RMGI & Compomers

Resin modified glass ionomers

In the early 1990s reformulated ionomer-based materials were introduced. The modified materials are based on modifications that replace part of the original glass ionomer formulation with alternative filler particles and / or matrix setting reactions to make them more compositelike. These materials are categorized as hybrid or resin-modified glass ionomers. They are usually light-cured, less technique sensitive, and may be finished at the time of placement. Because resin-modified glass ionomers are significantly stronger than traditional glass ionomers, they are recommended for Class V restorations and can be used for Class I and Class II restorations in primary teeth.

It is used in restorations, liners, bases and cores. Sets via an acid/base reaction as well as a photo- and/or chemical-initiated free radical resin polymerization reaction; the reaction can occur in the dark (e.g., Fuji II LC, Vitremer, and Photac-Fil. In general, the powder of RMGICs is similar to that in glass ionomers; the liquid is water, HEMA, and a polyacid. Several distinct differences exist between the RMGICs and traditional GICs.

Compared to traditional GICs,

1. The fluoride-release pattern from these materials is about the same; the majority of fluoride is released in the first few days to weeks and then drops to a low level that is released for a long time. 2. They release an equivalent (or slightly smaller) amount of fluoride than conventional GICs. 3. Their wear resistance is significantly less than that of traditional GICs. Both types of materials exhibit an improvement in wear resistance over time, due to the long-term continuation of their acid/base glass-ionomer setting reactions.

Polyacid-modified resin composites (Compomers)

The most recent evolution of glass-ionomer chemistry is the class of materials known as polyacid-modified resin composites or compomers. These materials are similar to resinmodified glass ionomers in that they contain all the major components of both polymer-based composites and glass ionomers, with the exception of water. Water is excluded to prevent premature setting of the material and also to ensure that setting occurs only through a polymerization reaction.

May contain one or more glass-ionomer components but does not undergo an acid/base reaction. These materials are essentially polymer-based composites that have been slightly modified to take advantage of the potential fluoride-releasing behavior of glass ionomers. The mechanical properties of polyacid modified resin composites are superior to those of traditional glass ionomers and resin-modified glass ionomers, and in some cases, are equivalent to those of contemporary polymerbased composites

Classification of glass ionomer cements (GICs) based on the Use

Type I: Luting cements Type II: Restorative cements Type III: chemically-activated liners and bases Type IV: light activated liners and bases

Differences between the GICs, RMGICs, and PAMCRs

Besides the obvious difference of method of polymerization (setting), other differences exist between the three types of products. For example,

* Fluoride release differences

GICs release the greatest amount of fluoride while the RMGICs release the same amount or slightly less. Fluoride release from PAMCRS is minimal. GICs > RMGICs > PAMCRs

* Wear Resistance
PAMCRs > GICs > RMGICs

* Strength
PAMCRs > RMGICs > GICs

* Ease of Handling
PAMCRs > RMGICs > GICs

* Polish ability and Esthetics

PAMCRs > RMGICs

Indications for use

1. Used as cements, liners and bases. 2. Restoration of erosion and abrasion lesions. 3. Pit and fissure sealants. 4. Restoration of deciduous teeth. 5. Restoration of permanent class III and V carious lesions. 6. Restoration of root caries. 7. Core build up materials.

Contraindications
1. Class IV carious lesions or fractured incisors. 2. Lesions involving large areas of labial enamel where aesthetic is of major importance. 3. Class II carious lesions where conventional cavities are prepared. 4. Lost cusp areas.

CLINICAL PROCEDURES FOR PLACEMENT

1. Select the appropriate shade of cement. 2. Isolate the tooth with a rubber dam. 3. Prepare the cavity: Erosion-abrasion lesion: clean only. Carious lesion: conventional instrumentation. No bevel 4. Where there is <0.5mm of remaining dentin, line the cavity with Ca(OH)2. 5. Place the matrix. 6. Apply a surface conditioner to the cavity for 10 seconds. 7. Dispense the cement on a refrigerated glass slab & mix quickly: 30 sec for hand mixing 10 sec for machine mixing

8. Wash & lightly dry the cavity. Do not dehydrate the dentin because this will tend to reduce wet ability. Insert the cement, preferably using a syringe. 9. Allow to set for the recommended setting time, at least 4min from the start of mix. 10. Remove the matrix & immediately apply a waterproof varnish or light cured bonding agent. (critical point) 11. Trim any excess material external to the cavity with sharp scalpel blades or excavators. Do not use rotary instruments at this stage of setting. 12. Reapply varnish. 13. If the marginal adaptation is good the final polishing of the restoration should be delayed until the patients next visit. The modern fast-setting GI may be finished within 10-15 min. 14. Reapply varnish after polishing.

Finishing technique:
The best surface obtainable is that produced when the cement is allowed to set against the matrix. Carving the cement external to the cavity margins with sharp knives after initial set is the best technique for finishing, thus preserving gel surface. Gross finishing of bulk surfaces with rotary instruments after initial set is contraindicated. It should never be finished under dry conditions.

SANDWICH TECHNIQUE
- The term sandwich technique refers to a laminated restoration using glass ionomer to replace dentin and composite resin to replace enamel. - This strategy combines the most favorable attributes of the two materials, i.e., caries resistance, chemical adhesion to dentin, fluoride release and remineralization of glass ionomer, with the enamel bonding, surface finish, durability, and esthetic superiority of composite resin. Additionally, composite resin bonds micromechanically to set glass ionomers and chemically to the HEMA in resin-modified versions. Either resin-modified or highly viscous glass ionomers may be used, depending upon anticipated mechanical stresses and esthetic considerations.

Sandwich technique can be either open or closed It can be used in restoring class V & class II lesions.

Technique
Apply in appropriate thickness of at least 0.4 mm in class IV & 1.5 to 2mm in class I and II. (to act as an elastic buffer)

The closed sandwich technique

It consists of restoring the cavity with GIC & few days (23) weeks later, re-preparing the restored tooth, leaving a thick GI base & creating a sufficient space to make a composite veneer. (or can be done in one visit)

The open sandwich technique

The clinician fills the inter proximal box with GIC & completes the occlusal restoration with resin composite. When gingival margin is deep on the root surface i.e. on dentin.

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