RECENT ADVANCES The GIC has come a long way since it was first introduced its properties have

improved and there are now many versions for various applications. Amongst the recent development are: 1. Metal reinforced ionomer cements. 2. New fast setting lining cements. 3. Water hardening luting agents. 4. Dual cure system which include: Resin modified GIC. Poly acid modified resin / compomer.

5. Packable GIC. 6. Self hardening resin GIC. 7. Smart materials / fluoride charged materials. 8. Bioactive GIC. 1) Metal Modified GIC The metal modified GIC were introduced in an attempt to improve the strength, fracture toughness and resistance to wear and yet maintain the potential for adhesion and anticariogenic property.

Two methods were employed:

a. Miracle mix : type II GIC powder mixed with Spherical silver alloy

Powder (in the ratio of 7:1).Developed by SIMMONS in 1983(BDJ 1988)

b. Cement : Fusion of (glass particles) to (silver elemental particles )

through high temperature sintering of a mixture of two powders. Developed by Mclean and Gasser in 1985.

Properties of Metal Modified GIC

a) i) Mechanical properties: The strength of miracle mix GIC is higher than that of conventional GIC. ii) iii) iv) v) vi) vii) viii) Increased flexural strength. Increased resistance to abrasion. Increased fracture resistance. Low thermal conductivity. Coefficient of thermal expansion same as dentine. Passes anticariogenic property due to decrease of fluorides. Chemical adhesion to tooth surface.

indications: 1. As an alternative to amalgam in conservative Class II

cavities, mainly in primary teeth. 2. 3. 4. 5. Core build up material. Lining of Class II SAF restoration / composite restoration. Root caps for teeth used under overdenture. Material used in conjunction with ortho traumatized or

mobile posterior teeth (Dental Update Nov. 1991). Contraindication: 1. Anterior teeth because of esthetics and where strong axial wall support is needed. Disadvantages: 1. Fluoride release is less than conventional GIC because the portion of original Glass particles is metal coated. 2. Esthetically poor. 3. Rough surface. 4. Reduced setting time. Advantages: 1. Ease of preparation and placement. 2. Adhesion to tooth structure. 3. Crown cutting can be done immediately.

2) Fast Setting Lining Cements (BDJ 1988) These faster setting GIC were discovered by Wilson and Crisp in 1972. They found that optically active d-tactaric acid modified the cement forming reaction thus improving. i) ii) iii) iv) v) 3) 1988) To solve the problems associated with the instability of polyacrylic acid, copolymer of acids were introduced which although stable in water might not yield the best cements. Thus in 1973 Wilson and Kent described the use of polyacrylic acid in dry form blended with Glass powder. Liquid consisted of water or an aqueous solution of tartaric acid. This was termed as ASPA V by Prosser et al 1984. Advantages: 1. Developed very low viscosity in early mixing stages. 2. Rapid set at minimal temperature. 3. Easy manipulation. 4. Excellent shelf life. Handling characteristics. Increases the working time. Shortens the setting time. Enabled the fluoride contents of glasses to be reduced. Increases cement strength. Water Hardening Cements / Anhydrous Cements (BDJ

4)

Dual Cure / Photocured GIC

A) Resin Modified GIC

Moisture sensitivity and low early strength of GIC are the results of slow acid base setting reaction. Hence to overcome these two inherent drawbacks, some polymerizable resin functional groups have been added to GIC to impart additional curing process and allow the bulk of material to mature through acid base reaction. 1. According to Nicholson (QI 1977) Resin modified GIC are those Glass ionomer materials that are modified by the inclusion of resin, generally to make them partly photo curable. 2. According to WM Tay (Dental Update Sept. 95) These are hybrid materials that certain significant acid base reaction as a part of their overall curing process. 3. According to Mount (Op. Dent. 1994) The term dual cure has been suggested because these cements undergo the original acid base setting reaction superimposed over that. 4. According to Christensen (JADA 1997) These materials are termed as Tricure as the RMGIC sets by 3 phenomena. a. Acid base reaction between the components of conventional GIC.

b. Light cure reaction stimulated by light application activates the initiated catalyst resin cure system. c. Auto cure reaction when the powder and the liquid components are mixed together the initiation catalyst system for resin gets activated and ensures that over time these will be a complete cure throughout the entire restoration with no free resin remaining. A feature of these material is that they will set in the dark. Dark setting although the process is slower than the conventional GIC and produce a material that is inferior to the product obtained by light curing. Composition:
-

Polyacrylic acid / modified polyacrylic acid with a light activated polymerizable side chain app. 5%.

Photo polymerizable monomer HEMA app. 5wt%. Ionizable glasses app. 70wt%. Water app. 8%, examples : Fuji II LC (GC), Photac Fil (ESPE), Vitremer 3M.

Properties: 1. Strength Die material values are higher than conventional GIC Type II GIC Composite strength 24 hours Hardness strength 24 hours Diamaterial strength 24 hours 150mPa 48 6.6mPa RM GIC 105mPa 40 20mPa

2. Translucency: There is a decrease of translucency as a significant difference between the refraction index of the GI powder and set resin matrix is present.
3. Fluoride release : According to Skinners There is increased fluoride

release as compared to GIC.

Conventional GIC

440gF in 14 days. 650gF in 30 days 1200 in 14 days. 1600 in 30 days.

L-C GIC

4. Adhesion to tooth structure: Bond strength is higher than conventional GIC to tooth structure and also to other restorative material such as composites. 5. Marginal adaptation: RM GIC exhibit a greater degree of shrinkage on setting as a result of polymerization thus exhibit greater microlekage.
6. Water sensitivity : Resins are added to GICs to reduce the water sensitivity

of GIC. Studies show that GIC liners are still susceptible to dehydration and that this material can also absorb water which can result in dimensional change.
7. Biocompatibility : Biocompatibility of RMGICs is controversial certain

studies suggests that precaution such as Ca(OH)2 for deep preparation are

recommended as there is a transient rise in temperature associated with polymerization process. Advantages: (DM Sept. 1995). 1. Sufficiently long working time controlled in command to a snap set by photo-curing. 2. Improved setting characteristics. 3. Protects the acid base reaction from problem of water balance. 4. Rapid deviation of early strength. 5. Can be finished and polished immediately after set. 6. Repairs can be easily carried out as the bond between old and new material is strong. 7. Exhibits increased adhesion to composite when as a base. 8. Fluoride release is present which is greater conventional GIC. 9. Increased tensile strength (20mPa). Disadvantages (DM 1995) 1. Biocompatibility is controversial. 2. Setting shrinkage is higher microleakage is more, poor marginal adaptation (about 1%). 3. Low wear resistance compared to composite (JADA 97).

4. Depth of cure can be a problem : Incremental placement technique necessary. Depth of cure 3-4mm. Uses: (DM Feb 1996) a. b. c. d. remains. e. f. g. h. Class I and II restorations in deciduous teeth. Microcavity / Tunnel preparation. Temporary repairs of # teeth. Temporary repairs of deflection crown margins. Liners and bases. Class V, III restorations. Cervical abrasion / Erosion lesion, root caries. Core build ups where sufficient tooth structure

B) Polyacid Modified Resin Composite

Definition : According to Mclean and Nicholson Materials that may contain either or both of the essential components of GIC but at levels insufficient to promote the acid base curing reaction in the dark. This material is essentially a resin composite in which the filler is Glass and variable quantity of dehydrated polyalkenoic acid which reacts only if water is available. Here there is a limited degrees of acid base reaction. The adhesion

system is based on the resin to dentine method because ion-exchange method cannot arise at any stage. Hence photoactivation is necessary for type of materials. Indications: 1. Pit and fissure sealants. 2. Restoration of deciduous teeth. 3. Minimal cavity preparation / tunnel preparation. 4. Lining of all types of cavities where a biological seal and cariostatic action is required. 5. Core build up. 6. Dentine substitutes as in sandwich techniques. 7. Repair of defective restoration margins. 8. Class III and IV lesions. 9. Abrasion / Erosion. 10. Sealing of root surfaces for overdentures. 11. Potential root canal sealers. 12. Retrograde filling materials in endo emergencies. 13. Luting agents. Advantages :

1. Superior working characteristics to RMGIC. 2. Ease of use. 3. Easily adapts to tooth. 4. Good esthetics. 5. Fluoride release, which is less than that of RMGIC. Contraindications: 1. Class IV carious lesion. 2. Lesions involving large areas of labial surface where esthetics is of prime concern. 3. Class II carious lesions where conventional cavities are prepared, replacement of old amalgam restoration. 4. Cusp coverage. 5. Underneath metal /PFM crowns where light cannot penetrate. Ex: Dyract (Dentsply), Compoglass (Ivoclar), Variglass (Caulk). Packable (Condensable) GIC (Fuji IX GIC / Ketac Molar) This is a new high viscosity GIC launched in early 1990s. This material was developed largely as a need for filling materials in the automatic / atraumatic restoration therapy ART. ART refers to the restoration of teeth under conditions of minimal instrumentation, especially carried out in the third world nations. Advantages:

1. Packable and condensable. 2. Easy placement. 3. Non-sticky. 4. Early moisture sensitivity is reduced. 5. Rapid finishing can be carried out. 6. Improved wear resistance. 7. Solubility in oral fluids is very low. Indications: 1. Ideal material for molar restoration in deciduous teeth. 2. Intermediate treatment restoration for permanent teeth. 3. Core build up. Self Hardening Resin GIC This is another recent development in resin modified GI luting cements. These materials are not light activated but certain monomers with initiators are added to allow self polymerization. Composition : Advantages: 1. Easily handled. 2. No significant post cementation sensitivity. 3. Significant fluoride release. 4. High compressive and fracture strength. 5. No length activation required. Benzoyl peroxide and amine accelerators are added to GIC.

Uses : 1. Used for luting stainless steel crowns, space maintainers, orthodontic brackets, bands in pediatric cases. Smart Mat / F Charged Materials (Dental Update 1998 Nov.) The development of fluoride releasing material was made in order to overcome the shortcomings faced by fluoride releasing materials. a. Increases the fluoride release more open is the

structure of the material. This is associated with low strength. b. In order to improve the strength of these fluoride

containing materials, if they are made more dense and strong the efficiency of ion release is reduced only after placement of restoration there is a sudden burst of fluoride release followed by a rapid decline in ion release rate. Hence to overcome these shortcomings and improve the therapeutic potential of these fluoride releasing materials two approaches were developed. a) Fluoride Charge Materials: This is a modified GIC and has two parts material system : Restoration part, Charge part. The restorative part of the material is used in the usual way. When the 1 st burst of fluoride is expanded and the therapeutic potential of the restoration is spent.

The material is given a second. Fluoride change using a gel material that replenishes the fluoride sites in the restoration by ion exchange and recovers the fluoride release and therapeutic potential of the restoration. This is achieved without replacing the material provided the restoration materials the normal standards of anatomical sufficiently. This approach is still in the experimental stage. b) Low pH smart materials The second approach is to optimize the efficacy of fluoride materials. This material is based on the fact that fluoride should be released at a low pH i.e. when caries attack may be most threatening. Hence, these materials are developed to release fluoride at a low oral pH. Hence termed as smart materials. Hence in these fluorides is not released all the time the episodic release prolongs the usefulness of the material. Bioactive Glass The idea of bioactive glasses were developed by Hench and Co-workers in 1973. Studies show that on dissolution of the glass by acid there is stimulation to formation of a layer rich in calcium and phosphate, around the glass that can bond with intimate bioactive bonds with the bone cells and hence the material gets fully integrated into the bone. These bioactive glasses grow calcium phophate rich layers in the presence of calcium and phosphate saturated saliva. This is an excellent material for use in maxillofacial craniofacial surgeries as it performs better than hydroxyapatite.

Uses: 1) Augmentation of alveolar ridges in edentulous patients. 2) Cementation of custom made present implants into place.

Conclusion:
During the relatively short time in which GI have been clinically available they have undergone major improvements. Consequently, their popularity and range of uses have been extended considerably. Undoubtedly this class of restorative materials will be important part of dental restorations for a long time to come.

GLASS IONOMER CEMENT CONTENTS 1.

INTRODUCTION

2. HISTORY Invention Early Development

3. DEFINITION - Classification 4. COMPOSITION 5. CHARACTERISTICS OF GIC 6. CHEMISTRY OF SETTING 7. PROPERTIES

8. INDICATIONS 9. CONTRAINDICATIONS 10. ADVANTAGES 11. DISADVANTAGES 12. MANIPULATION 13. RECENT ADVANCES