Glass ionomer cement

A glass ionomer cement is a dental restorative material used in dentistry as a filling material and luting cement, including for orthodontic bracket attachment. Glass-ionomer cements are based on the reaction of silicate glass-powder (calciumaluminofluorosilicate glass) and polyacrylic acid, an ionomer. Occasionally water is used instead of an acid, altering the properties of the material and its uses. This reaction produces a powdered cement of glass particles surrounded by matrix of fluoride elements and is known chemically as glass polyalkenoate. There are other forms of similar reactions which can take place, for example, when using an aqueous solution of acrylic/itaconic copolymer with tartaric acid, this results in a glass-ionomer in liquid form. An aqueous solution of maleic acid polymer or maleic/acrylic copolymer with tartaric acid can also be used to form a glass-ionomer in liquid form. Tartaric acid plays a significant part in controlling the setting characteristics of the material. Glass-ionomer based hybrids incorporate another dental material, for example resin-modified glass ionomer cements (RMGIC) and compomers (or modified composites). A glass ionomer cement is a dental restorative material used in dentistry as a filling material and luting cement, including for orthodontic bracket attachment. Glass-ionomer cements are based on the reaction of silicate glass-powder (calciumaluminofluorosilicate glass) and polyacrylic acid, an ionomer. Occasionally water is used instead of an acid, altering the properties of the material and its uses. This reaction produces a powdered cement of glass particles surrounded by matrix of fluoride elements and is known chemically as glass polyalkenoate. There are other forms of similar reactions which can take place, for example, when using an aqueous solution of acrylic/itaconic copolymer with tartaric acid, this results in a glass-ionomer in liquid form. An aqueous solution of maleic acid polymer or maleic/acrylic copolymer with tartaric acid can also be used to form a glass-ionomer in liquid form. Tartaric acid plays a significant part in controlling the setting characteristics of the material. Glass-ionomer based hybrids incorporate another dental material, for example resin-modified glass ionomer cements (RMGIC) and compomers (or modified composites). Glass ionomer cement is primarily used in the prevention of dental caries. This dental material has good adhesive bond properties to tooth structure, allowing it to form a tight seal between the internal structures of the tooth and the surrounding environment. Dental caries is caused by bacterial production of acid during their metabolic actions. The acid produced from this metabolism results in the breakdown of tooth enamel and subsequent inner structures of the tooth, if the disease is not intervened by a dental professional, or if the carious lesion does not arrest and/or the enamel re-mineralises by itself. Glass ionomer cements act as sealants when pits and fissures in the tooth occur and release fluoride to prevent further enamel demineralisation and promote remineralisation. Fluoride can also hinder bacterial growth, by inhibiting their metabolism of ingested sugars in the diet. It does this by inhibiting various metabolic enzymes within the bacteria. This leads to a reduction in the acid produced during the bacteria's digestion of food, preventing a further drop in pH and therefore preventing caries. The application of glass ionomer sealants to occlusal surfaces of the posterior teeth, reduce dental caries in comparison to not using sealants at all. There is evidence that when using sealants, only 6% of people develop tooth decay over a 2-year period, in comparison to 40% of people when not using a sealant. However, it is recommended that the use of fluoride varnish alongside glass ionomer sealants should be applied in practice to further reduce the risk of secondary dental caries. However, the addition of resin to glass ionomers, improves properties significantly, allowing it to be more easily mixed and placed. Resin-modified glass ionomers allow equal or higher fluoride release and there is evidence of higher retention, higher strength and lower solubility. Resin-based glass ionomers have two setting reactions: an acid-base setting and a free-radical polymerisation. The free-radical polymerisation is the predominant mode of setting, as it occurs more rapidly than the acid-base setting, which is comparatively slower. Only the material properly activated by light will be optimally cured. The presence of resin protects the cement from water contamination. Due to the shortened working time, it is recommended that placement and shaping of the material occurs as soon as possible after mixing. Dental sealants were first introduced as part of the preventative programme, in the late 1960s, in response to increasing cases of pits and fissures on occlusal surfaces due to caries. This led to glass ionomer cements to be introduced in 1972 by Wilson and Kent as derivative of the silicate cements and the polycarboxylate cements. The glass ionomer cements incorporated the fluoride releasing properties of the silicate cements with the adhesive qualities of polycarboxylate cements. This incorporation allowed the material to be stronger, less soluble and more translucent (and therefore more aesthetic) than its predecessors. Glass ionomer cements were initially intended to be used for the aesthetic restoration of anterior teeth and were recommended for restoring Class III and Class V cavity preparations. There have now been further developments in the material's composition to improve properties. For example, the addition of metal or resin particles into the sealant is favoured due to the longer working time and the material being less sensitive to moisture during setting. When glass ionomer cements were first used, they were mainly used for the restoration of abrasion/erosion lesions and as a luting agent for crown and bridge reconstructions. However, this has now been extended to occlusal restorations in deciduous dentition, restoration of proximal lesions and cavity bases and liners. This is made possible by the ever-increasing new formulations of glass ionomer cements. When the two dental sealants are compared, there has always been a contradiction as to which materials is more effective in caries reduction. Therefore, there are claims against replacing resin-based sealants, the current Gold Standard, with glass ionomer. Glass ionomer sealants are thought to prevent caries through a steady fluoride release over a prolonged period and the fissures are more resistant to demineralization, even after the visible loss of sealant material, however, a systemic review found no difference in caries development when GICs was used as a fissure sealing material compared to the conventional resin based sealants, in addition, it has less retention to the tooth structure than the resin based sealants.