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http://en.wikipedia.org/wiki/Glass_ionomer_cement
A Glass Ionomer Cement (GIC) is a dental restorative material used in dentistry for filling teeth and luting cements. These materials are based on the reaction of silicate glass powder and polyalkenoic acid. These tooth-coloured materials were introduced in 1972 for use as restorative materials for anterior teeth (particularly for eroded areas, Class III and V cavities). As they bond chemically to dental hard tissues and release fluoride for a relatively long period, modern day applications of GICs have expanded. The desirable properties of glass ionomer cements make them useful materials in the restoration of carious lesions in low-stress areas such as smooth-surface and small anterior proximal cavities in primary teeth. Results from clinical studies, do not support the use of conventional or metal-reinforced glass ionomer restorations in primary molars.
Contents
1 Chemical classification 1.1 Conventional glass ionomer cements 1.2 Resin Modified Glass Ionomer Cements 1.3 Hybrid Ionomer Cements or Resin-modified Glass Ionomers or Dual-Cured GIC 1.4 Tri-cure Glass Ionomer Cements 1.5 Metal Reinforced Glass Ionomer Cements or Cermets 2 Composition and preparation 2.1 GIC Powder 2.2 GIC Liquid 2.3 Setting Reaction 2.4 Manipulation 3 Properties 3.1 Setting Time 3.2 Film Thickness 3.3 Aesthetics 3.4 Water Sensitivity, Solubility and Disintegration 3.5 Adhesion 3.6 Margin Adaptation and Leakage 3.7 Physical Strengths
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3.8 Biocompatibility 3.9 Anticariogenic effect by way of fluoride release 4 Clinical Success in Primary Molars 5 Uses 5.1 As Luting Agents 5.1.1 Typical Physical Properties 5.2 As Orthodontic Brackets Adhesives 5.3 As Pit and Fissure Sealants 5.4 As Liners and Bases 5.5 For Core Build Up 5.6 For Intermediate Restorations 5.7 As Adhesive Cavity Liners (Sandwich Technique) 5.8 ART (Atraumatic Restorative Treatment) 5.9 As Restorations for Deciduous Teeth 6 References
Chemical classification
GICs are commonly classified into five principal types: Conventional Glass Ionomer Cements Resin Modified Glass Ionomer Cements (Conventional with addition of HEMA) Hybrid Ionomer Cements (Also known as Dual-cured Glass Ionomer Cements) Tri-cure Glass Ionomer Cements Metal-reinforced Glass Ionomer Cements
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Resin Modified Glass Ionomer Cements are conventional glass ionomer cements with addition of HEMA.
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GIC Powder
The powder is an acid-soluble calcium fluoroaluminosilicate glass similar to that of silicate but with a higher alumina-silicate ratio that increases its reactivity with liquid. The fluoride portion acts as a ceramic flux. Lanthanum, Strontium, Barium or Zinc Oxide additives provide radioopacity. The raw materials are fused to form a uniform glass by heating them to temperatures of 1100C to 1500C. The glass is ground into a powder having particles into a powder in the range of 15 to 50 m. Typical percentages of the raw materials are: Silica 41.9% Alumina 28.6% Aluminium Fluoride 1.6% Calcium Fluoride 15.7% Sodium Fluoride 9.3% Aluminium Phosphate 3.8%
GIC Liquid
Originally, the liquids for GIC were aqueous solutions of polyacrylic acid in a concentration of about 40 to 50%. The liquid was quite viscous and tended to gel over time. In most of the current cements, the acid is in the form of co-polymer with itaconic, maleic or tricarboxylic acids. These acids tend to increase the reactivity of the liquid, decrease the viscosity and reduce the tendency for gelation. Tartaric acid is also present in the liquid. It improves handling characteristics and increases the working time, but it shortens the setting time. The viscosity of Tartaric Acid-containing cement does not generally change over the shelf life of the cement. However a viscosity change can occur if the cement is out of date. As a means of extending the working time of the GIC, freeze-dried polyacid powder and glass powder are placed in the same bottle as the powder. The liquid consists of water or water with Tartaric Acid. When the powders are mixed with water, the acid powder dissolves to reconstitute the liquid acid and this process is followed by the acid-base reaction. This type of cement is referred to occasionally as water settable glass ionomer or erroneously as anhydrous glass ionomer.
Setting Reaction
The setting reaction is an acid-base reaction between the acidic polyelectrolyte and the aluminosilicate glass. The polyacid attacks the glass particles (also called leaching) to release cations and Fluoride ions. These ions probably metal fluoride complexes react with Polyanions to form
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a salt gel matrix. The Al3+ ions appear to be site bound resulting matrix resistance to flow, unlike the zinc Polyacrylate matrix. During the initial setting in the first 3 hours Calcium ions react with polycarboxylate chains. Subsequently, the trivalent Aluminum ions react for at least 48 hours. Between 20 and 30% of the glass is decomposed by the proton attack. The Fluoride and Phosphate ions are insoluble salts and complexes. The Sodium ions form a silica gel. The structure of the fully set cement is a composite of glass particles surrounded by silica gel in a matrix of Polyanions cross-linked by ionic bridges. Within the matrix are small particles of Silica gel containing fluorite crystallites. Glass Ionomer Cements bond chemically to dentine and enamel during the setting process. The mechanism of bonding appears to involve an ionic interaction with Calcium and/or Phosphate ions from the surface of the enamel or dentine. Bonding is more affective with a cleaned surface provided cleaning does not remove an excessive amount of Calcium ions. Treating dentine with an acidic conditioner followed by a dilute solution of ferric chloride improves the bonding. The cleansing agent removes the smear layer of dentine while the Fe+3 ions are deposited and increase the ionic interaction between the cement and dentin. Also, as the initial Calcium cross-links are replaced by Aluminium cross-links, most Sodium and Fluoride ions do not participate in the cross linking of the cement, however some Sodium ions may replace the Hydrogen ions of carboxylic groups whereas the remaining ions are dispersed uniformly within the set cement along with Fluorine ions. The cross linked phase becomes hydrates over time with the same water used for mixing. This process is called maturation. The unreacted portion of the glass particles are sheathed by a silica gel that develops during the removal of cations from the surface of the particles. Thus the set cement contains an agglomeration of unreacted powder particles surrounded by a silica gel in an amorphous matrix of hydrated Calcium and Aluminum Polysalts. Water plays a critical role in the setting of GIC. It serves as the reaction medium initially and then slowly hydrates the cross linked agents thereby yielding stable gel structure that is stronger and less susceptible to moisture contamination. If freshly mixed cements are exposed to ambient air without any protective covering the surface will craze and crack as a result of desiccation. Any contamination by water that occurs at this stage can cause dissolution of the matrix-forming cations and anions to the surrounding areas. Both desiccation and contamination are water changes in the structure during placement and for a few weeks after placement is possible.
Manipulation
To achieve long lasting restorations and retentive fixed prostheses, the following manipulative considerations for GIC must be satisfied: 1. 2. 3. 4. 5. Surface of the prepared tooth must be clean and dry The consistency of the mixed cement must allow complete coating of the surface irregularities and complete seating of prostheses Excess cement must be remove at the appropriate time The surface must be finished without excessive drying Protection of the restoration surface must be ensured to prevent cracking or dissolution.
The conditions are similar for lutting applications, except that no surface finishing is needed.
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Properties
Setting Time
GlC sets within 68 minutes from the start of mixing, setting time is lesser for type I materials than Type II materials. The setting can be slowed when the cement is mixed on a cold slab but this technique has an adverse effect on strength. GIC TYPE 1 57minutes GIC TYPE 2 within 10 minutes
Film Thickness
The film thickness of GICs is similar to or less than that of zinc phosphate cement and is suitable for cementation and luting.
Aesthetics
Conventional glass ionomer cements are tooth-coloured and available in different shades. Although the addition of resin in the modified materials has further improved their translucency, they are still rather opaque and not as esthetic as composite-resins. In addition, surface finish is usually not as good. The colour of resin-modified materials has been reported to vary with the finishing and polishing techniques used. Potential also exists for increased body discolouration and surface staining because of their hydrophilic monomers and incomplete polymerization. Nevertheless, the demand for esthetics in the primary dentition is usually lower than in the permanent dentition.
Adhesion
By bonding a restorative material to tooth structure, the cavity is theoretically sealed, protecting the pulp, eliminating secondary caries and preventing leakage at the margins. This also allows cavity forms to be more conservative and, to some extent, reinforces the remaining tooth by
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integrating restorative material with the tooth structures. Bonding between the cement and dental hard tissues is achieved through an ionic exchange at the interface. Polyalkenoate chains enter the molecular surface of dental apatite, replacing phosphate ions. Calcium ions are displaced equally with the phosphate ions so as to maintain electrical equilibrium. This leads to the development of an ion-enriched layer of cement that is firmly attached to the tooth. The shear bond strength of conventional glass ionomer cements to conditioned enamel and dentin is relatively low, varying from 3 to 7 MPa. However, this bond strength is more a measure of the tensile strength of the cement itself, since fractures are usually cohesive within the cement, leaving the enriched residue attached to the tooth. Comparisons between resin-modified glass ionomer cements and conventional materials reveal that the shear bond strength of the former is generally greater, but that they show very low bond strength to unconditioned dentin compared to conventional materials. Conditioning therefore plays a greater role in achieving effective bonding with the resin-modified glass ionomer cements. In addition, when the enamel surface is etched with phosphoric acid, the bond strength of the resin-modified materials is close to that of composite-resin bonded to etched enamel. This suggests, along with the effects of light-curing, that the bonding mechanism of resin-modified glass ionomer cements may be different from that of conventional materials.
Physical Strengths
The main limitation of the glass ionomer cements is their relative lack of strength and low resistance to abrasion and wear. Conventional glass ionomer cements have low flexural strength but high modulus of elasticity, and are therefore very brittle and prone to bulk fracture. Some glass
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cermet cements are arguably stronger than conventional materials but their fracture resistance remains low. The resin-modified materials have been shown to have significantly higher flexural and tensile strengths and lower modulus of elasticity than the conventional materials. They are therefore more fracture-resistant but their wear resistance has not been much improved. In addition, their strength properties are still much inferior to those of composite-resins, and so should not be subject to undue occlusal load unless they are well supported by surrounding tooth structure.
Biocompatibility
The biocompatibility of glass ionomer cements is very important because they need to be in direct contact with enamel and dentin if any chemical adhesion is to occur. In an in vitro study, freshly mixed conventional glass ionomer cement was found to be cytotoxic, but the set cement had no effect on cell cultures. In another study, the pulpal response to glass ionomer cements in caries-free human premolars planned for extraction was examined. The result showed that although glass ionomer cement caused a greater inflammatory response than Zinc-Oxide Eugenol cement, the inflammation resolved spontaneously with no increase in reparative dentin formation. More recently, Snugs and others have even demonstrated dentin bridging in monkey teeth where mechanical exposures in otherwise healthy pulps were capped with a glass ionomer liner. Therefore, lining is normally not necessary under conventional glass ionomer restorations when there is no pulpal exposure. Concern has been raised regarding the biocompatibility of resin-modified materials since they contain unsaturated groups. A cell culture study revealed poor biocompatibility of a resin-modified liner. In contrast, Cox and others showed that a resin-modified glass ionomer cement did not impair pulp healing when placed on exposed pulps. As a result of this uncertainty, use of resin-modified materials in deep unlined cavities is probably not advisable.
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Inherent adhesion to tooth structure High retention rate Little shrinkage and good marginal seal Fluoride release and hence caries inhibition Biocompatible Minimal cavity preparation required hence easy to use on children in and suitable for use even in absence of skilled dental manpower and facilities (such as in ART) Disadvantages Brittle Soluble Abrasive Water sensitive during setting phase. Some products release less fluoride than conventional GIC Not inherently radiopaque though addition of radiodense additives such as barium can alter radiodensity Less aesthetic than composite
Uses
The general use-based classification of GICs is as follows: Type I For luting cements Type II For restorations Type III Liners and bases Type IV Fissure sealants Type V Orthodontic Cements Type VI Core build up Type VII- Fluoride releasing Type VIII- ART(atraumatic restorative technique) Type IX- Deciduous teeth Additionally GICs may be also used for: Intermediate Restorations Adhesive Cavity Liners (Sandwich Technique) ART (Atraumatic Restorative Technique)
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Restorations for deciduous teeth The type of application prescribes the viscosity of the cement, which is adjusted by varying the particle size distribution and the powder-to-liquid ratio. The maximum particle size is 15 m for lutting agents and 50 m for restorative cements.
As Luting Agents
Glass Ionomer Luting Cement is excellent for permanent cementation of crowns, bridges, veneers and other facings. It can be used as a liner under composites. It chemically bonds to dentine/enamel, precious metals and porcelain restorations. It has good translucency and universal yellow shade, with early high compressive strength. It releases fluoride ions and reduces sensitizing by giving a firm foundation for composites, pulp protection and insulation. It mechanically bonds to composite restorative materials. It reduces the incidence of micro-leakage when used to cement composite inlays or onlays. It is easy to mix with good flow properties. It is fast setting with low fill thickness and low viscosity. It reaches the neutral pH fast, following placement on the tooth. It is used for cementation of orthodontic bands. Typical Physical Properties Mixing Time: 15 seconds Setting Time: 2 minutes Working Time: 2 minutes Total Time: 4.5 minutes at 23 C
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GICs have a number of advantages as cavity lining as they bond to dentine and enamel and release fluoride which not only helps in prevent decay and therefore minimizing the chance of appearance of secondary carries, but also promote the formation of secondary dentine. They can be used beneath both composite resin and amalgam.
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References
Phillips' Science of Dental Materials by Kenneth J. Anusavice Dental Materials: Properties and Manipulation by Robert Craig, John M. Powers and John C. Wataha Applied Dental Materials by J. F. McCabe, Angus Walls and John N. Anderson Introduction to Dental Materials, R van Noort, 2002, p137 Glass-Ionomer Cement, Alan D. Wilson and John W.McLean, 1988 Acid-base Cements, A.D. Wilson and J.W. Nicholson, 1993, p116 Retrieved from "http://en.wikipedia.org/w/index.php?title=Glass_ionomer_cement&oldid=451986694" Categories: Dental materials Glass chemistry This page was last modified on 23 September 2011 at 07:57. Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may apply. See Terms of use for details. Wikipedia is a registered trademark of the Wikimedia Foundation, Inc., a non-profit organization.
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