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Glass ionomer cement has been described as a hybrid of dental silicate cement
"powder" and zinc polycarboxylate cement "liquid".
Types:
1. Conventional GIC:
A. GIC Powder:
The powder is an acid-soluble calcium-fluoro-alumino-silicate 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” to reduce the melting
temperature of GI.
Strontium, barium or zinc oxide additives provide radiopacity.
B. GIC Liquid:
The liquid is an aqueous "watery" solution of polymers and copolymers of
polyacrylic acid*.
Tricarboxylic acids were added to the liquid to decrease the viscosity of liquid,
and to promote reactivity between the glass and the liquid.
Tartaric acid is also present in the liquid. It improves handling characteristics
and increases the working time, however, it shortens the setting time.
2. High Viscosity Conventional GICs
They are useful for atraumatic restorative treatment "ART" technique as they were
developed to act as a substitute to amalgam for posterior restorations in rural
areas.
In these cements, polyacrylic acid is made to finer grain size so that higher powder-
liquid ratios can be used "More viscosity".
Advantages of Highly Viscous Glass Ionomers:
Fast setting "Ch. Bond"
Low early moisture sensitivity
Low solubility in oral fluids "Low risk of moisture contamination".
Finishing can be done in five minutes after placement
Anti-cariogenic effect.
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3. Reinforced GICs: Strength of the GIC can be improved by modifying the chemical
composition of the original glass powder. It can be done by following:
A. Disperse-phase Glasses: glass was prepared with large amount dispersed phases
of strengthening.
B. Fiber-reinforced Glasses: alumina fibers, glass fiber, silica fiber and carbon fiber
were added. However, these materials showed difficulty to mix, and show low
resistance to abrasion.
C. Metal Reinforced GIC: metal powder or fibers were added to GIC to increase the
flexural strength.
The most famous type is the “Miracle mix”, which formed by incorporating the amalgam
alloy powders to the GIC. These cements show poor esthetics and resistant to burnishing
and poor resistance to abrasion.
D. Cermet Cements: GIC produced by sintering the metal and glass powders
together. It showed strong bonding of the metal to the glass. These cements have
shown improved resistance to abrasion and higher flexural strength.
4. Resin-Modified GIC
The typical RMGIC consists of approximately 80% GIC components
(fluoroaluminosilicate glass and polyacrylic acid), while the remaining 20% consists
of light cured methacrylates to overcome the drawbacks of conventional GICs..
Resin based bonding to tooth structure is via micromechanical mechanism and
chemically by the formation of ionic bonds between carboxyl groups of the RMGIC
and calcium ions of enamel and dentin.
Advantages of RMGIC: combined advantages of both composites and glass
ionomers.
Chemical adhesion to enamel and dentin with Fluoride release "Cariogenic
effect".
Superior strength characteristics.
Extended working time with control on setting.
Low interfacial shrinkage stress.
Good adaptation.
Improved aesthetics.
Disadvantages of Resin Modified Composites:
Shrinkage on setting.
Limited depth of cure especially with more opaque lining cements.
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Glass lonomer Cements mixing:
For simple and easier manipulation of GICs, modifications have been made for
dispensing glass ionomer cement:.
A. Capsules:
These capsules contain premeasured powder and liquid to assure correct ratio
for the mix.
These capsules have angled nozzle which acts as a syringe for accurate
placement of the cement into a preparation.
B. Paste dispensing system:
In this system, an ultra-fine glass powder is used to provide the cement in a
paste consistency.
It uses a cartridge and a material dispenser.
Advantages of this system are optimum ratio, simple placement, and easy mixing.
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Classification of GICs
Indications of GICs
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Advantages of GIC
Limitations of GIC
Clinical steps
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D. Surface Protection
The newly placed restoration should always be protected, as GIC show sensitivity to
both moisture contamination and surface desiccation immediately after matrix
removal.
It can be done with the help of resin bonding agent, petroleum jelly or varnish
“Coat”.
Special techniques
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B. Sandwich Technique
The term “sandwich technique” refers to a intermediate restoration using glass
ionomer to replace dentin and composite resin to replace enamel.
Advantages:
The open sandwich technique used for deep Class II forms where the cervical
margin lacks enamel, has shown the improved resistance to microleakage and
caries in comparison to resin bonding at dentin margins.
Better strength, aesthetics and finish of composite resins.
Fluoride release from GIC.
Reduced bulk of composite resins so less polymerization shrinkage.
Minimizes the number of increments of composite resin to be placed, so saves
time.
Use of GIC eliminates acid etching of dentin and thus reduces post-operative
sensitivity caused by incomplete sealing of etched dentin.
Good pulpal response because of biocompatibility of GIC.
Disadvantages:
Technique sensitive
Time consuming.
Clinical Steps:
1. Isolate the tooth to be prepared.
2. Prepare the tooth keeping the cavosurface margins involving dentin butt joint.
3. Condition the prepared tooth using polyacrylic acid for optimal adhesion of GIC.
4. Place freshly mixed fast setting GIC in the prepared tooth.
5. It is only necessary to etch a GIC with acid if the restoration has been in place for
some time and has fully matured. If the GIC is freshly placed and is immature,
bonding can be achieved simply by washing the GIC surface because water causes
wash out of GIC matrix from around the filler particles which gives microscopically
rough surface to which the composite will attach.
6. Coat the surface of prepared tooth either with an unfilled resin or a dentin
bonding agent for optimal adhesion and cure it for 20 seconds.
7. Place composite and cure following its manufacturer recommendations.
8. Finishing and polish the restoration.