International Journal of Adhesion & Adhesives 69 (2016) 33–38

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International Journal of Adhesion & Adhesives

journal homepage: www.elsevier.com/locate/ijadhadh

Adhesion of glass-ionomer cements to teeth: A review

John W. Nicholson
Bluefield Centre for Biomaterials, Unit 34, 67-68 Hatton Garden, London EC1N 8JY, United Kingdom

art ic l e i nf o a b s t r a c t

Available online 19 March 2016 This review covers the adhesion of glass-ionomer cements, both conventional and resin-modified, to the
Keywords: enamel and dentine of the tooth. These materials are widely used in modern dentistry, and studies have
Adhesion shown them to bond particularly to the mineral phase of the tooth material, with some evidence of direct
Glass-ionomer cements chemical bonds between carboxylic acid groups of the polymer and calcium ions in the tooth mineral.
Dentistry With time, conventional glass-ionomers have been shown to develop an ion-enriched interfacial zone
Teeth with dentine, which is probably responsible for the high durability of the adhesive bonds of this material.
Enamel Adhesion is exploited in many of the clinical applications of these materials, including ART, class V cavity
Dentine repairs, and pit-and-fissure sealants. These are described briefly.
& 2016 Elsevier Ltd. All rights reserved.

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2. Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2.1. Surface pretreatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
2.2. Bond strengths. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
2.3. Mechanisms of bonding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
3. Test methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
3.1. Clinical significance of adhesion of glass-ionomers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
4. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

1. Introduction glass-ionomer cements [4]. It is the latter that are the subject of this
review article. The emphasis of the article is on the inherent adhesion
For many years the repair of teeth damaged by caries was per- of these materials and its mechanism, and also the clinical applica-
formed with silver amalgam [1]. This material has the advantages of tions that follow from this adhesion.
being inexpensive and easy to place, and is durable in clinical service
[2]. However, it is not aesthetic. When set, it is an unsightly silver
colour and visually obtrusive. It also has the disadvantage that rela-
2. Background
tively large amounts of healthy tooth tissue have to be removed by the
dentist in order to create a retentive cavity shape capable of main-
Conventional glass ionomer cements are acid–base materials that
taining the set material in place [3,4].
were first introduced in 1972 by Wilson and Kent [6]. They are pre-
To overcome these drawbacks, aesthetic materials are increasingly
pared from an aqueous solution of polyalkenoic acid, either polyacrylic
used in the dental clinic [5]. These materials are conservative (i.e.
acid or acrylic/maleic acid copolymer, which is reacted with a pow-
allow more natural tooth material to be retained) and they generally
dered glass component that has a basic character. This glass is usually
match the natural tooth in colour and translucency. Two main classes
a calcium fluoro-aluminosilicate, though strontium based glasses are
of material are considered aesthetic, namely composite resins and
also available and used clinically. These glasses are complex materials,
and not only contain numerous components (see Table 1) but may
E-mail address: john.nicholson@bluefieldcentre.co.uk also show at least partial phase separation [7].

http://dx.doi.org/10.1016/j.ijadhadh.2016.03.012
0143-7496/& 2016 Elsevier Ltd. All rights reserved.
34 J.W. Nicholson / International Journal of Adhesion & Adhesives 69 (2016) 33–38
In the clinic, the powder and liquid are mixed together to form
a stiff paste, and this paste gradually hardens by an acid–base
reaction occurs. The acid attacks the glass, which causes ions
(Ca2 þ and Al3 þ ) to be released. These ions crosslink the polyalk-
enoic acid chains [8,9]. The combined effect of crosslinking by
metal ions and neutralization of the polyalkenoate molecules is
that the cement hardens [10]. This takes place in a short period of
time, typically 2–5 min from mixing, after which the cement can
be finished.
The freshly set cement is not completely fit for clinical service. It is
susceptible to water exchange across its immature outer surface. This
means it can dry out, a process which has been claimed to be
responsible for the formation of a network of micro-cracks in the
cement surface and the development of an unsightly chalky appear-
ance [11]. Alternatively, it can take in water, with the potential loss of
network-forming ions and associated swelling, which may also cause
micro-cracks to develop [8]. Covering the newly placed cement with a
layer of either petroleum jelly or varnish prevents this water move-
ment, and so stops the occurrence of a chalky appearance [12].
Further slow reactions continue with time. These are generally
described as maturation, a term that seems to cover a variety of
processes [10]. They include an increase in ionic crosslinking with
time [13]. In addition, there is an increase in the proportion of bound
water within the cement, which has been attributed to greater
binding of water to co-ordination sites around ions, or around neu-
tralised polyanion molecules. There is also some evidence of the for-
mation of silanol groups on the surfaces of the glass particles, a pro-
cess that involves hydrolysis of Si–O–Si groups [14]. There is
also evidence of some sort of inorganic network formation from the
ion-depleted glass [15], probably involving phosphate groups from the
latter [16]. Finally, it has been suggested recently that the size of the
pores trapped within the cement by the mixing process decreases
with time [17], though the mechanism of this observed reduction in
pore size is unclear.
These variation maturation steps lead to changes in the properties
of the glass-ionomer cement. Specifically, compressive and diametral
tensile strength increase with time, at least in cements derived from
poly(acrylic acid), and also translucency improves. Properties of glass-
ionomers vary widely, but must at least the minimum requirements
specified in the relevant ISO Standard [18]. These are shown in Table 2.
One of the developments of glass-ionomer cements has been the
high-viscosity version [19], which became available in the mid-1990s
and which set more rapidly than earlier types of glass-ionomer. They
have been called viscous or condensable by some authors [19], and
Table 1
Composition of a typical
ionomer cement glass
(G338).
Component % by mass
SiO2 24.9
Al2O3 14.2
AlF3 4.6
CaF2 12.8
NaAlF6 19.2
AlPO4 24.2
Table 2
ISO requirements for physical properties of clinical grade glass-ionomer cements
[18].
Property Luting cement Restorative cement
Setting time/min 2.5–8 2–6
Compressive strength/MPa 70 (minimum) 100 (minimum)
Opacity, C0.70 – 0.35–0.90
they were originally developed for use with the atraumatic restorative
treatment (ART) technique [20]. This application particularly exploits
the adhesion of glass-ionomers, and is considered later in this article.
The second important member of the glass-ionomer family that is
widely used in contemporary clinical practice is the resin-modified
glass-ionomer. Originally introduced as a liner/base material in 1991
[21], this material includes a polymerizable monomer, 2-hydroxyethyl
methacrylate (HEMA) as an additional component. In addition, poly-
merisation initiators are present to cause the HEMA to undergo
addition polymerisation. These initiators are usually light-activated, so
that the majority of brands of resin-modified glass-ionomer are light-
curable [21].
In resin-modified glass-ionomers, the acid–base reaction is aug-
mented by the HEMA polymerization [22,23]. In their simplest form,
these materials contain only the conventional components of glass-
ionomers (glass, polyalkenoic acid and water) together with HEMA.
However, more complex materials have also been developed in which
the polyalkenoic acid is modified with side chains that are terminated
in vinyl groups and which can consequently become involved in the
addition polymerization reaction. In all cases, however, these materials
retain their essential nature as glass ionomer cements because of their
ability to set by means of the acid–base reaction [22].
Resin-modified glass-ionomers have similar mechanical properties
to conventional glass-ionomers. They also show inherent adhesion to
both the enamel and the dentine layers of the tooth. However,
because of the presence of HEMA, some of which can be released from
the set material, resin-modified glass-ionomers have inferior bio-
compatibility to conventional glass-ionomers [24], a point not always
recognised in the clinical literature.
Both conventional and resin-modified glass-ionomers are used
with relatively minimal cavity preparation, which exploits their
good inherent adhesion. They are also used in repairs in which
good adhesion is a requirement, such as Class V cavities [25]. The
rest of this review focuses specifically on their adhesive properties.
2.1. Surface pretreatment
Bonding of restorative dental materials to the tooth is an
important topic that has been studied extensively for many years.
Bonding to dentine is considered a particular challenge, because
this tissue contains more water than enamel and also less mineral
phase for bonding. It has fluid-filled tubules running through its
structure, and these provide moisture that may possibly under-
mine the interface between the cement and the tooth [26]. Glass-
ionomers of both types have the advantage of being hydrophilic,
so have the capability of wetting the freshly cut dentine surfaces
and forming durable adhesive bonds.
When the tooth is cut, the result is a surface covered with a
thin layer of debris known as the smear layer [27]. This layer is of
the order of 1–2 mm thick and attached to the underlying dentine
quite tenaciously. It comprises mineral phase embedded in dena-
tured collagen [27], and is effectively a structure with less defined
order than either enamel or dentine. Bond strengths and durability
of bonding vary according to the precise details of the cutting
process applied to the tooth [28].
Removing the smear layer typically modifies this surface. Such
cleaning creates a uniform and reliable surface for bonding and may
also remove any smear layer blocking the dentinal tubules, which
allows freshly placed glass-ionomer paste to penetrate the surface to
an extent. The result is a degree of micro-mechanical attachment
when the cement has hardened [29].
Removal of the smear layer may be achieved either by treat-
ment with weak acid, such as citric acid, or by treatment with
strong acid, such as 37% phosphoric acid, typically as a gel [5]. The
former has been called “conditioning” while the latter is known as
“total etch”. Total etch is widely used, following its introduction
 J.W. Nicholson / International Journal of Adhesion & Adhesives 69 (2016) 33–38 35

some years ago [30], though there remain doubts about its overall Table 4
effectiveness and alternative approaches to bonding are con- Variation in shear bond strength with depth into dentine (Standard deviations in
parentheses) [40].
sidered desirable in many cases [31]. For glass-ionomers, con-
ditioning is usually carried out with dilute solutions of poly(acrylic Glass-ionomer Bond strength to superficial Bond strength to deep
acid), at concentrations of either 10% or 20% [24] or with more brand dentine/MPa dentine/MPa
concentrated solutions (37%) [32,33]. Application is typically for
Chelon Fil 2.43 (1.43) 3.21 (0.89)
10–20 s followed by rinsing [32,33].
Vitremer 7.04 (2.04) 10.30 (1.99)
Conditioning with poly(acrylic acid) solutions has similar effects to
treatment with citric acid in that it removes most of the smear layer in
a mild process that involves little or no attack the underlying sound Table 5
dentine. It also opens the dentinal tubules and partially demineralises Effective of irradiation time of Vitremer
the upper layer of the tooth, leading to an increase is surface area and resin-modified glass-ionomer on shear
bond strength to dentine (Standard devia-
exposure of micro-porosities, which allow micro-mechanical attach- tions in parentheses) [42].
ment and also hybrid layer formation [29]. These effects are sufficient
to promote sound bonding by glass-ionomers. Studies using both TEM Irradiation time/s Bond strength/MPa
and X-ray photo-electron spectroscopy have shown that the poly
5 4.07 (0.70)
(acrylic acid) used for conditioning is not completely removed by 10 4.59 (0.67)
rinsing [28,34], but instead remains present as a thin layer (up to 20 6.58 (1.07)
0.5 mm) on the tooth surface. This layer, which probably arises from 30 6.79 (1.22)
chemical reaction of the poly(acrylic acid) with the hydroxyapatite 40 6.89 (1.36)
50 6.97 (1.60)
phase [35], has been referred to as the gel phase [29].
Pretreatment of the dentine surface by conditioning has been
shown to be effective. For example, with resin-modified glass-iono- The nature of the substrate has been found to alter the measured
mers it was found to give significantly higher shear bond strengths bond strength, not only between enamel and dentine, but also
than pretreatment with phosphoric acid [36]. It also gave higher bond depending on the depth within the dentine to which the surface has
strengths than when surfaces were not treated at all. Consequently been cut [39]. This study employed the shear bond test, with speci-
such conditioning to prepare the tooth for bonding by glass-ionomer mens being only 24 h old. They showed that shear bond strength was
cements is the recommended procedure [25]. greater in deep than in superficial dentine (Table 4). Explaining the
results from this study is difficult, although they suggest an explana-
2.2. Bond strengths tion for the variations in the results reported in the literature.
Results in Table 4 also confirm the reasonable shear bond strengths
Bond strengths of glass-ionomers of both types have been deter- created by glass-ionomers on dentine. This is despite the high
mined in shear and in tension. Typical values for tensile bond moisture content of dentine, and is an indication of the hydrophilic
strengths varied from 4.90 to 11.36 MPa on enamel and from 2.52 to nature of the conventional glass-ionomer cement [40], a feature
5.55 MPa on dentine [36]. Resin-modified glass-ionomers tended to shared by resin-modified glass-ionomers. In fact, there is evidence
show values towards the upper end of these ranges [36]. The fact that that the presence of HEMA enhances the affinity between the dentine
bond strengths to enamel are generally greater than those to dentine surface and resin-modified versions of these cements [41].
suggests that the main interaction of the cement is with the hydro- For resin-modified glass-ionomers, irradiation time was found to
xyapatite mineral phase, rather than with the collagen component [8]. influence the measured shear bond strength (see Table 5). This is
Bond strengths are known to develop quickly, about 80% of the partly a reflection of failure mode, which was cohesive in all samples
eventual bond strength being achieved after 15 min [37]. They then [40], since increased irradiation time increases the extent of poly-
continue to increase for several days [32]. merization in these materials, and therefore results in a stronger
Failure of glass-ionomers tends to be either cohesive [25] or a cement.
mixture of cohesive and adhesive [38]. This means that it is diffi-
cult to obtain a fundamental understanding of adhesion by com- 2.3. Mechanisms of bonding
parison of notional bond strengths, as at least part of the infor-
mation that these results provide is about the strength of the There are several parts to the adhesion of these cements to the
cement itself, either shear or tensile. tooth surface, either enamel or dentine. Initially, when the freshly
Adhesion is known to be influenced by certain aspects of sample mixed cement paste is placed on the surface of the tooth, there
preparation, however. For example, shear bond strength of conven- must be wetting. This means that the cement paste is able to form
tional glass-ionomers to enamel has been shown to vary with storage a close contact with the surface, aided by the hydrophilic nature of
time, improving between 24 h and 3 months (see Table 3), but then both the cement and the surface.
declining somewhat between 3 and 6 months [38]. Given the known The adhesion that occurs at the wetting stage has been sug-
changes in strength (compressive and flexural) of the cement over this gested as being due to the formation of hydrogen bonds. Such
sort of time period, together with the mixed adhesive/cohesive nature bonds are proposed between the free carboxylate groups of the
of the failure, the significance of the latter observations is not clear. cement and the layer of tightly bound water on the surface of the
mineral phase of the tooth [42]. These hydrogen bonds seem to be
Table 3 gradually replaced by genuine ionic bonds formed from calcium
Variation in shear bond strength with storage time (Standard deviations in par- ions in the tooth and carboxylate groups from the with polymer
entheses) [39].
within the cement [43,44]. This concept is consistent with results
Storage time Ketac nano Ionofil molar showing an ion-exchange layer being formed slowly between the
cement and the tooth [45,46]. Infra-red spectroscopy has con-
24 h 9.30 (0.67) 5.25 (0.62) firmed the possibility of proper ionic bonds being formed between
3 months 12.02 (0.76) 7.82 (1.42)
the carboxylate groups of the poly(acrylic acid) and the tooth
6 months 6.7 (0.73) 5.91 (0.87)
surface [47].
36 J.W. Nicholson / International Journal of Adhesion & Adhesives 69 (2016) 33–38
The question of whether there is any bonding to collagen within
the tooth structure on the adhesion of glass-ionomers has not been
fully answered. The fact that bonds are stronger to enamel than to
dentine suggests that any bonds to the organic phase of the tooth are
not important and that collagen has no role at all. However, as col-
lagen is a protein containing both amino and carboxylic acid groups, it
is possible that there is an interaction with carboxylate groups so it is
possible that some of the adhesion is due to bonding to collagen [47].
However, overall the evidence suggests that bonds of this type are not
particularly important in the mechanism of adhesion of glass-
ionomers to the tooth [32].
Following detailed consideration of all the evidence, adhesion
of glass-ionomer cements to the tooth can be considered to result
from two inter-related phenomena, namely:
(i) Micromechanical interlocking. This arises from the formation of
short cement tags within the surface of the dentine and also a
thin hybrid layer between hydroxyapatite-coated collagen fibrils
at the tooth surface and the surface of the freshly placed glass-
ionomer cement [37,48,49]. This suggests that glass-ionomers
may be considered to be self-etching, an effect that arises from
the presence of the polyalkenoic acid component. Any micro-
mechanical interlocking is enhanced, if anything, by the presence
of HEMA in resin-modified glass ionomers, and is probably the
reason for their slightly higher bond strengths [37].
(ii) True chemical bonding. As we have seen, this involves the
formation of ionic bonds between the carboxylate functional
groups on the polyalkenoic acid molecules and calcium ions in
the hydroxyapatite surface [50]. This type of bonding has been
observed experimentally on hydroxyapatite [50] and also on
enamel and dentine [37] using XPS. However, care is needed in
the interpretation of these results because XPS is a high
vacuum technique. As a result, the substrate (either the
hydroxyapatite or the tooth surface) is almost certain to be
drier in these experiments than the freshly prepared tooth
surface in the mouth. Any true chemical bonds that are formed
with the tooth surface must form through a strongly adherent
layer of water. The extent to which such bonds can form in vivo
is unclear, and they may play only a minor role in the overall
bonding to glass-ionomers to the tooth.
In the longer term, there are substantial changes in the inter-
face between a conventional glass-ionomer cement and a restored
tooth. There appears to be a diffusion process in which ions from
Fig. 1. Interfacial ion-exchange layer formed between tooth surface and glass-ionomer cement [45].
the cement and from the tooth surface travel in opposite direc-
tions into the interfacial zone, thus creating an ion-exchange layer
(Fig. 1) [45,51]. This layer can be seen under the scanning electron
microscope and is evidence of a genuine chemical union between
the tooth and the glass-ionomer cement. The image shown in
Fig. 1 comes from work in which the strontium-based glass-
ionomer cement Fuji IX was used to restore a tooth. The interac-
tion zone that formed was a physically obvious structure, and
chemical analysis showed that both strontium and calcium were
present within it. These elements originated, respectively, in the
cement and the tooth surface and travelled into the interfacial
region to create the ion-exchange layer. This layer then binds the
cement and tooth together firmly. It has also been shown to be
strongly resistant to acid attack [51].
To date, there have been no comparable studies on resin-modified
glass-ionomers. However, these materials are known to release similar
ions to conventional glass-ionomers under similar conditions [52], so
they seem to be equally capable of forming such layers.
3. Test methods
Bond strengths of glass-ionomers have generally been determined
either in shear mode or in tension. Both approaches have their
advocates, but the latter have the advantage of more closely repli-
cating the patterns of loading that the material experiences under
clinical conditions. It has also been miniaturised, and workers in this
field are increasingly reporting micro-tensile bond strengths.
Substrates employed are typically extracted human teeth, usually
removed for orthodontic reasons. They do not fully replicate the
substrate to which glass-ionomers are bonded clinically, because they
are caries-free. This is likely to alter the results obtained [53], and
reduce the clinical relevance of any findings.
Bond strengths of glass-ionomer cements to teeth are generally
measured on immature cement specimens. The use of such spe-
cimens and the limited duration of the experiments mean that the
diffusion layer has not had time to develop fully, and so resulting
bond strengths are low, especially compared with those of com-
posite resin systems. As we have seen, higher values are found for
enamel than for dentine [8]. Slightly higher values have been
reported for bonding to caries-affected dentine, i.e. up to 8.3 MPa
[53] compared with unaffected dentine, but values are still lower
than for composite systems. Despite these results, there is evi-
dence that bonds formed by glass-ionomer cements are durable in
 J.W. Nicholson / International Journal of Adhesion & Adhesives 69 (2016) 33–38
clinical use, and this may be a reflection of the strength of the
interfacial ion-exchange zone that forms [45].
In vitro bonding studies typically show that failure of glass-
ionomer cements of both types is at least partly cohesive, i.e.
occurs within the cement, rather than at the interface, which is
adhesive failure [54]. This result is therefore not a measure of the
true adhesive bond strength, but rather a measure of the tensile
strength of the glass-ionomer material. This is low in immature
specimens [25], and not representative of the final value that fully
matured cement is likely to have. These considerations show that
determining the real strength of the adhesive bond is difficult, and
that values in the literature are almost certainly not the true
strength of the adhesive bond formed.
3.1. Clinical significance of adhesion of glass-ionomers
Adhesion is important because it not only aids the retention of
glass-ionomer cements in the repaired tooth, it also reduces the
problem of marginal leakage. Marginal leakage is a clinical problem
because the gaps at the edges of restorations through which it occurs
allow harmful micro-organisms to enter the space underneath the
restoration. Their metabolism then gives rise to secondary caries
below the restoration. Adhesion has been found to reduce this pro-
blem in in vitro studies [55–57], and almost certainly has this effect
under clinical conditions.
Applications of glass-ionomers of both types generally exploit their
inherent adhesion to the tooth. There are used as liners and bases,
where their good adhesion helps retain the overall restoration, and
also reduces or eliminates marginal leakage [25]. They are also used as
full restorations, for example in erosion cavities along the gum line,
so-called Class V cavities. These are routinely repaired with glass-
ionomers, and rely on excellent natural adhesion for retention in
cavities where are otherwise difficult to repair [8,25]. Indeed, the good
retention shown by these materials in Class V cavities can be con-
sidered to be a measure of the effectiveness of the adhesive bonds that
they form with the tooth surface [58].
Glass-ionomers, particularly conventional glass-ionomers, find
application in the atraumatic restorative treatment (ART) techni-
que [59]. This technique has been developed under the aegis of the
World Health Organisation to provide dental care in low- and
middle-income countries of the world. Typically in these coun-
tries, there is virtually no caries management and toothache is
generally dealt with by extraction of the offending tooth. These
countries typically have unreliable electrical power supplies,
which means that electrically driven dental drills cannot be used
routinely.
The ART technique addresses these issues by using hand
instruments to remove caries-affected dentine and enamel, fol-
lowed by employing high viscosity glass-ionomer cement to repair
the tooth [59]. Glass-ionomer cement is used because of its
adhesion, even to surfaces that have had only minimal prepara-
tion. The technique appears to be very successful, particularly in
the repair of single-surface lesions, with typical success rates over
2–3 years being in excess of 90% [60].
4. Conclusions
Glass-ionomer cements are useful materials in dentistry, mainly
because of their natural adhesion to the tooth and also their reason-
able aesthetics. Their adhesion has been widely studied, and shown to
be the result of a good initial wetting, which reflects the hydrophilic
nature of the freshly mixed cements, followed by long-term chemical
and mechanical interactions. Under experimental conditions, these
interactions have been shown to include the formation of prim-
ary chemical bonds between the cement and the mineral phase of the
37
tooth, and under clinical conditions, they have been shown to be
associated with the formation of a mechanically strong interfacial
zone. This zone develops as a result of an ion exchange process.
Adhesion influences the clinical uses of these cements, and make
them important materials in the modern dental clinic.
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