European Archives of Paediatric Dentistry

, Volume 12, Issue 3, pp 170–175 | Cite as

Evaluation of a resin modified glass ionomer serving both as indirect pulp therapy and as restorative material for primary molars

  • N. KotsanosEmail author
  • S. Arizos


AIM: The successful performance of resin modified glass ionomer cement (RMGIC) as an indirect pulp therapy (IPT) dressing material and, independently, as a class II restoration material for primary molars has been adequately documented. This study investigates if an RMGIC can be successfully used in a dual capacity. METHODS: A total of 61, 3.5–8.5 year old children with deep proximal carious lesions in one or more primary molars, radiographically suspected of pulp exposure, were included. Exclusion criteria were: continuous unprovoked pain and an exposed or a non-vital pulp. Following adequate caries removal, RMGIC restorations were placed. The teeth were followed-up for signs/symptoms and for restoration survival according to modified United States Public Health Service (USPHS) criteria. Descriptive statistics were applied. RESULTS: The prospective study was completed with 86 restorations in 41 first and 45 second primary molars. Three of the 86 teeth showed pulp necrosis and the remaining 83 (96.5%) were a) asymptomatic for a mean clinical observation time of 31.9 months (SD 10.8) and b) with no radiographic signs of pathology for 25.7 months (SD 10.3). Seventy-six of these 83 (91.6%) class II-‘extended’ restorations were acceptable, exhibiting varying levels of occlusal wear. CONCLUSIONS: A single application of RMGIC was used successfully for over 2 1/2 years as an IPT and restoration material in proximal caries of primary molars.

Key Words

Resin modified glass ionomer indirect pulp therapy restoration survival primary molar 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. AAPD. Guideline on pulp therapy for primary and immature permanent teeth. Reference manual 2010–11, Pediatr Dent 2010;32:194–201.Google Scholar
  2. Al-Zayer MA, Straffon LH, Feigal RJ et al. Indirect pulp treatment of primary posterior teeth: a retrospective study. Pediatr Dent. 2003;25:29–36.PubMedGoogle Scholar
  3. Andersson-Wenckert IE, van Dijken JW, Kieri C. Durability of extensive Class II open-sandwich restorations with a resin-modified glass ionomer cement after 6 years. Am J Dent. 2004;17:43–50.PubMedGoogle Scholar
  4. Atieh M. Stainless steel crown versus modified open-sandwich restorations for primary molars: a 2-year randomized clinical trial. Int J Paediatr Dent. 2008;18:325–32.PubMedCrossRefGoogle Scholar
  5. Bjørndal L, Reit C, Bruun G, et al. Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. Eur J Oral Sci 2010;118:290–297.PubMedCrossRefGoogle Scholar
  6. Casagrande L, Bento LW, Dalpian DM et al. Indirect pulp treatment in primary teeth: 4-year results. Am J Dent. 2010;23:34–38.PubMedGoogle Scholar
  7. Chadwick BL, Evans DJ. Restoration of class II cavities in primary molar teeth with conventional and resin modified glass ionomer cements: a systematic review of the literature. Eur Arch Paediatr Dent. 2007;8:14–21.PubMedCrossRefGoogle Scholar
  8. Coll JA. Indirect pulp capping and primary teeth: is the primary tooth pulpotomy out of date? Pediatr Dent. 2008;30:230–236.PubMedGoogle Scholar
  9. Duggal MS, Nooh A, High A. Response of the primary pulp to inflammation: a review of the Leeds studies and challenges for the future. Eur J Paediatr Dent2002;3:111–114.PubMedGoogle Scholar
  10. Dunston B, Coll JA. A survey of primary tooth pulp therapy as taught in US dental schools and practiced by diplomates of the American Board Of Pediatric Dentistry. Pediatr Dent. 2008;30:42–48.PubMedGoogle Scholar
  11. Farooq NS, Coll JA, Kuwabara A et al. Success rates of formocresol pulpotomy and indirect pulp therapy in the treatment of deep dentinal caries in primary teeth. Pediatr Dent. 2000;22:278–286.PubMedGoogle Scholar
  12. Hübel S, Mejàre I. Conventional versus resin-modified glass-ionomer cement for Class II restorations in primary molars. A 3-year clinical study. Int J Paediatr Dent.2003;13:2–8.PubMedCrossRefGoogle Scholar
  13. Innes NP, Ricketts DN, Evans DJ. Preformed metal crowns for decayed primary molar teeth. Cochrane Database Syst Rev. 2007;24(1):CD005512.Google Scholar
  14. Kassa D, Day P, High A et al. Histological comparison of pulpal inflammation in primary teeth with occlusal or proximal caries. Int J Paediatr Dent. 2009;19:26–33.PubMedCrossRefGoogle Scholar
  15. Kotsanos N. An intraoral study of caries induced on enamel in contact with fluoride-releasing restorative materials. Caries Res. 2001;35:200–204.PubMedCrossRefGoogle Scholar
  16. Leksell E, Ridell K, Cvek M et al. Pulp exposure after stepwise versus direct complete excavation of deep carious lesions in young posterior permanent teeth. Endod Dent Traumatol 1996;12:192–196.PubMedCrossRefGoogle Scholar
  17. Lula EC, Monteiro-Neto V, Alves CM et al. Microbiological analysis after complete or partial removal of carious dentin in primary teeth: a randomized clinical trial. Caries Res. 2009;43:354–358.PubMedCrossRefGoogle Scholar
  18. Marchi JJ, de Araujo FB, Fröner AM et al. Indirect pulp capping in the primary dentition: a 4 year follow-up study. J Clin Pediatr Dent. 2006;31:68–71.PubMedGoogle Scholar
  19. Monteiro J, Day P, Duggal M et al. Pulpal status of human primary teeth with physiological root resorption. Int J Paediatr Dent. 2009;19:16–25.PubMedCrossRefGoogle Scholar
  20. Murray PE, Hafez AA, Smith AJ et al. Bacterial microleakage and pulp inflammation associated with various restorative materials. Dent Mater. 2002;18:470–478.PubMedCrossRefGoogle Scholar
  21. Ng FK, Messer LB. Mineral trioxide aggregate as a pulpotomy medicament: an evidence-based assessment. Eur Arch Paediatr Dent. 2008;9:58–73.PubMedGoogle Scholar
  22. Ní Chaollaí A, Monteiro J, Duggal MS. The Teaching of Management of the Pulp in Primary Molars in Europe: A preliminary investigation in Ireland and the UK. European Archives of Paediatric Dentistry 2009;10:98–103.PubMedGoogle Scholar
  23. Orhan AI, Oz FT, Orhan K. Pulp exposure occurrence and outcomes after 1- or 2-visit indirect pulp therapy vs complete caries removal in primary and permanent molars. Pediatr Dent. 2010;32:347–355.PubMedGoogle Scholar
  24. Qvist V, Poulsen A, Teglers PT et al. The longevity of different restorations in primary teeth. Int J Paediatr Dent. 2010;20:1–7.PubMedCrossRefGoogle Scholar
  25. Rodd HD, Waterhouse PJ, Fuks AB et al. UK National Clinical Guidelines in Paediatric Dentistry: Pulp therapy for primary molars. Int J Paediatr Dent. 2006;16(Suppl1):15–23.PubMedCrossRefGoogle Scholar
  26. Sidhu SK. Clinical evaluations of resin-modified glass-ionomer restorations. Dent Mater. 2010;26:7–12PubMedCrossRefGoogle Scholar
  27. van Dijken JW, Kieri C, Carlén M. Longevity of extensive class II open-sandwich restorations with a resin-modified glass-ionomer cement. J Dent Res. 1999;78:1319–1325.PubMedCrossRefGoogle Scholar
  28. Vij R, Coll JA, Shelton P, Farooq NS. Caries control and other variables associated with success of primary molar vital pulp therapy. Pediatr Dent. 2004;26:214–220.PubMedGoogle Scholar
  29. Walker MP, Diliberto A, Lee C. Effect of setting conditions on mineral trioxide aggregate flexural strength. J Endod. 2006;32:334–336.PubMedCrossRefGoogle Scholar
  30. Zealand CM, Briskie DM, Botero TM et al. Comparing gray mineral trioxide aggregate and diluted formocresol in pulpotomized human primary molars. Pediatr Dent. 2010;32:393–399.PubMedGoogle Scholar

Copyright information

© European Archives of Paediatric Dentistry 2011

Authors and Affiliations

  1. 1.Department of Paediatric Dentistry, Faculty of DentistryAristotle University of ThessalonikiThessalonikiGreece

Personalised recommendations