The Benefits and Limitations of Glass-Ionomer Cements and Their Use in Contemporary Dentistry
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.
KeywordsCo-curing Remineralization Caries resistant Occlusal restorations Dental adhesive Polymerization shrinkage stress
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