GLASS IONOMER

CEMENTS
 CONTENTS
INTRODUCTION
DEFINITION
HISTORY
CLASSIFICATIONS
COMPOSITION
SETTING REACTION
PROPERTIES
CLINICAL PROCEDURES
INDICATIONS and CONTRAINDICATIONS
RECENT ADVANCES
CONCLUSION
 INTRODUCTION
Since its extensive usage to replace the
dentin ,has given different names
Dentin substitute
Man made dentin
Artificial dentin
Glass ionomer cements are tooth-
colored materials that bond
chemically to dental hard tissues
and release fluoride for a relatively
long period.
They have therefore been
suggested as the materials of
choice for the restoration of carious
primary teeth.
 DEFINITION of cement:
- 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)

GIC:
- Water based material that hardens following an
acid base reaction between basic
fluoroaluminosilicate glass and an aqueous
solution of polyacids. (Anusavice)
 HISTORICAL BACKGROUND
The search for improved materials initiated numerous
developments, such that by the 1920s three main
categories of cements had become established: zinc
phosphate cements, zinc oxide eugenol cements, and
silicate cements.

In 1966, D.C. Smith introduced yet another class of

cement, in which the liquid of the zinc phosphate cement
was replaced by aqueous polyacrylic acid. This so-called
carboxylate cement opened up new prospects for self-
adhesive dental materials.
 On the basis of these developments, Wilson et al.
introduced glass ionomer cementing materials in 1969,
a material class which remains very successful today.

The first glass ionomer cement product, ASPA

(Alumino-Silicate-Poly-Acrylate), introduced in the
1970s, was formulated by adding polyacrylic acid as
the liquid component to finely ground silicate pow
 Invention of glass ionomer cement in 1969 Wilson &

Kent.

Term to glass ionomer cement was coined by B.E

Kent.

1972 Wilson & Crisp found that tartaric acid

improves manipulative properties

1974 Mc. Lean & Wilson proposed clinical use of

GIC.
 CLASSIFICATIONS
Philips
Type I - Luting
Type II - Restorative
Type III - Liner & base

Davidson / Mjor
Conventional / Traditional GIC
Resin Modified GIC
Polyacid Modified Resin Composites
MOUNT:
A) Glass Ionomer Cements
(i) Glass Polyalkeonates
(ii) Glass Polyphosphates
B) Resin modified GIC
C) Polyacid modified composite resin

D)
Auto Cure
Dual Cure
Triple Cure

E)
Type I
Type II
- Type II 1 (AESTHETIC)
- Type II 2 (RESTORATIVE)
Type III
 Sturdvent
1.Conventional or Traditional
2. Metal Modified GIC
- Miracle Mix
- Cermet
3. Light Cured GIC
4. Hybrid (resin modified) GIC
5. Polyacid Modified Resin Composites

Mc Lean and Nicholson

Glass ionomer cements
Poly alkeonates
Poly phosphonates
Resin modified GIC
Poly acid modified GIC
 According to clinical use as:
Type I- Luting
TYPE II- Restorative
Type III- Liner/ Base
Type IV- Pit & Fissure Sealant
Type V- Luting for Orthodontic Purpose
Type VI- Core build up material
Type VII- High fluoride releasing command
set
Type VIII- ART
Type IX- Geriatric & Paediatric GIC
 COMPOSITION
POWDER (Calcium Fluroaluminosilicate)
ALUMINA (28.6%) Alumina: Silica --> 1:2
SILICA (41.9%)
FLUORIDE
CALCIUM FLUORIDE (15.7%)
ALUMINIUM PHOSPHATE (3.8%)
CRYOLITE
Na+, K+, Ca2+
La2O3, SrO
Liquid:
Originally was 40 to 50% aqueous solution of
polyacrylic acid.
Current cements the acid is in the form of
copolymer with
Maleic, Increase the reactivity of liquid
Itaconic, Decrease the viscosity
Tricarboxylic Reduce the tendency for
gelatin

Tartaric acid improves the handling

characteristics & increase working time, but
shortens the setting time.
 FUNCTIONS OF
COMPONENTS :
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
The liquid is an aqueous solution of
polymers and copolymers of acrylic
acid.
A copolymer is a chain consisting of
two
molecules.
polyacrylic acid, is the most
important acid contributing to
formation of the cement matrix .
 Itaconic acid

Itaconic acid promotes reactivity between

the glass and the liquid.

It also prevents gelation of the liquid which

can result from hydrogen bonding between
two polyacrylic acid chains
 Polymaleic acid
a stronger acid than polyacrylic acid

causes the cement to harden and lose

its moisture sensitivity faster.

more carboxyl (COOH) groups which

lead to more rapid polycarboxylate
crosslinking
 Tartaric acid
a reaction controlling additive .

it extends the working time.

promotes a snap set.

Strengthens and hardens the cement.

 Water-
It is reaction medium.
It serves to hydrate the siliceous hydrogel
and the metal salts formed.
It is essential part of the cement structure.
If water is lost from the cement by
desiccation while it is setting, the cement-
forming reactions will stop.
Mixing of the cement

Full spoon, no excess

Tip liquid bottle to side, then

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

Dont 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
Manipulation consideration for
GIC:
To achieve long lasting restoration and retentive fixed
prostheses, the following condition for GIC must be
satisfied:
The surface of prepared tooth must be clean and dry
Consistency of mixed cement must allow complete
coating of surface irregularities and complete sealing of
prostheses.
Excess cement must be removed at appropriate time.
Surface must be finished without excessive drying
Protection of restoration be ensured.
These conditions are similar for luting applications
except that no surface finishing is needed.
 The powder and liquid should not be dispersed on
slab until just before mixing procedure is begun; as
prolonged exposure to office atmosphere alters the
precise acid: water ratio of liquid.
The powder is incorporated into liquid with stiff,
spatula. The mixing time should not exceed 45-60s.
At this time mix should have a glossy appearance
which indicates residual polyacid
Prolonged mixing leads to dull surface and
adhesion will not be achieved.
GIC are also supplied in capsule containing
preproportioned powder and liquid. Mixing is
accomplished in an amalgamator after the seal that
separates the powder and liquid is broken. Capsule
also contains a nozzle for placement.
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 IIGIC --10 min
Film thickness should not exceed 20m for luting
agents
STAGES OF THE SETTING
REACTION OF GLASS
IONOMER CEMENTS
 SETTING REACTION:
The setting reaction of glass
Ionomer cements involves three
overlapping stages.
Stage1: Dissolution
Stage2: Precipitation of salt, gelation
and hardening
Stage3: Hydration of salts.
 Stage1: Dissolution:
At the beginning of the reaction the surface
of the glass particles is attacked by the
polyacid.
This results in the dissolution of the glass
particles releasing calcium and aluminium ions
leading to the formination of the cement sol
 Stage2: Precipitation of Salts, Gelation and Hardening:
During this stage calcium and aluminum ions bind
to polycarboxylate groups. The initial set is achieved
by cross-linking of the more readily available calcium
ions with the carboxyl of the acid.
This is the gelation phase and this reaction is
relatively rapid, usually forming a clinically hard
surface within 4-10 minutes from the start of mixing.
Maturation occurs over the next 24 hours as the less
mobile aluminium ions become bound within the
cement matrix, leading to more rigid cross lining
between the poly (alkenoic acid) chains.
Fluoride and phosphate ions donot particpate in the
crosslinking of the cement the unreacted portions of
the glass particles are sheated by the silica gel which
developes during the removal of the cations friom the
surface of the particles.
 Stage 3: Hydration of Salts:
Associated with the maturation
phase is a progressive hydration of
the matrix salts, leading to sharp
improvement in the physical
properties
 *) Factors affecting the setting mechanism:
Glass Composition: Higher the
alumima/Silica ratio, faster the set and
shorter the W.T.
Powder particle size: The finer the powder,
faster the set and shorter the W.T.
Addition of Tartaric acid sharpens the set
without reduction in W.T.
Temperature of mix: Increase the
temperature, faster the set and shorter the
W.T.
Relative proportion of constituent in the mix:
The greater proportion of glass and lower the
proportion of H2O; faster the set and shorter
the W.T
 INDICATIONS AND CONTRAINDICATIONS:
Indications:
Restorative Materials:
Restoration of erosive/abrasive lesions without cavity
preparation.
Sealing and filling of occlusal pit and fissures
Restoration of primary teeth.
Restoration of Class V carious lesions.
Restoration of Class III carious lesions, preferably using
lingual approach.
Repair of defective margins in restorations
Minimal cavity preparations in approximal lesions
through buccal and occlusal approach (tunnel
preparations)
 Contraindications for Use:

Class IV carious lesions (or) fractured incisors

Lesions involving large areas of labial enamel
where esthetics is of major importance.
Class II carious lesion where conventional
cavities are prepared, for replacement of
existing amalgam restorations.
Lost cusp areas.
 PROPERTIES
Mechanical Properties:
Strength: Glass Ionomer cements lacks sufficient
strength. Improving its strength is clearly desirable and
progress is being made through several approaches.
Mechanical mixing using capsules containing pre
proportioned amounts of the components will
statistically improve the performance of any Glass
Ionomer Cement.
The strength of Glass Ionomer cement is increased as
the filer content is increased and the water content is
reduced.
However increased strength is accompanied by an
acceleration of setting and loss of workability.
Compressive Strength:
Glass Ionomer compressive strength is 150-200
Mpa compressive strength is increased by
increasing alumina content but this is achieved
at the expense of translucency. The finer the
particles the more will be the compressive
strength.
Tensile Strength: Glass ionomers has a higher
tensile strength when compared with silicates
tensile strength 6.5 Mpa 17.4 Mpa.
Hardness:It is less than that of silicates the
value is 48 KHN.
Fracture Toughness: Glass Ionomer cements
are much inferior to composites in this aspect.

 PHYSICAL PROPERTIES:
Biocompatibility:
The biocompatibility of Glass-ionomer
cements with the living tissues is a subject of
importance because the glass Ionomer cements
have to be in direct contact with dentin
because they were designed to adhere to tooth
materials by molecular bonding.
The adhesion to tooth material endures that
they provide an excellent and enduring
marginal seal, thus eliminating secondary
caries.
Sustained release of fluoride confers resistance
to caries on adjacent tooth material.
 Fluoride Release:
The prolonged and substantial release of fluoride
ions from all glass Ionomer cements is of major clinical
significance.
Fluoride ions released from the restorative materials
become incorporated in hydroxyapatite crystals of
adjacent tooth structure to from to structure such as
fluorapatite that is more resistant to acid mediated
decalcification.
The fluoride originates from that used in preparing the
alumino silicate glass, which can contain upto 23%
fluoride.
Thickly mixed cements used for restorations release
more fluoride than thinly mixed ones used for luting
because they contain proportionately more glasses and
hence more fluoride.
DURATION OF FLUORIDE RELEASE:

Large amounts of fluorides are

released during the first few days after
placement after which it gradually
declines during the first week and
stabilizes after 2-3 months and
continues for a long time that is 8
years after placement and certainly
longer.
Fluoride release
 Sandwich techinque
The sandwich technique is developed by mclean to
combine the benifical properties of gic and composite
.presentely is called as bilayered or laminate techinque,
it is done in large class 3 , classs 5 class4.
Clinical steps: After cavity preparation condition the
cavity to develop adhension with glassinomer
Fast setting type 3glassinnomer cement is used to
replace the lost dentin in sufficent bulk,
either autocured or resin modified glassinommer
used.glass inomer is placed subgingivally.
Once it has set ,cut back to expose the enamel margins
and allow enough bulk for composite
Etch enamel ad autocure gic for 15 sec using phosporic
acid , this improes micromechinal bond to composite
resins
 Etching is not done for resin modified gic ,when they
are used etch enamel alone for 15 sec.
Wash and gentle dry
Apply enamel bonding agent ad gic base ad light cure
for 20 sec processed the composite resin buildup
Advantages : flouride nfrom gic minimizes recurrent
caries.
Favourable pulpal responses due to biocompatibility of
gic
Better strength
excellent subgingival responses
Disadvantages: time consuming
Techinque sensitive
 Tunnel preparation
It first described by jiks in 1963 as a
conservative alternative class 2 cavity
preparation in primary molars.
later hunt modifies the technique for
restoring small proximal caries using
glassionomercement in deciduous and
permanent teeth
 Clinical technique :
Following rubber dam Isolation access is gained to the
proximal caries through the occlusal aspect.
Using a no.2 round but in a high speed handplece, the
preparation is started 2mm away from the marginal
ridge on the involved side.
A tunnel is prepared diagonally under the marginal
ridge into the proximal carious dentin.
Removal of the carious dentin can be done using a
no.2 round bur in a slow speed hand piece.
Since access is limited loupes and caries disclosing
dyes are valuable aid s in verifying whether the caries
is completely removed during restoration sectional
matrix band is adapted and wedge is placed cermet
cement is usually used for these cavities
 Tunnel restorations
Indications : patients with high
esthetic demands and low caries
rate who exhbit small proximal
caries without involving marginal
ridges
Contraindications: large proximal
caries involving marginal ridges
Difficulty in access
Marginal ridges subjected to high
occlusal loads
 Tunnel
Advantages: restorations
Conservative
Conservative preparation allos easy retention of
restoration.
Less time consuming than tradition Cl II preparation
Less traumatizing to pulp
Maintenance of intact MR.
Minimal esthetic change to tooth.
Is considered not to alter interarch/Intra-arch
relations.
Disadvantages:
Difficulty in complete caries removal
Collapse of MR or enamel wall may occur
 ART Techinque
Modem restorative dentistry requirres electrically
powered equipment to perform various procedures.
Unfortunately, basic restorative procedures such as
restoring carious lesions are not possible in developing
countries especially in remote areas due to the lack of
infrastructure to provide water, electricity and
equipment.
In such areas, the atraumatic restorative treatment
(ART) technique has proved to be a valuable method to
retain as many teeth as possible under these adverse
circumstances.
The ART technique was first evaluated in Tanzania in
the mid 19805 and since then has become popular in
several parts of the world.
 The ART technique consists of a simplified
approach to caries management. Hand
instruments are used to excavate the soft caries
followed by restoring the cavities with the
acutocure gic.
Indications : occlusal piit and fissure cavities of
small to moderate sizes with adequate tooth
structure to surroujnd the restoration
Physically or mentally handicapped patients
 Clinical procedure
Teeth are isolated with cotton rolls
Undermined enamel is broken away using hand instruments such
as hatchets.
Caries is excavated using spoon excavators.
A highly viscous glass ionomer cement is placed into the cavity
and pressed by means of a gloved finger to fill the adjacent pits
and fissure also
Occlusion is checked and excess material is removed before it
hardens.
The restoration is finally coated with vasaline or petroleum jelly.
Advantages :max preserving tooth structure ,minimal
intervention procedure, lowcost, minimal discomfort,
gic{biocompatiability ,fluoride release}
Disadvantages: hand fatigue during instrumentationlack of
proper access
RECENT ADVANCES
IN
GIC
 HIGH VISCOSITY GIC
Developed as an alternative to amalgam.
Packable / condensable glass ionomer cements
Composition: Powder: Ca,,Al fluorosilicate glass
Liquid: PA,TA,water and benzoic acid
INDICATIONS: Molar restoration of primary teeth
Intermediate restoration
Core build up material
For A R T
ADVANTAGES: Packable or condensable
Improved wear resistance
Easy to use
Low solubility
Rapid finishing possible
Decrease moisture sensitivity
DISADVANTAGES: Limited life
Moderately polishable
Not esthetic
.
 LOW VISCOSITY GIC
1. Also called as Flowable GIC
2. Low P:L ratio thus increase flow.
3. Use for lining, pit and fisure sealer, endodontic
sealer and for sealing hyper sensitive cervical
area.
Eg fuji lining LC, Ketac endo etc.

Fuji lining LC Ketac-Endo

CERMET

Cermet: this is formed by fusing the glass

powder to the fine precious metal powders
like silver or gold through sintering .

MIRACLE MIX:
1 Seed & Wilson (1980) invented miracle mix
2 Spherical silver amalgam alloy+ G I C in
ratio 1:7,and mixing it with GIC liqiuid
Improves strength and abrasion resistance of
the cement
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
Advantages:
Ease for placement
Adhesion to tooth structure and anticariogenic
potential
Crown cutting can be done immediately
Increased wear resistance
Disadvantages:
Esthetically poor
Tooth discoloration
Rough surface
COMMERCIAL PRODUCTS

Miracle mix Ketac Silver

 RESIN MODIFIED GIC
Objective:
To overcome low early strength and moisture sensitivity
1. Defined as hybrid cement that sets partly by acid base
reaction and partly by polymerisation reaction (Mc
Lean)
2. Powder Ion leachable glass and initiators
liquid water, Poly acrylic acid, HEMA (15-25%),
methacrylate monomers.
 Advantages
Long working time due to photo curing
Improved setting characteristics
Decrease sensitivity to water (but not significantly,
Journal of Conservative Dentistry, June 2005)
Increase early strength
Finishing & polishing can be done immediately
Improved tensile strength.
Better adhesion to composite restoration
Increase fluoride release.
Repairable.
 Disadvantage

Biocompatibility is controversial
More setting shrinkage leading increase
microleakage and poor marginal adaptation
 POLYACID MODIFIED COMPOSITE
RESIN
Also called as compomer
Defined as : material that contain both the
essential components of GIC but in an
amount insufficient to carry out acid base
reaction in dark.
They are developed to combine fluoride
release of GIC and durability of composite
 Composition: one paste system containing ion
leach able glass, sodium fluoride, polyacid
modified monomer but no water
Recently 2 paste or powder liquid system is
introduced.
Powder:
Strontium aluminium flurosilicate glass particles, metal
oxides,and intiators

Liquid:
Polymerizable methacrylate/caboxylic acidic monomers
multi functional acrylate monomers and water ;
 Setting reaction
1. Initially light curing forms resin network
around the glass
2. After 2 to 3 month there is water uptake
which initiates slow acid base reaction and
fluoride release.
 Properties
Adhesion Micromechanical, absence of
water thus no self adhesion
Fluoride release minimal.
Physical properties better than conventional
GIC but less than composite.
Optical properties superior to conventional
GIC.
 Indications
Pit and fissure sealant
Restoration of primary teeth
Liners and bases
Core build up material
For class III & V lesions
Cervical erosion / abrasion
Repair of defective margins in restorations
Sealing of root surfaces for over dentures
Reterograde filling material.
 Contraindications

Class IV carious lesions

Large areas of labial surfaces
Class II cavities where conventional cavity
is prepared
Lost cusp areas
Under full crown or PFM crowns.
 Advantages

Ease of use
Easy adaptation to the tooth
Good esthetics
More working time than RM GIC
Commercial Products

Compoglass F Principle

Compoglass Flow
 Fiber-reinforced Glass Ionomer
Cements
Al and Sio2 fibers added to glass powder,polymer
rigid inorganic matrix material (PRIMM)
Diameter of fiber is 2m.
Advantages:
Increased wear resistance.
Improved handling characteristics
Increased depth of cure
Reduction of polymerization shrinkage
Improved flexure strength(50Mpa)
 GIOMERS
True hybridization of GIC and composite
Combine fluoride release and fluoride
recharge of GIC with esthetic easy
polishability and strength of composite
Based on PRG technique.
Two types:
S- PRG :Reaction of entire glass
S-PRG: Reaction with glass surface
 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

 Advantages
Increase wear resistance
Increase Radiopacity (glass filler)
Ideal shade match (improved light diffusion and
fluorescence)
High and sustained fluoride release and recharge
Provide almost complete seal against bacterial
microleakage
Little mechanical and chemical pulp irritation
Inhibit demineralization
Example

BEAUTIFUL (SHOFU)
 CONCLUSION
GICs 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
tomorrows restorative scene or will it go into total
oblivion. Who knows? Only the future will tell. Let us
wish GIC all the best for the coming years.
 References

Skinners Sciences of dental materials --- Ralph

W. Phillips --- 9th Edition
Phillips Sciences of dental materials ---- 11th
Edition
Restoration & Prevention of Tooth Structure ---
Graham J. mount ; W R. Hume
Browning WD. The benefits of glass ionomer
self-adhesive materials in restorative dentistry.
Compend Contin Educ Dent 2006
May;27(5):308-14
operative dentitry----vimal k sikri