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:Direct esthetic restorative material (Glass Inomer Cements (GIC

Our lecture today is a continuation on direct restorative materials which are esthetic or white fillings ,, last couple of lectures we talked about composites we will talk today about glass inomer cements , another white filling, it's slightly different , actually it's very different , it's not available in several shapes like in composites so it's not really your first choice when you want an esthetic material . that looks like natural teeth usually it appears a little bit opaque rather than similar to . a normal tooth shape Now originally , glass inomer cements were self- cured, tooth colored material and they are able to release fluoride which enable them to prevent caries or inhibit demineralization , they can bound chemically to tooth structure without needing a bonding agent; you don't need a bonding agent to bound them to enamel and dentine, . they can chemically bound to enamel and dentine Now, they are newer classes of glass inomer cements that can be light cured as well, they are a little bit modified but basic glass inomer cements are self- cured which means that you have a powder and a liquid to mix together to start the sitting reaction and the material needs a few minutes (5-6 minutes) or (4-5 minutes) to set, light- cured materials will be slightly modified so that they are sensitive to light so they set when they are subjected to . light now many types of glass inomers exist ,they can be different in some properties like for example there ability to flow or there viscosity ...so we have what we called (; ((luting agents) or cementing agents these materials or cements are usually highly flowable because we use them to attach crowns on prepared teeth so they should have the ability to flow very well to cover the internal surface of the crown and spread all around the

tooth structure so we call them cements or (luting .( agents some glass inomer cements are filling materials (restorative materials ) but since they are weak (brittle materials) we can't use them in areas that are subjected to high stress or high stress bearing area so they are specific for certain cases for example class (5) cavities : in the cervical marginal teeth whether labially or lingually, it's not subjected to high stress so you can safely place them there for example in primary teeth , force or stress is not very high or as high as permanent teeth so you can use them even in the occlusal surface for class (1) cavities for . example In some cases ,we use them as a temporary filling... for example, when you need to place composite in class (3) , you don't have enough time to place composite you want to place temporary material or filling instead of using zinc oxide Euginol because we said that we shouldn't use it under composite , we can use GIC ,in some cases some patients need root canal treatment... (3elaj 39b).... in between visits or in vacations when you need to go for a long time before you come back to the doctor to finish the treatment you need a temporary filling that can last for a long time and it's able to bound very well to tooth structure and prevent microleakage all around it ... glass inomer cement is an option *:It Can be use as liners (1 bases underneath restorations. like amalgam or (2 . composite in deep cavities If the cavity is( 2-2.5 )mm deep that's ok! we don't really need a liner or a base here , there is enough dentine remaining that can protect the pulp... isolate the pulp prevent any transfer of heat or any damage reaching the pulp but if your cavity is deeper and there is only a thin layer of dentine remaining ,you need something to isolate the pulp to protect it from the outer environment , if you have a deep cavity with a large amalgam filling that is able
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to transmit heat because it's a metalic filling we need something to protect your pulp so we need a liner or a base like glass inomer cements (GIC) can be use as a liner . or a base to protect the pulp in deep cavities It can also be used as a core build up material, it's not the first option ,if you have a bad destroyed tooth and you want to build it up again and place crown on top ...it's not your first option but some materials of GIC can be used to . build up tooth structure before placement of a crown ?what's is our first option .we said it's core build up material The strongest material among the restorative material , it's amalgam ,the second option is composite while GIC is .another option For example let's say you only have a remaining lingual and buccul walls , that are thin , you want to restore the rest of the tooth before you prepare for a crown so you need some structure to prepare or to drill ... you can use amalgam , in some cases there is not enough tooth structure to retain amalgam so composite can be used we . can bound it or GIC if you don't have enough tooth structure to retain(( amalgam ,don't use amalgam , you can use composite )) .or GIC

to prevent caries , some preparation of ( GIC ) are used as . pit and fissure sealants -: main components of glass inomer cements are glass particles like quartz or silica.(1 a polyacid which is present in the liquid.(polyacrylic acid (2 ( water : water is the reaction medium.. the reaction (3 happens within water , so when the reaction happens if the water dehydrated, the reaction will not proceed normally
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-: Pit and fissure sealants

. and the material will be weak tartaric acid is part of the liquid ( it will help to control(4 . ((regulate )working time and sitting time . soduim ,fluoride (5 They all are combined either within .the powder or within the liquid so in the glass or the glass particles have also several : things within it ( components of the glass particles ) Silica (1 Alumina(2 Calcium fluoride(3 sodium and aluminium fluorides(4 . calcium or aluminum phosphates(5 All these components are fused together and then ground to form small particles , so these small particles contain all of these components together and they are called glass particles , so glass particles are made up of many things : silica, alumina, calcium fluoride, aluminium phosphate , calcium phosphate all of them (small components )are fused together at high tempretures to form one large block then this block is ground in a machine to form the small fine particles and these are supplied as a powder in a bottle by the manufacturer , you are going to mix the powder in a liqiud , now the liqiud component is a mixture usually of several types of acids like (acrylic acid + itaconic acid or maleic acid) different types of acids , now if it was only composed of acrylic acid on it's own it will be highly viscous so they add different types of acids to reduce the viscosity of the liquid , if it's reduced a little bit it will be easy to mix and manipulate so it's not only composed of acrylic acid ( several types of acids are combined together to form the liquid which you mix with . ( the powder to control the viscosity Tartaric acid is another component that will help in regulate working time and setting time by making the .working time not too short it will allow you enough time to mix the material and. manipulate it . it will prevent the sitting time from being too long 5

if the setting time is too long it's not practical , it's not clinically practical ; you can't keep the fillings inside the patients mouth and ask him to keep his mouth open until the material set for 10 minutes so this acids will influence the working time and the setting time and we will see how in a couples of slides . so this is just a chemical representation of different acids that combined together to form the liquid component that form the glass inomer .cements so (GIC or self-cured GIC has powder made of glass which contain silica,aluminia,calcium fluoride and many things also the liquid ; the liquid is an acid that's why the setting reaction they call it ( acid -base reaction) ; because you mixed an acid which is the liquid (polyacrylic acid ) and you mix the base particles which is the glass , mix them together the setting will occur and the material will . become hard bit by bit with time

**:bottle system hand mix -2

so it's available as a two bottle system hand mixed , one contains the powder , one contains the liquid and you need to follow the instructions with regard to the ratio how many spoons , how many drops of the liquid , you need to . follow manufacturer instructions

:Dispensing *

:anhydrous cement **
supplements have both the acids and the glass particles combined together within the powder the liquid is freezed ride so powder and the acid are combined together in the powder and we just mix it with distilled water so they call (it (anhydrous cement

:capsules **
GIC can also be available in capsules , this capsules is just like amalgam; one end will have the powder and the other will contain the liquid it's mixed by shaking it in the ... (machine and you will have the paste coming out (GIC
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:so three forms are available .bottle system-2 (1 anhydrous cemenet: which is actually a powder and a (2 liquid but the liquid here is water and the powder here .contains the glass and the acid part capsules : which can provide us by good mixing and it (3 . will minimize the error in mixing because it's mechanical

(setting reaction : (acid- base reaction

we mix an acid liquid with a base powder which contains : glass, there are stages for the setting reactions -:dissolution (1 which means that when you mix the acid with the powder the acid will attack the particles and starts dissolving them which will leads to the release of ions (Ca, Al , Na) so this is called dissolution(once you mix the liquid with the powder) , so the polyacid (contain hydrogen ions ) will attack the glass particle this will lead to the release of many ions (AL, . Ca , Fluoride) for example (gelation :-(initial setting (2 if you remember when we talked about gypsums we said the loss of gloss represent initial setting so the material is not hard but it will start to become hard from that stage onward so let's say that it will be in a form of gel (not completely solid , not liquid or paste ) but it will start to become solid so it called the stage gelation ( what will happen in the stage that calcium will start to make bridges between the acid chains , these cross linking between the acid chains will lead the material .to gradually become hard or like the gel so calcium ions will go through acid liquid or polyacid chains and will crosslink them together , just like the polymerization reaction ( free radicals will cause crosslinking between monomer chains and make them into polymers or larger molecules that are harder, crosslinking between anticomponents make them harder (when we link
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.(two things together we make it harder the material in the end of this stage is not completely set , it's not hard enough , it's not strong enough , it's still in gel . form calcium is more reactive than aluminium ions it reacts quicker than the aluminium that's why these crosslinking is occurred due to calcium ions , now this is a critical things you need to be sure there is a good isolation .around the filling , no contamination and no dehydration you should not stop going air in the filling while it's still gelling or initially setting , if you dehydrated any loss of water or if there is contamination with saliva which leads to removal of aliminuim ions for example this will compromise the other stages of setting so you need to isolate the material very well (not dehydrated and .(not allowed to saliva to be in contact or blood

:hardening (3
when the material actually becomes hard ,still it's not completely set , it's just like amalgam ; it becomes hard after few minutes but you can't finish it or polish it immediately we need to wait 24 hours because the setting . reaction is not finish yet usually this material needs 24 hours or a little bit more it's hard ? yes but the setting reaction is not ) .( complete in this stage aluminium comes into contact with the acids and replaces calcium so instead of calcium bridges between the acid chains we will have aluminium this will leads to a harder material and this will lead to the hard set material so aluminium comes in removes calcium and .replaces it so initial setting involves calcium with the polyacid and the final setting involves aluminium with the .polyacid if you dehydrated any loss of water or if there is contamination with saliva which leads to removal of aliminuim ion for example this will comprimize the other
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stages of setting so you need to isolate the material very well (not dehydrated and not .( allowed to saliva to be in contact or blood

so there are stages the final cross-linked cement contains aluminium cross-linked within the polyacid chains , we've got some glass particles that have not reacted as well (not every single particle will react ) so the final cement will be a mixture doesn't happen with 10 miutes or two hours (this is a (( gradual process(it takes at least 24 hours so again any finishing or polishing should be delayed for 24 hours water here is the reaction medium , if we remove it the reaction will not proceed properly 3ashan haika we don't dehydrated , we don't try to dry up) the material while it's still setting , we need to maintain ( water inside so the reaction can proceed normally wojod el may eshi daroory jedan 7ata el tfa3ol ymshi) la2no el may howeh el wa9at yali b9eer feyo el tfa3ol ,, eza el nayeh enshalat w e7na bna-shef bel material , had be5ali el tfa3ol ma ymshi bshkl 9a7 w bel tali el material ma b9erelha set 9a7 w bel tali bt9eer da3efeh w shkelha ( 7ata mo mzbot Sodium fluoride didn't take part of the reaction , they are just ions present within the matrix or within the material ; that's why fluoride is not captured by anything , it's free to be released , this is what special about (GIC) , it's ability to release this fluoride another thing if for example if you went to a dentist and he placed a fluoride gel on your teeth , glass inomer is able to capture this fluoride and then later on after few days it's able to release it again this is called (recharging= it captures fluoride and can release it ) so it has the special ability to release fluoride (be recharged with fluoride and .release it
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back again over a long period of time (it can continue releasing fluoride for years but of coarse the intensity of release decreases gradually; it releases fluoride in high amount and quickly at the begining within the first few hours after setting and then gradually decreased if you eat or drink anything acidic (this will stimulate the release of even more fluoride because acid slightly attack the glass inomer surface filling this will lead to release of more fluoride so this material interacts with the oral environment by this way by releasing fluoride , capturing fluoride and releasing .( it again the gelation phase usually ends with (2-3 minutes) after you mix the material ; you can't manipulate the material (you can't keep adapting it to the cavity but it still not hard enough now within the next minute will start to become hard and this maturation or setting ,you can also call it maturation will go on many hours =24 hours if you try to finish and polish the material before the 24 hours it will be very weak it will start to chip and break down and part of this cavity will be deficient (no filling) so !!!! don't do that as i said usually setting finishes within 24 hour but it can . go on for 48 hours for several days so the glass particles that haven't reacted are surrounded . ( by silica in a matrix (polyacid cross-linked by aluminium -: properties when they invented the materials in early seventies (it wasn't like the current materials that we used ; the old material had to have a short working time or a long setting (time so they start to change percentage of certain components . to make it better and this goes on for all dental materials Improvements in dental materials are always (continuous

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The problem with GIC is that they aren't having aesthetics like composite due to their components. Pigments can be added to make different shades but still it's not our first choice.we use this material to restore anterior teeth but it doesn't have the same shade like enamel (it will give nice translucency of natural teeth ) that's why it's inferior to composite, appear opaque(dull). Not like composite which .(appears more natural (it's related to the glass component This material is sensitive to moisture so during setting(at the first five minute) we need to protect it from moisture contamination and from dehydration that's why when you finish placing the material after it set we need to place a barrier like bonding agent for example or a varnish (which is made of resin and alcohol) when you place it with a brush alcohol will evaporate and a layer will be on the top of GIC, this layer will prevent the material from dehydration or contamination and help the material set without any problem. If any contamination happens the material can be easily broken down because it's still weak and doesn't set properly and it's still immature so it can be .easily broken by abrasion or corrosion So after it fully sets there's a less chance to break down or (lose of the material (it will be stronger *:Fluoride release : it helps in (fighting bacteria (antibacterial agent inhabiting demineralization -

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Their action leads to re-mineralization by folding flouroapatite

* :Biocompatiblity
This material is biocompatible, it's well tolerated by surrounding structure like gingiva, buccal mucosa and the tongue when it comes in contact with them there's no damage but the problem is because it contains acid before it starts to completely set it's acidic and it will take some time to become neutral, so if your cavity is very deep it might be a good idea to place a liner to protect the pulp .from this acid It might cause sensitivity because of it's initial acidity and .take some time(few hours) to rise the PH

:Thermal expansion
It has a moderate strength, low tensile strength so its a brittle material in terms of thermal expansion it's similar to enamel and dentine so there's no danger of microleakage around it or percolation and it will expand and contract .similarly not like composite or amalgam : Now in terms of powder : liquid ratio If you decrease the P:L ratio the cement will be less viscous and more flowable which will increase it's solubility,so you should not do that with your own. So if you want the material to be more viscous you can control this P:L ratio but there are available materials in the market that are available as cementing agent " the P:L ration is already set",materials that are restorative which are more viscous and there is also a restorative material .which is highly viscous So you can play with the P:L ratio a little bit(to some degree) but if it's increase or decrease this will lead to a weaker material

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Done by : Raya Hijazi Forgive me for any mistake...Good luck all Thank you my twini Lamees Nimri for helping me in this script ma knt b3raf sho ra7 a3mal mn donek (Really thanx <3 <3 <3 (te rash rash

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