Resin Modified Glassionomer cement Conference on 16 September 2010

1. Glass Ionomer in Contemporary Restorative Dentistry By RoojRojasawasthien. DDS, MSc. 16 August 2010

2. Direct Tooth Colored Material Resin composite Compomer (Polyacid Modified Resin) Glass Ionomer Resin Modified Glass Ionomer

3. Direct Tooth Colored Material IMCR Ionomer-Modified Composite Resins (fluoride in resin) CR Composite Resins (glass-containing Hydrophobic resins) PAMR Polyacid-Modified Resin (compomer) RMGI Resin-Modified Glass Ionomers GIC Glass Ionomer Cements

4. Glass Ionomer Silicate cements ---> Glass ionomer(Wilson and Kent, 1972) Powder + Liquid Fluoroaluminosilicate glass + Polyalkenoic acid Acid – Base reaction

5. Phase I (Ion-leaching phase)Polyacid extracts ions from glass powder Mixing - Shiny, Glossy Phase II (Hydrogel phase)Ion cause formation of polyacid matrix Setting (3-6 min) - Rigid, Opaque Phase III (Polysalt gel phase)Silica gel forms and attaches powder to matrix Maturation (24 hrs – 1 yrs) More tooth-like color

6. Fully set Glass Ionomer

7. Advantages Less shrinkage than polymerizing resin No free monomers, Non-irritating to pulp Coefficient of thermal expansion similar to dentin High compressive strength

8. Advantages Adhere chemically to enamel and dentin (hydrophilic)

9. Advantage Fluoride release and recharge (reservoir effect) Delbem et al., 2005

10. Disadvantages Poor abrasion resistance Average esthetic Technique sensitive Susceptible to take up additional water Hygroscopic expansion Susceptible to dehydration Crazing, Cracking

11. Disadvantages Wear rate Tensile strength

12. Development of Glass Ionomer Conventional GI (capsule) Conventional GI (hand mix) Metal-reinforced GI High viscous glass ionomer

13. Classification Self-cure glass ionomer Conventional glass ionomer Fuji II lining (GC Co., Japan) KetacFil Plus (3M ESPE, USA) KetacCem

14. Classification Self-cure glass ionomer Metal-reinforced glass ionomer Miracle Mix (GC Co., Japan),Ketac silver (ESPE)

15. Classification Self-cure glass ionomer High viscous glass ionomer Fuji IX (GC Co., Japan), Ketac Molar (3M ESPE, USA)

16. Development of Glass Ionomer

17. Resin-modified glass ionomer Hydroxyethylmethacrylate (HEMA) Vitrebond, first commercial in 1989 Acid-Base reaction + Photo-chemical polymerization Dual-cure Tri-cure : add autocure resin

18. Resin-modified glass ionomer (RMGI) Conventional GI RMGI Vitrebond, Vitremer Acid-base and light-polymerization reaction compete with and inhibit one another (Berzin. et al, 2010)

19. Resin-modified glass ionomer (RMGI) Improve properties Set on demand Fewer desiccation and hydration problems Immediate finishing Better esthetics Tensile strength, fracture toughness Resistance to microleakage Bond to resin composite

20. RMGI products Luting agent Fuji Plus FujiCem Rely-X luting cement

21. RMGI products Liner / Base Fuji lining LC Vitrebond

22. RMGI products Composite bonding agent Fuji Bond LC

23. RMGI products Restorative buildup Fuji II LC VitremerKetacNano

25. 39% Ethyl alcohol

26. 15% Polyacrylic acid

27. Photoinitiator10% Polyacrylic acid

28. RMGI - Restorative Rinse Do not Rinse

29. RMGI - Restorative 10% Polyacrylic acid 37% Phosphoric acid 12,000x 800x An atlas of glass ionomer cements, 2002

30. RMGI - Restorative For Fuji II LC, 10% polyacrylic acid application is able to create micro-mechanical retention. (Sidhu, 1999) For Vitremer, due to high amounts of HEMA, hydrolitic degradation of Vitremer-dentin bonds might be expected to occur. (Fritz et al., 1996) In term of bond durability, sealing ability, Fuji II LC is better than Vitremer. (Fagundeset al., 2009)

31. Clinical using of RMGI – Class V

32. Clinical using of RMGI – Class V

33. Clinical using of RMGI – Class V Compomer Two years later Vitremer Composite Onal & Pamir, 2005

34. Clinical using of RMGI – Class V Survival rate 3-step etch and rinse Glass ionomer 2-step etch and rinse Puemans et al., 2005

35. Clinical using of RMGI – Class V Failure rate Puemans et al., 2005

36. Clinical using of RMGI – Root caries

37. Clinical using of RMGI – Sandwich tech. The sandwich technique with resin-modified glassionomer cements or compomers can improve the marginal adaptation of Class II composite restorations with cervical margins located in dentine (Dietrich. et al, 1999)

38. Clinical using of RMGI – Sandwich tech. Liebenberg , 2005

39. Clinical using of RMGI – Sandwich tech. Liebenberg , 2005

40. Clinical using of RMGI – Sandwich tech.

41. Clinical using of RMGI Secondary caries

42. Clinical using of RMGI Secondary caries Sidhu , 2010 Under fluoride dentifrice, the RMGI provided additional protection against secondary caries. (Sousa et al., 2009)

43. Clinical using of RMGI - Repair Maneenut et al., 2010

44. Conclusion

45. Conclusion Advantages Adhere chemically to tooth structure Fluoride release Less shrinkage Disadvantages Lower wear resistance and physical properties compare to composite Moisture sensitivity remain Unstable color

46. Thank You