Fluoride-Releasing Materials

Lecture Outline What is glass ionomer? Classification of glass ionomer. Advantages & disadvantages of using glass ionomer. Development & use of glass ionomer. The fluoride releasing material continuum. Acid Base Reaction Liquid acid attacks glass. Glass decomposition, metal ion release (Calcium, Aluminum, Fluoride). Migration of metal ions into liquid. Gelation of matrix by metal ions. Post-set hardening by continued binding of metal ions. Slow maturation (cross-linking, hydration, silica matrix). Role of Water Transport media for fluoride. Stabilizes the set matrix (25 - 50% water). Solvation of ionomers/polymers and metal ions. Glass Inomer Cement loses and gains water easily: Early moisture contamination leads to increased solubility and poor esthetics, (protect for first 7 minutes). Later desiccation causes shrinkage and crazing, (maybe even months later). How fluoride works: Inhibits demineralization. Enhances remineralization. Improves enamel crystal structure (fluorapatite). More readily taken up in demineralized enamel. Inhibits the process by which cariogenic bacteria metabolize carbohydrates (inhibits acid production).

 Interferes with ionic bonding during pellicle and plaque formation on tooth surface. halo effect around restoration ~ 3 mm. Level around restoration ~ 10 ppm. Level in saliva of average patient ~ 0.08 ppm. Fluorine release from GIC does not lead to restoration breakdown. Fluoride Release Rates Show burst for 1 to 2 days followed by a rapid decline to steady-state.

ADA Classification Type I: luting agents (Ketac-Cem, Fuji I) Type II: restorative material a = tooth-colored (Ketac-Fil, Fuji IX) b = reinforced (Ketac-Silver, Miracle Mix) Type III: fast-set liners and bases (Ketac-Bond) Usage Classification Restorative material Traditional (Fuji II, Ketac-Fil) Highly viscous (Fuji IX, Ketac-Molar) Metal reinforced (Miracle Mix, Ketac-Silver) Base/liner GC lining cement, Ketac-Bond Root surface sealing Cervical Cement Root canal sealing Ketac-Endo Strengths: Ionic exchange leads to adhesion to tooth structure (chemical bond). Fluoride release and rechargeable. GIC Physical Properties Weaknesses Moisture sensitivity. Lack of command cure, i.e. doesnt cure with light. Esthetics. Not recommended for stress-bearing areas.

 Difficult handling. Indications High caries risk patient Atrumatic Restorative Treatment (ART) Pediatric dentistry Class V lesions Liners & bases & sandwich technique Luting agents Core buildups ??? Maybe if > 2/3 of tooth structure remains Orthopedics (bone substitute material) Adding Resin to GIC (Resin modified GIC) Advantages: - Improves strength and toughness - Decreases moisture sensitivity - Command cure - Handling - Esthetics Disadvantages: - Increases overall dimensional changes - May reduce inherent adhesive properties (chemical bonding) - Reduces biocompatibility RMGI - Classifications Luting Fuji Plus, FujiCEM Filling Fuji II LC, Vitremer Base/liner Fuji Lining LC ,Vitrebond Fissure protection Fuji III LC

 Bonding Agent Fuji Bond LC Orthodontic bracket bonding, Fuji Ortho LC Indications of RMGIC High caries risk patients Pediatric dentistry Class V lesions Liners, bases & sandwich technique Luting agents Class I and II ??? If very small and very low stress Core buildups ??? If 2/3 of tooth structure remains Advantages over GIC: Longer working time Shorter setting time Stronger Less cracking More esthetic Less water sensitivity Disadvantages to GIC: Curing light required Thicker placements require layering, multiple exposures Less inherent adhesion Resin content GIC & RMGI Clinical Indications GIC Fuji VII (Triage) Caries remains Transitional sealant GIC Fuji IX Transitional restorations RMGI Fuji II LC Root caries

Crown repair Open sandwich technique RMGI Vitrebond Dentin liner RMGI Fuji Cem Luting agent GIC & RMGI Clinical Guidelines 1. Butt joint margins where possible, 1 mm thickness at all margins. Mechanical retention in preparation advised (no bevels). 2. Follow the directions of the manufacturer, use encapsulated when possible. 3. Use good field control. 4. Dentin conditioning (10 % polyacrylic acid for 10-20 seconds). 5. Do not desiccate dentin before application, leave moist surface. 6. Inject into preparation. Overfill the preparation. 7. Work efficiently, dont over manipulate. 8. Apply RMGIs incrementally when necessary. light cure (20 sec.) each 2 mm deep increment. 9. Avoid early finishing when possible. 10. Gentle contouring and finishing. 11. Avoid early contact with moisture. 12. Use surface protection when feasible. COMPOMERS (Polyacid-Modified Composite Resin) An inferior composite? Do not set without light. Water: none included, little absorbed. no acid-base reaction little fluoride released In Vitro behavior better than RMGI but worse than composite. Clinical Indications???

Factors Relative to Clinical Selection and Handling of GIC, RMGI and Compomers Caries risk of patient. Field control and effect of moisture on restorative material. Esthetic demands. Anticipated functional stresses. Placement and handling.

References Chapter 13 Fundamentals of Operative Dentistry