Review article Annals and Essences of Dentistry

10.5368/aedj.2016.8.4.3.4

NEWER ADVANCES IN GLASS IONOMER CEMENT: A REVIEW

1 1
Srikumar GPV Reader
2 2
Naiza Elsa Post graduate
3 3
Mookambika R Post graduate
4 4
Aanchal Agrawal Post graduate
1,2,3,4
Department of Conservative Dentistry and Endodontics, Triveni institute of Dental sciences, Hospital and Research
center, Bilaspur (C.G) Chhattisgarh, India.

ABSTRACT Glass Ionomer Cement has its origin in the mid twentieth century, as a biocompatible, cost effective, tooth
coloured restorative material and is in constant evolution. Considering its unique ability to bond to the tooth structure without
the use of any bonding agent coupled with fluoride releasing potential, GIC has gradually emerged as material of choice for
various applications in the field of dentistry. This article elaborates on the composition of GIC and its recent advances which
have markedly improved their properties for optimal incorporation of these materials into various restorative treatment
procedures.

KEYWORDS: Glass Ionomer Cements (GIC), Advances in GIC, Fluoride release.

INTRODUCTION

“Necessity is the mother of all inventions”. It was in Definition

the late 1960’s, history had already witnessed a host of
restorative materials including dental amalgam, GIC consists of a basic glass and an acidic polymer
composites, but all had fallen short of that certain which sets by an acid-base reaction between these
1
perfection that the dental researchers and clinicians components.
yearned for, that of a material which is tooth
coloured,esthetic, adhesive, biocompatible, anticariogenic GIC was originally invented by Wilson and Kent in
5 5
and relatively economical.
1 1972. Other Names of GIC : Glass Polyalkenoate
Cement, Alimino Silicate PolyAcrylate (ASPA), Dentin
Substitute, Man-Made Dentine, Artificial Dentin. ANSI/ADA
Glass ionomer cements (GIC) have a large number of 6
Sp. No: 96.
applications in dentistry. One of the advantages of GIC
compared to other tooth coloured restorative materials is
First commercial glass ionomer cement was
that they can be placed in prepared cavities without any
2 manufactured by De Trey Company & Caulk in the United
need for bonding agents.
States, known as ASPA (AluminoSilicate PolyAcrylate). It
consists of ion leachable aluminosilicate glass and an
Glass Ionomer Cement came as a breakthrough and aqueous solution of a copolymer of acrylic acid.
created quite a sensation, by not only possessing majority
of desirable properties, but also with its various Composition
3
advances. This article is an attempt to review various
newer advances of Glass Ionomer Cement like, Bioactive Glass ionomer cement is a combination of Glass
3,7
GIC, Fibre Reinforced GIC, Giomers, Amalgomers, powder and Ionomer acid as liquid.
Chlorhexidine impregnated GIC, CPP-ACP containing
GIC, Zirconomer, Nano Bioceramic Modified GIC, Calcium GIC Powder
4
aluminate GIC.
The powder is a acid-soluble calcium fluoroalumino-
silicate glass similar to that of silicate but with a higher
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Review article Annals and Essences of Dentistry
alumina-silicate ratio. Fluoride portion acts as a "ceramic material ‘HAINOMER’ was developed using
flux". Lanthanum, Strontium barium or zinc oxide additives hydroxyappatite with glass powder and have shown a
provide radiopacity, these components are combined and promising future during initial clinical trials as retrograde
0
fused ( at temperatures 1100 to 1500 C) with a fluoride filling material. More recently, Zirconia containing GIC,
flux which serves to reduce their fusion temperature. The Proline containing GIC, CPP-ACP GIC are synthetically
molten glass is then poured onto a steel tray. To fragment manufactured to enhance the remineralization potential
5
it, the mass is plunged into water and the resulting and aimed at improving the strength.
fragments are then crushed, milled and powdered. The
particles are then sieved to separate them according to (a) Bioactive glass (BAG)
size. Particle size ranges from 20 microns for luting forms
10
to 50 microns for restorative products. For cementation Larry Hench etal invented the first Bioglass at the
purposes, a glass particle size of 13 to 19 microns is University of Florida. It takes into account the fact that on
optimal. The powder contains fluoride in a 10% to 23% acid dissolution of glass, their is formation of a layer rich in
+ +
concentration resulting from the calcium fluoride, sodium Ca and PO4 ions around the glass, such a glass can
fluoride and aluminium fluoride. The fluoride flux also form intimate bioactive bonds with bone cells and gets fully
2
contributes to the final fluoride concentration. integrated with the bone.

I.Powder: Because of its good bioavailability, osteo-conductivity

and biodegradability, BAG has been used as a restorative
Silica - 41.9% material for more than a decade and its degradation
Alumina - 28.6% products stimulate for the production of growth factors,
Aluminum fluoride - 1.6% cell proliferation and activate the gene expression of
Calcium fluoride - 15.7% osteoblasts, also helps in treating dentine hypersensitivity
11
Sodium fluoride - 9.3% and promoting enamel remineralisation.
11
Aluminum phosphate - 3.8 BAG bonds to both hard and soft tissues. Hydrated silica
formed on the surface of BAG includes nucleation of the
apatite. Hence, it was confirmed that pure silica gel
II.Liquid prepared by hydrolysis and poly-condensation of
tetraethoxysilane in aqueous solution containing
Polyacrylic acid (Itaconic acid,maleic acid ) - polyethylene glycol induces the formation of the apatite
40- 55% layer on its surface, when the gel is leaked in stimulated
Tartaric acid - 6-15% body fluid. A material is said to be bioactive, if it gives an
Water - 30% appropriate biological response and results in the
formation of a bond between material and tissue in
10
Original liquid for GIC was aqueous solution of 40 to 50% addition to remineralisation.
polyacrylic acid . It was quite viscous with a tendency to
gel over time. To overcome this, liquid was modified by BAG has antibacterial effect as it raises the pH of
adding itaconic and tri-carboxylic acids. Addition of these aqueous solutions. Combination of bioactive nano silica
acids causes: with dental cement improves its biocompatibility, which is
- Decrease in viscosity helpful to overcome marginal gap formation which is a
11
- Increase in reactivity between powder and liquid major disadvantage of many dental cements.
- Reduced gelation of liquid.
(b) Casein Phosphopeptide Amorphous Calcium
Newer advances of Glass Ionomer Cement Phosphate Complex (CPP – ACP):

Conventional GIC lacks in sufficient strength and ACP is the initial solid phase that precipitates from a
toughness, which has attracted focused research in order highly supersaturated calcium phosphate solution and
to improve the mechanical properties of conventional GIC, converts readily into stable crystalline phase such as
Resin-modified glass-ionomers(RMGI) were introduced, osteocalcium phosphate. Morphologically, Structurally and
which contains hydrophilic monomers and polymers like X -ray- diffraction patterns are typical for non crystalline
HEMA and they have higher flexural strength compared to substances with short range periodic regularity. ACP has
8 shown to have better in-vivo osteo-conductivity than
conventional GIC. Recently, a new restorative concept is
marketed, a system application consisting of a posterior hydroxyapatite, better biodegradability than tricalcium
restorative GIC combined with a novel nanofilled coating phosphate. These properties make ACP widely used in
material, the compounded nanofillers protect against the restorative dentistry. It was first developed by Aaron S
abrasive wear and the coating acts as a glaze, enhancing Posener in mid 1960's. In conjunction with CPP it is
9,10 3
its esthetic properties. Hybridization of GIC and creating wonders with GIC as restorative material.
Composites using pre-reacted glass ionomer technology,
9
‘Giomer’ was developed by Shofu. Newer bioreactive

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CPP is a milk product which helps in remineralisation and (e) Chlorhexidine impregnated GIC
helps in the prevention of dental caries. CPP kills
streptococcus mutans bacteria and it binds to calcium and High viscosity GIC is the material of choice for
phosphate ions of tooth structure and also to CPP. CPP atraumatic restorative treatment, since GIC adheres
forms nanoclusters with ACP and makes a pool of Calcium chemically to the tooth structure and releases fluoride,
and phosphate ions which maintains the super saturation which contributes to the reduction in amount of residual
12
of saliva. Mazzoui etal in 2003, used CPP-ACP with bacteria in restored teeth but also favors in
15
fluoride and demonstrated a synergistic remineralisation remineralisation of tooth. GIC releases approximately 10
potential. It can be delivered using tooth mousse, chewing ppm of fluoride during the 1st 48 hrs following its
16
gums, mouth rinses, toothpastes and GIC. It has the placement in the prepared cavity. In order to improve
13
ability to counteract acid action. the antibacterial characteristics Chlorhexidine digluconate
3
can be added to it.
Incorporation of 1.56% CPP-ACP into the GIC
significantly increases its tensile strength, compressive (f) Nano bioceramic impregnated GIC
strength and significantly enhances the release of calcium,
13
phosphate, and fluoride ions at neutral and acidic pH. It is well-documented that incorporation of nano-sized
particles in powder-modified nano glass ionomers
17 18
(c) Reinforced GIC improves its mechanical properties. De Caluwé etal
showed that doping conventional GICs with nano-sized
Incorporation of alumina fibres into the glass powder glass particles can decrease the setting time and enhance
17
of GIC helps in improving the flexural strength of GIC. This the compression strength and elastic-modulus. The main
technology is called as Polymeric Rigid Inorganic Matrix advantages of decreasing setting time of direct restorative
Material. It is a light-cured GIC. It involves the materials are: enhanced ease of handling, manipulation
incorporation of continuous network / scaffold of alumina and it decreases treatment time and is helpful to both the
and SiO2 ceramic fibres into the powder. This increases clinician as well as to the patient. Enhancing the
the depth of cure, reduces the polymerization shrinkage, mechanical properties adds to the serviceability and shelf-
improves wear resistance and increases the flexural life of GIC, as they are able to withstand the masticatory
2
strength of the set cement. and occlusal forces more efficiently. Addition of apatite to
GIC powder, increases the crystallinity of the set GIC,
Recently, nano particles such as TiO2, nano tubes, hence improving the chemical stability and water
nano fluroapatites are incorporated into GIC matrix to insolubility.
enhance their mechanical strength. This allows a highly
packed density of particles within the GIC matrix. An acid- Due to the similarity to that of mineralized bone and
base reaction takes place during the setting procedure, dental tissues, hydroxypatite and fluoro-hydroxyapatite
which forms a salt hydrogel, acting as a bonding element have been used in many fields of dentistry such as implant
19
in matrix within which glass acts as a reinforcing dentistry and caries prevention. Addition of nano-
component. Thus, Al2O3 and TiO2 nano powders can be fluoroapatite (nFAp) to the powder component of
3
used to manufacture reinforced GIC. conventional GIC has a positive impact on its
compressive, tensile and flexural strengths of the set
(d) Zirconomer cement. Nano-apatite containing glass ionomers are
expected to have superior bonding to the tooth surface
A new class of restorative GIC with increased strength due to the formation of the strong ionic linkages between
and durability is developed, it shows strength of amalgam, the apatite crystals/particles in the cement and Calcium
20
so it is also called white amalgam. The inclusion of ions in the tooth structure. Calcium fluoride (CaF2)
zirconia fillers in the glass component of zirconomer nanoparticles can be incorporated into RMGIC to improve
reinforces the structural integrity of the restorative material its mechanical properties. However, it slightly reduces its
& imparts higher mechanical properties for the restoration fluoride releasing ability, as CaF2-doped GIC becomes
of posterior teeth and the protective and esthetics of GIC, highly insoluable. Likewise, addition of TiO2 (3–5 wt. %)
14
completely eliminating mercury hazards. The nano particles to GIC powder has shown to improve
polyalkenoic acid and other components have been mechanical properties and anti-bacterial effect of the set
20
specially processed to impart superior strength. Easy glass ionomer cement.
mixing and adequate working time enhances its utilization
as a restorative material. Combination of outstanding Nano-Filled Resin-Modified Glass Ionomer
18
strength, durability and sustained fluoride release, deems Cement consists of glass powder and a polyacid
it as the ideal restorative material for posterior teeth solution, resin modified GIC also have a polymer resin
especially in patients with high caries incidence. Easy component which usually set by a self-activated
mixing and adequate working time enchances its utilization (chemically cured) or light-activated polymerization
3
as a future restorative material of choice. reaction. These “hybrid” materials have been developed to
combine the mechanical properties of a resin composite

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with the anti-carious potential of GIC. Indeed, it has been strength values. It is evident that ceramic-reinforced glass
observed that RMGIC not only release fluoride but also ionomer restorative material has physico-mechanical
have high flexural strength compared to conventional GIC properties that are so close and even superior to dental
21 25
and it also shows lower solubility. amalgam.

(g) Calcium Aluminate GIC/Ceramir CONCLUSION

The most recent modification in bioactive chemically There exists a plethora of direct tooth coloured
bonded dental cements with a predominant use in restorative materials in today's era of clinical dental
restorative dentistry is calcium aluminate–glass ionomer practice. The exclusive inherent features of the Glass
luting cement (CM Crown & Bridge, originally named Xera Ionomer family discussed above, place them in their own
Cem). The luting cement is actually a hybrid composition ubiquitous league. In contrast to resin bonding, the
combining both calcium aluminate and glass ionomer adhesion of glass-ionomer to tooth structure is not
chemistry. The setting mechanism of Ceramir is a technique sensitive and its quality increases with time.
combination of a glass ionomer reaction and an acid base Their is a continuous urge for innovations in dentistry
4
reaction of the type occurring in hydraulic cements. Glass originating from changing professional perceptions and
ionomer component contributes to: Low initial pH, changing demands from the patient with raising
improved flow and setting characteristics, early adhesive consciousness that, treatment of dental caries is not
properties to tooth structure, early strength properties. merely a technique, but also requires a bio-medical
Calcium aluminate component in the cement contribute to: approach that is less-invasive. This new family of GIC
increased strength and retention over time, restorative materials in their course of inception, have held
biocompatibility, better sealing of tooth-material interface, many nifty facets and are still holding the baton in never
bioactive because of apatite formation, stable, shows ending quest of clinical dental research excellence. GIC
sustained long-term properties, lack of will make it all to happen.
19
solubility/degradation.
References
(h)Giomer
1. TR. Mahesh Singh, P. Suresh, J. Sandhyarani, J.
Giomers are the latest category of hybrid dental Sravanthi. Glass ionomer cements (GIC) in dentistry:
restorative materials. This fluoride-releasing ,light-cured A Review. Int J of Plant, Animal and Environmental
restorative material is touted as true hybridization of glass Sciences. 2011:1:1:26-30.
ionomer and composite restorative materials, as they 2. Sri Vasavi Kadiyala, James D Raj. Recent advances
exhibit both fluoride release and recharge of glass ionomer and modifications of dental restorative materials A
cement. The added advantages of giomers are its good Review. Int J of Recent Advances in Multidisciplinary
esthetics, ease of handling and improved physical Research 2016:03:07:1609-1616.
properties of the set material. The "giomer" concept is 3. Aishwarya Sharma, Mausmi Singh, Vinisha Pandey.
based on the fluro-aluminosilicate glass reacted with Glass Ionomer Cement-A Phoenix and its new flight.
polyalkenoic acid to yield a stable phase of GIC, this pre- Int J of Research in Health and Allied Sciences
reacted glass is then mixed with the resin depending on 2015:1:1:9-12.
the amount of glass which is reacted. Depending on the 4. Rohit Dhoot, Sarvesha Bhondwe, Vishal Mahajan,
unique pre-reacted glass ionomer technology (PRG) fillers Sourabh Lonare, Kuldeep Rana. Advances in Glass
produced using either the surface pre-reacted type of Ionomer Cement: A Review. IOSR Journal of Dental
glass ionomer (S-PRG) or the fully pre-reacted type of and Medical Sciences 2016:15:11:124-126.
23
glass ionomer(F-PRG) technology. 5. Manvi Malik, Karan Sharma, Vasudha Kak.
Chemistry, Composition and Biocompatibility of GIC’s
(i)Amalgomer with future horizons: An Insight. Journal of Dental
Herald 2015:1:2:7-10.
Amalgomer technology (ceramic reinforced glass 6. John M Powers, Ronald L, Sakaguchi. Craig's
ionomer cement ) is introduced into restorative dentistry to restorative dental materials: Text book. Twelfth
match the strength and durability of dental amalgam. It edition, Chapter 20: Cements. page no: 484-502.
contains a high level of fluoride with good aesthetics and 7. Nisha Grag, Amit Garg. Textbook of operative
minimal cavity preparation required. It bonds to tooth dentistry, 3rd edition, Chapter 24:Glass Ionomer
structure and has excellent biocompatibility and shows all Cement. page no:420-423
the advantages of GIC. Amalgomer shows the 8. Nagaraja Upadhya, Kishore G. Glass Ionomer
conventional acid-base reaction of GIC. The product Cement - Different generations, trends. J. biomater
includes a particulate ceramic component with the artif organs 2005:18:158-65.
intention of increasing its strength, supposedly without 9. Wilson AD. Glass Ionomer Cement-Origin,
sacrificing the appearance or the general characteristics of development and future. J. Clin mater 1991:7:4:275-
24
GIC. It shows higher compressive and diametral tensile 82

Vol. VIII Issue 4 Oct–Dec 2016 22c

Review article Annals and Essences of Dentistry
10. Hench LL. The story of Bioglass. J. Mater sci 2006 bacteria causing severe early childhood caries. J.
;17;11:967-78 Indian Soc Pedod Prev Dent 2016:34;10;23-29
11. Maryam Khoroushi, Fateme Keshani. A review of 25. Neveen M Ayad, Salwa A, Elnogoly, Osama M. Badie.
glass ionomers: From conventional glass ionomer to An in-vitro study of the physico-mechanical properties
bio active. J. dent res 2013:10:4:411-420. of a new esthetic restorative versus dental amalgam.
12. Mazzoui SA, Burrow MF, Tyas MJ, Dashper SG, J. Clín Odontol 2008:4:3:137-144.
Eakins D, Reynolds EC. Incorporation of casein
phospho peptide-amorphous calcium
phosphate(CPP-ACP) into glass ionomer cement. J Corresponding Author
Dent Res 2003:82:914-918.
13. Piekar C, Rajnikanth S. An In-Vitro assessment of role
of tooth mousse in preventing wine erosion. Aust Dent
J 2008:53:22-5 Dr.Srikumar G.P.V. MDS.,
14. Mohammad Almuhaiza. Glass Ionomer Cement in Reader.
dentistry. Journal of contemporary dentistry practice Department of Conservative Dentistry and
2016:17:4:331-336 Endodontics,
15. Edward R Hook, Olivia J Owen, Candice A Bellis, Triveni institute of Dental sciences, Hospital and
James A Holder, Dominic J O’Sullivan, Michele E Research centre. Bilaspur-495220,
Barbour. Development of a novel antimicrobial- Chhattisgarh, India.
releasing glass ionomer cement functionalized with E-Mail : drsrikumar2611@gmail.com
chlorhexidine hexametaphosphate nanoparticles. Phone no: 9685514220
Journal of nano biotechnology 2014:12:3;121-25
16. Deepalakshmi M, Poorni S, Miglani R, Rajamani I,
Ramachandran S. Evalation of the antibacterial and
physical properties of Glass Ionomer Cements
containing chlorhexidine and cetrimide: An in vitro
study. Indian J Dent Res 2010:21:552-60.
17. Shariq Najeeb, Zohaib Khurshid, Muhammmad Sohail
Zafar, Abdul Samad Khan ,Sana Zohaib, Juan Manuel
Nunez Marti, Salvatore Sauro, Jukka Pekka.
Modifications in Glass Ionomer Cements:Nano-sized
fillers and bioactive nanoceramics. Int J Mol Sci
2016:17:7:1134
18. De Caluwe T, Vercruysse CW, Fraeyman S,
Verbeeck RM. The influence of particle size and
fluoride content of aluminosilicate glass on the glass
ionomer cement properties. J Dent Mater
2014:30:1029–1038.
19. Gu YW, Yap AU, Cheang P, Khor KA. Effects of
incorpoartion of HA/ZrO(2)into Glass Ionomer
Cement. J. Biomaterials 2005:26:713-720.
20. Elsaka SE, Hamouda IM, Swain MV. Titanium dioxide
nanoparticles addition to a conventional glass-
ionomer restorative: Influence on physical and
antibacterial properties. J. Dent 2011:39:589–598
21. Garcia Contreras R, Scougall Vilchis RJ, Contreras
Bulnes R, Sakagami H, Morales Luckie RA, Nakajima
H. Mechanical, antibacterial and bond strength
properties of nano-titanium-enriched Glass Ionomer
Cement. J. Appl. Oral Sci 2015:23: 321–328.
22. Geeta Asthana, Shaveta Bhargava. Bioactive
Materials: A Comprehensive Review. Sch J. App Med
Sci 2014:2;6:3231-3237
23. S. Mahalaxmi. Textbook on materials used in
dentistry, 1st edition, Chapter 4: Direct Restorative
Materials, page no:273-274.
24. Bariker RH, Mandroli PS. An in-vitro evaluation of anti
bacterial effect of amalgomer CR and Fuji VII against

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