Silver Glass
Glass ionomer CementsINTRODUCTION
GIC was produced by Wilson and Kent England, in 1972. This material was introduced in US as ASPA (Alumino Silicate Poly Acrylate) in 1977. The GIC have been evolved as a hybrid from silicate cement as a powder and polyacrylate as a liquid. ISO terminology for cement was extensive used as a dentin alternate material. Dentin has likewise been referred as man made dentin or dentin substitute. The biggest vantage of this cement is – Chemically adherent to tooth structure and anticariogenic property. Now a days GIC is employed for dissimilar application such as – Luting, restoration, baseliners, core builders and cementation of orthodontic band and brackets and also form atraumatic revitalizing treatment.
HISTORICAL DEVELOPMENT
Summary of the historical evolution of glass-ionomer cements. The original cement (GIG) is hydrophilic because of the water content required to dissolve the polyacrylic acid chains and maintain the ion-cross-linked hydrogel. Hydrogels (bottom middle) are neither as strong nor as esthetic as dental composites (upper right). Early experiments concentered on replacing a great deal of of the fluoroaluminosilicate filler with metal or cement particles. These metal-modified glass-ionomers (MM-GIC) were not esthetic, but have been used as cores. Replacing share of the hydrogel with water-soluble, light-curing monomers and polymer phases generated resin-modified glass-ionomer (RM-GIC or RMGI). Complete substitute of the matrix with typical composite alchemy but inclusion of the fluoride-releasing matrix phases or glass devised compomers (composites competent of freeing F ions). Modification of compomers by blending in precured glass-ionomer phases as molecules formulated giomers. Original glass-ionomer "as is" or altered with little additions of polymer resin or more F-enriched glasses generated resin-reinforced glass ionomers (RR-GIG or RR-GI), which have been exceedingly standard as ART and temporary materials. Fuji IX (GC Corporation) is a noteworthy representative of this category.
REQUIREMENT OF IDEAL RESTORATIVE MATERIALS
SYNONYMS OF GIC v Poly (alkenoate) cement v GIC (Glass ionomer cement) v ASPA (Alumino silicate polyacrylic acid)
CLASSIFICATION The following is the accepted classification –
Type I – luting v Cementation of crowns, bridges and orthodontic devices. v Powder : Liquid symmetry approximately 1:5:1 v Radio – opaque
Type II – revitalizing v Type II.1 – Restorative aesthetic v All types of aesthetic restorations v Auto – heal or resin modified v Radio – opaque generally v High physical properties
Type II.2 – Restorative v Restorations underneath high occlusal load v Auto heal or resin modified v Powder : Liquid ration 3:1 or greater v Radio opaque v Used as a dentin alternate or interim restoration
Type III – Lining or base v Simple lining under a metallic restoration v Powder: liquid ration 1:5:1 only v Auto cure v Radio – opaque
COMMERCIAL NAMES
Available as:
COMPOSITION
1. Powder
The powder is an acid soluble calcium fluoro – alumino silicate glass. Silica (SiO)2 – 41.9 Alumina (Al2O3) – 28.6 Aluminium fluoride (AlF3) – 1.6 Calcium fluoride (CaF2) – 15.7 Sodium fluoride (NaF) – 9.3 Aluminium phosphate (Al Po4) – 3.8 The fluoride factor acts as a ‘ceramic flux' Lanthanum, strontium, barium or zinc oxide addition provide radio opacity. Liquid:
Earlier the liquid was a 50% aqueous solution polyacrylic acid. It was very viscous and has a tendency to gel.
In most current cements, the liquid holds – v Polyacrylic acid – in the form of co – polymer with iticonic acid, maleic acid and tricarballylic acid v Tartaric acid v Water
Copolymerizingwith iticonic, maleic acid, etc have a tendancy to increase reactivity of the liquid, decrease viscosity and reduce tendency for gelation. Tartaric acid improves the handling characteristics, increase working tissue and shorter setting time. Water is the most important constituent of the cement liquid, it is the medium of reaction and it hydrates the reaction products. The amount of water results in a weak cement. Too little water impairs the reaction and subsequent hydration.
SETTING REACTION
Leaching:
When the powder and liquid are mixed together, the acid attacks the glass particles. Thus calcium, aluminium, sodium and fluoride ions reach out into the aqueous medium.
Calcium cross – links:
The introductory set occurs when the calcium ions cross – links (binds) the polyacrylic acid chains. This forms a solid mass.
Aluminium cross – links:
In the next phase( next 24 hours) the aluminium likewise begins to cross – link with polyacrylic acid chains. Sodium and fluorine ions:
These ions do not take portion in the cross – linking, numerous of the sodium ions may replace the hydrogen ions in the carboxylic groups. The rest combine with fluorine to form sodium fluoride which is uniformly circulated within the cement.
Hydration:
Water plays a very indispensable role in the cement. Initially it serves as the medium, later, it tardily hydrates the matrix, adding to the strength of the cement.
Silica gel sheath:
The unreacted glass (powder) particle is sheathed (covered) by a silica gel. It is formed by the leaching of the ions (Ca2+, Al3+, Na+, F-) from the outer position of the glass particle.
STRUCTURE OF SET CEMENT
The set cement comprises of agglomerates of unreacted powder atoms surrounded by silica gel and embedded in an amorphous matrix of hydrated calcium and aluminium polysalts.
MANIPULATION
v Conditioning of tooth surface v Proper manipulation v Protection of cement for the duration of setting v Finishing
PREPARATION OF TOOTH SURFACE
The tooth must be clean for effective adhesion of cement. The smear layer present after cavity preparation have a tendancy to block off – the tooth surface, and so ought to be got rid of to achieve adhesive bonding.
This is achieved by v Pumice wash v Polyacrylic acid (The goal to be attained is to remove the smear layer but still leave the collageous tubule plug in place. This plug act as a barrier to the penetration of acid from the cement). Apply 10% polyacrylic acid for 10 to 15 seconds. Next, rinse with water for 30 seconds, very deep areas of the penetration ought to be protected by a dab of calcium hydroxide.
Eroded areas
The dentin and cementum are introductory cleaned with a pumice slurry followed by swabbing with polyacrylic acid for 5 seconds or more. After conditioning and rinsing, the surface is dried but not desiccated. It must be kept free of contamination with saliva or blood as these will interfere with bonding. It contaminated, the whole procedure is repeated.
PROPORTIONING AND MIXING
Powder / liquid ratio:
Generally 3:1 by weight (manufacturers recommendation ought to be followed) low powder / liquid ratio reduces mechanical properties and increase the chances of cement degradation. Moisture contamination modifies the acid – water balance. Most manufacturers provide a plastic scoop, which is utile for measures.
Spatula Used v Agate Or Plastic
MANUAL MIXING
The powder bottle is tumbled gently. The powder and liquid is dispensed just prior to mixing. A cool and arid glass slab is preferent as it allows all the powder to be integrated into the mix and yet maintain it is plasticity.
The powder is divided into two equivalent increments. The firstborn increments is integrated into the liquid speedily with the stiff bladed spatula to invent a homogenous milky consistency. The remainder of the powder is then added. The mixing is done in a folding method in order to preserve the gel structure.
Mixing Time v 45 seconds
Insertion
The mix is without delay packed into the cavity with a plastic instrument.
MECHANICAL MIXING
GIC supplied in capsule form containing prepropertioned powder and liquid is mixed in an amalgamator which is operated at a very high speed. The capsule has a nozzle, and so the mix may be injected into the cavity.
Advantages:
Disadvantages: v Cement amount fixed by the manufactures v Shade selection is limited, colours may not be blended.
HAND MIXING
Divide the dispensed powder into two equivalent parts. Gently disseminate the liquid drop a little over the glass slab. Roll the firstborn half of the powder into the liquid and comprise the two together rapidly. This is completed in 10 seconds and the rest of the powder is brought into the mix. No undertake will have to be made to try and dissolve the powder into the liquid. It is only necessary to wet the surface of each particle so that ion release may occur leading to the initiation of the acid/base setting reaction. The final mix will have to be finished within 25-30 seconds.
PLACEMENT OF GIC AS A RESTORATIVE MATERIAL AND REMOVAL OF EXCESS
The revitalizing cement mixture is used by a plastic instrument or injected on the prepared tooth surface. Tooth cavities must be more or less overfilled with cement. After placement, the surface will have to be covered with a plastic matrix to protect the setting cement from losing or profiting water for the duration of the initial set. The matrix is left in place for at least 5 minute, even though this time varies according to the product, based on the setting rate. Upon remotion of the matrix, the surface ought to without delay be protected while the excess material is trimmed from the margins. Further finishing procedures, if needed, must be delayed for at least 24 hours. However, because this is clinically unrealistic, finishing, of the restoration must be finished in the same appointment. Thus quicker setting cement are desirable. Even so, the longer the dentist waits to in the right manner protect the surface, the more mature the cement becomes, the lower the peril for surface cracks, and the lower the tendency, for the restoration to become somewhat more opaque.
In the case of resting applications, no matrix shelter is needed. The excess cement may be got rid of without delay upon seating or after a length of time as prescribed in the manufacturer's instructions.
PROTECTION OF CEMENT DURING SETTING
GIC is exceedingly sensible to air and water for the duration of setting. Thus, without delay after placement into the cavity, a preshaped matrix is employed to:
The matrix is got rid of after five minutes. Immediately after removal, the cement surface is again protected with :
This protects the cement from drying while the dentist proceeds with the finishing. Failure to protect the cement surface from contact with air results in a chalky or crazed surface.
The cause for chalky or crazed surface: v Inadequate shelter of freshly set cement (from air) v Low powder / liquid ratio v Improper manipulation
Finishing v Excess material is trimmed from the margins, hand instruments are preferent to rotary, tools to refrain from ditching. Further finishing if required is done after 24 hours.
Protection of cement after setting
Before dismissing the patient, the restoration is again coated with protective agent, to protect the trimmed areas. Failure to protect the cement from saliva for the introductory 24 hours may weaken the cement.
Precautions
POSTOPERATIVE PROCEDURES
Before the patient leaves, the type II GIC restoration must be coated again with a protective agent, because the exposed cement around trimmed areas and boundary line is still vulnerable to the surroundings until it reaches full maturity. If these commended procedures for providing shelter to the setting cement are not followed, a chalky or a crazed surface will inevitably result.
In summary, shelter of glass ionomer restoration depends on meticulous attention to commended procedures to: (1) conditioning to the tooth surface (2) proper manipulation, and (3) shelter of the cement for the duration of setting and for the duration of potential situations when desiccation might occur. When these parameters are controlled, high quality restorations ought to be produced.
Setting time v Type – I – 4-5 minutes v Type – II – 7 minutes
PROPERTIES
1. Compressive strength: (150 MPa), it is a less than silicate tensile strength : (6.6 MPa), higher than silicate
2. Hardness: (49 KHN), less harder than silicates. The wear resistance is also less when equated to composites.
3. Fracture toughness: A measure of energy required to formulate fracture. Type II GIC's are inferior to composites in this respect.
4. Solubility and disintegration: Like silicates, the initial solubility is high (0.4%) due to leading of intermediate products. The finish setting reaction takes place in 24 hours. Therefore the cement will have to be protected from saliva in the mouth for the duration of this period. Glass ionomer cements are more immune to attack by organic acids.
5. Adhesion: It adheres well to enamel and dentine. Mechanism of adhesion: Glass ionmer bonds chemically to tooth structure. The precise mechanisms has not been entirely understood. The bonding is due to the reaction amid the carboxy groups of the polyacids and the calcium in the enamel and dentine.
The bond to enamel is always higher than to denture, in all likelihood due to the dandier inorganic content of enamel and it is more outstanding homogeneity.
6. Esthetics :Esthetically they are inferior to silicates and composites. They lack translucency and have a rough surface texture. They may pile up stain with time.
7. Biocompatibility:Pulpal response mild – Type II glass ionomer are comparatively biocompatible. The pulpal reaction is more outstanding than that of zinc oxide – eugenol cements but less than that invented by zinc phosphate cement. Polyacids are comparatively weak acids.
The water settable cements show higher acidity. Type I GIC is more acidic than type II, because of the slower set and lower powder / liquid ratio.
Pulp shelter :In deep cavities, the smear layer ought to not be got rid of as it acts as a barrier to acid penetration. Deep areas or protected by a dab of calcium hydroxide cement.
8. Anticariogenic properties:Type II glass ionomer releases fluoride in amounts comparable to silicate cements initially and proceed to do so over an extended amount of time of time.
In addition, due to it is adhesive effect they may have the potential for reducing infiltration of oral fluids at the cement – tooth interface, thereby preventing secondary caries.
MODIFICATION OF GLASS IONOMER CEMENTS
1. Fast setting materials They are also called as highly viscous GIC or condensable GIC. The powder is chemically modified for the duration of manufacturing to decrease the calcium content & thence limit the production of calcium polyalkenoate chains which are highly water soluble. This allows rapidly and without delay maturation of the material but decreases the translucency.
2. Water settable glass ionomer cements The polyacrylic acid copolymers are freeze dried & coated onto the powder particles. The liquid integrate tartaric acid and water. These cements are called as ‘water settable GIC'. They set rapidly and without delay than the established GIC.
3. Resin modified GIC Also called ‘hybrid ionomers, polyacid modified resin (PAMR)'. 5% of resin matrix is added by modifying the liquid factor of the GIC.
Various organic compounds have been applied like v Polymerisable monomers v Polymerisable polyalkenoid vied v Preppolymer substitution or addition to polyalkenoi acids v Acid monomers
The setting reaction is necessary an acid base reaction. The resin element is activated by light, chemicals or both. As the ion interchange system is available for adhesion, a resin bonding scheme need not be used. The acid base reaction proceeds even in the absence f light activation.
4. Metal altered GIC GIC have been altered by inclusion of filler atoms in an attempts to improve their strength, fracture toughness and wear resistance. Two methods have been employed. The initial approach involves mixing of spherical silver amalgam alloy molecules with glass inomer powder. This cement is called siturs alloy admix or miracle mix.
The second method involves the fusion the silver corpuscles to the glass ionomer corpuscles by sintering at high temperature. This is called as ‘CERMET'.
5. Compomers (Polyacid modified resins)
The word compomer is derived from composites & glass ionomers. They are resin composites in which the filler is a glass similar to the aluminofluorosilicate glass used for GICs. A variable amount of dehydrated polyalkenois acid is integrated along with the fitter but this is not available for reaction with the glass until there is a good deal of water uptake into the restoration. The introductory setting is by a light activated system similar to the composites. As water is absorbed from the saliva into the there is a fixed degree of acid bare, which releases little uantities by fluoride. However, the adhesion is based on the acid technique using premirs because chemical adhesion does not occurs.
Advantages v Inherent adhesion to tooth structure v High retention rate v Little shrinkage and good marginal seal v Fluoride release and accordingly caries inhibition v Biocompatible v Minimal cavity preparation required accordingly easy to use on children in and suitable for use even in absence of skilled dental manpower and facilities (such as in ART)
Disadvantages v Brittle v Soluble v Abrasive v Water sensible for the duration of setting phase. v Some productions release less fluoride then traditionalisti GIC v Not inherent radiopaque even though addition of radiodense additives such as barium may modify radiodensity v Less aesthetic then composite
USES:
1. As Luting Agents:
Glass Ionomer Luting Cement is splendid for permanent cementation of crowns, bridges, veneers and other facings. It may be used as a liner underneath composites. It chemically bonds to dentine/enamel, precious metals and porcelain restorations. It has good translucency and universal yellow shade, with early high compressive strength. It releases fluoride ions and reduces sensitizing by giving a firm foundation for composites, pulp shelter and insulation. It mechanically bonds to composite revitalizing materials. It reduces the incidence of micro-leakage when applied to cement composite inlays or onlays. It is easy to mix with good flow properties. It is fast setting with low fill thickness and low viscosity. It reaches the neutral pH fast, following placement on the tooth. It is applied for cementation of orthodontic bands.
Typical Physical Properties: v Mixing Time: 15 seconds v Setting Time: 2 minutes v Working Time: 2 minutes v Total Time: 4.5 minutes at 23 C
Mixing Directions: 2 Scoops of powder and 3 drops of liquid. The powder must be placed separately on the mixing pad. The introductory scoop of powder must be integrated into the liquid and as soon as it is entirely wet, add the second scoop and mix with no problems or difficulties to a smooth, creamy state ready for cementation. The cement in this shiny state will have to be used without delay to clean arid restoration which is sealed on the arid prepared tooth. The excess cement is trimmed away at it is rubbery stage, just prior to the final set.
2. As Orthodontic Brackets Adhesives:
Currently the most ordinarily used adhesive for orthodontic bracket bonding are based on composite resin. However Glass Ionomer schemes have sure advantages. They bond directly to tooth tissue by the fundamental interaction of Polyacrylate ions and hydroxyapatite crystals, thereby avoiding acid etching. In addition they have anticariogenic affect due to their fluoride leaching ability. Nevertheless their use in orthodontic bracket bonding has been fixed due to inferior mechanical properties, in queer bond strength.
3. As Pit and Fissure Sealants:
Another suggested use of glass ionomer cements is as fissure sealants. The material is mixed to a more liquid consistency to grant flow into the depths of the pits and fissures of the posterior teeth. Early cements were found to be undesirable for use as sealants if the fissures were less than 100µ meter wide. The big glass atoms of cement prevented adequate penetration of fissures with a bur.
4. As Liners and Bases:
GICs have a number of vantages as cavity lining as they bond to dentine and enamel and release fluoride which not only helps in prevent decay and consequently minimizing the probability of aspect of secondary carries, but also promote the formation of secondary dentine. They may be employed underneath both composite resin and amalgam.
5. For Core Build Up:
Some dentists favour glass ionomers cements for cores, in view of the evident ease of placement, adhesion, fluoride release, and matched coefficient of thermal expansion. Silver containing GICs (eg the cermet, Ketac Silver, Espe GMbH, Germany) or the 'miracle mix' of GIC and unreacted amalgam alloy have been in particular popular. Some believe the silver within the material enhances it is physical and mechanical properties, however, in-vitro studies are equivocal and a study of a cermet applied to fill deciduous teeth showed that it performed less well than a established GIC. In the days when a lot of GICs were radiolucent, the addition of silver conferred radiopacity without which it would be difficult or out of the question to diagnose secondary caries. Nowadays, numerous traditionalisti GICs are radiopaque and are having little impact to handle than the silver containing materials. Nevertheless, a good deal of laborers regard GICs as inadequately strong to support major core build-ups. Hence the recommendation that a tooth must have at least two structurally intact walls if a GIC core is to be considered. In our view it is best to regard GIC as magnificent filler but a comparatively weak build-up material. In order to protect a GIC core the crown margin should, wherever possible, wholly hug 1-2 mm of sound tooth structure cervically. Extension of the crown margin in this way is termed the 'ferrule effect' and ought to ideally be employed for all cores.
Advantages: v Intrinsically adhesive v Fluoride release - but this does not guarantee freedom from 2° decay (Figure VIII) v Similar coefficient of thermal elaboration to tooth
Disadvantages: v Considerably weaker than amalgam and composite v Tendency to crack worsened by early instrumentation v Silver containing materials offer little betterment in physical properties v Some materials radiolucent
Recommendations: v Excellent filler but relies on having sufficient dentine to aid crown v Where used as a build-up, best to leave tooth preparation until next appointment v Good material on which to bond restorations with resin cement
6. For Intermediate Restorations:
Because of their inherent adhesive nature and brittleness and with regards to adequate for the purpose aesthetics GICs are also widely used to restore loss of tooth structure from the roots of teeth either as consequence of decay or the so called cervical abrasion cavity. Abrasion cavities were once even though to be the product of over zealous tooth brushing, perhaps in association with the use of an abrasive dentifrice. It is now recognized that both dietary components and functional loading of teeth (causing the teeth to bend) may be co-factors in their aetiology. In addition they're likewise applied oftentimes as in non-undercut cavities, with reliance being placed upon their adhesive characteristics to ascertain their retention.
7. As Adhesive Cavity Liners (Sandwich Technique):
The so called sandwich technique involves using GIC as dentine substitute and a composite to replace enamel. These intention designed lining materials set speedily and may be made receptive for the bonding of composite resins plainly by washing the material surface if the material is freshly placed (excess water results in numerous of the GIC matrix being washed out from around the filler molecules giving a microscopically rough surface to which the composite wall will attach in an analogous manner to etched enamel). This surface must be coated either with an unfilled resin or a DBA to optimize attachment. It is only necessary to etch a GIC with acid if the restoration has been in place for numerous time and has to the full or entire extent matured. The sandwich technique has a number of attractions but it will have to be undertaken as planned routine rather than as method to improve the aspect of highly inadequate GIC restoration.
8. For ART (Atraumatic Restorative Treatment):
ART or the Atraumatic Restorative Treatment is a method of caries management invented primarily for use in the Third World countries where skilled dental man power and facilities are fixed and the population need is high. The technique uses simple hand instruments (such as chisels and excavators) to break through the enamel and remove as much carries as possible. The cavity is loaded using cotton rolls. When excavation of carries is finish (or as finish as may be achieved) the residuary cavity is restored using a altered GIC. These GICs are reinforced to give increased strength underneath functional loads and are radio opaque. There aesthetic properties are poorer with the material being optimally opaque.
9. As Restorations for Decidous Teeth:
Because of their high fluoride release and minimal cavity preparation requirement GIC is now widely the materials of choice for the restoration of carious important teeth. Restoring carious teeth is one of the major treatment needs of young children. A restoration in the essential dentition is dissimilar from a restoration in the permanent dentition due to the fixed lifetime of the teeth and the lower biting forces of children. As early as 1977, it was suggested that glass ionomer cements could offer peculiar vantages as revitalizing materials in the important dentition because of their capacity to release fluoride and to cohere to dental hard tissues. And because they require a short time to fill the cavity, glass ionomer cements present an further and added vantage when treating young children. However, the clinical performance of conventional and metal-reinforced glass ionomer restorations in essential molars is disappointing. And though the handling and physical properties of the resin-modified materials are better than their predecessors, more clinical studies are required to assert their efficacy in the restoration of indispensable molars.
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