The Benefits and Limitations of Glass-Ionomer Cements and Their Use in Contemporary Dentistry

  • Geoffrey M. KnightEmail author


Since the advent of glass-ionomer cement as a dental restorative material, the number of clinical applications has steadily increased as both the efficiency and improved clinical outcomes for patients have been realized.

Glass-ionomer cements provide tooth-coloured restorations with a low technique sensitivity. They bond chemically to sound and caries-affected tooth structure and release levels of fluoride that protect cavosurface margins from recurrent caries attack. In a clinical environment, a more predictable bond is achieved by pretreating teeth with 37 % phosphoric acid than 20 % polyacrylic acid.

The ion exchange layer between glass-ionomer cement and dentine facilitates the remineralization of caries-affected dentine into fluorapatite that provides a caries-resistant base beneath a glass-ionomer cement restoration or lining.

Auto-cure glass-ionomer cements can be used to restore carious lesions in a tooth where the cusps are not undermined and the restoration does not involve a high-wear area such as a centric stop. Resin-modified glass-ionomer cements should be limited as restorative materials to sites that are not subject to occlusal forces, and photo-curing is able to penetrate to the base of the restoration to minimize any residual unpolymerized HEMA.

Photo-cured resin-modified glass-ionomer cements are well suited as lining materials, luting agents and dental adhesives. As dental adhesives, resin-modified glass-ionomer cements eliminate the effects of polymerization shrinkage stress of composite resins and provide a caries-resistant zone around the perimeter of the restoration.

When composite resins and auto-cure glass-ionomer cements are combined to form a “sandwich restoration”, the use of a resin-modified glass-ionomer cement adhesive as a “co-cure” intermediary between the two materials provides a time-efficient technique that effectively triples the bond strength between glass-ionomer cement and composite resin.


Co-curing Remineralization Caries resistant Occlusal restorations Dental adhesive Polymerization shrinkage stress 


  1. Brown LR, Handler SF, Horton IM, Streckfuss JL, Dreizen S. Effect of sodium fluoride on the viability and growth of Streptococcus mutans. J Dent Res. 1980;59(2):159–67.CrossRefPubMedGoogle Scholar
  2. Chow LC, Vogel GL. Enhancing remineralization. Oper Dent. 2001;Suppl 6:27–38.Google Scholar
  3. Duque C, Negrini TC, Sacono NT, Spolidorio DM, de Souza Costa CA, Hebling J. Clinical and microbiological performance of resin-modified glass-ionomer liners after incomplete dentine caries removal. Clin Oral Investig. 2009;13(4):465–71.CrossRefPubMedGoogle Scholar
  4. Forsten L. Fluoride release and uptake by glass-ionomers and related materials and its clinical effect. Biomaterials. 1998;19(6):503–8.CrossRefPubMedGoogle Scholar
  5. Forsten L, Mount GJ, Knight GM. Observations in Australia of the use of glass ionomer cement restorative material. Aust Dent J. 1994;39(6):339–43.CrossRefPubMedGoogle Scholar
  6. Hamama HH, Burrow MF, Yiu C. Effect of dentine conditioning on adhesion of resin-modified glass ionomer adhesives. Aust Dent J. 2014;59(2):193–200.CrossRefPubMedGoogle Scholar
  7. Hicks J, Garcia-Godoy F, Donly K, Flaitz C. Fluoride-releasing restorative materials and secondary caries. J Calif Dent Assoc. 2003;31(3):229–45.PubMedGoogle Scholar
  8. Hunt PR. A modified class II cavity preparation for glass ionomer restorative materials. Quintessence Int Dent Dig. 1984;15(10):1011–8.PubMedGoogle Scholar
  9. Knight GM. The use of adhesive materials in the conservative restoration of selected posterior teeth. Aust Dent J. 1984;29(5):324–31.CrossRefPubMedGoogle Scholar
  10. Knight GM. The tunnel restoration – nine years of clinical experience using encapsulated glass ionomer cements. Case report. Aust Dent J. 1992;37(4):245–51.CrossRefPubMedGoogle Scholar
  11. Knight GM. The co-cured, light-activated glass-ionomer cement – composite resin restoration. Quintessence Int. 1994;25(2):97–100.PubMedGoogle Scholar
  12. Knight GM, McIntyre JM, Mulyani. Bond strengths between composite resin and auto cure glass ionomer cement using the co-cure technique. Aust Dent J. 2006;51(2):175–9.CrossRefPubMedGoogle Scholar
  13. Knight GM, McIntyre JM, Craig GG, Mulyani. Electron probe microanalysis of ion exchange of selected elements between dentine and adhesive restorative materials. Aust Dent J. 2007a;52(2):128–32.CrossRefPubMedGoogle Scholar
  14. Knight GM, McIntyre JM, Craig GG, Mulyani, Zilm PS, Gully NJ. An in vitro investigation of marginal dentine caries abutting composite resin and glass ionomer cement restorations. Aust Dent J. 2007b;52(3):187–92.CrossRefPubMedGoogle Scholar
  15. Lazaridou D, Belli R, Krämer N, Petschelt A, Lohbauer U. Dental materials for primary dentition: are they suitable for occlusal restorations? A two-body wear study. Eur Arch Paediatr Dent. 2015;16(2):165–72.CrossRefPubMedGoogle Scholar
  16. Lenzi TL, Bonifácio CC, Bönecker M, Amerongen WE, Nogueira FN, Raggio DP. Flowable glass ionomer cement layer bonding to sound and carious primary dentin. J Dent Child (Chic). 2013;80(1):20–4.Google Scholar
  17. Matos AB, Oliveira DC, Vieira SN, Netto NG, Powers JM. Influence of oil contamination on in vitro bond strength of bonding agents to dental substrates. Am J Dent. 2008;21(2):101–4.PubMedGoogle Scholar
  18. McComb D, Erickson RL, Maxymiw WG, Wood RE. A clinical comparison of glass ionomer, resin-modified glass ionomer and resin composite restorations in the treatment of cervical caries in xerostomic head and neck radiation patients. Oper Dent. 2002;27(5):430–7.PubMedGoogle Scholar
  19. McLean JW. Clinical applications of glass-ionomer cements. Oper Dent. 1992;Suppl 5:184–90.PubMedGoogle Scholar
  20. Morand JM, Jonas P. Resin-modified glass-ionomer cement restoration of posterior teeth with proximal carious lesions. Quintessence Int. 1995;26(6):389–94.PubMedGoogle Scholar
  21. Naoum SJ, Mutzelburg PR, Shumack TG, Thode DJG, Martin FE, Ellakwa A. Reducing composite restoration polymerization shrinkage stress through resin modified glass ionomer based adhesives. Aust Dent J. 2014. doi: 10.1111/adj.12265 [Epub ahead of print].
  22. Ngo HC, Mount G, McIntyre J, Tuisuva J, Von Doussa RJ. Chemical exchange between glass-ionomer restorations and residual carious dentine in permanent molars: an in vivo study. J Dent. 2006;34(8):608–13.CrossRefPubMedGoogle Scholar
  23. Nicholson JW, Aggarwal A, Czarnecka B, Limanowska-Shaw H. The rate of change of pH of lactic acid exposed to glass-ionomer dental cements. Biomaterials. 2000;21(19):1989–93.CrossRefPubMedGoogle Scholar
  24. Tantbirojn D, Rusin RP, Mitra SB. Inhibition of dentin demineralization adjacent to a glass-ionomer/composite sandwich restoration. Quintessence Int. 2009;40(4):287–94.PubMedGoogle Scholar
  25. Tyas MJ. Placement and replacement of restorations by selected practitioners. Aust Dent J. 2005;50(2):81–9; quiz 127.CrossRefPubMedGoogle Scholar
  26. Van Meerbeek B, De Munck J, Yoshida Y, Inoue S, Vargas M, Vijay P, Van Landuyt K, Lambrechts P, Vanherle G. Buonocore memorial lecture. Adhesion to enamel and dentin: current status and future challenges. Oper Dent. 2003;28(3):215–35.PubMedGoogle Scholar
  27. Watson TF. Fact and artefact in confocal microscopy. Adv Dent Res. 1997;11(4):433–41.CrossRefPubMedGoogle Scholar
  28. Welbury RR, Murray JJ. A clinical trial of the glass-ionomer cement-composite resin “sandwich” technique in Class II cavities in permanent premolar and molar teeth. Quintessence Int. 1990;21(6):507–12.PubMedGoogle Scholar
  29. Wilson AD, McLean JW. Glass-ionomer cement. London: Quintessence Publishing; 1988.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Private PracticeBrightonAustralia

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