ANTICARIOGENIC

RESTORATIVE
MATERIALS
GUIDED BY ;- PRESENTING BY ;-
DR. SHUBHASHINI N DR. AKHILESH MN
 CONTENTS

Introduction
Fluroide
Conventional GIC
Resin modified GIC (RMGICs)
Polyacid – modified composite resins (COMPOMERS)
Composite resin containing PRG fillers (GIOMERS)
Fluroide releasing composite resins
Nano ionomer GIC
Amalgomer CR
Chlorexidine impregnetaed GIC
Casein phosphopeptide amorphous calcium phosphate complex (CPP-
ACP)containing GIC
Calcium aluminate GIC(CERAMIR)
Activa bioactive restorative
DENTAL CARIES
Present findings suggest that the
prevalence of dental caries is a
pressing health concern affecting
at least half of the Indian
population.
Insert video
 ANTICARIOGENIC

The term "anticariogenic" refers to substances or actions that help prevent

or inhibit the formation of dental caries, which are commonly known as
cavities or tooth decay.

Anticariogenic agents or measures work to protect the teeth from the

harmful effects of bacteria in the mouth that produce acids, leading to the
demineralization of tooth enamel.
 SALIVA AS ANTICARIOGENIC PROPERTIES

Saliva plays a crucial role in maintaining oral health and has natural
anticariogenic (anti-tooth decay) properties.

It has numerous defense proteins, including

immunoglobulins (IgA, IgG, and IgM),
lysozyme (LYZ),
lactoferrin (LF),
Agglutinins, mucins, and histidine-rich polypeptides .
This study showed that saliva has an important anticariogenic
effect. The inhibitory effect of saliva on hard tissue
demineralization and on the characteristics of the biofilms
formed on enamel and dentin showed a clear dilution-
dependent
 ANTICARIOGENIC RESTORATIVE
MATERIALS

FLUROIDE RELEASING RESTORATIVE MATERIALS

Conventional GIC
Resin modified GIC (RMGICs)
Polyacid – modified composite resins (COMPOMERS)
Composite resin containing PRG fillers (GIOMERS)
Fluroide releasing composite resins
Nano ionomer GIC
Amalgomer CR
Chlorexidine impregnetaed GIC
Casein phosphopeptide amorphous calcium phosphate complex (CPP-ACP)containing GIC
Calcium aluminate GIC(CERAMIR)
Activa bioactive restorative
 FLUORIDE

 Fluoride taken up by the tooth reduces demineralization and

enhances remineralization.

 Fluoride ions also play a role in the interference of pellicle and

plaque formation and the inhibition of microbial growth.

 Fluoride ions are released during the acid-base reaction of the

cement and they are not an essential part of the matrix formation .
In-vitro studies have shown that glass-ionomer cements can
serve as rechargeable reservoirs, delivering a constant low
level of fluoride due to uptake from fluoridated solutions,
dentifrices and mouthwashes
GIC VIDEO
MECHANISM OF FLUORIDE:
FLUROIDE MECHANISM OF ACTION
The setting chemistry of glass-ionomer cement is an acid-
base reaction between the polyalkenoic acid and fluoride
containing aluminosilicate glass.

Various media (deionized water, artificial saliva and lactic

acid) have been used for measuring the amount of fluoride
released.
  Process I is a short-term reaction which involves rapid dissolution of fluoride from the outer
surface into the solution.
Process II is more gradual and results in a sustained diffusion of fluoride through the bulk cement .
The high sensitivity of these cements to water causes erosion of the glass
ionomers during the early setting period, and this further increases the
elution of fluoride.

The quantitative leaching of fluoride is increased by the presence of

cracks and pores on the surface of the material, leaving behind a low
amount of residual fluoride
 In a study by Neelakanten et al , the conventional GIC showed highest
amount of fluoride release on the first 3 days when compared with RMGIC,
Nano ionomer ,compomer and resin composite.
Compomer and Resin composite showed a low but a constant level of
fluoride release..

The cumulative fluoride release at the end of the study period in GIC,
RMGIC and Nano, was significantly higher than Compomer and Resin
composite.
 This is responsible for the phenomenon of “burst effect,” wherein high
amounts of fluoride are released during the first two days.

Fluoride release declines rapidly during the first week and stabilizes after
three to four weeks.
 FLUORIDE RELEASE FROM RESTORATIVE
MATERIALS

A study by Gabriela et al , showed greatest amount of fluoride release by Rely-

X luting 2 RMGIC followed by Vitremer RMGIC and ketac molar easymix –
conventional GIC. Composite resin was used as a negative control and it didn’t
release fluoride.

 RELY-X2 showed the highest rate of F release during all 28 days.

Higher F release values were observed in the first day, rapidly decreasing in the
second and third days, and gradually decreasing in the following days until it
reached a constant F-release level
 FLUORIDE RECHARGE

 Since F from external sources can be absorbed by the

material, thus increasing its capacity to remineralize dental
structures adjacent to the restoration.

GICs present a high F recharge and release capacity,

especially in the first 24 hours and after the treatment with a
high-fluoride dentifrice, even after material aging.
 FLUORIDE RECHARGE

The ability to recharge glass ionomer cement is potentially

beneficial in caries prevention, since it allows the formation of
a slow release and storage system for the long-term dental
remineralization process.

 The F release by the GICs occurs by dissolution and ion

exchange.
 FLUORIDE RECHARGE

The increased fluoride release after fluoride recharge of resin-based restorative

materials is most probably because of pores or surface retained fluoride.
Compomers and Giomers act more like composite resins than like GICs with
respect to fluoride recharge ability.

The fluoride-recharging ability of a restorative material depends on the

composition of the material, on the frequency of fluoride exposure and on the kind
and concentration of the fluoridating agent
 NANO IONOMER GIC

It has higher fluoride releasing ability .

Nano fillers constitute 2/3 rd of the filler content.
It has a structural morphology that is hybrid of RMGIC & nano
filled resin composite.
NANO IONOMER GIC- COMPOSITION
 NANO IONOMER GIC

oNano ionomer have a unique property- it has a capacity to

provide more release of fluoride .

oIncrease surface area to volume of nano sized filler have the

capacity to release fluoride in the powder more quickly
increasing the fluoride release of the material.
RESIN MODIFIED GLASS IONOMER CEMENTS
Definition: RMGIC can be defined as a hybrid cement that
sets via an acid base reaction and partly via a photo-
chemical polymerization reaction.
Eg:Fuji II LC, Vitrebond, Photac–Fil, Vitremer, FujiV.
 COMPOSITION
• Powder : Ion leachable glass and initiators for light /
chemical / both types of curing
• Liquid : Water + Polyacrylic acid modified with HEMA
monomers.
• Initiator- Camphorquinone.
• The HEMA content is around 15-25% and water content
is low to accommodate the polymerizable ingredients.
• It is a powder : liquid system with P:L = 3:1
 SETTING REACTION

2 distinct setting reactions occur

Thus a cement can be termed
- dual cure if cross linking is via acid base + L ightC ure
- tri cure if its via acid base + Light cure + chemical cure
 PROPERTIES

• Esthetics: there is a definite improvement in translucency as the

monomer brings the refractive index of the liquid close to that of the
glass particle.

• Fluoride release: is less compared to conventional GIC.

• Strength: The diametrical tensile strength is much higher but

compressive strength and hardness is lesser.
• Adhesion: to tooth is reduced. This is expected
because of reduction in carboxylic acid in the
liquid and interruption of chemical bonding due to
the resin matrix.

Adhesion to composites is increased due to the

presence of residual non-polymerized functional
groups within the RMGIC

• Micro leakage: A higher degree of Microleakage is

seen due to polymerization shrinkage
 INDICA TIONS

• Luting cement esp. in orthodontics

• Liner and base
• Pit and fissure sealant
• Core build up material
• For amalgam repair

ADVANTAGES
• Long Working time
• Early water sensitivity is reduced
• Rapid development of early strength
POLYACID MODIFIED RESIN COMPOSITE/COMPOMER

FLUORIDE
DURABILITY
OF
COMPOSITE
S

COMPOME
R
• Definition: Compomer can be defined as a
material that contains both the essential
components of GIC and composite but at
levels insufficient to promote the acid –base
reaction.
 COMPOSITION
• Compomers are essentially a one – paste system
containing ion leachable glass & polymerizable
acidic monomers with functional groups of
polyacrylic acid & methacrylates.
• NaF and some other fillers are also present for
additional F release.
• There is no water in the formulation.
• Glass particles are partially silanated to
ensure bonding.
 SETTING REACTION

Stage 1: composite • Stage II : a

resin network slow acid base
around filler reaction with
particles forms on formation of
light activation hydrogels
within the
resin.
 PROPERTIES
• ADHESION: to tooth requires acid –etching. Bond
strengths achieved usually approach the typical resin
bonding systems.

• It is = 18-24Mpa

• FLUORIDE RELEASE: is limited. It is significantly less

than Type II or RMGIC. F release usually starts after
about 2-3 months; it peaks initially and then falls rapidly
 BIOCOMPATIBILITY;
concerns about the release of HEMA from these materials, no other
biocompatibility issues have been associated with their usage
 INDICATION
S
P& F sealant

Restoration of primary teeth

Class III and V lesions along with cervical abrasions and erosions and

Intermediate restorations

Bases for composites, liners

Small core build ups

Root surface sealing

CONTRAINDICATIONS
• Class IV lesions
• Conventional class II cavities
• Lost cusp areas
• Restorations involving large labial surface

ADVANTAGES
• Superior working characteristics to RMGIC
• Ease of use
• Easily adapts to the tooth
• Good esthetics
• To summarize the differences between
the three types of materials:

• Fluoride Release and Rechargability

GICs>RMGICs>PAMCRs
• Wear Resistance
PAMCRs>GICs>RMGICs
• Strength
PAMCRs>RMGICs>GICs
• Ease of Handling
PAMCRs>RMGICs>GICs
• Polishability and Esthetics
PAMCRs>RMGICs>GICs
 GIOMERS

• Giomers are the latest category of hybrid dental restorative

materials.

This fluoride-releasing ,light-cured restorative material has a

true hybridization of glass ionomer and composite restorative
materials, as they exhibit both fluoride release and recharge of glass
ionomer cement.
 GIOMERS

• .

New research investigates the usage of giomers in the field of

orthodontics, for the prevention and treatment of white spots
and incipient caries.
AMALGOMER CR /CERAMIC REINFORCED
GIC
 AMALGOMER CR
• Strength and durability of amalgam.
• High F- release, natural adhesion to tooth structure, excellent
biocompatibility and prevents shrinkage, creep, corrosion or
thermal conductivity problems associated with other filling
materials
• They have been found to have exceptional wear characteristics,
along with other advantages of GIC
• Amalgomer shows the conventional acid-base reaction of
GIC
 INDICATIONS

1. Class I and
Class II Cavities

6. On the root 2. Repair of

surfaces for amalgam restored
locating over- tooth or #
dentures restoration

3. As a Base
5. As core build
under composite
up under crowns
restorations

4. Classes of cavity
were radiopacity is
prime concern
Conclusion:
Amalgomer CR can be recommended as a permanent
restorative material based on its better compressive
strength and comparable antimicrobial efficacy to GIC
Fuji IX.
The fluoride release rate was significantly higher in first day and reduced
after third day to a nearly constant level.

Hence it was concluded that Amalgomer CR showed the highest fluoride

release among all the dental restorative materials .
 CHLORHEXIDINE IMPREGNATED
GIC

• Chlorhexidine Impregnated GIC releases approximately 10 ppm of

fluoride during the 1st 48 hrs following its placement in the prepared
cavity.

• In order to improve the antibacterial characteristics Chlorhexidine

digluconate can be added to it.
Conclusions: The incorporation of 1.25% CHX increased the in vitro
antimicrobial activity, without changing chemical-mechanical properties of GIC
and odontoblast-like cell viability.
This combination improved the in vivo short-term microbiological effect without
affecting clinical performance of ART restorations.
CASEIN PHOSPHOPEPTIDE AMORPHOUS CALCIUM PHOSPHATE
COMPLEX (CPP-ACP)CONTAINING GIC

Mazzaoui SA et al. J DENT RES 2013 NOV 82(11)

• It was first developed by Aaron SPosener in mid 1960's.

• Incorporation of 1.56% CPP-ACP into the GIC significantly

increased microtensile bond strength (33%) and
compressive strength (23%) and significantly enhanced the
release of calcium, phosphate, and fluoride ions at neutral
and acidic pH.
 CASEIN PHOSPHOPEPTIDE AMORPHOUS CALCIUM PHOSPHATE
COMPLEX (CPP-ACP)CONTAINING GIC

CPP is a milk product which helps in remineralisation and

helps in the prevention of dental caries. CPP kills streptococcus
mutans bacteria and it binds to calcium and phosphate ions of
tooth structure and also to CPP.

CPP forms nanoclusters with ACP and makes a pool of

Calcium and phosphate ions which maintains the super
saturation of saliva.
Mazzoui et al in 2003, used CPP-ACP with fluoride and demonstrated a
synergistic remineralisation potential. It can be delivered using chewing
gums, mouth rinses, toothpastes and GIC.

CONCLUSION;- CPP–ACP products have provided a new direction to preventive

dentistry. the role of CPP–ACP in the prevention of dental caries is quite evident
and therefore its incorporation in various dental materials should be encouraged.
 CALCIUM ALUMINATE
GIC/CERAMIR

• A hybrid product with a composition between that of

calcium aluminate and GIC,

• The setting mechanism of Ceramir is a combination of a glass

ionomer reaction and an acid base reaction of the type
occurring in hydraulic cements.
 • Powder - calcium aluminate

• polyacrylic acid,

• tartaric acid,

• strontium-fluoro- alumino-glass

• strontium fluoride.

• The liquid -99.6% water and 0.4% additives.

• The calcium aluminate contributes to a basic pH during curing,

reduction in microleakage,
Conclusions: This study showed that the hybrid
CaAl-GIC possess favourable properties and have
potentials to expand its clinical applications as a dental
biomaterial.
 ZIRCONOMER

The inclusion of zirconia fillers in the glass component of zirconomer

reinforces the structural integrity of the restorative material & imparts
higher mechanical properties for the restoration of posterior teeth and the
protective and esthetics of GIC, completely eliminating mercury hazards.

The polyalkenoic acid and other components have been specially processed
to impart superior strength.
 ZIRCONOMER

Easy mixing and adequate working time enhances its utilization as a

restorative material.

Combination of outstanding strength, durability and sustained fluoride

release it is therefore used as an ideal restorative material for posterior teeth
especially in patients with high caries incidence.

Easy mixing and adequate working time enchances its utilization as a

future restorative material of choice
CONCLUSION;- Combination of outstanding strength, durability and
sustained fluoride release it is therefore used as an ideal restorative material
for posterior teeth especially in patients with high caries incidence
 NANO BIOCERAMIC. IMPREGNATED GIC

Calcium fluoride (CaF2) nanoparticles can be incorporated into RMGIC to improve its
mechanical properties.

However, it slightly reduces its fluoride releasing ability, as CaF2-doped GIC becomes
highly insoluble.
CONCLUSION;- Nano-apatite containing glass ionomers are expected
to have superior bonding to the tooth surface due to the formation of the
strong ionic linkages and high caries susciptible
 ACTIVA BIOACTIVE RESTORATIVE

ACTIVA BioACTIVE-RESTORATIVE chemically bonds to teeth and seals

against bacterial microleakage.

ACTIVA combines the esthetics, strength, and resilience of composites

with bioactive properties that are superior to glass ionomers and RMGIs
 ACTIVA BIOACTIVE RESTORATIVE

ACTIVA responds to changes in the oral environment with

release and recharge of calcium, phosphate, and fluoride.
It stimulates apatite formation at the material-tooth
interface.

The bioactive difference supports a prevention model and

helps maintain the health of the dentition .
ACTIVA BIOACTIVE RESTORATIVE VIDEO
 CONCLUSION
 Fluoride-releasing restorative materials reduce enamel and dentin
demineralization around restorations but in different extent, depending on their
fluoride release ability.

 The use of the high-fluoride dentifrice leads to higher F release by the

materials.

 Glass ionomer materials exhibit greater effectiveness on inhibition of dental

tissues demineralization than resin-based materials.

 Fluoride releasing restoratives may be useful as a part of a caries preventive

program, especially for patients with high caries risk.
 REFERENCES

• Glass Ionomer in dentistry ,Springer

• An atlas of GIC, Graham J Mount
• Philips science of dental materials, 11th ed
• Sturdevant’s Art and science of operative dentistry, Fifth
edition
• Advances in Glass ionomer cement , Carel L. Davidson, J
Minim Interv Dent 2009; 2 (1)
• Clinical evaluation of glass-ionomer Cement restorations,
Martin John TYAS J Appl Oral Sci. 2006;14(sp.issue):10-3
 REFERENCES

• GIC at It’s best – A review on ceramic reinforced GIC

International Journal of Applied Dental Sciences 2017;
3(4): 405-408
•A Review of Glass-Ionomer Cements for Clinical
Dentistry
Sharanbir K. Sidhu and John W. Nicholson

• The Effect Of Fluoride-releasing Restorative Materials

On Inhibition Of Secondary Caries Formation,
Dimitrios Dionysopoulosa Thessaloniki, Greece
Research review Fluoride 47(3)258–265 July-
September 2014
THANK YOU.