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FluorideFluoride-Releasing Materials I

Glass Inomer & Resin Modified Glass Inomer

Dr.Ghada Maghaireh BDS, MS, ABOD

Lecture Outline
  

What is glass inomer? Classification of glass inomer. Advantages & disadvantages of using glass inomer. Development & use of glass inomer. The fluoride releasing material continuum.

 

Dental Cements
Powder Zinc Oxide
Zinc Phosphate cement

Aluminosilicate Glass
Silicate cement

Phosphoric Liquid acid Polyacrylic acid

Polycarboxylate cement

Glass Inomer cement

Glass inomer cement (GIC) - Composition

Ionomer
    

Glass
Basic ion-leachable calcium fluoroionfluoroaluminoalumino-silicate glass powder

Acrylic acid Maleic acid Itaconic acid Butene dicarboxylic acid Vinyl phosphonic acid

Glass inomer cement Setting Reaction


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. PostPost-set hardening by continued binding of metal ions. Slow maturation (cross-linking, hydration, silica matrix). (cross-

   

Simplified Diagram of Setting Reaction


Polyacrylic Acid

H+
Silica gel core

Anions

Aluminosilicate glass

Ca2+,Al3+,Na+, F-

Matrix (Polycarboxylate salts)

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, crazing, (maybe even months later).

Fluoride
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.

GIC - Fluoride Release

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. steady-

Recharging.

Classification
ADA Classification
 

Type I: luting agents

(Ketac-Cem, Fuji I) (Ketac-

Type II: restorative material


a b

= tooth-colored (Ketac-Fil, Fuji IX) tooth(Ketac= reinforced (Ketac-Silver, Miracle Mix) (Ketacliners and bases (Ketac-Bond) (Ketac-

Type III:
 fast-set fast-

Classification
Usage Classification  Restorative material
   

Traditional (Fuji II, Ketac-Fil) KetacHighly viscous (Fuji IX, Ketac-Molar) IX, KetacMetal reinforced (Miracle Mix, Ketac-Silver) Ketac-

Base/liner GC lining cement, Ketac-Bond KetacRoot surface sealing Cervical Cement Root canal sealing KetacKetac-Endo

GIC Physical Properties

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. stressDifficult handling.

GIC 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)

Steps of Clinical Use of Glass Inomer 1. Mechanical retention in preparation advised (no bevels).

Steps of Clinical Use of Glass Inomer 2. Dentin conditioning (10 % polyacrylic acid for 1010-20 seconds). 3. Inject into preparation. Overfill the preparation.

Steps of Clinical Use of Glass Inomer


4. Trim excess with finishing bur (wet, with very light pressure as the cement material cuts easily!) and polish (if necessary). Be cautious not to over-reduce, the material is softer than overcomposite resin. 5. Dry the surface and paint on a thin layer of lightlightcured unfilled resin (smoothes the surface and prevents desiccation but lowers fluoride release. (optional)

References


Chapter 13 Fundamentals of Operative Dentistry.

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