Resin-modified glass ionomer cement restorations in primary molars.

The aim of this multicenter study was to evaluate the 3-year performance of a resin-modified glass ionomer cement in primary molars. A total of 174 class II restorations were placed in 85 children by 6 dentists. The restorations were evaluated during a 3-year period using slightly modified USPHS criteria (van Dijken 1986). Of the 174 restorations 161 were evaluated after 1 year, 121 after 2 years and 68 after 3 years. A total of 81, restorations exfoliated or was extracted during the study. The cumulative failure rate after 1, 2 and 3 year was 8.1%, 11.7% and 19.8% respectively. The main reasons for failure were secondary caries and loss of retention.     

Evaluation of the clinical behavior of resin modified glass ionomer cement on primary molars: a comparative one-year study

AIM: The objectives of the present study were to evaluate and compare the clinical behavior of resin modified glass ionomer cement (RMGIC) on primary molars with conventional and modified cavity preparations. METHODS AND MATERIALS: Forty-two children, 5-9 years of age, having bilateral initial occlusal caries on the mandibular primary second molars were selected for the study. A split mouth design was employed where conventional Class I cavities with a 90 degrees cavosurface angle were prepared randomly on primary second molars on one side and modified cavities with a 1 mm straight bevel along the cavosurface margin on the contra-lateral side. These cavities were restored with RMGIC. The restorations were evaluated during subsequent visits, for a period of one year. RESULTS: At the end of one year, 90% of the restorations survived in the conventional cavity group whereas 100% of the restorations survived in the modified cavity group. CONCLUSION: Incorporation of a bevel in Class I cavities increases the survival rate of RMGIC restorations. There was no significant difference in the clinical behavior between the two groups. However, beveling does contribute to long term clinical success of these restorations. CLINICAL SIGNIFICANCE: Incorporation of a straight bevel in conventional cavities will improve the retention of RMGIC by increasing the bonding area and enhancing the desired properties of the material.     

The survival of resin modified glass ionomer and stainless steel crown restorations in primary molars, placed in a specialist paediatric dental practice

AIMS: To prospectively report on the survival of resin-modified glass ionomer cement (RMGIC), photac-fil and pre-formed stainless steel crown (SSC) restorations in primary molar teeth placed over a seven-year period in a specialist paediatric dental practice under private contract of remuneration. METHOD: All primary molar restorations placed by a specialist paediatric dentist over a seven-year period were reviewed and the outcome results recorded. Data were recorded at review visits until June 30, 2003. Data recorded included Class I restorations, Class II restorations and SSC. The Class II cavities were either mesial or distal, with or without buccal/palatal extensions. If both proximal surfaces were decayed or if after cavity preparation the resultant outline form was significantly larger than the minimal classical form, RMGIC was not used; an SSC was placed instead. Stainless steel crown preparation followed conventional guidelines. The crowns were cemented with reinforced zinc oxide and eugenol (Kalzinol). The status was recorded as satisfactory restoration, tooth exfoliated, tooth extracted for orthodontic reasons with the date of extraction, or needing replacement. If replaced then the reason for replacement was also recorded. RESULTS: A total of 544 Class I RMGICs, 962 Class II RMGICs, and 1,010 SSCs were placed. At the last review of each restoration, 98.3% of Class I, 97.3% of Class II RMGICs and 97.0% of SSCs were either satisfactory or withdrawn intact. CONCLUSION: Under the conditions of private specialist practice-based study SSCs continued to prove very successful for the restoration of larger cavities and for pulp-treated primary molar teeth. For the smaller cavities RMGIC were also very successful.     

Clinical effects of glass ionomer restorations on residual carious dentin in primary molars

PURPOSE: To evaluate the mineralization and morphology of residual (infected and affected) carious dentin following the restoration of vital primary molars with viscous glass-ionomer cement (GIC). METHODS: Encapsulated Fuji IX GP and Ketac-Molar Aplicap GICs were placed in cavities that were prepared using the atraumatic restorative treatment (ART) approach. Four suitable exfoliated teeth with intact restorations were sectioned and then examined by electron probe microanalysis (EPMA) and scanning electron microscopy (SEM). RESULTS: EPMA demonstrated the presence of fluorine and strontium that had penetrated into the underlying residual carious dentin from the adjacent GIC. The concentrations of these two elements, and those of calcium and phosphorous, varied with distance from the GIC/dentin interface. SEM showed varying degrees of dentin tubule destruction and intratubular (peritubular) dentin present immediately subjacent to the GIC/dentin interface. Incomplete removal of carious dentin was observed in all specimens, and GIC remained adherent to the tissue.     

Comparative evaluation of the microleakage of two modified glass ionomer cements on primary molars. An in vivo study

This in vivo study was conducted to compare and evaluate the microleakage of two modified glass ionomer cements on deciduous molars. Thirty children (10-16 years) were selected. In each patient, standardized class V cavities were prepared on the buccal surfaces of two different retained deciduous molars and these cavities were restored with GC Fuji II LC (Improved) and GC Fuji IX GP, respectively. Following a period of four weeks after the restoration, these teeth were extracted and immersed in 2% Basic Fuschin dye solution for 24 hours. The depth of dye penetration was assessed after sectioning the teeth and the microleakage determined. The results were statistically analyzed using Student 't' test. It was concluded that both the materials, GC Fuji II LC (Improved) and GC Fuji IX GP were comparable in performance and can be considered to be materials safe for Pedodontics usage, and decrease bacterial penetration.     

Remineralizing effects of glass ionomer restorations on adjacent interproximal caries

The purpose of this study was to examine the in vitro remineralization of incipient caries lesions on teeth adjacent interproximally to teeth with Class II glass ionomer cement restorations. Sixty-four extracted molars were selected and 1 x 5 mm artificial caries lesions were created at the interproximal contact point. One hundred micrometer sections were obtained at the caries sites, and polarized-light photomicrographs were obtained. The sections were covered with varnish, leaving only the external section site exposed, and were placed back into the original tooth. In another sixty-four molars, Class II cavities were prepared. Equal numbers of preparations were filled with Fuji IX GP, Vitremer, Ketac-Molar, or Z 250. These sixty-four teeth were mounted to have interproximal contact with the adjacent teeth containing the artificial caries lesions. Specimens were placed in closed environments of artificial saliva for one month. After thirty days, the same sections were photographed again under polarized light, and areas of the lesions were quantitated. Decrease in the size of caries lesions indicated the glass ionomers had significantly greater remineralization effects on adjacent caries than the nonfluoridated composite resin (ANOVA p < 0.05). There were no significant differences among the three glass ionomers tested.     

Clinical evaluation of atraumatic restorations in primary molars: a comparison between 2 glass ionomer cements

Dental caries continues to be a highly prevalent disease among Brazilian preschoolers, especially those with low socioeconomic status. The purpose of this randomized, controlled trial was to evaluate in vivo 245 simplified restorations in deciduous molars using glass ionomer cements (Vidrion R and Ketac-Molar). Dental restorations were evaluated at 6- and 12-month follow-ups. The teeth restored with Vidrion R (SS White) on a single tooth surface were successful in 87% of the cases evaluated at 6 months and in 63% at 12 months. The teeth restored with Ketac-Molar on one surface achieved a success rate of 95% at 6 months and 82% at 12 months. No recurrent caries or pulpal infection was evident. Logistic regression analysis demonstrated that teeth with cavities restricted to the occlusal surface on sclerotic dentin showed the best adhesion to the restorative material. The restorations with Ketac-Molar had a better clinical performance than those with Vidrion R.     

Microleakage of glass ionomer/composite resin restorations: A laboratory study. 1. The influence of glass ionomer cement

Acid-etching of enamel margins, often combined with bevelling and use of a low viscosity resin, has resulted in improved sealing of composite restorations. When enamel is absent and margins involve dentine or cementum, microleakage is more often observed. The use of glass ionomer cement, as both a restorative material and as a base combined with a veneer of composite resin, has been advocated as a means of minimizing microleakage where margins are placed in dentine or cementum. Four restorative techniques incorporating glass ionomer cement were used, in vitro, to restore cervical cavities. After thermal cycling, dye penetration was scored along occlusal and gingival margins. In all instances the gingival margin exhibited a less reliable seal than the occlusal margin. The sandwich restorations produced a superior seal at both occlusal and gingival margins when compared with glass ionomer restorative cement.     

A one-year clinical evaluation of a high-viscosity glass ionomer cement in primary molars

In this study one-year clinical results of high-viscosity glass ionomer cement (GIC) (Fuji IX, A3, GC, Japan) were determined in class I and class II restorations in 68 primary molars with occlusal or approximal caries. Following caries removal and cavity preparation, the teeth were restored with Fuji IX. The restorations were evaluated according to the U.S. Public Health Service's (USPHS) criteria at the end of one year. Statistical analyses of the data obtained were analyzed using the X2 test. The evaluations showed no statistically significant difference between class I and class II restorations in terms of the color mismatch, anatomic form, marginal adaptation, and secondary caries (P>0.05), but they were statistically significant with regard to cavosurface marginal discoloration (P<0.05). At the end of one year, the success rate of the class I and class II restorations of the primary molars restored with Fuji IX was 94%.     

Two-year clinical evaluation of light-cured composite resin restorations in primary molars

The restorations were evaluated at baseline, and at 6, 12, and 24 months by two trained examiners. In the system used, the highest, most desirable rating is Alfa. Of the restorations evaluated at 24 months, 99% had Alfa ratings for color match, 87% had Alfa ratings for no discoloration at cavosurface margins, and 86% had Alfa ratings for no loss of anatomic form. In addition, 75% of the restorations had Alfa ratings for margin adaptation, and 91% had Alfa ratings for no recurrent caries at the 24-month evaluation. In conclusion, the light-cured composite resin restorative material functioned well at the 12- and 24-month evaluation periods, when used in primary molars.     

Clinical behaviour of glass ionomer restorations in primary teeth.

OBJECTIVE: To compare a silver-reinforced glass ionomer material (cermet) with a resin-modified glass ionomer in minimal Class II preparations in primary teeth. METHODS: Matched pairs of primary molars with approximal caries that required operative treatment were used. Each cavity was filled with either Vitremer or Ketac-Silver. The restorations were followed for at least 36 months and examined annually using bitewing radiographs and clinical inspections. Impressions were taken at each recall and models were examined microscopically. RESULTS: After 36 months, one of the resin-modified glass ionomer (RMGI) restorations and 13 (26.5%) of the silver cermet restorations had failed. The RMGI failed because of secondary caries, while most of the failures of the silver cermet fillings were marginal defects alone or in combination with secondary caries. The median survival time (MST) for the silver cermet restorations was 37 months. The RMGI restorations had a MST exceeding 42 months, but MST could not be calculated exactly because of the low failure rate during the study period. CONCLUSIONS: The resin-modified glass ionomer had the overall best performance of the two materials under comparison. The silver cermet material cannot be recommended for Class II restorations in primary teeth.     

Silver amalgam versus resin modified GIC class-II restorations in primary molars: twelve month clinical evaluation

The purpose of this study was to compare the clinical efficacy of resin modified GIC with amalgam as a restorative material, in Class-II cavities of primary molars. Restorations were evaluated at four, eight, and twelve months for their marginal integrity, anatomic form and development of recurrent caries. When each parameter was considered separately, there was no difference in the success rate between the two groups, except development of recurrent caries significantly less (p<0.05) in RMGIC group(4.7%) compared to amalgam group (12.5%) at twelve month follow up. However, the cumulative success rate at 12 month was found to be significantly higher (p<0.05) in RMGIC (Fuji II LC) group(83.1%) compared to amalgam(72%).     

Fiber reinforcement of a resin modified glass ionomer cement

ObjectivesUnderstand how discontinuous short glass fibers and braided long fibers can be effectively used to reinforce a resin modified glass ionomer cement (RMGIC) for carious lesion restorations.MethodsTwo control groups (powder/liquid kit and capsule) were prepared from a light cured RMGIC. Either discontinuous short glass fibers or braided polyethylene fiber ribbons were used as a reinforcement both with and without pre-impregnation with resin. For the former case, the matrix was the powder/liquid kit RMGIC, and for the latter case the matrix was the capsule form. Flexural strength was evaluated by three-point beam bending and fracture toughness was evaluated by the single-edge V-notch beam method. Compressive strength tests were performed on cylindrical samples. Results were compared by analysis of variances and Tukey’s post-hoc test. Flexural strength data were analyzed using Weibull statistical analysis.ResultsThe short fiber reinforced RMGIC both with and without pre-impregnation showed a significant increase of ∼50% in the mean flexural strength and 160–220% higher fracture toughness compared with the powder/liquid RMGIC control. Reinforcement with continuous braided fibers gave more than a 150% increase in flexural strength, and pre-impregnation of the braided fibers with resin resulted in a significant flexural strength increase of more than 300% relative to the capsule control. However, for the short fiber reinforced RMGIC there was no significant benefit of resin pre-impregnation of the fibers. The Weibull modulus for the flexural strength approximately doubled for the fiber reinforced groups compared to the control groups. Finally, compressive strength was similar for all the groups tested.SignificanceBy using a RMGIC as a matrix, higher flexural strength was achieved compared to reported values for short fiber reinforced GICs. Additionally, the short fibers provided effective toughening of the RMGIC matrix by a fiber bridging mechanism. Finally, continuous braided polyethylene fibers gave much higher flexural strength than discontinuous glass fibers, and their effectiveness was enhanced by pre-impregnation of the fibers with resin.     

Eight-year study on conventional glass ionomer and amalgam restorations in primary teeth

The aim of this randomized clinical study was to compare the longevity and the cariostatic effects of conventional glass ionomer and amalgam restorations in primary teeth placed in everyday practice in the Danish Public Dental Health Service. All restorations inserted during a 7-month period by 14 clinicians in 2 municipalities were included in the study. The sample consisted of 515 conventional glass ionomer restorations and 543 amalgam restorations in 666 children aged between 2.8 and 13.5 years. The restorations were in contact with 592 unrestored surfaces in primary and permanent teeth. The study was terminated after 8 years, with 2% of the restorations in function and 7% patient dropouts. Fifty percent of the teeth restored with glass ionomer and 63% of those with amalgam were exfoliated with the restoration in situ, while 42% of the glass ionomer and 20% of the amalgam restorations had been repaired or replaced. Fracture of restoration, endodontic complication, and loss of retention were the major reasons for failure. The 50% survival time for glass ionomer restorations in all cavity types was 42 months, while the median survival time for amalgam restorations could not be estimated but exceeded 7.8 years (P < 0.001). Progression of caries lesions on tooth surfaces adjacent to amalgam restorations required operative treatment on 30% of the teeth, while only on 16% of teeth adjacent to glass ionomer restorations. The 75% survival time was 40 months for surfaces in contact with glass ionomer compared to 25 months for surfaces in contact with amalgam (P = 0.005). Multivariate analyses were performed in order to assess the influence of a number of factors on the longevity of restorations, occurrence of prevalent failures, and caries treatment of surfaces in contact with the restorations. Owing to the high frequency of failures of the conventional glass ionomer restorations, it was concluded that they are not an appropriate, universal alternative to amalgam for restorations in primary teeth, although they reduce caries progression and the need for operative treatment of adjacent surfaces.     

Clinical evaluation of a glass ionomer cement in primary molars

PURPOSE: The aim of the study was to evaluate the clinical performance of a high powder:liquid ratio self-cure glass ionomer cement in the restoration of primary molars. METHODS: Fuji IX GP (GC International, Tokyo, Japan) was used to restore 129 carious cavities (56 1-surface; 73 2-surface) in 69 patients of mean age 6 y 7 mo. Approximal cavities were prepared with a slot only design, and all cavities were small to medium in size. Restorations were evaluated at 6 mo, 1 y and 2 y using USPHS criteria, and the survival rate calculated using survival analysis. RESULTS: The cumulative survival rate of single-surface restorations was 100 percent at 2 y, and of 2-surface restorations was 99 percent at 6 months and 1 year, and 93 percent at 2 y. All failures were due to loss of restoration. The overall USPHS alfa ratings at 2 y were: marginal discoloration, 96 percent; anatomic form, 100 percent; marginal adaptation, 99 percent. There was no incidence of secondary caries. CONCLUSIONS: A high powder:liquid ratio glass ionomer cement was successful over 2 years in the restoration of small-medium sized cavities in primary teeth. It is predictable that the performance will continue to be highly satisfactory over the next 2-3 years.     

Effectiveness of surface protection of resin modified glass ionomer cements evaluated spectrophotometrically

The effectiveness of four surface protectors for resin-modified glass ionomer cements was evaluated by spectrophotometrically determining dye uptake. Ninety specimens, 3.0 mm in diameter and 1.0 mm in height, were made with Photac-Fil, Fuji II LC and Vitremer and divided into six groups for each material. Positive and negative controls were not protected while experimental specimens were protected with proprietary glaze, nail varnish, flowable resin and glaze. The discs were immersed in 0.1% methylene blue solution for 10 minutes after mixing, except for those negative control specimens that were immersed in deionized-water. After 24 hours, the specimens were washed and the protectors trimmed with Sof-Lex discs. The specimens were then removed from the matrixes and individually placed in 1.5 mL of 65% nitric acid for five hours. The absorbance was determined spectrophotometrically at 590 nm. Dye uptake was expressed in microgram dye/specimen. The data were analyzed by two-way ANOVA and Tukey-Kramer tests. All surface protectors tested were effective. For Fuji II LC and Vitremer no differences were observed among tested protections. For Photac-Fil, nail varnish showed better performance than the proprietary glaze.     

Amalgam, composite resin and glass ionomer cement in Class II restorations in primary molars--a three year clinical evaluation.

Amalgam (ANA 2000), composite resin (Occlusin), and glass ionomer cement (ChemFil) were compared in conventional Class II restorations in second primary molars. Twenty-five restorations of each material were placed by two dentists in 50 patients. The restorations were evaluated during a three year period using the USPHS criteria. Great differences could be found between the materials. The failure rate (USPHS ratings Charlie) was after three years 8 per cent for the amalgam, 16 per cent for the composite resin and 60 per cent for the glass ionomer cement restorations.     

A review of glass ionomer restorations in the primary dentition

Glass ionomer cements are tooth-coloured materials that bond chemically to dental hard tissues and release fluoride for a relatively long period. They have therefore been suggested as the materials of choice for the restoration of carious primary teeth. However, the clinical performance of conventional and metal-reinforced glass ionomer restorations in primary molars is disappointing. And although the handling and physical properties of the resin-modified materials are better than their predecessors, more clinical studies are required to confirm their efficacy in the restoration of primary molars.