GLASS INOMER

CEMENT
Dr.Shiren Sultana
 Classification of glass inomer cement:
 Type I –Luting cement
 Type II – Restorative cement
 Aesthetic filling
 Reinforced materials
 Type III – Lining cement
 Type IV- Fissure sea lent
 Type V- Orthodontic cement
 Type VI – Core build up cement.
 Newer classification:
 A. Traditional glass inomer
 Type I-Luting
 Type II-Restorative
 Type III-Liners and bases
 B.Metal Modified Glass Inomer
 Miracle Mix
 Cermet cement
 C. Light Cure Glass Inomer- HEMA added
to liquid.
 D. Hybrid Glass Inomer/ Resin Modified
Glass Inomer.
 Composite resin in which filler are
substituted with glass inomer.
 Pre cured glass blended into composite.
 Composition:
 Power
 1. Slica -41.9%
 2. Alumina-28.6%
 3. Aluminum F-1.6%
 4.Calcium F-15.7%
 5.Sodium F-9.3%
 6.Alumium Phosphate-3.8%
 Liquid-
 Poly acrylic acid 40-55 percent
 Itaconic acid
 Maleic acid
 Tartaric acid-6-15 percent
 Water -30%
 Setting Reaction:
 1. Ion Leaching phase.
 2. Hydrogel phase.
 3.Poly Salt gel phase.
 Ion Leaching phase:This phase occur
when power and liquid are mixed.When
power and liquid are mixed the polyacid
attacks the glass particles to release
cations like Ca and Al3.
;
 Hydrogel phase:
 In this phase Ca++ are released
rapidly.This liberated ions react with the
acid and and cross link with the
polyacrylic and form calcium
polycarboxylate gel. At this stage the
cement appear rigid and opaque.
 Structure of fully set cement consists of
glass particles surrounded by silica gel
in a matrix of polyanions crosslinked by
ionic bridges.
 Poly salt gel phase: In this stage
continue release of hydrogen ions
causes a delayed release of AL ion from
silicate glass in the form of ALF which
are deposited in the already preformed
matrix to form a water insoluble Ca-Al-
Carboxylate gel.
 Indications of Glass Inomer:
 Restoration of permanent teeth
 -Class V, Class III,small class I tooth
preparation
 -Abrasion/Erosion
 -Root caries
 Restoration of deciduous tooth
 -Class I to Class VI tooth preparations
 -Rampants and nursing bottle caries
 Luting or cementing
 -Metal restorations(Inlay,onlay,crowns)
 -Nonmetal restorations(composite inlays
and onlays)
 -Veneers
 -Pins and posts
 -orthodontic bonds and brackets.
 Preventive restorations
 -Tunnel preparation
 -pit and fissure sealants
 Protective liner under composite and
amalgam.
 Bonding agent
 Dentin substitue
 Core build up
 Splinting
 Glazing
 Endodontics
 Water Sensitivity:
 If moisture contamination occur in first 24
hours of setting, calcium and Aluminum
ions leach out of set cement ,thus they
are prevented from forming
polycarboxylates.This results in formation
of chalky and eroded rough surface of
restoration with low surface hardness.
 If desiccation occurs during initial setting
of cement, it retards the setting reaction
since water plays an important role in
setting reaction.
 If desiccation occurs in later stage, it
prevents increase in strength of cement
because hydration of silica based
hydrogel and polycarboxylate can not
occur. It can also result in
crazing,decreased esthetics and
deterioration of the cement.
 SETTING TIME

• Type 4-5
I minutes
• Type 7
II minute
s
 PROPERTIES
• Compressive strength -
150 mpa

• Tensile strength - 6.6

mpa.

• Hardness - 49
KHN.
 SOLUBILITY &
DISINTEGRATION:-

• Initial solubility is high due to

leaching of intermediate
products.

• The complete setting reaction

takes place in 24 hrs, cement
should be protected from saliva
during this period.
Adhesion :-
☻Glass ionomer cement bonds chemically
to the tooth structure.
☻Bonding is due to reaction occur between
carboxyl group of poly acid & calcium of
hydroxyl apatite.
☻Bonding with enamel is higher than that of
dentin ,due to greater inorganic content.
Esthetics :-
GIC is tooth coloured material &
available in different shades.
Inferior to composites.
They lack translucency & rough
surface texture. Potential for
discolouration & staining.
BIOCOMPATIBI
LTY :-
• Pulpal response to glass ionomer cement
is favorable.
• Pulpal response is mild due to
- High buffering capacity of hydroxy
apatite.
- Large molecular weight of the
polyacrylic

acid ,which prevents entry into

dentinal tubules.
Anticariogenic properties :-
•Fluoride is released from glass ionomer at
the time of mixing & lies with in matrix.
Initial release is
high. But
declines after 3
months.
After this, fluoride
release continuous
for a long period.
Fluoride can also
be
taken up into the
cement during
topical fluoride
treatment and
 Uses of glass inomer:
 As pit and fissure sealants
 As Liners and Bases
 As Luting Agents
 As Orthodontics Brackets Adhesives
 For Restoration of class III AND CLASS V
lesions.
 Fissure Sealing
 Restoration of Root Caries
 High Caries risk patients
 Emergency Temporary Restorations
 For Intermediate Restorations.
 For Core Build up
 Atraumatic Restorative Treatment(ART)
SANDWICH TECHNIQUE
 Devolped by Mclean.
 The term “Sandwich Technique” refers
to a laminated restoration using glass
ionomer to replace dentin and
composite to replace enamel.
 Synonyms of Sandwich technique:
 -Replacement dentin technique
 -Bilayered technique
 Laminate restoration technique
 Indications of Sandwich technique:
 Large Class III,IV,V and Class I AND II
lesions.
 For laminate Veneers.
 Steps of Sandwich technique:
 1. Isolation of the tooth
 2.Prepare the tooth .Keep the
cavosurface margins involving dentin as
butt joint.Bevel the enamel margins to
increase the composite resin bonding.
 3.Provide pulp protection if needed.
 4. Conditioning the prepared tooth using
polyacrylic acid .
 Placed freshly mixed fast setting GIC in the
prepared tooth.
 If the restoration has been in placed for
sometimes and has fully matured then we
need to etch the GIC with acid.
 If the GIC is FRESHLY PLACED AND IS
immature bonding can be achieved simply
by washing the GIC surface because water
washout the GIC matrix from around the
filler particles which gives microscopically
rough surface for attachment of composite.
 Now coat the surface of prepared tooth
either with an unfilled resin,or a dentin
bonding agents for optimal adhesion
and cure it for 20 sec.
 Place composite and cure in usual
manner.
 Do finishing and polishing of the
restoration and finally recure for 20 sec.
 Advantages of Sandwich technique:
 -Better strength esthetics and finish of
composite resins.
 -Fluoride release from GIC.
 -Reduced bulk of composite resins so less
polymerization shrinkage.
 Minimizes the number of increments of
composite to be placed ,so save time.
 Uses of GIC eliminates acid etching of dentin
and thus reduces post operative sensitivity.
 Good pulpal response because of
biocompatibility of GIC.
 Water Sensitivity:
 If moisture contamination occurs in first 24
hours of setting ,calcium and aluminum ions
leach out of setting cement, thus they are
prevented from forming polycarboxylate
cement. This results in forming
polycarboxylates.This results in formation of
chalky and eroded rough surface of
restoration with low surface hardness.
 If desiccation occur during initial stage of
setting ,it retards the setting reaction since
water plays an important role in setting
reaction.
 If desiccation occurs in later stage ,it
prevents increase in strength of cement
because hydration of silica based
hydrogel and and polycarboxylate
cannot occur.It can also result in crazing
,decreased esthetics and deterioration
of the cement.
 Therefore, to prevent moisture
contamination and desiccation of freshly
placed cement, surface of restoration
should be covered by low viscosity
bonding resin, varnish and vaseline.
 A traumatic Restorative Treatment(ART):
 ART was introduced in South Africa BY Jo
Frencken in 1996.
 This technique was first evaluated in
Tanzana in 1980.
 Indication:
 1.Area without electricity and
sophsticated dentals aids .
 2.Children from poor families
 3.In homes for mentally and physically
disabled and the elderly pt.
 4. Small to moderate pit and fissure
caries.
 Steps for ART technique:
 Tooth is isolated using cotton rolls.
 Access is made by breaking off
undermined enamel.
 After removal of soft demineralized
dentin by excavation, tooth is restored
using a modified GIC .This modified GIC
is basically reinforced GIC so as to give
increased strength under functional
loads and is radio opaque in nature.
 Restored tooth is contoured and
occulusion is checked.
 Since no rotary instruments can be used
,all adjustments should be done while
the restorative is in a workable state.
 Restoration is covered with petroleum
jelly.
Advantages:
 Mechanics needed for ART does not
require complicated mechanical
instruments.
.
 Reinforced Glass Ionomer cements: Strength of
the Glass ionomer cement can be improved by
modifying the chemical composition of original
glass powder. It can be done by the following.
 Disperse –phase glasses: In this to improve
strength glass was prepared with large amount
dispersed phases of strengthening, crystallites
like carborundum(Al2O3)and Tillite).
 Fiber-reinforced glasses: To improve the flexural
strength of cement,alumina fiber,and carbon
fiber were added.But these materials showed
difficulty to mix,and low resistance to abrasion.
 Metal reinforced glass ionomer
cements:It was introduced by Simmons
in 1983.In this metal powder or fiber
were added to GIC to increase the
flexural strength.
 Miracle Mix:is prepared by physical
blend of silver alloy powder to glass
ionomer cement. This cements show
poor esthetics and resistance to
abrasion.
 Powder: physical blend of silver alloy
and glass powder in 1:7 ratio.
 Cermet cements:Cermet is
manufactured by sintering compressed
pellets made from fine silver powder
and glass ionomer powder at Tm 8oo
degree C.The sintering metal and glass
fit is then ground into the form which
results in ceramico metal particles of
fused metal and ground glass.
 Powder: Sintering of Silver powder and
glass powder 5 percent Titanium oxide.
 Liquid:Glass inomer Liquid
 Resin- modified Glass ionomer cement:
 Powder:Fluoroaluminosilicate glass
particle along with photoinitiator or
chemical initiator.
 Liquid:15 to 25 percent resin component
in the form of HEMA.
 Polyacrylic acid copolymer along with
photoinitiator and water.
 Cermet cements:Cermet is
manufactured by sintering compressed
pellets made from fine silver powder
and glass ionomer powder at Tm of 800
degree C.The sintered metal and glass
fit is then ground into fine form which
results in ceramic metal particles of
fused metal and ground glass.
 Clinical steps for placement ofGIC:
 Isolation: Saliva control is important for
successul glass inomer restorations. If
moisture contaminates the cement
during manipulation and setting , the
gel will weaken and wash out
premturely. Commonly used methods for
isolation are rubber dam, retraction
cords, cotton rolls and saliva ejectors.
 TOOTH
PREPARATION
 Tooth preparatio for glass inomer cement is
done in two ways:
 1. Mechanical preparation
 2. Chemical preparation(conditioning)

MECHANICAL PREPARATION
Glass inomer an be used for class III, class V,
small class I and class II preparations.
CLASS II TOOTH PREPARATION:
INDICATION:
 In patient with high caries index
 When caries extend onto the root surface
 In areas with low occlusal stress
Class V Tooth preparation
INDICATIONS:
 Patient with high caries index
 When esthetic is not primary concern
 In root surface lesion

1. OUTLINE FORM: External outline form is limited to the

extension of the lesion. Prepare the tooth with high
speed round bur with air and water coolant. Do not
make further preparations in cases of cervical abrasion
or erosion where most part is in cementum.
2. RETENTION AND RESISTNCE FORM: Retention is
achieved by chemical bonding, so do not need any
added retenton.
3. CONVENIENCE FORM: Lip and cheek retractors and
tongue guards are used for convenience of operation.
4. PULP PROTECTION: Same as Class III
 CLASS I TOOTH PREPARATION
INDICATION:
 Deep pit and fissures
 Recently erupted teeth in patients with high caries index.

1. OUTLINE FORM: Use a small bur to enter in the fissure

and remove carious dentin. After this , use fine tapered
fissue bur to widen the fissures.
2. RETENTION FORM: No added retention needed because
glass inomer cement is retained chemically.
3. CONVENIENCE FORM: Widen the fissure properly for
better flow of the glass inomer cement. Use of rubber
dam is always preferred for convenience form.
 CLASS II TOOTH PREPARATION:
INDICATION:
 When life expectancy of tooth is not more
than 5 years. Used in deciduous teeth or
mobile teeth in geriatric patient.
 Incipient proximal lesions of posterior teeth.
 Low caries index of patient.

CONTRAINDICATION:
 When proximal decay undermines the
marginal ridge.
 Difficult access
 Excessive occlusal loading on marginal ridge
STEPS:
1. Before initiating the treatment, determine loction
and extent of the caries.
2. Isolate and dry the tooth.
3. Place a wedge below the carious proximal portion.
4. Penetrate the occlusal surface of the tooth with a
round bur. Entry of bur should be 2mm inside the
marginal ridge. Angle of bur should be 45 degree
angle to the carious lesion.
5. After enamel has penetrated spoon excavator is
used to remove the carious lesion and use taperred
fissure bur to widen the preparation.
6. Now remove the caries by cutting into proximal
lesion and remove the wedge to see the extent o
the preparaion.
 Once the complete caries removal is
done, use rubber dam and wedge to
avoid overhanging of the restoration
and injury to gingiva.
 Use restorative material and condence
it from occlusal surface , avoiding any
void.
 Remove wedge and matrix and do
final finishing and polishing of the
restoraton.
 MIXING OF CEMENT
Mixing should be done using powder: liquid ratio as
recommended by the manufacture.
Mixing should be done at room temperature for 40 to 60
seconds on a cool dry glass slab or paper pad with the
help of a flat and firm plastic spatula.
RESTORATION
After mixing , glass inomer cement is carried with the
help of cement carrier for placement into the prepared
tooth. For optimal restoration and avoiding any void
use of matrix is always advisable. After placing the
cement , the gross excess is removed immediately and
final contouring is done. In case of chemically cure
glass inomer , matrix is held till the initial hardening of
cement starts but in case of light cure glass inomers,
photoactivation can be done or accelerated setting.
 FINISHING AND
POLISHING
As we know, surface of glass inomer is sensitive to
both moisture contamination and dessication.
During initial phase of cement setting it is always
preferred to delay the finishing and polishing for at
least 24 hours after the cement placement because
by then the the surface of restoration attains ionic
equilibrium in the environment. But in case of resin
modified glass inomer cements , finishing is started
after their placement. After placing the restoration
gross finishing is done following the matrix removal.
Before starting the finishing procedure , the surface
of the restoration is coated with protective agent. A
sharp knife is used to remove the extra cement.
Final finishing is done by superfine diamond points,
soflex disk, and abrasive strips in moist condition.
 SURFACE PROTECTION
 Since glass inomers shows sensitivity to
both moisture contamination and
surface desiccation, the newly placed
restoration should always be protected
immediately after matrix removal so as
to prevent water exchange. It can be
done with the help of cocoa butter, resin
bonding agent, petrolium jelly or
varnish. Among these, resin bonding
agents provides the best surface
protection as they fill the
microporosities of the surface and stay
for longer time in comparison to other
 Procedural steps for GIC restoration:
 A.Initial Clinical Procedure:
 1.Prophylactic,scaling and polishing.
 2.Local anaesthesia for patient
comfort,if needed.
 3.Occlusal assessments to help in
property adjusting the restorations
function and in determining the tooth
preparation.
 4.Isolation of the area with rubber dam,
cotton roll with or without retraction
cord and saliva ejector.
 B.Tooth preparation:
 i.Mechanical preparation:

1. Outline form: Outline form is governed by

caries, discolouration, and esthetics. As GIC
resists caries the preparation is done very
conservatively.
 THE MAIN POINTS ARE AS FOLLOWS:
 A) If not involved is caries , contact areas are
not cut to bring the margins to self cleansing
areas.
 B) The unsupported enamel is not removed if
it is not exposed to heavy masticatory forces.
2) Retention and resistnce form:
 Glass inomer cement has true or
chemical adhsion to enamel and
dentin. Hence , excessive , major and
undue undercuts and dovetails are not
required at the cost of healthy tooth
structure.
 The material should be sufficiently
thick in bulk, at least 1mm thick to
resist the fracture under masticatory
load and 2-3 mm thick in the areas
where masticatory load is heavy.
 ii) Chemical preparation or conditioning:
1. Protection of the pulp with a calcium hydroxide
liner,when indicated. ( within 0.5mm of the pulp)
2. Conditioning or etching of the dentinal surfaces
to remove the smear layer by 10% polyacrylic
acid placed in the preparation for approximately
20 seonds. Other conditioning agents- EDTA
10%, citric acid 50%, tannic acid 25%, H202 3%.
3. Etching is followed by rinsing and removal of
excess water , living the dentin moist.
4. After conditioning , priming agents are applied in
a thin coat and light cured for 20-40 seconds.
( for light curing glass inomer , RMGI and
compomers.)
5. Mixing of glass inomer using powder :
liquid ratio is 3:1 or according to the
manufacturer within 30 seconds in a
mixing paper pad or glass slab with the
help of a flat and firm plastic spatula.
6. After mixing , the material is caried in
one bulk to the cavity.
7. Placement of matrix for providing
contour to the restoration.
8. In case of chemically cure glass inomer ,
matrix is held till the initial hardening of
cement starts.
9. For light cure glass inomer , cure with
visible light for a minimum of 40 seconds
both labially and lingually.
10. Immediately after removal of matrix,
chemically cure glass inomer should be
coated with a thin layer of light cured resin
bonding agent to prevent dehydration and
cracking of the restoration. The other
materials for surface protection are cocoa
butter, varnish, petroleum jelly or vaseline.
11. New RMGIs are more resistant to
dehydration and do not typically required
this step.
12. When the material has set, the matrix , if used , is
removed and the gross excess is shaved away
with a no. 12 surgical blade in a Bard parker
handle or other appropriately shaped knives or
salers.
13. As much as possible of the contouring and
finishing should be accomplished with hand
instruments, while striving to preserve the
smooth surface that occurs on setting.
14. If rotatory instrumentation is needed, micron
finishing diamonds with petrolium lubricant are
used at a very slow speed without water coolant.
15. The restoration is finally covered with light cure
resin bonding agent , colourless varnish petrolium
jelly or cocoa butter to prevent dehydration.
16. Rubber dam is removed
17. Final contouring and finishing is done
after a complete polymerization period
of 24 hours.
18. Final finishing can be done using
flexible abrasive disks, coarse to fine
finishing diamond points, fine white
stones etc with a lubricant.
19. A fine-grit aluminium oxide polishing
paste applied with a prophycup is used
to impart a smooth surface.