GLASS IONOMER

CEMENT

PRESENTED BY

DR. PRITI ADSUL

FIRST YEAR POST GRADUATE
DEPARTMENT OF PEDODONTICS
 CONTENTS
• INTRODUCTION
• DEFINITION
• HISTORY
• COMPOSITION
• CLASSIFICATION
• SETTING REACTION
• INDICATIONS
• MODIFICATIONS OF GIC
• RECENT ADVANCES IN GIC
• RFERENCES
 INTRODUCTION
• It is water based cement & ADA specification number: 96

• Glass ionomer-term coined by wilson & kent

Glass-alumino silicate glass particles
Ionomer-poly carboxylic acid.
• ISO terminology- poly alkenoate cement.
• Dentin substitute
Man made dentin
Artificial dentin
• Introduced into u.s as ASPA-Alumno silicate polyacrylate
 A cement is a substance that hardens to act
as a base , liner , filling material or
adhesive to bind devices or prosthesis to
the tooth structure or to each other.

- philips’ science of dental

materials (12th ed)
Glass-ionomer is the generic name of a
group of materials that use silicate glass
powder and aqueous solution of
polyacrylicacid”

-Kenneth J Anusavice.
 HISTORY
•Class I restorations, fissure
sealing and preventive dentistry in
1974 by Mc Lean and Wilson
• Improved clinical techniques
between 1976-77 by G.J.Mount
• The invention of glass
& Makinson,1978
ionomer cement was done in
• Tunnel class I and II preparations
1969.first reported by
by Hunt and Knight in 1984
Wilson and Kent in 1971.
 COMPOSITION
•The glass ionomer powder is an acid soluble calcium fluoroalumino
silicate glass- ion leachable glass.

• Composition of two commercial glass ionomers

Compound Composition A(wt%) Composition B(wt%)

SiO2 41.9 35.2

Al2O3 28.6 20.1

AlF3 1.6 2.4

CaF2 15.6 20.1

NaF 9.3 3.6

AlPO4 3.8 12.8

•ROLE OF COMPONENTS IN POWDER
• Alumina :
It forms the skeletal structure of the glass. It also increases the
opacity of the glass.

• Silica :
It forms the skeletal structure of the glass and increases the
transparency of the glass

• Aluminium Fluoride :
It partially replaces silicon in the glass network providing negative
sites, which are vulnerable to acid attack by H+ leading to
decomposition of glass and providing cement potential.
 Fluoride :
 It contributes to therapeutic value by releasing fluoride
over a prolonged period of time.

 It helps to lower the fusion temperature.

 It enhances translucency and improves the working

characteristics.

 It also helps to increase the strength of set cement

 Calcium Fluoride :

 It acts as a flux and provides opacity to the set cement

 Phosphate :

 It lowers the melting temperature and modifies the setting

characteristics of the cement.

 Lanthanum, Strontium, Barium :

 It provides radio - opacity to the cement Aluminum

phosphate :

 It helps to add body to cement and improve the translucency of

the cement
LIQUID
•Polyacrylic acid --- 45 %
•Water --- 50 %
•Modifiers Itaconic acid --- 05 %
maleic acid
tricarballylic acid
viscosity ,inhibits gelation , shelf life.
•Tartaric acid --- Working Time & setting time.
•POLYACRYLIC ACID-IS the most important acid contributing to
formation of the cement matrix.
• WATER-
• It is reaction medium.
•It serves to hydrate the siliceous hydrogel and the metal salts formed.
•Plays a role in transporting calcium and aluminium ions to react
with poly acids.

If water is lost from the cement by desiccation while it is setting,

the cement-forming reactions will stop.
• ITACONIC ACID
• promotes reactivity
• It also prevents gelation of the liquid

MALEIC ACID
• Causes the cement to harden and lose its moisture sensitivity
faster.
•TARTARIC ACID
•turn controls the rate of dissolution of the glass.
•facilitates extraction of ions from the glass
 CLASSIFICATION
A.ACCORDING TO A.D. WILSON AND J.W.McLEAN IN 1988

Type I --- luting cements

Type --- restorative
II cements
a.Restorative aesthetic
b.Restorative reinforced

B. ACCORDING TO SKINNERS
Type I – Luting
Type II- Restorative
Type III- Liner and base
 C. ACC.TO CHARACTERISTICS SPECIFIED BY
MANUFACTURER
• Type I --- Luting cement eg. Fuji I, KETAC

• Type II --- Restorative material eg. Ketacfil, Fuji II, fuji

IX
• Type III --- a. Bases & liners -- weak with less acidic
b. Bases & liners -- stronger but more acidic
• Type IV --- c. Bases & liners -- strong even in thin layer
Admixture --- eg. Ketac silver, miracle mix
D. ACCORDING TO J.W.McLEAN et al IN
1994
 - Glass ionomer cement (traditional)

 -Resin modified glass ionomer cement

 -Poly acid modified composite resins

 E. ACCORDING TO CLINICAL APPLICATIONS

• Type I – Luting
• Type II – Restorative
• Type III – Liner/base
• Type IV – Pit & fissure sealant
• Type V – Luting for orthodontic purpose
• Type VI – Core buildup material
• Type VII – High fluoride releasing command set
• Type VIII – Atraumatic restorative treatment
• Type IX − Pediatric Glass Ionomer cements
 F. NEWER CLASSIFICATION
• Traditional glass ionomer
a. Type I --- Luting cement
b. Type II --- Restorative cements
c. Type III --- Liners&Bases
• Metal modified Glass Ionomer
a. Miracle mix
b. Cermet cement
• Light cure Glass Ionomer
HEMA added to liquid
• Hybrid Glass Ionomer/resin modified Glass Ionomer a.Composite
resin in which fillers substituted with glass ionomer particles
b.Precured glasses blended into composites
 Properties of Glass Ionomer cement
luting cement
PROPERTY VALUES
1.Setting time(min) 7.0

2.Film thickness(µm) 24

3.24 hr compressive strength(Mpa) 86

4.24 hr diametrical tensile 6.2

strength(Mpa)
5.Elastic modulus(Gpa) 7.3

6.Solubility in water(Wt%) 1.25

7.Pulp response Mild to moderate

 Solubility & Disintegration:-

▪ Initial solubility is high due to leaching of intermediate

products.

▪ The complete setting reaction takes place in 24 hrs, cement

should be protected from saliva during this period.

Adhesion-
• Glass ionomer cement bonds chemically to the tooth structure.

• Bonding with enamel is higher than that of dentin ,due to greater

inorganic content.
 Esthetics :-
• GIC is tooth coloured material & available in different
shades.
• Inferior to composites.
• They lack translucency & rough surface texture.
Potential for discolouration & staining.
 Biocompatibility

 Pulpal response to glass ionomer cement is favorable. Pulpal

response is mild due to

 High buffering capacity of hydroxy apatite.

 Large molecular weight of the polyacrylic

 acid ,which prevents entry into dentinal tubules.

 FLUORIDE RECHARGE

•Glass ionomers may have synergistic effects when used with

extrinsic fluorides
• topical APF (acidulated phosphate fluoride), with fluoride rinses
and fluoridated dentifrices recharging takes place
 Durability
Affected by the factors
• Inadequate preparation of the cement
• Inadequate protection of restoration
• Variable conditions of mouth

Failure rate is more a measure of clinician’s skill than inherent

quality of the material

One of the longest observation periods for the conventional glass

ionomers in non-carious cervical lesions showed retention in the
order of 90% after 10 yrs for KetacFil
 INDICATIONS
• 1. Restorative materials:
• Restoring of erosion/ abrasion lesions without cavity preparation.
• Sealing and filling of occlusal pits and fissures
• Restoration of deciduous teeth.
• Restoration of class III lesions, preferably using a lingual
approach with labial plate intact.
• Repair of defective margins in restorations
• Minimal cavity preparations – Approximal lesions, Buccal and
Occlusal approach (tunnel preparation)
• Core build-up
 CONTRAINDICATION
• Class IV carious lesions or fractured incisors.
• Lesions involving large areas of labial enamel where esthetics is of

major importance

• class II carious lesions where conventional cavities are prepared.

• replacement of existing amalgam restorations.

• Lost cusp areas.
 CEMENT PLACEMENT
Conditioning the Tooth Surface

•Dentin conditioning prior to placement of a GIC is done primarily

to remove the smear layer.

• GIC is better able to wet the dentin surface.

• Promotes ion exchange.
Poly acrylic acid,
• Chemically cleans dentin. 25% aq for 30
• Increases surface energy. seconds
MIXING OF THE
CEMENT
Full spoon, no excess

P:L -

Tip liquid bottle to side, then

invert completely
If water / tartaric acid, only 1
drop used.
Liquid should not stay on paper pad
longer than 1minute (some of it may soak
into it)

Don’t mix beyond 30 seconds

The objective is – only wet the particle –
no dissolving it.

First half folded into liquid in 10-

15seconds

Second half incorporated in 15

seconds Small mixing area
 WORKING TIME & SETTING
TIME
•It sets rapidly in the mouth that is within 3-5 min and hardens to
form a body having translucency that matches enamel

• Setting time for type I –GIC –5 -7 min

• Setting time for type II–GIC --10 min
• Film thickness should not exceed 20µm for luting agents
MIXING CAPSULES
• To activate capsule apply
pressure 3-4 seconds before
placing in machine

• Ultrahigh speed machine :

4000 cycles/minute
 FINISHING TECHNIQUE
• cement allowed to set under matrix
•Carving the cement external to the cavity margins with sharp knives
or scalers
•Finest abrasive should be used to minimize tearing
•Finishing with rotary instruments should be done at subsequent
visit
 SETTING REACTION
•1. acid-base reaction
•2. light activated polymerisation
• ACID – BASE REACTION
•GIC formed by the reaction of three materials
Fluoro alumino silicate glass powder
Poly acrylic acid
Water
• An acid – base reaction occurs between the glass powder and
the ionic polymer.
•Water is essential because that is the medium through which ion
transfer takes place
Acid attack

Dissolution

Cross linking

Maturation
 Decomposition of glass & migration of ions

•The glass particles are attacked at the surface by poly acid which leads
to withdrawal of the cations thus the glass network breaks down to silicic
acid.

•Principally Al3+, Ca2+, F-, are released and migrate into aqueous
phase of cement and form complexes
•Increase in strength and rigidity are associated with slow increase
in cross linking.
• Initially calcium complexes predominate but later Aluminium
complexes are more.

Gelation and vulnerability to water

• At critical pH and ionic conc. Precipitation of insoluble poly acrylates

takes place.
•Initial set occurs due to calcium polyacrylate but hardening of cement is
due to slow formation of aluminium polyacrylate
• When cement is not fully hardened Al, Ca, F and polyacrylate ions
may leach out leading to irretrievable loss of cement matrix

• Calcium acrylate is more vulnerable to water. So the freshly set

cements are to be protected.

Hardening and slow maturation

• This process continues for about 24 hrs
• Undergoes slight expansion and increase in translucency
• Cement becomes resistant to dessication and strength also
increases for at least a year
 PIT & FISSURE SEALANT
• The size of the fissure should allow sharp explorer tip to enter the
crevice which should be > 100 µ wide. Otherwise, GIC can get lost
through erosion due to its low wear resistance and solubility

Core buildup

• Glass ionomer cements reinforce the

teeth &prevent root fracture when
root canals are over widened.
 SANDWICH TECHNIQUE
• Devolped by clean,
• To combine the beneficial properties of GIC & composite.
Clinical steps:-
•After cavity preparation,
condition the cavity to develop
good adhesion with GIC.
•Place Type III GIC into prepared
cavity.
•After setting, etch the enamel &
GIC with orthophosphoric acid for
15 seconds.
•This will improve •Apply a thin layer of low
micromechanical bond viscosity dentin bonding agent &
to composite resin. finally place the composite resin
over GIC & light cure it.
 GIC IN ENDODONTICS
They are used for:
• Sealing root canals orthogradely , retrogradely

• Restoring pulp chamber

• Perforation repair

• Sometimes for repairing vertical fracture

 Recent advances in
Glass ionomer cement
 METAL MODIFIED GIC

The main shortcoming of GIC that limits its use in stress

bearing areas is its lack of fracture toughness. To improve
upon it metal reinforced GICs were developed.

They are mainly of two types:

1. MIRACLE MIXTURE 2. CERMET MIXTURE
 Miracle Mixture
•Seed & Wilson (1980) invented Miracle Mixture: Spherical silver
amalgam alloy+Type II G I C in ratio 7:1

• Miracle mixture was far inferior to those of amalgam, so it was

not well received as restorative material.

• Main problem was that the matrix would not adhere to

strongly to the silver- tin alloy particles
 Cermet Mixture

CERMET MIXTURE: Ceramic-Metal Mixture

• Mc lean & Gasser (1985) invented Cermet Mixture.

• The silver-tin alloy particles were substituted by Silver-

palladium(Ag-Pd), which generate passivation of oxide film of

palladium oxide that is chemically reactive by chelation with

polyacrylic acid.

• Used mostly as cores

 COMMERCIAL PRODUCTS

Miracle mix Ketac silver

Indications:
 Class I cavities in primary teeth

 Core build up material

 Lining of class II amalgam restorations

 Root caps for teeth under over dentures As a preventive

restoration

Contraindications:
 Anterior restoration

 In areas of high occlusal loading

RESIN MODIFIED GLASS IONOMER
CEMENTS
 RESIN MODIFIED GLASS IONOMER
CEMENTS
• developed by Antonucci, Mc Kinney and SB Mitra.

Objective: To overcome low early strength and moisture sensitivity

hybrid cement that sets partly by acid base reaction and partly
by polymerisation reaction
2. Powder – Ion leachable glass and initiators
liquid – water, Poly acrylic acid, HEMA (15-25%),
methacrylate monomers.

Eg:Fuji II LC, Vitrebond, Photac –Fil, Vitremer, FujiV.

 INDICATIONS
• Luting cement esp. in orthodontics

• Liner and base

• Pit and fissure sealant

• Core build up material

• For amalgam repair

 Advantage Disadvantage

• Long Working time and Snap  Biocompatibility is

setting controversial

• Early water sensitivity is reduced  More setting shrinkage

• Rapid development of early leading increase
strength microleakage and poor
• No etching is needed either to tooth marginal adaptation
for adhesion or forthe material if
composite lamination is to be done.
• Bonding to composite is higher
• Finishing can be done immediately
• F release
• Diametrical tensile strength is
 Two-bottle powder liquid system.

Photac Fil Quick Aplicap GC Fuji Plus Capsule Ketac Nano; a paste-paste
system using static mixing.
 POLYACID MODIFIED RESIN
COMPOSITE/
COMPOMER
FLUORIDE
RELEASING DURABILITY
CAPABILITY OF
OF GIC COMPOSITES

COMPOMER
• Clinical use and performance it is best considered as a
composite
 INDICATIONS

• Pit & Fissure sealant

• Restoration of primary teeth, with cervical abrasions and
erosions and intermediate restorations
• Bases for composites, liners
• Filling of pot holes & undercuts in old crown
preparations
 The low viscosity/flowable GIC
• For lining, pit and fissure sealing

• endodontic sealers

• for sealing of hypersensitive cervical areas

• These had a low P:L ratio and possessed increase flow.

eg: Fuji lining LC, Fuji III and IV, Ketac – Endo.
2.Low pH “Smart” Material

• Developed to enable release fluoride when the oral pH is low.

• Aptly called “Smart” materials, the F release is episodic and

not continuous which helps to prolong the therapeutic
usefulness of the material
 THE BIOACTIVE GLASS
• This idea was developed by Hench in 1973.
• It takes into account the fact that on acid dissolution of
glass, there is formation of a layer rich in Ca and PO4
around the glass
•such a glass can form intimate bioactive bonds with the
bone cells and get fully integrated with the bone.

Srikumar GPV, Naiza Elsa, Mookambika R, Aanchal Agrawal 2016. Newer advances in
glass ionomer cement: a review IOSR-JDMS 15(11);124-126
 FIBER REINFORCED GIC

 Incorporation of alumina fibres into the glass powder

 to improve upon its flexural strength

 This technology called the Polymeric Rigid Inorganic Matrix

Material or PRIMM developed by Dr. Lars

 It involves incorporation of a continuous network / scaffold of

alumina and SiO2 ceramic fibres
 GIOMER
 Developed by Shofu

 It is hybridization of GIC and composite by using a unique

technology called the pre-reacted glass ionomer technology.

 can be 2 types:

 F- PRG = reaction of Full glass

 S- PRG = Surface of glass

 Eg: Beautiful, Reactmer

 INDICATIONS

 Class I, II, III, IV, and Class V cavities

 Restoration of cervical erosion and Root caries

 Laminates and core build up

 Restoration of primary teeth.

 Repair of fracture of porcelain and composites

 AMALGOMERS
 glass ionomer based but with the strength of amalgam.

 They also provide F- release

 natural adhesion to tooth structure

 good compatibility and prevent shrinkage

 exceptional wear characteristics, along with other advantages of

GIC

Srikumar GPV, Naiza Elsa, Mookambika R, Aanchal Agrawal 2016. Newer advances in
glass ionomer cement: a review IOSR-JDMS 15(11);124-126
 HAINOMERS
 These are newer bioactive materials developed by
incorporating hydroxyapatite within glass ionomer powder.

 These are mainly being used as bone cements in oral

maxillofacial surgery and may a future role as retrograde
filling material.
 CHLORHEXIDINE
IMPREGNATED GIC

 To increase the anticariogenic action of GIC

 Still under experimental stage.
 Experiments conducted on cariogenic organisms

Srikumar GPV, Naiza Elsa, Mookambika R, Aanchal Agrawal 2016. Newer advances in
glass ionomer cement: a review IOSR-JDMS 15(11);124-126
 CPP – ACP CONTAINING
GIC
 Incorporation of 1.56% w/w 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.

Mazzaoui, S. A., Burrow, M. F., Tyas, M. J., Dashper, S. G., Eakins, D., &
Reynolds, E. C. (2003). Incorporation of Casein Phosphopeptide-Amorphous
Calcium Phosphate into a Glass-ionomer Cement. Journal of Dental Research,
82(11), 914–918.
 ZIRCONIA CONTAINING GIC

 The diametral tensile strength of zirconia containing GIC

significantly Greater than that of Miracle mix due to better
interfacial bonding Between the particles and matrix.

Gu, Y. W., Yap, A. U. J., Cheang, P., & Khor, K. A. (2005). Zirconia–glass ionomer
cement––a potential substitute for Miracle Mix. Scripta Materialia, 52(2), 113–116.
 CONCLUSION

 GIC’s have come a long ways since its modest beginning in 1969.
Even though research can boast of substantial improvements,
certain essential properties still seem to be wanting and further
clinical trials are warranted for a majority of these developments.
At this point of time, we are left wondering if GIC will ever be
able to dominate tomorrow’s restorative scene or will it go into
total oblivion
 REFERENCES
 Glass ionomer cement by Alan D.Wilson and John W. Mclean

 Philips science of dental materials, 11th ed & 12th 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)

 Srikumar GPV, Naiza Elsa, Mookambika R, Aanchal Agrawal 2016. Newer

advances in glass ionomer cement: a review IOSR-JDMS 15(11);124-126

 Gu, Y. W., Yap, A. U. J., Cheang, P., & Khor, K. A. (2005). Zirconia–glass
ionomer cement––a potential substitute for Miracle Mix. Scripta Materialia,
52(2), 113–116.