How to Use…
Glass Ionomers
Introduction
I t is a fact of life that most practitioners ignore the “novelette” included with all dental products—that is, the “manual”—pre-
ferring to use intuition and instinct to figure out how to use clinical products. However, if we want to achieve the desired
outcome, and get predictable results, we need to follow the instructions and recommendations the manufacturers provide.
This article is part of an ongoing series that examines how to make different categories of dental materials work better and
more predictably in the dental practice.
G
lass ionomer restorative materials have many uses
in dental practice. When used properly with the
right case selection, glass ionomer restorative ma-
terials can provide long-lasting, predictable results. Con-
versely, their use under the wrong conditions can lead to
treatment failure and clinical complications. A list of the
clinical procedures for which glass ionomers are appro-
priate is presented in Table 1.
Glass ionomers are composed of a fluorosilicate glass
combined with a water-soluble polymer acid to which
other modifiers may be added to improve the properties of
the material. One of the main benefits of these materials
relates to the fluorosilicate glass component that provides
continual release of fluoride ions to assist in the preven-
tion of recurrent caries. These glasses are rechargeable and
will absorb fluoride from the saliva, so that in caries-prone
patients, use of these materials as cervical restorations has
an ongoing benefit. It is suggested that in geriatric patients
who often have dry-mouth issues, use of a daily fluoride
Gregori Kurtzman, DDS, MAGD, FPFA, FACD,
DICOI, DADIA
Private Practice
Silver Spring, MD
Phone: 301.598.3500
E mail: dr_kurtzman@maryland-implants.com
Web site: www.maryland-implants.com
Vol. 4, No. 6 (Suppl 1)
rinse or toothbrush-applied product will keep the caries-
protecting ability of the glass ionomer maximized.
Table 1 Indications/Contraindications for Glass Ionomers
Indications
Cementation of metal posts
Cementation of metal-based inlays, onlays, and crowns
Cementation of zirconia-based inlays, onlays, and crowns
Cementation of zirconia- or metal-based crowns to implant
abutments
Cementation of stainless steel crowns
Sealants on erupting teeth
Conservative (small) buildups
Fillings restricted to the cervical region
Fillings restricted to pits and fissures
Sealing of the pulpal floor after endodontic treatment
Bases under amalgam or composite resin restorations
Blocking undercuts on inlay, onlay, or crown preparations
before impressions
Contraindications
Cementation of alumina-based inlays, onlays, and crowns
Cementation of fiber posts
Cementation of zirconia or ceramic posts
Cementation of resin-based inlays, onlays, and crowns
Moderate or large buildups
Fillings involving replacement of a cusp or marginal ridge
Sealants on fully erupted posterior teeth
Dental Learning / June 2010 1
Conventional Versus Resin-Modified
These materials can be generally divided into 2 groups:
conventional glass ionomers and resin-modified glass
ionomers. Conventional glass ionomers are well suited for
applications in which the material will be placed under
low wear and load, such as metal restoration cementation,
restoration bases under amalgams, and sealing of partially
erupted molars. Resin-modified glass ionomers, however,
are better suited for applications in which greater wear
potential is present (ie, cervical fillings, conservative fill-
ings), greater loads will be placed on the material (ie, core
buildups, restoration cementation), or as bases under resin
composite restorations. With regard to bases under resin
composites, the practitioner must remember that the
dentin adhesive placed over the glass ionomer base bonds
to the resin component of the resin-modified glass
ionomer; therefore, use of conventional glass ionomers as
bases will result in low bond strength between the glass
ionomer and resin restoratives. This does not apply with
regard to bases under amalgams, as the amalgam does not
bond to the base.
Pooled water and saliva
will hamper adhesion
of any product—
even glass ionomers—
so the area may be wet
but should not be saturated.
This concept can be applied to cementation of fiber
posts. A fiber post needs to be bonded to the canal walls
to gain its best strength. Glass ionomers have very good
compressive strength, but are weak when tensile and shear
loads are applied. Microflexure in the posted tooth during
normal function creates shear and tensile forces between
the fiber post and the luting material. As the glass ionomer
does not achieve high bond strengths to the fiber post, this
can in time lead to failure of this interface. Whereas, a
resin luting cement has high shear and tensile strength and
the fiber post, cement, and root effectively become a
mono-block, preserving the interfaces and yielding a long-
term restorative success.
2 Dental Learning / June 2010
Dry, Moist, or Wet?
One of the benefits of glass ionomer materials is their
ability to adhere to dentin in the presence of moisture that
would prevent the bonding of composite adhesives and
resins. The key word is “moisture.” Pooled water and
saliva will hamper adhesion of any product—even glass
ionomers—so the area may be wet but should not be sat-
urated. This is a particular benefit when cementing crowns
in the mandibular posterior, where isolation may not be
possible and thus use of a resin adhesive is not indicated.
Additionally, placement of sealants on erupting molars or
cervical restorations in the posterior may not allow etching
and sufficient drying to place a resin sealant; therefore, use
of a glass ionomer may have significant clinical benefits.
What Is the Condition?
The literature demonstrates that the use of dentin con-
ditioners before placement of a glass ionomer significantly
improves adhesion to dentin. Use of a dentin conditioner
is recommended when placing a cervical restoration, a
base, or buildup as the improved adhesion in these appli-
cations because these situations present with higher shear
and tensile loads on the restorative materials. When luting
a metal post, full coverage crown, or placing a sealant on
an erupting tooth, these situations will not have high loads
placed on the cement interface, and a dentin conditioner is
not as critical to long-term success.
Dentin Conditioner
Glass ionomers bond to dentin by creating a hyper-
mineralized zone (hybrid layer). Bond strength of glass
ionomers to tooth structure is enhanced greatly by the use
of suitable conditioners for the pretreatment of enamel and
dentin to remove the smear layer, and bond strengths equal
to the cohesive strength of the glass-ionomer cement can be
attained, with increases of up to 30% reported. The goal
with use of the conditioner is to remove the smear layer, al-
lowing the glass ionomer to better wet the surface but not
remove the plugs of smear material from the dentinal
tubules. For this reason, phosphoric acid is contraindicated
when using glass ionomers, as it removes the dentinal
plugs. The most effective surface conditioners are solutions
containing polyacrylic acid. These conditioners contain
groups capable of hydrogen bonding to tooth structure
Vol. 4, No. 6 (Suppl 1)
that ensures effective cleaning and wetting of the tooth sur- Table 2 Glass Ionomers Available Materials
faces. They do not disrupt the surfaces of enamel or dentin
and are more effective then chelating agents, such as citric Product name Manufacturer Recommended uses
acid and ethylenediaminetetraacetic acid, which dissolve Fuji II LC GC America b, c, d, h, i, k
Fuji TRIAGE GC America a, c
calciferous tooth structure.1 A 10-second application of the
Ketac Nano 3M ESPE b, c
dentin conditioner is sufficient to remove the smear layer,
Vitremer Core
and longer applications are not required.2 Buildup/Restorative 3M ESPE b, c, d, e, h, i
By removing the smear layer, the glass ionomer is better CX-Plus Shofu f, g
able to wet the dentin surface. The cement also bonds to Glasionomer
dentin and not to the smear layer—a benefit, because bond- FX II cement Shofu b, c, d, h, i, k
Geristore DenMat b, c, d, f, h, i, k
ing to the smear layer is undesirable inasmuch as prema-
Infinity DenMat b, c, d, f, h, i, k
ture bond failure may occur cohesively within the smear Riva Light cure SDI a, b, c, d, e, h, i, k
layer or adhesively between the cement and the smear layer. Riva Luting SDI f, g
Ionoseal VOCO America h, i
To Coat or Not to Coat? Glass Ionomer
Glass ionomers in the early stages of setting and Cement Dentronic f, g
Glass Ionomer Liner Dentronic h, i
shortly after are susceptible to dehydration of the water
component, which can lead to a chalky, rough surface that a- Sealant partially erupted tooth
will wear faster because of a decrease in surface hardness b- Conservative occlusal filling
c- Cervical filling
and ready absorption of stain.3 Conventional glass d- Preparation blockout
ionomers are more susceptible to this than the resin-mod- e- Conservative buildup
f- Cementation of metal post
ified glass ionomers. When contaminated, calcium and g- Cementation of metal or zirconia based restoration
aluminum ions leach out of the aqueous cement phase and h- Base under amalgam restoration
i- Base under resin composite restoration
are prevented from forming polycarboxylates. Moisture j- Cementation of orthodontic bracket
sensitivity is lost as the calcium and aluminum ions take k- Seal pulpal floor following endodontic treatment
part in polycarboxylate formation and become less sus-
ceptible to leaching. Once set, glass ionomers are one of
the least soluble luting agents.4 they break through the soft tissue. This has been a clinical
To avoid these issues, it is recommended that for all challenge because, from an isolation standpoint, it is diffi-
conventional glass ionomers that will be exposed to saliva, cult to place resin sealants on erupting teeth. These patients
an application be made of a low-viscosity, light-curable also tend not to tolerate techniques that require multiple
surface coating before dismissing the patient. Use of these steps and additional time, precluding the use of conven-
coatings is also recommended on self-cured resin-modi- tional resin sealants. Glass ionomers such as Fuji Triage
fied glass ionomers, as their full set does not complete (GC America), Ketac Nano (3M ESPE), and Riva Light Cure
until up to 1 hour or more after placement. The light-cur- (SDI) (Table 2) have been introduced for these specific clin-
able resin-modified glass ionomers set quickly, so surface ical applications. The surface of the erupting tooth is
coatings are not required with these materials. It is best scrubbed with a cotton pellet soaked in the dentin condi-
to use the glass ionomer surface coating that the manu- tioner to remove any surface plaque, and the patient can
facturer recommends because these are maximized to rinse/spit. The material is triturated and squirted over the
work with the chemistry of their glass ionomer material. occlusal surface and under the pericoronal tissue, pressed
down into the tooth’s anatomy with a finger, and then ei-
Seal of Approval ther allowed to self-cure or light cured to accelerate the set.
One frustration for the practitioner as well as the pa- The occlusion does not have to be adjusted, as the material
tient’s parent is when molars erupt with caries as soon as will wear in the occlusion as the tooth fully erupts.

Vol. 4, No. 6 (Suppl 1) Dental Learning / June 2010 3

Shaken or Stirred?
Glass ionomers are supplied in 3 ways: powder-liquid,
capsulated, and paste-paste. Capsulated and paste-paste
formulations are the most popular because of their ease
of use. As the setting reaction of glass ionomers is tem-
perature dependent, heat will accelerate the set, which
may hamper the use of powder-liquid formulations. To
overcome this, it has been recommended that the cement
be mixed on a chilled glass slab to increase the working
time; placement of a glass slab sealed in a zip-lock bag in
the freezer (to prevent moisture on the slab that may be in-
corporated into the cement mix) along with refrigeration
of the liquid component has also been suggested.
With regard to glass ionomers in capsulated formula-
tions, chilling is not needed and these versions have good
working time when triturated to the manufacturers’ speci-
fications. As all triturators are not identical, it is important
to set the speed and time recommended by the manufac-
turer (which requires the practitioner or staff to look at the
“novelette” included with the glass ionomer capsules). Trit-
urating the capsule at a higher speed increases the heat in
the material with the capsule and will lead to decreased
working time or more viscous material when extruded from
the capsule. Increasing the trituration time will decrease
working time and make extrusion of the material more dif-
ficult. Conversely, a decrease in trituration time will in-
crease working time and provides a less viscous material
that can be extruded easier. However, alteration of the trit-
uration time should only be adjusted if the material is set-
ting too fast or is not uniform in color when extruded,
4 Dental Learning / June 2010
which would indicate an incomplete mix during trituration.
The paste-paste formulations are the better choice be-
cause these allow controlled mixtures of the catalyst and
base and the correct amount is dispensed with less waste or
insufficient amount of material for the prescribed treat-
ment. These can be mixed on a disposable pad and refrig-
eration is not needed. Should the practitioner wish to inject
the mixed material into the preparation or post space after
mixing, it can be placed into a tube and plug tip.
Conclusion
Glass ionomers have many applications, and when
used properly under the right clinical applications can pro-
vide successful treatment. The key, as with any dental ma-
terial or technique, is case selection and knowing how to
properly use the material.
Up Next: How to use…. Fiber Posts
References
1. Powis DR, Follerås T, Merson SA, et al. Improved adhesion
of a glass ionomer cement to dentin and enamel. J Dent
Res. 1982;61;1416-1422.
2. Berry EA 3rd, von der Lehr WN, Herrin HK. Dentin surface
treatments for the removal of the smear layer: an SEM
study. J Am Dent Assoc. 1987;115:65-67.
3. Mojon P, Kaltio R, Feduik D, et al. Short-term contamination of
luting cements by water and saliva. Dent Mater. 1996;12:83-87.
4. Van Zeghbroeck L. Cements. Part I: Theoretical consider-
ations. J Esthet Dent. 1995;7:49-61.
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