GLASS IONOMERS GLASS IONOMERS

in Restorative Dentistry in Restorative Dentistry

The many faces of glass ionomers
GI -- what are they ?
GI categories ?
GI setting reactions ?
GI reIease of F and recharging ?
GI appIications ?
1970 1970 1980 1980 2000 2000 1990 1990
DentaI AmaIgam DentaI AmaIgam
DentaI Composite DentaI Composite
GIass Ionomer GIass Ionomer
First GIC in 1972 First GIC in 1972
DentspIy A.S.P.A. DentspIy A.S.P.A.
A.S. = A.S. = A AIumino Iuminos siIicate gIass iIicate gIass
P.A. = P.A. = PPoIyacryIic oIyacryIic a acid in water cid in water
DEVELOPMENT DEVELOPMENT
TimeIine for "direct restorative materiaIs" usage TimeIine for "direct restorative materiaIs" usage
GIass Ionomer GIass Ionomer: : "gIass" refers to the gIassy ceramic particIes and the "gIass" refers to the gIassy ceramic particIes and the
gIassy matrix (non gIassy matrix (non- -crystaIIine) of the set materiaI, whiIe "ionomer" crystaIIine) of the set materiaI, whiIe "ionomer"
refers to ion refers to ion- -crossIinked poIymer. crossIinked poIymer.
PoIyaIkenoic or PoIyaIkenoate PoIyaIkenoic or PoIyaIkenoate: : refers to poIymer chain which refers to poIymer chain which
incorporates aIkenoic monomers such as acryIic acid, tartaric acid, incorporates aIkenoic monomers such as acryIic acid, tartaric acid,
maIeic acid, etc. maIeic acid, etc.
FF- -ReIease ReIease: : refers to reIease of fIuoride ions but there is no impIication refers to reIease of fIuoride ions but there is no impIication
as to the source of the ions as to the source of the ions -- -- and there are many possibiIities. The and there are many possibiIities. The
confusion for current systems is, if "F" does not come from the confusion for current systems is, if "F" does not come from the
traditionaI GI matrix, then some peopIe say that the system is not a traditionaI GI matrix, then some peopIe say that the system is not a
"true" GI (but the point is irreIevant). "true" GI (but the point is irreIevant).
MuItipIe MuItipIe- -Cure Cure: : refers to muItipIe curing mechanisms possibIe with refers to muItipIe curing mechanisms possibIe with
resin resin- -modified systems modified systems -- -- the terminoIogy was first introduced in 1992 the terminoIogy was first introduced in 1992
by 3M for their Vitremer product because it underwent the (1) by 3M for their Vitremer product because it underwent the (1)
traditionaI GI chemicaI setting reactions, (2) a seIf traditionaI GI chemicaI setting reactions, (2) a seIf- -cured cured
poIymerization reaction, and a (3) Iight poIymerization reaction, and a (3) Iight- -cured poIymerization reaction. cured poIymerization reaction.
TERMINOLOGY TERMINOLOGY
Don't be confused by some of the strange Ianguage. Don't be confused by some of the strange Ianguage.
Si, Na,
F, Ca,
AI
H2O,
H3PO4,
AI, Zn
+
Ca+2
AI+3
F-
Si+4
H+
GIass particIe
Etched periphery
Ca, AI, Na, Zn
Phosphates and
FIuorides
REACTANTS PRODUCTS
SiIicate Cement SiIicate Cement
ZnO
H2O
PAA
ZnO + COOH
HOOC
COOH
HOOC
-OOC
COO-
-OOC
COO-
Zn++
Zn++
COO-
-OOC
COO-
-OOC
ResiduaI
ZnO
Zinc polyacrylate gel
PoIycarboxyIate Cement PoIycarboxyIate Cement
GLASS IONOMERS GLASS IONOMERS
HYBRID = HYBRID = SC [Powder] SC [Powder] and and PCC [Liquid] PCC [Liquid] = A.S.P.A. = A.S.P.A.
SiO
2
,
AI
2
O
3
,
Na, Ca,
F
PAA
in
H
2
O
SiO
2
,
AI
2
O
3
,
Na, Ca,
F
ResiduaI GIass ParticIe
POLYACRYLATE HYDROGEL
(initiaIIy Ca poIyacryIate geI
and Iater AI poIyacryIate geI)
Si
+4
, AI
+3
, Ca
+2
, Na+, F
-
Ions
SiO
2
,
AI
2
O
3
,
Na, Ca,
F
Si
+4
AI
+3
Na
+
Ca
+2
F
-
PAA
H2O
GLASS IONOMERS GLASS IONOMERS
HYBRID = HYBRID = SC [Powder] SC [Powder] and and PCC [Liquid] PCC [Liquid] = A.S.P.A. = A.S.P.A.
COO COO
COO COO
OOC OOC
COO COO
COO COO
COO COO
COO COO
OOC OOC
OOC OOC
OOC OOC
OOC OOC
AI+3 AI+3
-- --OO- -Si+4(OH) Si+4(OH)2 2
Ca++ Ca++
Ca+ Ca+
Ca+ Ca+
OOC OOC
OOC OOC
COO COO
OOC OOC
COO COO
FF- -AI AI- -SiO SiO2 2
CaF CaF2 2
H H- -OO- -H H
H H- -OO- -H H
H H- -OO- -H H
H H- -OO- -H H
H H- -OO- -H H
Ca Ca
+2 +2
AI AI
+3 +3
Si Si
+4 +4
FF
- -
GI SETTING REACTIONS GI SETTING REACTIONS
UniversaI UniversaI
CEMENTS CEMENTS
GI GI
COMPOSITE COMPOSITE
HYDROGEL HYDROGEL
Hydrophobic POLYMER Hydrophobic POLYMER
RM RM- -GI GI
GI and
VLC HydrophiIic
monomer and poIymer
CEMENTS CEMENTS
MM MM- -GI GI
GI and
MetaIIic fiIIers
Cermet fiIIers
CORES CORES
COMPOMER COMPOMER
VLC Composite and
F source
FILLING MATERIALS FILLING MATERIALS
RR RR- -GI GI
GI and
Resin-FiIIers
A.R.T. and A.R.T. and
TEMPORARIES TEMPORARIES
GIOMER GIOMER
VLC Composite and
Pre-reacted GIC powder
FILLING MATERIALS FILLING MATERIALS
CEMENTS CEMENTS
FILLING MATERIALS FILLING MATERIALS
FLUORO FLUORO- -ALUMINO ALUMINO- -SILICATE SILICATE
PARTICLE PARTICLE
CEMENT CEMENT
MATRIX MATRIX
F
-1
,
Ca
+2
, AI
+3
, Si
+4
InitiaI
dissoIution
for
starting
reaction
rapid earIy
F reIease
from matrix
SIow Iong term
F reIease
by diffusion
from particIe
FLUORIDE RELEASE FLUORIDE RELEASE
FIuoride comes from matrix and particIes at different rates. FIuoride comes from matrix and particIes at different rates.
EFFECTIVE LEVELS EFFECTIVE LEVELS
20 20
10 10
15 15
5 5
14 14 21 21 28 28 7 7 0 0
TIME (Days) TIME (Days)
F
L
U
O
R
I
D
E

R
E
L
E
A
S
E

(
p
p
m
)
F
L
U
O
R
I
D
E

R
E
L
E
A
S
E

(
p
p
m
)
FIuoride Toothpaste, FIuoride Toothpaste,
TopicaI FIuoride, TopicaI FIuoride,
FIuoride Mouthrinse FIuoride Mouthrinse
PARTICLES PARTICLES
M
A
T
R
I
X
M
A
T
R
I
X
Mjor IA. Mjor IA. GIass ionomer cement restorations and secondary caries: a GIass ionomer cement restorations and secondary caries: a
preIiminary report. preIiminary report. ":intessence Int ":intessence Int 1996; 1996;27(3):171-174
GIass Ionomer GIass Ionomer
Composite Composite
AmaIgam AmaIgam
RepIacement rate (%) for secondary caries RepIacement rate (%) for secondary caries
0 20 40 60 80 100
CARIOSTATIC EFFECTS CARIOSTATIC EFFECTS
GI is not more effective than composite or amaIgam. GI is not more effective than composite or amaIgam.
1. 1. Cement Cement
2. 2. Liner / Base Liner / Base
3. 3. Restoration Restoration
4. 4. Core / Foundation Core / Foundation
5. 5. (TunneI Restoration) (TunneI Restoration)
6. 6. (Sandwich Restoration) (Sandwich Restoration)
7. 7. Retrograde FiIIing MateriaI Retrograde FiIIing MateriaI
8. 8. P/F SeaIant P/F SeaIant
9. 9. Root Caries CervicaI Restoration Root Caries CervicaI Restoration
10. 10. Temporary, or ART Restoration Temporary, or ART Restoration
TechnicaI modifications:
> P/L FPrecapsuIated
> Addition of etching and then BA
> Addition of different reinforcing fiIIers
> Finer and finer particIe sizes
GeneraI Properties:
> Strength
> Adhesion
> BiocompatibiIity
> FIuoride reIease
APPLICATIONS APPLICATIONS
GI have been tried for about every conceivabIe appIication. GI have been tried for about every conceivabIe appIication.
COMMERCIAL PRODUCTS COMMERCIAL PRODUCTS
Hytac
Vitremer
Ketac-Cem
Dyract FIow
Fuji MiracIe Mix
SOME PRODUCTS SOME PRODUCTS
Fuji IX
Now being used as permanent restoration in pedodontics.
DeveIoped as temporary restorations for 3rd worId countries.
First tested in African countries.
Now used wideIy in Asian countries.
Current technique = P/L or precapsuIated mixture.
OriginaI technique = scoop, finger mix, finger insertion.
A.R.T. RESTORATIONS A.R.T. RESTORATIONS
ART = Atraumatic Restorative Technique ART = Atraumatic Restorative Technique
"WHO" GIobaI A.R.T. Project "WHO" GIobaI A.R.T. Project
Atraumatic Restorative Treatment (ART) = prevention and treatment of
dentaI cariesbased on excavating and removing caries using hand
instruments onIy and restoring gIass ionomer.
Fuji IX GP Fuji IX GP
MinimaI equipment and instrumentation
TEMPORARY RESTORATIONS TEMPORARY RESTORATIONS
Fuji IX Dominates the Landscape Fuji IX Dominates the Landscape