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ข้อดี 1. ลด shrinkage 2. bond ในตำแหน่ง root dentin ได้ดีกว่า adhesive 3. ปลดปล่อย F Close sandwich - F release สู่ oral environment จะลดลง แต่มีข้อดีในแง่ esthetic, wear resistance

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There is some evidence that they maybe associated with a reduced incidence of secondary caries (Randall RC . J Dent Res 1999)

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RMGIC have been characterized as having a longer working time, a rapid set, improved esthetic appearance and translucency, and higher early strength

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Glass Ionomer in Contemporary Restorative Dentistry By Rooj Rojasawasthien. DDS, MSc. 16 August 2010

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

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

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

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Mixing - Shiny, Glossy Phase I (Ion-leaching phase) Polyacid extracts ions from glass powder

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Fully set Glass Ionomer

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

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Advantages Adhere chemically to enamel and dentin (hydrophilic)

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

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

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Disadvantages Wear rate Tensile strength

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

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Classification Self-cure glass ionomer Conventional glass ionomer Fuji II lining (GC Co., Japan) Ketac Fil Plus (3M ESPE, USA) Ketac Cem

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

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

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Development of Glass Ionomer

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

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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)

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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

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RMGI products Luting agent

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RMGI products Liner / Base

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RMGI products Composite bonding agent Fuji Bond LC

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RMGI products Restorative buildup

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RMGI - Restorative GC Fuji II LC Dentin conditioner 3M Vitremer, Ketac Nano Primer 10% Polyacrylic acid 46% HEMA 39% Ethyl alcohol 15% Polyacrylic acid Photoinitiator

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RMGI - Restorative Rinse Do not Rinse

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

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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. (Fagundes et al., 2009)

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Clinical using of RMGI – Class V

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Clinical using of RMGI – Class V

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Clinical using of RMGI – Class V Onal & Pamir, 2005 Vitremer Compomer Composite

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

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

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Clinical using of RMGI – Root caries

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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)

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Clinical using of RMGI – Sandwich tech. Liebenberg , 2005

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Clinical using of RMGI – Sandwich tech. Liebenberg , 2005

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Clinical using of RMGI – Sandwich tech.

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Clinical using of RMGI Secondary caries

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

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

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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

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Thank You

Summary: Resin modified glass ionomer cement in dentistry

Tags: dentist resin modified glass ionomer cement using

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