Ion-exchange adhesion with underlying tooth structure
Continuing ion activity, with mobility of fluoride, calcium and
phosphate ions

 Definition (Akinmade & nicholson, 1993) water based

cement where-in following mixing, the glass powder &
polyalkenoic acid undergo an acid/base setting reaction.
The acid attacks the surface of powder particles,
releasing calcium & aluminium ions, thus developing a
diffusion-based adhesion between powder & liquid

Types of glass ionomer cements

1.

Based on chemical composition

2 types of glass ionomer :
Glass-ionomer cement
Glass polyalkenoates
Glass polyphosphonates
Glass-ionomer hybrid materials
Resin modified glass-ionomer

2.

Based on types of cure :

Autocure : Chemical cure acid-base reaction

Dualcure : Light initiation followed by acid-base reaction
Tricure : Autocure resin reaction in remaining uncured resin

Glass-ionomer hybrid materials

The term Resin-modified glass-ionomer originally

used by Antonucci et al, is the trivial name.

Systematic name, for precise chemical nomenclature

as in ISO standards is Resin-modified glasspolyalkenoate

Consists of components of glass ionomer, modified

by inclusion of a small quantity of additional resin,
mostly HEMA.

They set partly by acid-base reaction & partly by

photochemical polymerization.

Other polymerizable restorative materials :

Polyacid modified composite resins (Compomers)

Donot belong to glass-ionomer category.

The correct ingredients are present (acid decomposable glass
& possibly some polymeric acid) but in an insufficient amount
to promote acid-base cure in dark
Donot set without light activation.
Donot bond to tooth structure through ion-exchange
mechanism.
Fluoride reservoir effect of glass ionomer is not available.

Diagram showing theoritical composition of various resin-modified materials &

the potentialeffect of modifying the relative percentage of the contents

As resin component increases acid-base reaction reduces ; benefits of

glass ionomer are lost & the material becomes light activated only
Compomers would belong in one of the middle 2 bars (acid-base component
is negated & therefore belong to composite resin end of table)

Mix under a light proof cover

Compomer anhydrous resin-based material
not possible to have ion
transport within it.
Fluoride release is minimal

At 20 min ; compomer does not

show signs of set if not light
activated
Resin modified glass ionomers
-By 7-10min show signs of
chemical set
-Over the next 15020min becomes
quite hard

SCIENTIFIC & CLINICAL

DEVELOPMENT

INVENTION :
Resulted directly from basic studies on dental silicate
cements & studies where the phosphoric acid in dental
silicate cements were replaced by organic chelating acids.

EARLY DEVELOPMENT

1966 : A.D.Wilson examined cements prepared by mixing

dental silicate glass powder with aqueous solutions of various

organic acids (including poly(acrylic acid)
- unworkable, set slowly, sluggish, not hydrolytically
Silica glass :
stable.
Highly cross linked
network of connected
silicon & oxygen
atoms; does not carry
an electric charge
Impervious to acid
attack

Ionomer glass :
ionic polymer ;
contains negative
sites which are
vulnerable to attack
by positive hydrogen
ions of acid

 1968,1969 : A.D.Wilson + Kent & Lewis found that

hydrolytically stable cements could be produced by

employing novel glass formulations.

1968 : Kent found that setting of these cements was

controlled by Al2O3/ SiO2 ratio in the glass.

1973,1979 : Kent et al found a glass that was high in

fluoride that gave a usable cement ASPA 1
(aluminosilicate polycrylates).

 1972 (reported in 1976): Wilson & Crisp key discovery

tartaric acid modified the cement-forming reaction, thus

improving manipulation, extending working time & greatly
sharpening setting rate.

This refinement of ASPA I was termed ASPA II & constituted

the first practical GIC.

1975 : Crisp et al the disadvantage for general practice was

that its liquid tended to gel.

1975,1977 : Crisp & Wilson developed copolymer of acrylic &

itaconic acid that did not gel at high (50%) concentration in
aqueous solution

ASPA IV. But this was inferior in other properties to ASPA II

1974 : McLean & Wilson used it for fissure sealing & filling

1977c : McLean & Wilson ideal for restoration of class V erosion lesions.

1979 : Crisp et al ASPA X with excellent translucency.

1977 : Wilson et al ASPA IVa fine grained version for luting.

With less viscous polyacid, lacked the mobility of traditional zinc

phosphate cement.
1977 : Mclean & Wilson in a review article suggested use in pediatric
dentistry & as a liner in composite resin / ionomer laminate.

LATER DEVELOPMENT

1973 : Wilson & Kent reported use of poly(acrylic acid) in dry

powder form blended with glass powder.
The cement was formed by mixing this powder with water or
tartaric acid solutions.
1984 : Prosser et al re-examined the above & resulted in
development of ASPA V
ASPA Va a water-hardening luting agent proved to have the
mixing qualities & mobility of zinc phosphate cement.
1985 : McLean et al the original 1977 idea of using composite resin
/ ionomer laminate was revived in a modified form.
GIC & enamel was etched double etch technique (composite resin
was attached micromechanically to enamel & GIC bonded
indirectly to dentin).

1984 : Hunt & Knight tunnel preparation for Class II

The reasoning behind the technique GIC core bonds enamel
shell together, preventing fracture (described by Hunt 1984, &
Mclean 1987)

1980 : Sced & Wilson & 1983 : Simmons incorporated metallic

oxides & metal alloy fillers, to improve strength of GIC.
1985 : McLean & Gasser fused silver particles onto ionomer glass,
giving cement radioopacity, burnishability, smoother surface,
increased wear resistance (reported by Moore et al 1985)
1986 : McLean Developed new Cermet cements for clinical use.

 1988 : Wilson & McLean Highly viscous glass ionomer

cements

Late 1980s : Resin-modified glass ionomer cements

COMPOSITION

Glass ionomer cement is defined as an acid-base

reaction cement (Wilson 1978, Wygant 1958)

Basic component
Calcium
aluminosilicate
glass containing fluoride

Acid component
Polyelectrolyte which is a
homopolymer or copolymer of
unsaturated carboxylic acids
known
scientifically
as
alkenoic acids.

Chemical composition of original ionomer glass (G-200)

(Modified from Barry et al 1979)
SiO2
Al2O3
AlF3
CaF2
NaF
AlPO4

30.1%
19.9%
2.6%
34.5%
3.7%
10.0%

Types of Calcium fluoroaluminosilicate glass:

SiO2 - Al2O3 - CaF2
(Simple 3-component system)
SiO2 - Al2O3 - CaF2 - AlPO4
SiO2 - Al2O3 - CaF2 - AlPO4 Na3AlF6
Components are fused between 1100C - 1500C
Melt poured onto metal plate / into water
Glass then ground to fine powder
(Maximum particle size: 50m for restorative & 20m for luting)

Fluoride Lowers temperature of fusion

Improves working characteristics of cement paste
Increases markedly strength of set cement
Enhances translucency
Contributes to cements therapeutic value

Cryolite (Na3AlF6) - Supplements fluxing action of CaF2

Reduces temperature at which glass will fuse
Increases translucency of set cement
AlPO4 - Increases translucency
Adds body to set cement

Visual appearance of glass clear /

opal / opaque

Glasses high in SiO2 (>40%)

transparent
Glasses high in Al2O3
opaque

Al2O3 / SiO2 ratio :

Crucial , required to be 1:2

Increase in ratio
Decreases setting time
Clear to opaque
Compressive strength increases
Determines the rate at which
breakdown of glass matrix occurs

Negative sites are vulnerable to acid

attack ; if enough Al atoms, all the
connecting links in network will be
completely decomposed ; such a glass
has cement forming potential

VARIATION ON BASIC GLASS COMPOSITION

1.

Calcium may be replaced by strontium / barium /

lanthanum
Radioopaque glass

2.

Disperse phase glasses

Flexural strength

3.

Fibre re-inforcement (eg. Alumina fibres )

Flexural strength

4.

Metallic inclusions

POLYELECTROLYTES
Are both electrolytes and polymers
includes copolymers of unsaturated mono-, di-, and tricarboxylic acids, particularly those of acrylic acids.

The more important carboxylic acids in ionomer include

acrylic acid, maleic acid and itaconic acid.

The polyacids may be

in the form of concentrated aqueous solution (40-50% by mass)

Blended dry with glass powder

COMPOSITION OF ASPA CEMENTS

ASPA I G-200 + 50% polyacrylic acid

ASPA II G-200 + 47.5% polyacrylic acid + 5% tartaric acid
ASPA III G-200 + 45% polyacrylic acid + 5% tartaric acid +
5% methyl alcohol

ASPA IV G-200 + 47.5% copolymer of acrylic & itaconic

acid 2:1 ratio + 5% tartaric acid

Different configurations affect adhesion ??

Polyacrylic acid cements bond more strongly to enamel &

dentin (Aboush & Jenkins, 1986)
Copolymer cements less resistant to acid attack than
Polyacrylic acid cements (Setchell et al, 1985)

Copolymer cements harder than polyacrylic acid aids early

finishing (Mount & Makinson 1982, Matis & Philips 1986)

Effect of molecular weight and concentration of polyacrylic

acid

Increase in molecular weight and concentration

Shortens setting time

Increases strength
Increased viscosity of mix

Water

Reaction medium
Plays role in hydrating reaction products i.e metal
polyalkenoate salts and silica gel

Tartaric acid

The principal obstacle in developing practical GIC was

Sluggish nature of set
Working time was minimal
Slow hardening

In 1976 Wilson et al reported addition of tartaric acid made

glass ionomer cement a practical one
It enabled reduction of fluoride
Delayed onset of viscosity

Other additives
Working time

Polyphosphates

Metals
Stannous
fluoride

Setting time

SETTING REACTION

Cement forming reaction of glass ionomer cement

Showing extraction of ions from the glass, migration into aqueous

phase, & subsequent precipitation as polyanion hydrogels

Decomposition

There are 4 overlapping

stages that can be identified
but not clearly separated out

Migration
Gelation
Further slow maturation
Post-set hardening

Unattacked
glass
particles
dispersed
in polyacid
liquid

Outer layer of glass

particles is depleted
of metal ions &
degraded to silica gel.
Metal ions migrate to
liquid, where they
remian in soluble form
(red dots)

Initial gelation
Soluble metal
ions remain ..
The cement is
still vulnerable
to moisture

Fully hardened glass

ionomer in an
insoluble form

Cement is no longer
vulnerable to attack
by moisture

2
n
d

st

s
t
a
g
e

Glass structure
unattacked
(electrically charged
network)

3
r
d

s
t
a
g
e

s
t
a
g
e

H ions attack
network dwelling
ions, Ca 2+ & Na+

H ions attack the

charged aluminosilicate
network, destroying the
glass network &
liberating Al ions

Silicic acid formed condenses

to form silica gel

Setting reaction of auto cure cements

Only the surface of each particle is
atacked by the acid
Releasing Ca & Al ions, & F ions which
remain free & are not part of the matrix
The calcium polyacrylate chains form
first then the aluminium polyacrylate
chains follow immediately

By stage 3, there is a degree of maturity,

with more calcium & aluminium chains

Also a halo of siliceous hydrogel

surrounding each glass particle, which
increases resistance to acid attack
Note : these chains can break & reform
throughout the life of the restoration

Stage 1 : Decomposition of glass & migration of metal ions

(Dissolution)

20-30% of glass is attacked by polyacid

Surface of the glass particles decompose

Releasing metal ions (Al 3+ , Ca 2+ )

Glass network breaks down into silicic acid which polymerises at surface of the
glass powder
As pH of aqueous phase increases, polyacrylic acid will ionize & create
electrostatic field that will aid the migration of liberated cations into the
aqueous phase

The ions thus migrate into the aqueous phase

As the negative charge increases, polymer chains unwind, viscosity increases

Stage 2 : Precipitation of salts; gelation & hardening

At a critical pH & ionic concentration, precipitation of insoluble

polyacrylates begins
Ca 2+ &Al 3+ bind to polyanions via carboxylate groups
The initial set is achieved by the cross-linking of the more readily available
Ca 2+ (forming clinically hard surface within 4minutes of start of mix)

Maturation occurs over the next 24hours when the less mobile Al 3+
become bound within the cement matrix, leading to more rigid crosslinking between poly (alkenoic acid) chains
Aluminium polyacrylate ultimately predominates in the matrix

Few points to remember .

1.
2.
3.
4.
5.

Why not sodium ions ???

What happens to fluoride & phosphate ions??
Do all COOH convert to COOPeriod of vulnerability ??

Causes of gelation

1. Why not sodium ions ???

They cannot displace the hydrogen sphere

They are not site bound, because of their low ionic charge
They do not precipitate as polyacrylates
What happens to them ??
They contribute to formation of orthosilicic acid on the
surface of particles
As pH rises, this converts to silica gel which assists in
binding the powder to matrix

2. What happens to fluoride & phosphate ions??

They form insoluble salts and complexes

3. Do all COOH convert to COO-?? . No

1.

When most of the carboxylic acid groups have ionized

Negative charge on polymer chain increases

Positively charged H ions now become very strongly bound

to remaining un-ionized carboxylic acid group & not easily
replaced by metal ions

2.

As density of cross-links increase

Hinders movement of metal ions towards carboxyl sites

4. Period of vulnerability ??

Till soluble ions

insoluble matrix

After material is set, but not fully hardened; a proportion of ions (Ca 2+ ,Al 3+
polyacrylate ions ) are in soluble form
Can be dissolved out by aqueous fluids
Weakened cement
Softened surface
Opaque restoration

[In a freshly set cement, calcium polyacrylate predominate, they are more vulnerable to
water than aluminium polyacrylates]

5. Causes of gelation

Multivalent Ca 2+ ,Al 3+ ions displace various hydration spheres

that interpose themselves between cation-anion pairs

Cation-polyacrylate ion pairs are formed

Desolvation of hydration spheres renders ionic pairs more
hydrophobic and precipitation occurs

Chain entanglement
Ionic cross-linking

Hydrogen bonds
Involved in matrix formation

Ca 2+ bridge 2 chains ; so do Al 3+ bridge 3??

Stearically unlikely because of presence of negatively charged
ligands
Coordination number of Al is 6 in water, therefore it should be
attached to 6 ligands

In glass ionomer cement, ligands are COO-, F-, OH-, water

molecules

Fig 3-4

Possible molecular structure of the set glass ionomer cement

A- represents F- / OH-

Stage 3 : Hydration of salts ; Hardening & Slow maturation

Progressive hydration of matrix salts, leading to sharp

improvement in physical properties

Continues for about 24hours

Slight expansion under high humidity

Further changes occur for >= 1 year

What are the underlying chemical changes ?

What are the indicators of these slow changes ?

What are the underlying chemical changes ?

Increase in bound water (Wilson et al)

Slow increase in cross-linking (Hill,1986)
Slow replacement of residue carboxyl hydrogen ions by ,metal ions,
increasing cross-linking

Increasing predominance of Al over Ca in the matrix

What are the indicators of these slow changes ?

Translucency improves
Becomes more resistant to dessication
Strength continues to increase for atleast 1 year

Ability to absorb / loose water decreases with age

Initially the cement is plastic, then as it ages rigidity increases,
approaching that of phosphate bonded cements

Hydrogel matrix :

Cement structure

Ca & Al polyacrylates + fluorine

as fluoroaluminium polyacrylate
Water in bound & free form

Glass core pitted by

selective etching

Siliceous
hydrogel
(with fluorite
crystallites)
Smaller filler
particles; contain
only siliceous
hydrogel

Cohesive forces binding matrix together :

mixture of ionic cross-links, hydrogen
bridges, chain entanglement

This framework is porous ; ions with

small dimensions (Eg. OH- & F-) are
free to move through the material

Role of water

Glass ionomer cements are water based cements

- they contain water
Role of water / Significance
- make water during setting reaction
Water plays an important role in
Setting reaction

Final structure

-Reaction medium

-Hydrating species

-Coordinating species

-plasticizer

In the set cement

24% is water
Loosely bound

Tightly bound

As it ages tightly bound : loosely bound increases

Early contamination

Loss of calcium polyacrylate chains

Absorption of water
Loss of translucency

Loss of physical properties

Leaves cement susceptible to erosion

Dehydration
Cracking & fissuring of cement
Softening of surface
Loss of matrix-forming ions

Factors affecting setting characteristics

Role of fluoride

Role of tartaric acid

Role of fluoride
Fluoride forms metal complexes
They retard the binding of cation to
anion sites on polyacrylate chain

Delays gelation & prolongs working

time

Release of H+
Acidity of paste increases
Delays pH dependant gelation

Role of tartaric acid

Tartaric acid is stronger than polyacrylic acid
Forms stronger complex with Al
Therefore increases extraction of Al from glass
Initially tartaric acid alone complexes cations
As neutalisation proceeds & pH ~ 3

Improves
manipulation
Increases working
time

Sharpens set by
accelerating
precipitation
Increases strength

Polyacrylic acid becomes neutralised by metal ions until cement sets at pH ~ 5-5.5
Also ionization of polyacrylic acid is suppressed & unwinding of the
chain is retarded, resulting in decrease in viscosity & delaying gelation
Once gelation occurs, tartaric acid accelerates hardening

Tartaric acid & calcium react preferentially therefore initial set may be due to
formation of calcium tartarate
Tartaric acid controls initial setting of cement

Factors affecting rate of setting

1.

Glass composition : increase in Al/Si ratio faster set

2.

Particle size : finer faster set

3.

Tartaric acid sharpens set without shortening working time

4.

Relative proportion of constituents Powder : Liquid

5.

Temperature of mixing increase faster set

Among these the factors within the province of the clinician are
Temperature of mixing

Powder : Liquid

Factors within the province of the clinician

1. Temperature of mixing

Chilling powder & mixing pad increases working time up to 25% (Mc
Lean 1970)

Increase in working time occurs without loss of physical properties

(Makinson 1978)
Word of warning

Chilling of liquid will cause gelation

Increase in humidity & temperature below dew point weakens the cement

2. Powder : Liquid

Increase in powder faster set

But insufficient liquid decrease in translucency of the set cement

Setting reaction of resin-modified light cured materials

2 distinct mechanisms :

The original acid base setting reaction

Vinyl polymerisation of acrylate groups that can be activated through
the presence of photo initiators such as camphorquinone

When mixed, original acid base reaction appears to continue without interruption
Light activation

Resin component provides as umbrella effect

Some degree of cross linking may be present between 2 matrices ;

both reactions may proceed without interference

Over time, any remaining resin not affected by light - activation may
undergo further chemical setting reaction
A Dark cure reaction

Lead to the term Tricure or Triple-cure

Is depth of cure an important factor??? Yes

1.
2.
3.

Lack of water

inhibition of acid-base reaction

Residual HEMA in lower levels, closest to pulp

Fully light activated restoration is notably superior in
physical properties

Therefore, depth of cure is important ; incremental build up recommended

Unless, a mechanism for chemical curing of methacrylate

groups is incorporated
Redox catalyst
Allows for continuing polymerisation in absence of light activation,
thus ensuring activation of any remaining HEMA

Micro encapsulated potassium persulphate & ascorbic acid

Showing influence of resins

incorporated into the glass
ionomer
The red chains represent fully
activated resins to the depth of
penetration of activator light
Note : there is already a degree
of cross-linking between the
polyalkenoic acid chains and
the polymer chains
Showing progress of setting reaction
of resin component of RMGIC
Autocure redox reaction continues
until entire mass is set

Red chains represent completion of

auto cure setting
Note complete cross linking between
polyalkenoic acid chains & polymer chains

To summarise..

2 distinct types of setting reaction occur :

Acid-base neutralisation reaction
Free-radical metharylate cure

Relationship between the 2 reactions may take one of 2 forms

Formation of 2 separate matrices
Ionomer salt hydrogel
Poly-HEMA matrix

Multiple cross-linking pendant methacrylate groups may replace a small fraction

of carboxylate groups of polyacrylic acid, thus preventing separation of 2 potential

matrices

Cross linking of polymer chains may take place through 1/more of the
following reactions

Acid base reaction

Light cure mechanism
Oxidation reduction reaction

Full physical properties are not achieved till acid base reaction continues for
some days

Structure of set cement

RMGIC is presumed to have either

A multiple cross linked matrix or

Matrix containing 2 separate phases

Depth of cure
3-4mm

Criticisms against RMGI

1.

2.
3.
4.

HEMA monomer toxic relative lack of

biocompatibility, potential for allergic response
HEMA hydrophilic set material takes up water
expansion + less resistance to wear & erosion
Potential for color change over time (Doray 1994)
HEMA low molecular weight monomer more
polymerisation shrinkage + substantial exotherm
that can last for sometime

Setting reaction of resin modified auto cure material

Mixing of powder + liquid

Usual acid base reaction initiated
Catalyst in powder will initiate polymeristaion of HEMA &
cross-linkable monomers

Ultimately, there will be cross-linking between 2 systems

& the entire mass will set hard with uniform physical
properties

Setting reaction of light initiated auto cure material

Involves enhancing speed of acid-base reaction by utilizing a simple physical

principle
No resin is added
The glass ionomer is colored (Eg. red) ; on irradiation with a blue halogen activator
light , acid-base reaction will take place more rapidly
Setting time is reduced dramatically
No heat generation
Physical properties not downgraded
Highly bactericidal
Flows easily
Uses :
Easily identified
Fissure sealant
Uncooperative patient
Root surface protection
Lining/ base in very deep cavities
Transitional restoration during stabilization phase
Temporary seal for endodontics

ADHESION

 Glass ionomer cements are the only restorative materials

that depend primarily on chemical bond to tooth
structure.

They form an ionic bond to the hydroxyapatite at the

dentin surface and also obtain mechanical retention from
microporosities in the hydroxyapatite.

Bond strength to dentin : (Richard S. Schwartz et

al JOE,vol.31,no.3,March2005,156)

Lower initial bond strength compared to resins (around

8MPa)
Despite this they succeed clinically because of the
following factors:
They form dynamic bond. As the interface is stressed,
bonds are broken, but new bonds are formed.
Low polymerization shrinkage
Coefficient of thermal expansion similar to tooth
structure

Barriers to adhesion :

1.

Water aqueous fluids in dentin & enamel

2.

Dynamic nature of tooth material

Hydrophilic, highly ionic GIC competes successfully with

water because of its
multiplicity of carboxyl groups
that form H bonds with the substrate

Enamel : ion exchange

Bonding to these is
like trying to bond to
shifting sand

Dentin : living material subject to change

The adhesive bond must have dynamic character

Polymeric nature of glass ionomer ensures multiplicity of
bonds between GIC and substrate. Scission of single bond
does not lead to failure because the bond can reform.

Mechanism of adhesion to enamel

& dentin

Smith (1968): Chelation of calcium contained in apatite involved in adhesion

Beech (1973): Suggested interaction of polyacrylic acid & apatite.
Bonding only to apatite, therefore weaker adhesion of GIC to dentine and non
existence of adhesion to decalcified dentine.
Wilson (1974): Considered possibility of polyacrylates bonding to collagen.
Initially, when paste is fluid, adhesion is by H-bonding provided by free
carboxyl groups present in fresh mix.
As cement ages, H bonds are progressively replaced by ionic bonds, the
cations coming from cement or hydroxyapatite.
McLean & Wilson (1977): Hypothesized presence of an intermediate later
between cement 7 tooth surface.
Wilson, Prosser & Powis (1983): Postulated the adsorption phenomenon of bond
to mineralized tissue.

Adhesion
Bond to mineralized tissue

Bond to collagen

Diffusion

H bonding

Adsorption phenomenon

Metallic ion bridging

Bond to mineralized tissue

Phosphate ions are displaced from apatite by carboxyl groups.
To retain electrical neutrality, phosphate takes with it calcium.
Setting of the material + dissolution of enamel & dentin surface results in
buffering of polyacid.
Rise in local pH & reprecipitation of minerals at cement-tooth interface
occurs.
Therefore chemical bond is achieved by a calcium phosphate polyalkenoate
crystalline structure acting as an interface between enamel or dentin & the
set material.
Bond to collagen
May occur by H bonding or metallic ion bridging between carboxyl groups on
polyacid & collagen molecules of dentine.
Chain length may also be an important factor in adhesion.
The GIC is based on a polymer chain that is capable of bridging gaps between
the cement body and the substrate.

The poly (alkenoic acid ) chains actually

penetrate the surface of both enamle &
dentine & displace phosphate ions,
releasing them into the cement
Each phosphate ion takes with it
a calcium ion to maintain
electrolytic balance, leading to an
ion-enriched layer at the interface
As the acid is buffered by the release of ions the pH will rise & the interface will set
as a new ion-enriched material between the tooth & the restoration.

Bond strength & nature of

polyacid
Cements based on polyacrylic acid appear to bond

more strongly than those based on copolymers of

acrylic acid with itaconic & maleic acids (Aboush &
Jenkins, 1986)
Adhesion of cermet cements is inferior to
conventional GIC (Thorton et al, 1986)
Pretreatment of enamel & dentin with polyacrylic
acid, which is not washed off, so that intermediary
bonding is formed. (Powis, 1986)

Improving adhesion surface

conditioning :

Surface conditioning McLean & Wilson (1977) first used the term, to
differentiate from acid etching.
Powis et al (1982); Aboush & Jenkins (1986) smoother the surface stronger the
bond.
Surface irregularity --- air entrapment + stress concentration
Ideal requirement of surface conditioners (Mount, 1984)

Isotonic (to decrease osmotic effect)

The Ph = 5.5 8 (neutral)
Nontoxic
Compatible with chemistry of cement
Water soluble, be easily removed
Not deplete enamel & dentine chemically
Enhance surface chemically in preparation for bonding.

Agents

Polyacrylic acid

Proposed
by

Conc
entr
ation

D
u
r
at
io
n

Powis et
al (1982)

25%

Enamel
etches slightly & removes
1 polishing marks.
0 Dentin - Removes debris,
se smoothes irregularities &
c opens up tubules

Mount
(1984)

Long et al
(1986)
Tannic acid

Mineralizing
solutions (Eg.
Levine et al
solution & ITS
solution)

Powis et
al

Advantage

Disadvantage

May cause sensitivity with

luting agents

3035%
3
0
se
c

Enamel
smooth featureless
surface without etching/
decalcification
Dentine
Tubules not opened

23
m
in

Smear layer will be

included in ion-exchange
layer & will not interfere
with adhesion

Forms calcium & phosphate

rich layer between GIC &
tooth - ineffective

CLASSIFICATION
1.
2.
3.

By Wilson & McLean (1988)

By McLean et al (1994)
By Smith / Wright (1994)

Classification by Wilson & Mclean (1988)

Type I : Luting & bonding materials

Type II : Restorative

Type II.1 : Restorative aesthetic (autocure & resin-modified)

Type II.2 : Restorative reinforced / Bis-reinforced filling materials

Type III : Lining or Base

Classification by Mclean et al (1994)

Glass ionomer cement

Resin modified glass ionomer cement
Polyacid modified composite resin

Classification

by

Smith

Wright

Type I Luting cement

Type II a) aesthetic filling material
b) reinforced resin filling material

Type III Fast setting lining cement

Type IV Fissure sealing cements
Type V Orthodontic cements
Type VI Core build up material

(1994)

Type I : Luting & Bonding

Factors in favor of glass ionomer lute

1. Tensile strength as high as zinc phosphate
2. Solubility lower

3. Thixotropic flow properties allow easier placement ; without need to vent

casting / retain pressure during setting
4. Fine film thickness
5. Fluoride release
6. Potential for postinsertion sensitivity same as for other cements

2. Solubility lower

4. Fine film thickness

Significant factors
Powder particle size - 4-15 m
Film thickness 10-20 m
P/L ratio 1.5:1
pH newly mixed cement 1.8 ; within 30min 4.5
Dispensing & mixing P/L system & 2 paste system
Time to mature less time desirable; break away excess when cement is crisp
& firm
Adhesion to enamel & dentin cementation of crown hydraulic pressure
penetartion of polyacrylic acid into tubules post-insertion sensitivity therefore
seal surface of dentin ; do not remove smear layer
Adhesion to noble metals by electroplating the fitting surface with 2-5m tin
oxide immediately prior to placement

Cementation on vital teeth - 25% tannic acid (for 2min) or dentin bonding
agent containing polalkenoic acid applied just before cementation

Remove temporary
cement

Paint small quantity

on tooth

Washed only ; not

conditioned / seal

Mixing time 25 seconds

String up 2-3 cm

Apply to inside,
especially margins

Seat crown with positive

pressure ; no need to
maintain pressure

Remove excess when

cannot be indented with
sharp instrument

Remove debris from

gingival crevice

Cemented crown

Cementation on non vital teeth 10% polyacrylic acid conditioning (for 10-15sec) to
remove smear layer

Preparation cleaned

Canal filled to top

with cement

Root surface & post

hole conditioned

Post seated

Washed & dried with

alcohol

Cement painted on
post

Inside of crown
painted with cement

Seat crown with positive

pressure ; no need to
maintain pressure

Cemented crown

Bonding with glass ionomer - Bonding composite resin

Glass ionomer used as
bonding agent in small shallow
cavities (Yamada et al 1996)

Prepare cavity
Condition for 10sec ; wash &
dry

Low viscosity, low P/L ratio, resinmodified glass ionomer used

Prepare cavity

Paint thin layer of Glass

ionomer bonding agent over
entire cavty including walls
Blow off excess

Condition

Light activate for 20sec

Place composite
incrementally ; finish, contour
& polish
Advantage :acid-base reaction
of glass ionomer will continue
& compensate for shrinkage of
glass ionomer

Glass ionomer
bonding agent
Light activate

Place composite
finish, contour & polish

SEM showing interaction

layer / ion-exchange layer

Bonding with glass ionomer - Bonding amalgam

Long term results not available

Short term results suggest reduced
post-insertion sensitivity to
temperature changes in newly placed
restoration
Greatest hazard potential for
incorporation of fragments of glass
ionomer into amalgam during
condensation reducing the physical
properties ; unlikely to be sufficient to
prevent cusp loss

Similar clinical technique

Type II.1 : Restorative

aesthetic materials

Factors in favor :
Adequate aesthetics & translucency

Sufficient physical properties in fully supported restoration

Adhesion achieved
Fluoride reservoir

Significant factors
P/L ratio 2.9:1 to 3.6:1 (if polyacrylic acid is liquid)
6.8:1 (in anhydrous cements)
Time to mature :
Autocure
Resin modified

Initial snap set - 4min from start of mix

Require atleast 1 week to mature
Light activation - 20-40sec
Resin glaze : to paint over finished restoration ;
no effect on continuing maturation ;
will seal voids / porosities on surface

Erosion lesion

Cement placed
excess removed
after 4 min

Matrix checked for

accuracy of fit

After matrix
removed ; bonding
resin applied

Pumice slurry - 5
seconds ; flushed
& dried

Bonding resin light

activated

10% polyacrylic
acid - 10-15 sec

Finished
restoration

Type II.2 : Restorative

reinforced materials

Reasons for use :

When fast setting material is desirable
With increased physical property

But where color match not important

Significant factors:
Resistant to uptake of water in 5min

But first 2 weeks water loss is a problem

Following material earlier marketed as reinforced ; now considered a misnomer

Because physical properties not significantly improved

Adhesion & fluoride release reduced

Need another material to cover for esthetics

1. Silver cermet

2. Amalgam alloy admix

3. Silver alloy admix
Newer generation high strength glass ionomers

Silver cermet
Manufactured by incorporating 40% by weight of microfine silver particles <
3.5m in diameter in which powdered glass particles
The 2 were then sintered under pressure
Unreacted silver was washed out
5% titanium dioxide added to modify color

Advantages :

Color : closer to tooth

Radioopacity : same as amalgam

Surface could be burnished

High density & low porosity restoration

High abrasion resistance

High compressive strength & fracture resistance
Disadvantage :
Earlier used for core build-up but their
physical properties cannot be relied on
Less adhesion (mechanical retention required)

Uses : In repairing chipped &

faulty margins of existing
restorations ; alternative to
replacement

Amalgam alloy admix

Spherical amalgam alloy particles incorporated with a fast-setting glass

ionomer powder (Simmons 1983)
Amalgam alloy was incorporated in proportion of 8 parts cement powder
: 1 part alloy by volume
This was then mixed with polyacrylic acid (3:2 by weight)
black restoration

Physical properties slightly improved

Early resistance to water uptake
Set rapidly

Adhesion & fluoride release less than unfilled

Difficult to mix to required consistency by hand ; capsules were later
available

Silver alloy admix

Include silver containing alloy in flat brokenpieces rather than

spheres ; flakes would offer larger surface area for reaction with
polyacrylis acid
Higher abrasion resistance because when subjected to wear, the
preparation developed a Beilby type smear layer on its surface
Physical properties, color, fluoride release, adhesion better
than above 2
But material has had limited market

New generation High strength / Condensable glass

ionomers

Fast setting Auto cure

10-15% better physical properties than resin modified glass ionomer
Available as normal set or fast-set

Particularly useful as transitional restoration

Changes : powder particle size
particle size distribution

heat history of glass (improvement in surface reactivity of powder )

Significant factors :
P/L ratio : 3:1 to 4:1
Time to mature : resistant to water uptake / loss as soon as set
Adhesion : stronger because cement is stronger
Release of ions : similar to other types of autocure, therefore useful for root
surface caries, tunnels

Physical properties :
Tensile strength & fracture resistance substantially better than autocure,
marginally better than resin modified glass ionomer

Abrasion resistance as they mature they match that of amalgam, composite

resin
Radioopacity adequate

Main application :
1. Minimal lesions
2. Transitional restoration

Type III :Lining & Base

cements

Definition :
Lining thin layer of a neutral material placed on the floor of a cavity, prior
to final restoration, to make good a deficiency in the cavity design or to
provide thermal protection to the pulp
Base is identified as a dentine substitute that is placed to make up for
major area of dentine loss prior to lamination of an enamel substitute over
the top
Significant factors :
Lining cements :
Low P/L 1.5 :1 (do not act as bonding agent ; should not be
left exposed ; low physical properties)
used in thin sections to fill voids in cavity design ; act as
thermal insulator

Base / dentin substitute :

P/L : 3:1

Properties

Physical Properties
Erosion & Longevity
Aesthetic properties
Biologic properties

Properties of glass ionomer luting cement

Cement Settin Film
24hr
type
g time thickness compressive
(min) (m)
strength
(MPa)

24 hr
Diametral
tensile
strength
(MPa)

Elastic
modulus
(GPa)

Solubility
in water
(wt%)

Pulp
response

Glass
ionome
r luting

6.2

7.3

1.25

Mild to
moderat
e

7.0

24

86

Compressive strength is comparable to zinc phosphate

Diametral strength is slightly higher
Modulus of elasticity is of zinc phosphate
Thus, it is less stiff & more susceptible to elastic deformation
It is thus not as desirable as zinc phophate to support an all ceramic crown,
because greater tensile stress would develop in the crown under occlusal loading

Properties of restorative glass ionomers

Compressive Diametral
strength
tensile
(MPA)
strength
(MPa)

Knoop
Solubility
Anticariogenic/
hardness (ANSI/ADA Pulp response
(KHN)
test)

Glass
150
ionomer
type II

6.6

48

0.4

YES/MILD

Cermet

150

6.7

39

YES/MILD

Hybrid
105
Ionomer

20

40

YES/MILD

Fracture toughness a measure

of energy required to cause crack
propagation that leads to fracture

Restorative glass ionomers

are much inferior to
composites

Material

Fracture
toughness
(MPa.m1/2)

Admixed
amalgam

1.29

Light cured glass 1.37

ionomer
Hybrid composite 1.17

Also more
vulnerable to wear

Glass ionomer
lining cement

0.88

Cermet

0.51

Metal-reinforced
glass ionomer

0.30

Erosion & Longevity

1.
2.

Dissolution & erosion

Durability & longevity

Dissolution & erosion

2 aspects
Leaching of soluble
constituents from cement
Disintegration only if they
are matrix formers

Short term aspects

Damage in
technique
Moisture
contamina
tion before
cement
hardened

Desiccation
before cement
fully matured

Actual erosion
Because of chemical &
mechanical wear

Long term aspects

Because of acids from plaque,
food & beverages

In glass ionomer cement,

anion is a polymer where the
active carboxylic groups are
connected by covalent
linkages impervious to acid
attack.

Fig 7.4 wilson &

mclean

Only cross-links are ionic, and

many of these have to be
broken before the matrix would
decompose
Acid erosion :
Glass ionomer < silicates < zinc phosphate < zinc polycarboxylate

Durability & longevity

Depends on

Adequate preparation of cement

Adequate protection

Conditions of mouth

Aesthetic properties

Translucency
Glass ionomer cements has a degree of translucency
Because its filler is a glass (not opaque)
Because of slow hydration reactions, glass ionomer cements take at least 24hrs to fully mature & develop translucency
Early contamination with water reduces translucency
Dark shades are less translucent
Glass ionomer remain unaffected by oral fluids
Opacity

Opacity is also termed as contrast ratio (Cr)

If Cr=1 material is opaque
If Cr = 0 perfectly translucent
To match enamel Cr < 0.55
Glass ionomers Cr < 0.9

Scattering power & reflectance

Opacity also depends on the scattering coefficient

Light reflectance
Thickness of specimen

Biologic properties

Biocompatibility
Effect on pulp & cells

They elicit greater pulp reaction than ZOE (Plant et al 1984)

But less than zinc phosphate (Tobias 1978)
With any glass ionomer cement, it is wise to place a thin layer of
protective liner, such as Ca(OH)2 , within 0.5mm of pulp chamber
(Anusavice)
Inflammatory response of pulpal tissues resolves within 30 days &
there is no enhancement of reparative or secondary dentine
formation (G J Mount)
Response of gingival tissues is minimal (Garcia et al 1981)

Reasons for blandness of polyacrylic acid (McLean

& Wilson, 1974)

Polyacrylic acid weak acid

Dissociated H+ ions remain in neighbourhood of polyanion
chain because of electrostatic attraction from multiple
negative charges.
When partly neutralized, the negative charge on the chain
increase, tendency of polyacylic acid to dissociate into H+ ions
& polyacrylate ion decreases.
Diffusion of polyacrylic acid into dentinal tubules is unlikely
because of its high molecular weight & chain entanglement.
Polyacrylic acid is readily precipitated by Ca+2 in tubules.
Therefore sensitivity under luting GIC may be due to faulty
technique than chemistry of cement.

Fluoride release

Biological potential of glass ionomer cements

Significance of water in glass ionomer cements

Glass ionomer water based material
Water plays important part in

Setting reaction
Final structure

Water is the reaction medium

Hydrates siliceous hydrogel

Once GI sets,

Loosely bound easily lost

shrinkage& cracking & undue

stress on ion exchange

adhesion

Water is in
the form of
Tightly bound - cannot be removed ; associated with hydration shell of
cation-polyacrylate bond

As material ages, ratio of tightly bound water : loosely bound water increases

Increase in strength & modulus & decrease in plasticity

One important factor in these materials being water based lies in the
chemical principle that it is only possible to have ion mobility in presence of
water

Which is essential for demineralization-remineralisation of tooth

(anhydrous material can play no part )

Ionic components of GIC

Calcium
Strontium
Aluminium
Silica
Fluoride
All ions are available for transfer from matrix into surrounding because of presence of water.
Lower the pH, greater the release of ions.
Note: (i) Calcium & strontium have similar polarity & atomic size, therefore they can replace each
other in cement & hydroxyapatite.
(ii) Strontium imparts radioopacity
(iii) Strontium has anticariogenic properties.
Therefore strontium can participate effectively in remineralisation.

Mineral phase of enamel & dentin

Enamel & Dentin are porous to migrating ions especially dentin

Enamel :
Each crystal of hydroxyapatite is surrounded by a
layer of tightly bound water hydration shell
which shows that the crystal is electrically charged
& can attract ions that are able to play a part in
remineralization

By weight

By volume

By weight

By volume

Remaining water fills spaces between rods main

diffusion pathway into & thru enamel
Dentin :
23% water by volume

Water filled pores + inter-tubular lateral

microtubules + dentinal tubules

Increased potential for ion transfer

 Enamel rods are tightly packed

Pores are not large enough to allow bacteria
Only when sufficient disintergration has occurred, process
becomes irreversible

Outer apatite crystals dissolve from surface

Increase porosity

Facilitating acid transport & demineralisation

Also, ions can return along the same pathway

Carious lesion

1960s Massler, Fusayama & Brannstrom wrote detailed

reports on science of demineralisation & remineralisation ; &

theoritical value of ion exchange

Carious dentin
Fusayama et al 1966
Massler 1967
Pitts 1983,
Mertz Fairhurst et al
1992

1st decalcified layer

2nd decalcified layer

Infected layer

Affected layer

Actively carious

Pre-carious

This concept was reinforced by a clinical study

Heavily carious 1st molars taken

Minimal caries removal

Restored using strontium based high strength glass ionomer cement

Harvested

Fl & Sr penetrated both layers of dentin & became part of normal apatite
crystals beyond

2 distinct zones identified

Outer layer of nonremineralised dentine with

minimal Fl & Sr uptake

Deeper zone of well

re-mineralised dentine

Postulated that
Collagen network in outer zone is totally devoid of mineral
Lack of seeding sites
Preventing uptake of mineral ions
Remineralisable dentine contained atleast 20% by weight of mineral onto
which incoming ions were able to absorb

External ion exchange

Glass ionomer acts as fluoride reservoir

Movement of fluoride out of glass ionomer

Electrolytic imbalance on surface of restoration

Cations from plaque & salive are taken up by the restoration

Balanced state

Increase in maturation & strengthening of restoration

(Nicholson et al, 1999)

Also, plaque on surface of glass ionomer will have reduced count of S.mutans,
therefore tissue tolerance of glass ionomer is more & less inflammation is
seen.

Internal remineralization

Dental pulp demonstrates very high level of tolerance to glass ionomer.

Very mild inflammatory response to freshly mixed GIC seen, with rapid
recovery.

Snuggs et al, 1993 dentin bridging in mechanical exposure of pulp

sealed with GIC
Brannstrom, 1982 Pulpal irritation is direct result of bacterial activity.
Therefore, if no irritation, no inflammation will occur.

Glass ionomer demonstrates ion-exchange adhesion, which could be an

ideal sealant, thus preventing ingress of bacterial nutrients.
Therefore GIC can be placed in very close proximity to pulp without risk
of irreversible pulp inflammation & CaOH sub-lining is not justified.

Suggested clinical technique

Entire margin of
cavity cleaned down
to sound dentine

Light initiated autocure

glass ionomer over axial
wall (sublining)

Axial wall still in softened

demineralised affected
dentine is retained

10% polyacrylic acid 10

second conditioning

High strength autocure glass

ionomer then placed

Cut back to expose

enamel walls

Entire cavity covered with thin

layer of Resin modified
adhesive glass ionomer

composite

Glass ionomer as bone substitute

Rober Purrmann originated the work

Owing to its properties of bioactivity & biocompatibility, glass

ionomer has been tried as bone cement & bone replacement

material.
Through ion-exchange mechanism, it can cause stable
integration with bone & can affect both its growth &
development adjacent to surface of material.
Note : unset GI is strictly contraindicated to be contacted with
neural tissues (because of controversy over Al release)

Glass ionomer as bone cement

Prof. Charnleys, 1960s Use of PMMA to provide stable

mechanical anchor for metallic prosthesis.
Morphologic fixation / cement fixation
Owing to disadvantages of PMMA, glass ionomers replaced
them
Advantage :
- No exotherm setting reaction
Chemically bond to bone & some metals & less shrinkage
Osteoconductive property of material
In oral surgery,
Applied to prevention of bone loss following extraction
Used as filler for bone donor sites & cyst cavities.

Clinical applications of glass

ionomer cements

Uses
Conservative

Luting & bonding

Restorative

Lining & base

Minimal intervention the place of

glassionomer
Transitional restoration

Endodontics

Root canal sealing

Orthograde root canal sealing
Root-end filling material
Repair of perforations and root
resorption defects
Perforation repair
Repair of root resorption cavities

Treatment of vertically fractured teeth

Coronal seal

Use of glass ionomer in conventional & surgical endodontics

Pitt Ford (1979) - Use in root canal first introduced

Stewart (1990) - made modifications
to increase working time
added barium sulphate : increase radioopacity
Ray & Seltzer (1991) usable experimental formulation
Adequate working time
Adequate radioopacity
Adequate adhesion to root canal wall

These modifications led to commercialization of Ketac

Endo (ESPE, Germany) in 1991
RMGIC Vitrebond (RM)
More recent developments : KT- 308 (GC)
ZUT

Minimal intervention cavity designs The place of glass ionomers

Site 1 Size 0 lesions

Site 1 : pit & fissure on occlusal surface of posterior teeth
Size 0 : initial lesion ; not yet resulted in cavitation

Concept of fissure seal 1st discussed by Simonsen (1989)

The anatomy of enamel within a fissure is covered with a
layer of enamel rods that appear to run parallel with the
surface rather than at right angles. When etched, it will not
develop the usual pattern of porous enamel that allows
penetration of unfilled resin

Wilson & McLean (1988) show that a glass ionomer will

successfully occlude fissure
This is now termed fissure protection to differentiate it
from a resin seal

Neither resin nor glass ionomer will flow into a fissure beyond the point where
fissure narrows to 200m

Retention thus mainly depends on adhesion to enamel at the entrance to fissure

rather than mechanical interlocking into complexities of fissure
Even though enamel rods lie in different
orientation, glass ionomer will develop ion
exchange adhesion & show acceptable longevity
(Mount & Hume, 1998)

Technique involved

8 years

12 years

In young patient fast set autocure

like light initiated autocure glass
ionomer used

Site 1 Size 1 lesions

Size 1 : smallest minimal lesion
requiring operative intervention

Technique
involved

Fissures are explored using small tapered

diamond bur #8107 at intermediate high speed
under air water spray then lightly polished with
#3107

Satisfactory
adaptation of
entire fissure

Site 1 Size 2 lesions

Size 2 : Moderate size cavities

Technique
involved

Why glass ionomer used as base ?

If resin composite used, might

require removal of more dentin
which would otherwise remineralize

Site 2 Size 0 lesions

Site 2 contact areas between anteriors / posteriors
Size 0 : initial lesion ; not yet resulted in cavitation

Site 2 Size 1 lesions

Site 2 contact areas between anteriors / posteriors
Size 1 : smallest minimal lesion requiring operative intervention

If lesion 3 mm below the crest of marginal

ridge Tunnel cavity design

If lesion < 2mm from the crest of marginal

ridge Slot cavity design

If proximal surface accessible Proximal

approach

Tunnel cavity design

Slot cavity design

Glass ionomer will flow readily into a

small cavity & has the ability to
remineralise

Access through
occlusal surface

Triangular
access cavity

Clean enamel
margins

Glass ionomer syringed

mylar strip in place

Completed
restoration

Note : internal
dimension of cavity

Glass ionomer is a sound

option because occlusal
load will not be great

Proximal approach
Fast set, high strength auto
cure used because
radioopaque & will not be
under occlusal load

Site 2 Size 2 lesions

Site 2 Contact areas between anteriors / posteriors
Size 2 : Moderate size cavities

Laminate technique / bilayered restoration with glass ionomer as the base

If resin modified is used; no

need to etch after placement
because enough resin content
to provide adhsion with
composite

Substantial layer of glass ionomer

across the entire floor is exposed to
oral environment at gingival
proximal box

Site 3 lesions
Cervical areas related to gingival tissues including exposed root surface

Glass ionomer ideal : Because can withstand flexure

Root surface not under occlusal load

INSTRUCTIONS FOR DENTAL

ASSISTANTS

Storage
Powder & liquid by different manufacturers should
not be interchanged
Both bottles firmly closed (water based)

Polyacrylic acid liquid thickens over time, within 12 months

viscosity increases. It can be thinned down by : immerse bottle
with lid on in water at 75C for 15minutes, place in rubber
bowl, let water from hot tap run over it. Test at 15minutes for
viscosity. Let it cool before use.

Liquid should never be refrigerated.

Mixing slab should cool, but never below
dew point.

Hand dispensing

Full spoon, no excess

Tip liquid bottle to side,

then invert completely
If water / tartaric acid, only
1 drop used.

Hand mixing

Liquid should not stay on paper pad

longer than 1minute (some of it may
soak into it)
Dont mix beyond 30 seconds
The objective is only wet the
particle no dissolving it.

First half folded into liquid in 10-15seconds

Second half incorporated in 15 seconds

Small mixing area

Mixing of capsules

To activate capsule apply pressure

3-4 seconds before placing in
machine
Ultrahigh speed machine : 4000
cycles/minute
(< 3000 cycles/minute not
desirable)

Loss of gloss test

This point is reached at 2minutes
after start of mix
10sec in 4000cycles/minute

Correct consistency for hand

mixed
Type I : Luting : string up to 3-4cm from
slab

Type II : string 1cm + gloss

Type III : for lining amalgam : 1.5:1 P/L

ratio : 3-4cm string
For base for composite : 3:1 P/L ratio :
1-1.5cm string

Clean up
Before it sets, immerse slab
& spatula in water
If set, chip off / place in
water then clean

Summary & Conclusion

Review of literature

REFERENCES

REFERENCES : (Text books)

1.
2.
3.
4.
5.
6.

Glass-ionomer cement : Alan D. Wilson / John W. Mclean

An atlas of Glass Ionomer Cements A Clinicians guide (3rd
edition) : Graham J. Mount
Preservation & restoration of tooth structure : Graham J.
Mount
Phillips Science of Dental Materials (11th edition) : Kenneth
J. Anusavice
Sturdevants Art & Sience of Operative Dentistry (4th
edition):Theodore M. Roberson et al
Tylmans theory & practices of fixed prosthodontics, chapter
21, page 394-406 : Franklin Garcia Godoy et al

REFERENCES : (Journals)
1.
2.
3.
4.
5.

6.
7.

8.
9.

Proposed nomenclature for glass-ionomer dental cements & related

materials. John W. Mclean et al. QI vol. 25, no. 9, 1994 ; 587-589.
GIC Past, present & future. Graham J. Mount. Buonocore memorial
lecture (Michael B.) Operative dentistry 1994, 19, 82-90.
Glass ionomer cements in restorative dentistry. John W. Nicholson et
al. QI vol. 28, no.11, 1997, 705-714.
The need for caries preventive restorative materials. Gordon J.
Christensen. JADA, vol. 131, sept. 2000, 1347-1349.
Composite resin & GIC : current status for use in cervical restorations
William W. Brackett et al. QI 1990; 21: 445-447.
Longevity in glass-ionomer restorations: review of successful
technique. Graham J. Mount. QI 1997 ; 28: 643-650.
Viscous GIC : a new alternative to amalgam in primary dentition.
Roland frankenberger et al. QI 1997 ; 28:667-676.
Adhesion of GIC in clinical environment. G.J.Mount. operative dentistry
1991;16:141-148.
Glass ionomer : a review of their current status. G.J.Mount. Operative
dentistry 1999 ; 24 : 115-124.

10.The use of glass ionomer cements in both conventional & surgical

endodontics. (review) M.A.A.De Bruyne et al. IEJ, 37; 2004: 91-104.
11.Pulpal consideration of adhesive materials. Harold R. Stanley. Operative
dentistry, supplement 5, 1992, 151-164.
12. Glass ionomer cements used as fissure sealants with the atraumatic
restorative treatment (ART) approach : review of literature. H.K.Yip et al.
IDJ (2002)52, 67-70.
13. Demineralization & remineralization of dentine caries, and role of glassionomer cements. W. Gao et al. IDJ (2000) 50, 51-56.
14. Advances in restorative materials. Charles W. Wakefield et al. DCNA, Vol.
45, no. 1, January 2001, 7- 27.
15.Direct & indirect restorative materials. ADA council on scientific affairs.
JADA, vol.134, April 2003, 463-471.
16. Minimal intervention dentistry : Rationale of cavity design. G.J.Mount.
Operative dentistry, 2003, 28, 92-99.
17. The sealant restoration : indications, success and clinical technique.
D.C.Hassall et al. BDJ, vol. 191, no.7, October 13, 2001, 358-362.
18. Minimally invasive dentistry. Carol Anne Murdoch-Kinch et al. JADA,
vol.134, January 2003, 87-94.
19. The influence of various conditioning agents on the interdiffusion zone &
microleakage of a glass ionomer cement with a high viscosity in primary
teeth. Y. Yilmaz et al. Operative dentistry 2005, vol. 30, no.1, 105-113

cements. S.S. Wu et al. Operative dentistry 2005; 30-2; 180-184

21. Invitro evaluation of cariostatic action of esthetic restorative materials in
bovine teeth under severe cariogenic challenge. MLG Pin et al. Operative
Dentistry 2005, 30-2, 368-375
22. The microtensile bond strength of Fuji IX GIC to antibacterial conditioned
dentin. M.G.Botello. Operative Dentistry 2005, 30-3 ; 311-317
23. Fluoride release & neutralising effect by resin-based materials. T.Itota et al.
Operative Dentistry 2005, 30-4, 522-527
24. Effect of neutral citrate solution on the fluoride release of conventional
restorative glass ionomer cements. Roeland J.C.De Moor et al. Dental
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