Supervisor :

Dr. Yaser Fathi Ali

By:

Asmaa Akrem Ahmed

Liner / Base
filling material

cement

Technical modifications

Restoration

Application G.I

faces
General Properties
Sandwich restoration

Identification
root caries cervical restoration tunnel restoration

Temporary restoration

1) Identification
The term glass ionomer cement should be applied only to a material that involves a significant acid base reaction as a part of its setting reaction and show a continuing fluoride release.

Glass ionomers have been a part of dentistry officially since 1972. However, they were, for all practical purposes, a derivation of the earlier silicate cements. Alan D. Wilson (a government chemist in England) guided the transition from silicates to glass ionomers. Throughout the following presentations, we will jump back and forth between the terms glass ionomer (GI) and glass ionomer cement (GIC). For all practical purposes, we will be referring to the same product. However, technically glass ionomer is a classification and glass ionomer cement is a glass ionomer used for cementing applications. Do not worry about this distinction. Quite often you will hear the term glass ionomer cement when one is referring to a restorative filling material application.

General Properties
* Bond chemically to enamel & dentin *Release fluoride ions over a prolonged period of time. * Biocompatible & have approximately same coefficient of thermal expansion as that of tooth structure.

a.

General.

The primary use of glass ionomer cement is for permanent cementing of inlays, crowns, bridges, and/or orthodontic band/brackets. In addition, it can be used as a cavity liner and as a base.

b. Clinical Uses
Glass ionomer cement is used in the same way as zinc phosphate cement, both as an intermediate base and as a cementing medium.

c. Chemical Composition.
(1) Powder. The composition of glass ionomer cement powder may vary slightly depending on the manufacturer. It generally contains a mixture of aluminosilicate glass with dry polymaleic acid. (2) Liquid. Glass ionomer cement liquid consists of an aqueous solution containing an accelerator. (A chemical accelerator shortens the setting time.)

d. Properties. Glass ionomer cement is free from phosphoric acid and has very low solubility. It adheres chemically to enamel and dentin and, readily, to wet tooth structure, leaving minimal film thickness. It is well tolerated by the pulp and remains rigid under a load, exhibiting no creep. Glass ionomer possesses high compressive strength. It releases fluoride ions to tooth structure. It is simple to proportion, mix, apply, and clean up.

e. Setting Reactions.
For glass ionomer cement as for other dental cements, the working time is reduced if a higher powder to liquid ratio has been used. Higher temperature shortens working time and lower temperature extends working time. Glass ionomer cement should always have a glossy appearance. When the surface becomes dull, the setting reaction has started, and the mix should be discarded. Exceeding the working time will result in loss of adhesion to enamel and dentin.

Components of Glass Ionomer

Fluoro-alumino silicate glass particles Complex acids Resin components

Timeline for direct restorative materials usage

First GIC in 1972 Dentsply A.S.P.A.
A.S. = Aluminosilicate glass P.A. = Polyacrylic acid in water

DEVELOPMENT

1970

1980

1990

2000

Dental Amalgam Dental Composite Glass Ionomer

The first dental product appeared as Dents ply ASPA. Quickly, other companies developed similar products. Over their more than 30-year history, glass ionomers have never been quite as good as bonded composites for any application. Looking back, it almost seems as though glass ionomers have been reborn many times and so the comment about the many faces of glass ionomers. In the competition between glass ionomers and composites, glass ionomers have lagged behind by 3-5 years in terms of their development. Small filler sizes, better matrix designs, and a host of other changes occurred first in composites and later in glass ionomers. Even if glass ionomers were competitive with composites in potential properties, they were never improved fast enough and lost many of the marketing battles. Today, the two major applications for glass ionomers are as resin-modified glass ionomer cements for luting fixed appliances and as ART restorations.

The original term glass ionomer was derived from the descriptors for the filler and the matrix components. The filler is a silicate glass. The matrix is ion-cross linked (ionomer). The technical term in chemistry for these materials is polyalkenoic or polyalkenoate cement. While Europeans are adamant that only the technically correct term should be used, most of the rest of the world uses the terms glass ionomers, or GIs, or GICs.

All glass ionomers are capable of fluoride ion release. However, materials other than glass ionomers may release fluoride ions as well. There is nothing magical about if or how fluoride ion is released.
Glass ionomer setting reactions are complex and involve many options or stages. For that reason, some products have been designated as having multiple cures. These refer mainly to separate reactions and not multiple methods of inducing the setting reaction..

GLASS IONOMERS
HYBRID = SC [Powder] and PCC [Liquid] = A.S.P.A. Silicate Cement
S i , N a , H O , 2 H + F , C a , H P O , 3 4 A l

A l , Z n

C a + 2 A l + 3 F S i + 4

G l a s s p a r t i c l e E t c h e d p e r i p h e r y

C a , A l , N a , Z n P h o s p h a t e s a n d F l u o r i d e s

R E A C T A N T S

P R O D U C T S

Polycarboxylate Cement
H O O C
O O C

Z i n c p o l y a c r y l a t e g e l O O C R e s i d u a l C O O Z n O H O 2 + C O O H Z n + + Z n O Z n O C O O C O O P A A C O O H O O C Z n + + C O O H O O C O O C

Glass ionomers are a hybrid formed from two earlier dental cement products, silicate cement (which contributes the powder portion) and polycarboxylate cement (which contributes the liquid portion). The hybrid was created to combine the best properties of the two materials. However, such marriages are never really truly perfect. Silicate cement is formed when silicate glass powder particles react with phosphoric acid solution. A composite structure results that is a complex matrix of reaction products surrounding mostly unreacted silicate glass filler particles. The cement is soluble and tends to release F ions that are part of the matrix. Hence, the reputation for silicate cements as caries preventing restorations. Yet, continued dissolution always led to rough surfaces that absorbed stain and discolored. Therefore, the esthetics were limited to just a very few years at best.

Polycarboxylate cement forms from the reaction of ZnO powder particles with a polyacrylic acid solution. Zinc ions are released that chelate carboxyl's on the polymer chains and produce cross linking. The final material is a polyacrylate gel surrounding the reinforcing ZnO filler particles. This cements claim-to-fame is that the liquid solution (while initially acidic) is based on large molecules with little tendency to migrate into dentin or down dentinal tubules. It is viewed as more biocompatible (less irritating to the pulp) for this reason. The material is strong. The same carboxyl's that undergo cross linking are also capable of chelating available Ca ions on the surface of enamel or dentin causing chemical bonding and good adhesion. Since the cement is based on water, it wets tooth structure well.

GLASS IONOMERS
HYBRID = SC [Powder] and PCC [Liquid] = A.S.P.A.
H2O Si+4 Al+3 SiO2, Na+ Al2O3, Ca+2 Na, Ca, FF PAA SiO2, Al2O3, Na, Ca, F PAA in H2O

Residual Glass Particle SiO2, Al2O3, Na, Ca, F POLYACRYLATE HYDROGEL (initially Ca polyacrylate gel and later Al polyacrylate gel) Si+4, Al+3, Ca+2, Na+, F- Ions

Glass ionomers exist as an aqueous solution. The set product is a hydro gel. It is hydrophilic. It requires a certain amount of water to be stable. Removing the water, destabilizes the chelation. While this is an advantage in terms of wetting and chelating tooth structure, it is a disadvantage for strength and esthetics. The hydro gel can not be made to be as strong as a typical hydrophobic composite system. The water also refracts light making the colors of glass ionomers more opaque in appearance. They never achieve the excellent translucency of composites or ceramics.

GI SETTING REACTIONS
H-O-H

Ca+2 Al+3

FCOO F-Al-SiO2 CaF2

Si+4
--O-Si+4(OH)2 H-O-H COO

OOC

OOC OOC

H-O-H

Ca+ COO

COO

OOC Ca+ OOC OOC

COO Ca++ OOC COO COO OOC Al+3 COO

H-O-H

H-O-H

Imagine tooth structure as an adherent portrayed to the left in the slide above. A single alumino-silicate particle is shown at the top surrounded by a milieu of ions released from the edges of the particle. A couple of polyacrylic acid polymer chains are revealed as partly ionized in the watery matrix. Calcium ions which have been released from the particles form divalent cross links between chains at first. These are replaced gradually over 1-3 days by trivalent cross links from aluminum ions. Fluoride ions in the matrix tend to quickly diffuse outward into aqueous surroundings. At the same time, the pendant carboxyl's that are reacting with ions, may also react with partially ionized calcium ions on the surfaces of the powder particles and on tooth structure to create chemical bonds. Long after these processes have been completed, the siliceous network develops within the hydro gel. To improve the properties of the final hydro gel and to increase the setting speed of the cement, a number of modifications have been explored over the last 30 years. To understand these effects (and the subsequent applications for modified GI cements) consider the following map of glass ionomers.

Hydrophobic POLYMER

GIOMER
VLC Composite and Pre-reacted GIC powder

COMPOMER
VLC Composite and F source Universal

COMPOSITE
CEMENTS FILLING MATERIALS

FILLING MATERIALS

CEMENTS FILLING MATERIALS

RM-GI
GI and VLC Hydrophilic monomer and polymer

CEMENTS

MM-GI
GI and Metallic fillers Cermet fillers

GI

RR-GI
GI and Resin-Fillers

CORES
HYDROGEL

A.R.T. and TEMPORARIES

Glass ionomers have evolved in most cases to become more and more like composites. Starting at the middle of the bottom of this map, we can trace the evolution of the materials from a traditional hydro gel toward the upper right-hand corner that represents a standard hydrophobic composite. The first substantial modifications to glass ionomers were made by adding presumed reinforcing fillers. Amalgam alloy powder was admixed with conventional GI to produce metal-modified GIs (MM-GI or MM-GIC). However, since the Ag-Sn alloy particles were not well-bonded to the matrix, the admixture was actually weaker. This was proposed at a time that dental amalgam was first coming under fire in the U.S. (about 1982) due to its Hg content. The admixture was called the miracle mixture and substituted for dental amalgam in some practices. Unfortunately its poor properties were quickly revealed and all such restorations had to be replaced. Yet, this mixture is still sold today as an alternative for build-ups or cores. Another version of MMGIs was developed by adding metallic particles with ceramic coatings (cermets) as reinforcing fillers. These have continued to be used as cores. A major hurdle for GI acceptance was overcome when water-soluble acrylic monomers (predominantly HEMA) were added along with double-bond functional polyacrylic-acid chains and initiators. These were called resin-modified glass ionomers (RMGI). It was now possible to visible light cure (VLC) the materials to achieve high early strength and more protection of the hydro gel. The same GI reactions still took place, but they were secondary for the performance of the materials. Compomers eliminated the need for GI chemistry altogether. They were simply composites with the inclusion of fluoride releasing alumino-silicate glass filler particles. Another way of thinking of these materials is as GI powder particles substituted into composites. They are truly composites.

In response to the criticism that Compomers were not really glassionomer-like at all, pre-cured glass ionomer particles were blended into Compomers to create giomers. However, these products are not really competitive with standard composites as filling materials or cements.

Finally, in the early 1990s, a version of traditional glass ionomer was targeted at a market called A.R.T. (atraumatic restorative technique). In second and third world regions in which dentistry is not readily available, it is important to halt caries before it completely destroys a tooth and leads only to extraction. ART materials were designed to be placed by non-dental personnel as a holding procedure to stop caries until the individual could be treated in a dental office. To increase the longevity, these products may have a small amount of polymer added for improved toughness and so they are called resin-reinforced glass ionomers (RR-GIs). The market for these materials is incredible expansive. This is the largest volume of GI sold today.
A more recent push toward universal cements has evolved a new class situated between RMGI and COMPOMER.

FLUORIDE RELEASE
Fluoride comes from matrix and particles at different rates.
rapid early F release from matrix Slow long term F release by diffusion from particle

F-1, Ca+2, Al+3, Si+4

Initial dissolution for starting reaction

FLUORO-ALUMINO-SILICATE PARTICLE

CEMENT MATRIX

Now lets examine the mechanism and effectiveness of fluoride release from GI. During reaction about 10-15% of the alumino-silicate powder particle is dissolved, releasing the ions necessary for setting into the matrix. At the same time, fluoride is released as well and persists in the hydro gel .Once the material is placed interiorly, there is a strong osmotic pressure for fluoride to leave the cement. The environment outside of the cement has low or no fluoride concentration and so the driving force is the outward diffusion of fluoride. All the matrix fluoride ions are released from the cement in about 24 hours (at about ~20 ppm levels). After that time, the only remaining fluoride is within the powder particles. Release of fluoride from the powder particles occurs very slowly and produces very low concentrations (at about ~1-2 ppm).

20

FLUORIDE RELEASE (ppm)

15

EFFECTIVE LEVELS
10
Fluoride Toothpaste, Topical Fluoride, Fluoride Mouthrinse

MATRIX PARTICLES

14

21

28

TIME (Days)

Over the last few years there have been efforts to recharge the material (i.e., add fluoride back into the restorations for subsequent release) by exposing the surfaces to fluoride ion sources. Quite a few things can push fluoride back into cements or restorations. This is simply a way of changing the osmotic pressure. If the concentrations on the outside are higher than the inside, then fluoride ion moves in rather than out. The best way to make this happen is with fluoride containing toothpastes, fluoride mouth rinses, or topical fluorides. This temporarily boosts the fluoride concentration. However, quickly this falls back to original levels again. Unfortunately, the boosted levels are not high enough for even a short time to be considered clinically efficacious as an anti-caries therapy.

CARIOSTATIC EFFECTS
GI is not more effective than composite or amalgam.

Glass Ionomer

Composite

Amalgam 0 20 40 60 80 100

Replacement rate (%) for secondary caries Mjor IA. Glass ionomer cement restorations and secondary caries: a preliminary report. Quintessence Int 1996;27(3):171-174.

It would have wonderful to have had well-designed, long-term clinical trials that tested the efficacy of fluoride release on caries reduction. However, any trial would have been very expensive to conduct. All manufacturers side-stepped this option. The problem for a clinical trial would be to exclude the fluoride that is present in the rest of the environment (food, beverages, drinking water, etc.) so that only the restorative material effect could be observed. Instead, for 25-30 years everyone has relied on circumstantial or anecdotal evidence to argue that these materials must be providing some anti-caries effect. In fact, there was no real effect at all. In the middle 1990s, this suspicion began to surface as more and more surveys of practitioners revealed that glass ionomer restorations were actually failing at a faster rate than amalgams or composites and because of secondary caries.

Benefits of Glass Ionomer

Direct Bond to tooth - no bonding agent required Bonds to moist tooth Fluoride protection Excellent marginal seal - no shrinkage Thermal expansion = tooth Biocompatable - Ideal match for dentin

APPLICATIONS
GI have been tried for about every conceivable application.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Cement Liner / Base Restoration Core / Foundation (Tunnel Restoration) (Sandwich Restoration) Retrograde Filling Material P/F Sealant Root Caries Cervical Restoration Temporary, or ART Restoration
General Properties: > Strength > Adhesion > Biocompatibility > Fluoride release

Technical modifications: > P/L Precapsulated > Addition of etching and then BA > Addition of different reinforcing fillers > Finer and finer particle sizes

Now lets examine the plethora of glass ionomer applications. These individual situations will be discussed in more detail by Dr. Wilder. Here is a capsular summary. Cements are popular applications for GI to attach crowns and bridges to tooth structure. Gi liners and bases are used by half the folks in practice but are not used by the other half. Glass ionomer restorations are losing more and more to composites. Cores or foundations for fixed prosthetics are popular but not as durable as composite or amalgam. Tunnel restorations are MO or DO restorations formed under marginal ridges without breaking them. Sandwich restorations are composites bonded over GI with the GI exposed as surfaces in some cases for fluoride release. Retrograde filling materials are root canal fillings of teeth that are removed, filled, and replanted. Sealant applications have not fared well because GI tend to be brittle. Cervical restorations are hard to restore because of moisture control challenges so traditional glass ionomers are often preferred because of the ability to work in wet fields. Temporary restorations in permanent teeth or ART restorations in primary teeth are extremely popular.

In all cases, the sophistication of the restorative product has improved. Originally all glass ionomers were made by mixing powders and liquids but now most are pre-capsulated. Most have bonding agent options. Reinforcing fillers and much more careful powder phase grinding have improved handling, wear resistance, and esthetics. In general, the major reason for selecting a glass ionomer instead of a composite is because of challenges for moisture control, since they tend to demonstrate some adhesion to tooth structure in the presence of moisture.

Glass Ionomer Cements

GI Comparison
Glass-Ionomer terminology has become quite complicated and with so many products in the market it is hard to know what to choose. The products available have different enhancements to make them more suitable for specific indications. In general there are three classifications of GIs a) Glass Ionomer Cements or traditional glass ionomer restorative products. Consist of an acid-decomposable glass and an acidic polymer that undergo an acid/base reaction when mixed. The reaction does not require light to occur - the mixed material sets in the dark. Examples of these products are Ketac-Fil (ESPE) and Fuji II (GC America).

b) Resin-Modified Glass-Ionomer Cements This group can be divided into 2 subgroups : Light Cured Resin Modified Glass Ionomer Base/Liners & Light Cured Resin Modified Glass Ionomer Restoratives. Resin has been added in one form or another. In addition to the GI acid/base reaction, they also undergo a resin polymerization reaction that is usually initiated by light exposure (these products require light exposure to harden.) Examples are Fuji II LC (GC America), Vitremer (3M), and Photac-Fil (ESPE).
c) Polyacid Modified Composite Resins These are more resin than glass ionomer. They contain one or both of the basic glassionomer components but the components are in such small quantities that they either do not cause an acid/base glass-ionomer setting reaction or contribute little to the overall setting reaction of the material. These products usually do not set without light exposure or set very slowly. Examples are VariGlass VLC (Caulk), Dyract (Caulk), and Geristore (Den-Mat).

Comparison Table

The use of laminate or sandwich technique is one of the recommended techniques in operative dentistry and it is currently the subject of many researches.1 This technique was developed by McLean et al in 1985, 2 who employed the dentine adhesive properties of glass ionomer cements to seal the cavities and reduce micro leakage. Also, the technique utilized the advantages of GIC fluoride release in combination with resin esthetic material to enhance clinical serviceability.3,4,5,6 The concept of lamination or sandwich technique is the use of two different materials to form one final restoration. The rational behind the technique is to make the most of the physical and aesthetic properties of each material. They bond to tooth structure, are esthetic and possess long-term fluoride release than that can be recharged with neutral topical fluoride application7. The first open sandwich restorations used conventional autocure glass ionomer cement which develops mechanical interlock between it and composite resin. However, failure occurred because of moisture sensitivity and progressive loss of the glass ionomer cement.8 The bond strength between conventional glass ionomer cements and composites is limited by the low cohesive strength of the glass ionomers and the lack of chemical bonding. This could be attributed to the difference in the setting reactions between dental composites and conventional glass ionomer cement.5

RM GIC was introduced as both a restorative and base material because it showed improved mechanical and physical properties than conventional GICs.9 Also, it was stated that the flexural strength of RMGIC were significantly improved compared to the conventional one and showed a true adhesive bond to resin composites4 than to the cured conventional glass ionomer cement.5 Dyract as a compomer combines the polymers of composites with the characteristics of glass ionomers that may include adhesion to tooth structure and cariostatic properties due to fluoride release.7 However, all compomer systems provide dentin bonding agents similar to that used with composites. Therefore Dyract was combined with Dyract PSA marketed with Prime and Bond NT.10However, Compomers have significantly lower fluoride release than glass ionomer and because their mechanical properties and wear resistance are inferior to composite resins, there is little indication for their use.7 Meanwhile, a new generation of material was introduced to the market in the late 1998 based on the new organically modified ceramic, or ormocere. The ormocere composite consists of inorganic-organic copolymer. Its complex composition is poorly understood ,and its bonding capabilities is unknown . However, it is already being widely used in modern technology.11,12 Studies on sandwich technique in literature reports were limited with composite resin restorative materials only. Also there is confusion in the literature on the effect of etching GIC on the bonding strengths with different restorative materials. Therefore, the aim of this in vitro study was to measure the shear bond strength of different esthetic tooth-colored restorative materials when bonded to RMGIC with and without acid etching. In addition, the location of bond failure after debonding was assessed.

SOME PRODUCTS

Ketac-Cem

Hytac

Dyract Flow

Here are just a few examples are shown of the types of materials from the previous list. Note the different delivery systems there are involved.

Fuji Miracle Mix

Vitremer

Hytac and F2000 are compomers. Dyract Flow is a flowable version of a resinmodified glass ionomer.

Fuji I LC is a light-cured RMGI that has substantial quantities of glass ionomer components in the overall cement.
Vitremer is a common RMGI that is extremely popular as a lining cement over calcium hydroxide for for deep amalgam or composite restorations.

PROGLASS ONE Radiopaque Glass Ionomer Luting Cement

ProGlass One chemically bonds to tooth structure & metal providing excellent strength and marginal integrity for long term restorations. Features Type I : Luting crowns, bridges and orthodontic brackets Type III : Lining cements, Base. Minimizes microleakage Easy seating of restoration No need for primer or adhesive Fluoride release Enhanced physical properties Indications Cementation of all types of metal, porcelain fused to metal, resin crowns, inlays, onlays & bridges Cementation of orthodontic bands Cementation of stainless steel crowns or orthodontic appliances retained with stainless steel crowns Base or liner Packaging

PROGLASS TWO LC Radiopaque Light Cured Reinforced GI Cement

ProGlass Two LC is specially formulated with smaller particles that make it ideal for restorative fillings & other secondary indications such as liner and base. Features Type II a : Aesthetic restorative cements Type II b : Reinforced restorative cements Type III : Lining cements, Base. * High Polishability * Excellent chemical adhesion * Exceptional mechanical properties * Fluoride release Indications Class III & V restorations, particularly restoration of cervical erosions & root surface caries Restoration of deciduous teeth Small Class I & III restorations Pit & Fissure sealant Good results in areas where rubber dam is difficult to use Packaging Box of 50 capsules * Sample box * Powder (15g) / Liquid (6.8ml) Kit

PROGLASS NINE Radiopaque Packable Glass Ionomer Cement

The high translucency of ProGlass Nine ensures use in anterior restorations without compromising aesthetics. Features Type II a : Aesthetic restorative cements

* Condensable viscosity * High wear resistance * Early resistance to water uptake permitting one visit treatment * Excellent chemical bonding, no etching & excellent marginal seal
Indications Final restorative for Class I, II, III & V deciduous teeth Long-term restorative in non load-bearing areas of Class I & II Intermediate restorative and sandwich material for heavy stress bearing Class I and II cavities Packaging Box of 50 capsules * Sample box * Powder (16g) / Liquid (6.4ml) Kit

PROGLASS PLUS Radiopaque Glass Ionomer Luting Cement

ProGlass Plus, a resin modified glass ionomer luting cement, bonds chemically and mechanically to tooth structure & to all types of core material. Features Type I : Luting crowns, bridges and orthodontic brackets Type III : Lining cements, Base. * Higher bond strengths than conventional glass ionomer cements * Simple placement technique * Low coefficient of thermal expansion * Maintains all benefits of true glass Ionomer Indications Cementation of all types of metal, porcelain fused to metal, resin crowns, inlays, onlays and bridges Cementation of porcelain inlays Cementation to all types of core material including prefabricated pins , posts & cast posts Cementable reinforced all ceramic crowns Packaging Box of 50 capsules * Sample box * Powder (15g) / Liquid (9.6ml) Kit

PROGLASS Silver Radiopaque Siver Alloy Glass Ionomer Cement

Core Bulid Up
ProGlass Silver is a unique blend of spherical silver-tin alloy with glass ionomer. The glass component provides an ultimate balance between working and setting time. Features Unique blend of spherical silver tin alloy with GI * High Flouride release * No discoloration or staining * Excellent direct bond * Versatile clinical application * Strong abrasion resistant * Optimal level of radiopacity
*

Indications
Core Build up Base or liner Restoration of primary teeth Class I, limited Class II Temporary filling Delivery form: Powder (20g) / Liquid (10ml) Kit

Study of micro leakage prevention in recently developed aesthetic dental restorative materials
Introduction Dental caries occurs as the result of metabolic activity of bacteria in dental plaque, leading to acid production and tooth demineralisation. The conventional restorative material, amalgam, is increasingly being replaced by, more aesthetic, glass-ionomer cements (GICs). GICs were first described by Wilson and Kent in the early 1970s 1. This material consists of a glass powder and a polyacid solution, which when mixed set in minutes to produce a solid. The main features of GICs are their adhesive property and ability to release fluoride. The major benefit of using adhesive materials is the bonding between the filling material and the tooth can prevent micro-leakage. Microleakage is the passage of bacteria between a restoration and dentine. It can cause recurrent caries and pulpal infections. The fluoride released from GICs can also increase caries resistance of the tooth adjacent to the restoration, and inhibit the growth of bacteria. GICs, however, cannot be used in load bearing regions due to their low flexural strength. This limitation has been partially overcome by incorporating resin, i.e. methacrylate monomers, into the GIC formulation. The resultant cements are known as Resin Modified Glass Ionomer Cements (RMGIC). The Constant Depth Film Fermentor (CDFF) 2 provides a new in vitro method to model the oral condition allowing studies of oral biofilms. In this work, CDFF was used to investigate the microleakage of bacteria into the microspace between 3 different filling materials and dentine in restored dentine cylinders.

Aims
The aims of this study were to assess 1)GIC and RMGIC setting reactions by Fourier Transform Infra-red Spectroscopy (FTIR); 2)whether recently developed resin modified glass ionomer cements are as effective as conventional GICs in preventing bacterial microleakage using a Constant Depth Film Fermentor (CDFF).

Materials and Methods Both GICs and RMGICs (Fuji IX GP and Fuji II LC, GC Corporation, respectively) were prepared according to the manufacturer's directions and powder / liquid ratios. FTIR Materials of 1 mm thickness were placed onto the single reflection diamond ATR attachment in the sample chamber of a Perkin Elmer 2000 series FTIR spectrometer. Spectra were then taken at vairous times. Fluoride release The cements were made into discs and the amount of Fions released into distilled water measured, using a fluoride meter, as a function of time. Microleakage studies Dentine cylinders were prepared from bovine teeth. Each was then centrally drilled and restored with either Amalgam (Tytin FC), a GIC (Fuji IX) or an RMGIC (Fuji II LC from GC Corporation) according to manufacturers instructions. Human saliva was used as an inoculum to provide a multi-species biofilm consisting of organisms found in the oral cavity. The biofilms were formed on the dentine cylinders and grown in a Constant Depth Film Fermentor (CDFF) with a continuous supply of artificial saliva. At selected time periods, samples were removed and examined by Scanning Electron Microscopy (SEM). Smear layer The effect of conditioning on smear layer (cutting debris) was also investigated. The drilled cavities were washed with GC dentine conditioner thoroughly before being restored. After submerged in sterile artificial saliva for 10 weeks, the samples were examined as described above.

Fig. 1a IR spectra of Fuji IX as function of time

O R O H loss of H+ R O O delocalisation R O O

0.6

C=O COO

0.4
C-O

0.2

0 1700 2 min 16 min 4 min 30 min 1500 1300 Wavenumber (cm-1) 6 min 7 min 120 min 1440 min 1100 10 min

Abs

Fig. 1b IR spectra of Fuji II LC as function of time

R1 R3 R2 R4 polymeriation R1 R2 n R3 R4

0.6

0.4
C=C C-O

0.2

0.0 1700 1500 wavenumber (cm-1)

148 sec 294 sec 50000 sec

1300

1100

Abs

Fig. 2 Fluorie ion released from Fuji IX and Fuji II LC

F- released (g) per mg of specimen

0.35 0.30 0.25 0.20 0.15 0.10 0.05 0.00 0 2 4 6 8 SQRT Time (hr) 10 12 14 16 Fuji IX

Fuji II LC

Fig. 3a SEM picture of the amalgam sample at 10 weeks

Fig. 3c SEM picture of the RMGIC surface without conditioning on the smear layer prior to restoration

Fig. 3b SEM picture of the GIC sample at 10 weeks

Fig. 3d SEM picture of the RMGIC surface with conditioning on the smear layer prior to restoration

Summary
Fig. 1a During acid / glass reaction, the proton from the acid group is lost and a COO- group formed. Consequently, this reaction causes the peaks marked on the left and on the right to decrease, and gives rise to the peak marked in the centre. The rate of acid / glass reaction can be determined by monitoring any absorbance changes as function of time. Fig. 1b - During polymerisation, the methacrylate C=C and C-O peaks decrease. The levels of change observed are consistent with full polymerisation within 2 min after the start of exposure to a dental light. The changes in spectra at latter time indicates the occurrence of acid / glass reaction (compare Figure 1a and 1b). This process is required to generate fluoride ions. Fig. 2- This graph shows fluoride release from the GIC and RMGIC are comparable. The initial linear relationship with square root of time suggests a diffusion controlled process. Fig. 3a,b The reduced number of bacteria observable on the GICs and RMGICs in comparision with the amalgam specimens are consistent with reduced bacterial microleakage. Much of the roughness on the GIC and RMGIC surfaces may be due to a combination of a smear layer and nanoleakage of artificial saliva. Fig. 3c,d - Without the smear layer, the structure of dentine tubules can be seen clearly, and the imprinted structure of dentine tubules were observed on the cement surface. This result suggests better interactions between the cements and the dentine in the absence of smear layer.

Resin-modified glass-ionomer cements (RMGICs) Consist of

F containing glass polyacrylic acid solution HEMA (hydrophillic monomer)

Main advantages

Setting reactions
polymerisation acid / base reaction

adhere to tooth high fluoride release water sorption induced swelling

Main disadvantages
intermediate strength low wear resistance polymerisation shrinkage monomer toxicity

Water sorption in dental cements

24hr
4

1week
RMGIC (After polymerisation)

Mass increase (%)

3 2 1 0 0 5

GIC (after 1 hour set)

Fuji IX Fuji II LC

10

15

Square root of time / hr