RECENT ADVANCES IN GIC.ppt glass ionomer cement

Recentl advance

1. RECENT ADVANCES IN GIC DR . SHRAVYA S GIRJI

2. CONTENTS INTRODUCTION DEFINITION CLASSIFICATION COMPOSITION APPLICATION & AVAILABILITY SETTING REACTION PHYSICAL PROPERTIES MANUPULATION WATER SETTABLE CEMENTS PACKABLE GIC MODIFIED GIC CONDENSABLE OR SELF HARDNING GIC BIOACTIVE GLASS FIBER REINFORCED GIC GIOMER

3. GIOMER AMALGOMERS HAINOMERS CHLORHEXIDINE IMPREGNATED GIC PROLINE CONTAINING GLASS IONOMER CEMENT CPP-ACP CONTAINING GIC ZIRCONIA CONTAINING GIC NANO -APATITE MODIFIED GIC NANO RMGIC CERAMIR

4. CEMENT A Cement is a substance that hardens to act as , filling material or adhesive to bind devices or prosthesis to the tooth structure or to each other. - philips science of dental materials(11 th ed )

5. - philips science of dental materials(11 th ed ) Glass ionomer is the generic name of a group of material that use silicate glass powder and aqueous solution of poly acrylic acid. - Kenneth J Anusavice

6. Glass ionomer term was coined by wilson and kent Glass ionomer cement is water based cement ADA specification number is : 96 SYNONYMS Poly alkenoate cement ASPA- Alumno silicate polyacrylate

7. CLASSIFICATION OF GIC By Wilson & Mclean (1988) Type I - Luting Powder/liquid ratio - 1.5: 1 Particle size - 15 microns Type II- Restorative 1. restorative esthetic 2. restorative reinforced Powder/liquid ratio- 3:1 Particle size – 50 microns Type III - Liners and Base Powder/liquid ratio – 1.5:1 (liner) 3: 1 (Base)

8. BASED ON APPLICATION Type I - Luting cement Type II - Restorative cement Type III - Liners and base Type IV - Fissure sealents Type V - orthodontic cement Type VI - For core build up Type VII - Fluoride releasing cements Type VIII and IX- For ART ( Atraumatic Restorative Technique)

9. OF CONVENTIONAL GIC

10. APPLICATION Anterior esthetic restorative material for class III cavities. Restorative material for eroded areas and class V restorations. As a luting agent for restorations and orthodontic brackets. As liners and base For core build up Intermediate restorative material.

11. AVAILABLE AS: Powder /liquid in bottles Pre- Proportioned powder/liquid in capsules Light cure system Powder /distilled water( water settable type)

12. ADVANTAGES Adhesion to enamel and dentin. Anticariogenic effect. Less technique sensitive compared to composites. Biocompatibility - pulpal response is favorable.

13. DISADVANTAGES Low fracture resistance . Low wear resistance. Sensitivity to moisture soon after setting Esthetics inferior to silicates and composites Lacks translucency, rough surface texture, stains over time.

14. SETTING TYPE I – 7 minutes TYPE II – 4 to 5 minutes

15. PACKABLE GLASS IONOMER FOR POSTERIOR RESTORATIONS A packable GIC (Fuji ix) with dough like consistency is available . It is cheaper alternative to compomers and composite posterior restorations.

16. INDICATIONS In Atraumatic restorative technique Pediatric and gediatric restoration Intermediate restorative material Permanent restorative material in non stess zones As a core material ADVANTAGES High wear resistance then conventional GIC Packable , pressable or condensable Fluroide release , simple one step

17. MODIFIED GIC METAL MODIFIED GIC RESIN MODIFIED GIC

18. Metal modified GIC was introduced to improve strength ,fracture toughness and resistence to wear and yet maintain potential for adhesion and anticariogenic property TYPES SILVER ALLOY ADMIXED – Silver amalgam powder is mixed with type II GIC powder(miracle mix). CERMET – this is done by sintering a mixture of two powders at a high temperature

19. PROPERTIES Metallic fillers have little or no influence on mechanical properties of restorative gic . In vitro wear tests has shown that when used on the occlusal surface of primary molars they perform well initially but do not perform any better then conventional GIC in long term In vitro acidic condition both conventional and metal reinforced GI exhibit similar degree of wear at contact free areas at pH of solution between 6-7 and greater wear at pH 5. Both silver alloy admix and cermet release appreciable amount of fluoride initially but magnitude decreases substantially.

20. USES Restorations of small class I cavities as an alternative to amalgam or composite resins . They are particularly useful in young patients who are prone to caries. For core build up when the cement will constitute less than 40% of build up.

21. ADVANTAGES Harden rapidly so can be finished immediately Adheres to the tooth structure Show resistance to caries . DISADVANTAGES Not esthetic because its grayish in colour Low fracture toughness

22. RMGIC

23. RESIN MODIFIED GIC OTHER NAMES Resin ionomer RMGI Light cured GIC Dual cure GIC Tricure GIC Reinforced GIC Hybrid ionomer They were developed to over come drawbacks of conventional GIC like Moisture sensitivity Low intial strength Fixed working times

24. CLASSIFICATION DEPENDING ON PREDOMINANT COMPONENT RESIN MODIFIED GLASS IONOMER CEMENT COMPOMERS OR POLYACID MODIFIED COMPOSITES

25. USES Restoration of class I , III, IV cavities. Base and liners As adhesives for orthodontic brackets Cementation of crowns and FPDs . Retrograde root canal filling materials . Fissure sealant

26. SUPPLIED AS Chemical cure ( acid –base setting reactions of glass ionomer portion). Dual cure ( combines acid base reaction of the GIC portion and light curing of resin portion Tricure (combines acid base setting reaction ,chemical and light cure polymerization of resin portion). All of them are supplied in powder & liquid . The light cured type is supplied in dark bottles for light protection.

27. COMPOSITION POWDER Ion leachable fluroaluminosilicate glass particles Photoinitiators or chemical initiators or both polymerizable resin LIQUID Polyacrylic acid ,Water or Polyacrylic acid modified with Methacrylate monomer & Hydroxyethyl methacrylate monomers

28. SETTING REACTION The initial setting reaction of the material occurs by the polymerization of methacrylate groups The slow acid base reaction is ultimately responsible for unique maturing process and final strength.

29. PROPERTIES COMPARING TO CONVENTIONAL GIC Good translucency because monomer brings refractive index of liquid close to the particle. Fluroide release equivalent. Higher diametral strength . Similar bonding to tooth structure Bond strength to tooth structure & resin based composite is higher. Comparable biocompatiblity DRAWBACKS Greater polymerization shrinkage upon setting. Microleakage more then conventional GIC

30. MANIPULATION Conditioning the tooth with polyacrylic acid (10 to 25%) Powder & liquid mixed according to manufactures instructions. Then inserted into cavity and light cured

31. COMPOMERS

32. This material has structure and physical properties similar to composites as well as release fluoride and it undergoes acid base reaction in the presence of saliva. AVAILABLE AS Light cured single paste in moisture proof packets. Consists of silicate glass particles ,sodium fluoride, and polyacid modified monomer without any water

33. SETTING REACTION The initial set is by free radical polymerization reaction activated by light. Subsequently water is absorbed from saliva by the cement that contributes to acid base reaction between acidic functional groups within the matrix and silicate glass particles which is further responsible for fluoride release. Because of absence of water in the formulation they are not self adhesive like conventional GIC and requires separate bonding agent.

34. PROPERTIES They have fluoride release less compared to conventional GICs. Bond strength of compomer to tooth structure is same as conventional GIC because of dentin bonding agent. INDICATIONS Restorations in low stress areas. Base Luting Class V lesions

35. ADVANCES In recent years compomers are also marketed in powder & liquid form as well as two paste system POWDER Strontium aluminium fluro silicate Metallic oxides Chemically or light activated initiators LIQUID Polymerizable methacrylate / carboxylic acid monomers Multifunctional acrylate monomers Water Because of presence of water they are self adhesive and an acid base reaction starts at the time of mixing.

36. INDICATIONS They are indicated mainly for cementing prosthesis fabricated with metallic substrate .

37. MANIPULATION SINGLE COMPONENT SYSTEM Tooth is etched and bonding agent applied followed by injecting the material into cavity and light cured. TWO COMPONENT SYSTEM Powder and liquid system is dispensed and mixed according to manufacturers instructions for 30 sec The cement mixture is placed only on the prosthesis and the prosthesis is seated with finger pressure. After 90 sec the excess cement has to be removed The margins should be light cured immediately to stabilize the prosthesis.

38. CONDENSABLE / SELF HARDNING GIC These are purely chemically activated RMGIC with no light activation required Developed mainly for luting purpose They contain monomers and chemical initiators such as benzoyl peroxide and t – amines to allow for self polymerization. Mainly used in pediatric dentistry for Cementation of stainless steel crown , space maintainer, bands and brackets Ravi dhoot et al.Advances in glass ionomer (GIC): review.Iosr-jdms.2016;15:124-126.

39. ADVANTAGES Packable + condensable Easy placement Non sticky Rapid finishing can be carried out Improved wear resistance Low solubility in oral fluids

40. THE BIOACTIVE GLASS Developed by Hench and co in 1973. They are called bioactive because they induce biological response and result in formation of bond b/w material and tissue. They are silicate based containing calcium and phosphate Most commonly used bioactive glass is Bioglass TM ( 45S5) . Ravi dhoot et al.Advances in glass ionomer (GIC): review.Iosr-jdms.2016;15:124-126

41. Mechanism of action Bioactive glass in aqueous solution reacts with it resulting in change in its structure and chemical composition which causes its dissoution and formation of hydroxycarbonated apatite

42. USES Retrograde filling material For perforation repair Augmentation of alveolar ridges in edentulous ridges. Infra bony pocket correction. In reducing dentinal hypersensitivity as it causes occlusion of dentinal tubules. Antibacterial effects as its raises p H of the aqueous solution.

43. FIBER REINFORCED GIC This technology is called polymeric rigid inorganic matrix material. It involves incoperation of a continous network / scaffold of alumina and Sio2 ceramic fibers ADVANTAGES Increased depth of cure Reduced polymerisation shrinkage Improved wear resistance Increase in flexural strength Ravi dhoot et al.Advances in glass ionomer (GIC): review.Iosr-jdms.2016;15:124-126

44. GIOMER It is the hybridization of GIC and composite using a unique technology called prereacted glass ionomer technology. PRG fillers are fabricated by the acid-base reaction between fluoroalumino –silicate glass (FASG) and polyalkenoic acid (PAA) in the presence of water to form a wet siliceous hydrogel . After freeze-drying they are further milled and silanized to form PRG fillers This pre reacted glass is then mixed with the resin

45. Depending on the amount of glass reacted ,the PRG technology can be of 2 types F-PRG – Reaction of full / entire glass S-PRG – Surface of glass. Eg . Beautifil , reactmer Modified S-PRG : This trilaminar structure forms a type of stable glass ionomer which allows : Ion release and recharge to take place Protecting the glass core from the damaging effects of moisture Greatly improving long-term durability Releases the F-ion as well as other ions such as Al, B, Na, Si, and Sr .

46. ADVANTAGES Fluoride release and fluoride recharge Formation of acid resistant layer Reinforcement of tooth structure Antiplaque effect Remineralization of dentin Acid buffering capacity and reduce acid production by acidogenic bacteria . Excellent aesthetics . Compressive strength greater then compomers and composites

47. APPLICATIONS Restorations of Class III, IV and V cavities Restorations of Class I cavities Restorations in deciduous teeth Base / liner under restorations Fissure sealant Undercut blockout Restorations of fractured porcelain and composites Restoration of cervical erosion and root caries Repair of fractured incisal edges Veneers Direct cosmetic repairs Pulp capping agent

48. AIM : to evaluate the long-term performance of Giomer restorative system ( Beautifil , Shofu , Kyoto, Japan) containing surface prereacted glass ionomer filler ; a 13-year recall examination CONCLUSION : The study results showed that most of the restorations observed at the 13-year recall examination maintained acceptable clinical qualities in terms of color match, marginal adaptation, anatomy, surface roughness, marginal staining, interfacial staining, & secondary caries. Valeria V. Gordan et al, A clinical evaluation of a giomer restorative system containing surface prereacted glass ionomer filler: results of 13 year recall examination, Journel of american dental association ,145,1036-1043,2014

49. AMALGOMERS These restoratives are glass ionomer based but with the strength of amalgam.

50. PROPERTIES Sustained high level of fluoride release . Natural adhesion to tooth structure Good biocompatibility Prevent shrinkage, creep, corrosion or thermal conductivity problems associated with other filling materials. Good wear resistance . Minimal cavity preparation needed Mercury and metal free .

51. Compressive strength greater (323Mpa) then amalgam and GIC Flexural strength, tensile strength and fracture toughness are also reportedly much higher than conventional GICs thus preventing fracture Young s modulous is higher and close to dentin meaning that under stress the material deforms similarly to the dentine so that the adhesive bond is less likely to fail. Excellent esthetics

52. TYPES AMALGOMERS ANTERIOR AMALGOMERS CR (POSTERIOR)

53. AMALGOMER ANTERIOR INDICATIONS Class V cavities Class III cavities pits and fissures

54. AMALGOMERS CR Class I and II cavities Repair of amalgam restored teeth when either tooth or restoration has fractured As a Base under amalgam and posterior composite restorations As a core build up under crowns On the root surfaces for locating overdentures Long term temporary replacement for cusp(s)

55. HAINOMERS These are newer bioactive materials developed by incorporating hydroxyapetite within glass ionomer powder. They mainly being used as bone cements in oral and maxillofacial surgery. They have a role in bonding directly to bone and its growth and development.

56. CHLORHEXIDINE IMPREGNATED GIC Developed to increase the anticariogenic action of GIC. Still under experimental stage.

57. Luana Mafra Marti et al.Addition of chlorhexidine gluconate to a glass ionomer cement: A study on mechanical ,physical and antibacterial propeties.Brazilian Dental Journal ,25,33-37, 2014 CONCLUSION : The addition of 0.5% chlorhexidine to GIC increased its antibacterial activity without changing its physical and mechanical properties. Higher the concentration of chlorhexidine greater is the decrease in the physical –mechanical properties . AIM : To determine the effect of different concentration s of chorhexidine on setting time ,surface hardness , maximum tensil bond strength and antibacterial activity of gic .

58. PROLINE CONTAINING GLASS IONOMER CEMENT It is amino acid containing GIC It has better surface hardness properties then commercial FUJI IXGIC It is a fast set glass ionomer showing increased water sorption without adversly affecting the amount of fluoride release. It is biocompatible It can also be used as bone cement with low cytotoxicity . Ansari S,et al.Properties of proline containing glass ionomer dental cement. J Prosthet Dent ,110,408-13,2013

59. CPP-ACP CONTAINING GIC Casein phosphopeptide –amorphous calcium phosphate ( 1.56% w/w) is incorporated into glass ionomer cement. This improved microtensile bond strength (33%) & compressive strength (23%). Also there is significant increase of calcium, phosphate, and fluoride ions in neutral and acidic pH . Mazzaoui SA ,et al. Incorporation of casein phosphopeptide amorphous calcium phosphateinto GIC , journel of dental research 82(11),914-18,2003

60. ZIRCONIA CONTAINING GIC ZIRCONOMER defines a new class of restorative glass ionomer that promises strength and durability of amalgam with protective benefits of GI with completely eliminating hazard of mercury . It is a potential sustitute for Miracle mix. Its diametral tensile strength is greater then then miracle mix due to better interfacial bonding between the particles and matrix.

61. PROPERTIES Reinforced with special zirconia fillers to match the strength and durability of amalgam Sustained high fluoride release for anti- cariogenic benefits especially in cases with high caries risk Packable and condensable like amalgam without the hazard of mercury, the risk of corrosion, expansion and thermal conductivity

62. High flexural modulus and compressive strength ensures longevity in stress bearing areas Chemically bonds to enamel/dentin and has tooth -like co-efficient of thermal expansion resulting in low interfacial stresses and long-lasting restorations Ceramic fillers impart remarkable radiopacity for accurate follow up and diagnosis Adequate working time Excellent resistance to abrasion and erosion

63. INDICATIONS Class I & II cavities Structural base in sandwich restorations Core build-up under indirect restorations Root surfaces where overdentures rest Pediatric and Geriatric restorations Long-term temporary replacement for fractured cusps Fractured amalgam restoration Suitable for ART techniques

64. AIM : To assess the clinical performance of zirconia infused GIC compared to conventional GIC CONCLUSION Zirconia infused GIC showed better colour stability . But conventional GIC is better then zirconia containing gic in terms of colour match , surface texture, and marginal adapation . Ar prabhakar et al,assessment of the clinical performance of zirconia infused glass ionomer cement: an in vivo study, International journal of oral health sciences,5,74-79,2015

65. DISADVANTAGES Poor working consistency Longer setting time then conventional GIC Rough surface texture Nonblending with the tooth structure. High microleakage compared to composite and amalgam

66. NANO -APATITE MODIFIED GIC Here Nano hydroxyapatite / fluroapatite particles added to FUJI II GC. This has improved the mechanical properties due to ionic interaction b/w polyacrylic acid and apatite crystals. Also improved bond strength to dentin Because of formation of strong ionic linkage b/w apatite crystals and Ca ions in the tooth structure also decrease in the size of apatite particles increases the surface area and infilteration of crystals into demineralized dentin and enamel pores .

67. PROPERTIES CONVENTIONAL GIC NANO –APATITE MODIFIED GIC COMPRESSIVE STRENGTH 160 177 - 179 MPa DIAMETRAL STRENGTH 11.8 19- 20 Mpa FLEXURAL STRENGTH 14. 8 26 – 28 MPa

68. NANO FILLED- RMGIC Nano -sized fillers and bioceramics particles are added to RMGICs But this combination has shown no added advantages over conventional RMGIC . Only advantage is good finishing and polishing characteristics because of smaller filler particles and presence of bioceramics .

69. CERAMIR It is a permanent , radiopaque , luting cement combining calcium aluminate and GIC INDICATIONS conventional cementation of metal-, lithium disilicate -, alumina- and zirconia -based restorations .

70. AVAILABLE AS Capsules containing glass ionomer and bioceramic (calcium aluminate ) powder plus water. Capsules activated using ceramir activator for 5 sec and then titurated for 8 sec followed by dispensing using ceramir applicator

71. ADVANTAGES Reduction in micro leakage Excellent biocompatibility Long term stability and strength . Good marginal integrity Steven R. Jefferies, Cornelis H. Pameijer , David C. Appleby, Daniel Boston & Jesper Lööf . A bioactive dental luting cement - Its retentive properties and 3-year clinical findings. Compend Contin Educ Dent. 2013;34 Spec No 1:2-9.

72. Philips science of dental materials(11 th ed ). Ravi dhoot et al.Advances in glass ionomer (GIC): review.Iosr-jdms.2016;15:124-126 Valeria V. Gordan et al, A clinical evaluation of a giomer restorative system containing surface prereacted glass ionomer filler: results of 13 year recall examination, Journel of american dental association ,145,1036-1043,2014 Luana Mafra Marti et al.Addition of chlorhexidine gluconate to a glass ionomer cement: A study on mechanical ,physical and antibacterial propeties.Brazilian Dental Journal ,25,33-37, 2014 Ansari S,et al.Properties of proline containing glass ionomer dental cement. J Prosthet Dent ,110,408-13,2013 Mazzaoui SA ,et al. Incorporation of casein phosphopeptide amorphous calcium phosphateinto GIC , journel of dental research 82(11),914-18,2003 REFERENCES

73. Ar prabhakar et al , assessment of the clinical performance of zirconia infused glass ionomer cement: an in vivo study, International journal of oral health sciences,5,74-79,2015 Steven R. Jefferies, Cornelis H. Pameijer , David C. Appleby, Daniel Boston & Jesper Lööf . A bioactive dental luting cement - Its retentive properties and 3-year clinical findings. Compend Contin Educ Dent. 2013;34 Spec No 1:2-9.