Tooth Preparation

Tooth preparation refers to the mechanical alteration of a defective, injured, or diseased tooth to best
receive a restorative material that re-establishes normal form and function. The process involves removing
the diseased or structurally compromised portion while preserving as much healthy tooth structure as
possible.

Classification of Tooth Preparation

Tooth preparations are classified based on their location and extent of caries or defects:

1. Conventional Preparations

o Used for amalgam, cast metal, and ceramic restorations.

o Involves precise and uniform steps to create appropriate walls and depths.

2. Modified Preparations

o Used for adhesive restorations (e.g., composite resins).

o Focuses on defect removal with minimal removal of sound tooth structure.

Principles of Tooth Preparation

I. Initial Stage

This stage includes:

1. Outline Form and Initial Depth

o Establishing the outer shape and depth of the preparation.

o Removing the carious lesion and unsupported enamel.

o Extending preparation to areas accessible for cleaning.

o Factors influencing outline form:

 Extent of caries or defect.

 Restorative material to be used.

 Occlusal stress and aesthetic considerations.

2. Resistance Form

o Design features that allow the restoration and remaining tooth to withstand forces of
mastication.

o Key considerations:

 Flat pulpal and gingival floors perpendicular to occlusal forces.

 Adequate bulk of restorative material.

  Rounded internal line angles to reduce stress.

3. Retention Form

o Design elements to resist displacement of the restoration.

o Examples:

 Mechanical undercuts.

 Grooves or slots for amalgam.

 Micro-mechanical bonding for composite.

4. Convenience Form

o Modifications to access and visibility for instrumentation and material placement.

II. Final Stage

This stage focuses on finishing the preparation and includes:

1. Removal of Remaining Carious Dentin

o Achieved after the initial preparation using excavators or low-speed handpieces.

2. Pulp Protection (if required)

o Use of liners or bases to protect the pulp in deep preparations.

3. Secondary Resistance and Retention Features

o May include grooves, slots, bevels, or occlusal dovetails.

4. Finishing of External Walls

o Refinement of cavosurface margins to provide optimal adaptation of restorative material.

o For adhesive materials: enamel beveling enhances bonding.

5. Cleaning and Inspection

o Removal of debris and drying of the preparation to ensure no loose particles interfere with
bonding or adaptation.

Types of Tooth Preparation

1. Class I: Pits and fissures on occlusal, facial, or lingual surfaces.

2. Class II: Proximal surfaces of posterior teeth.

3. Class III: Proximal surfaces of anterior teeth without involving the incisal edge.

4. Class IV: Proximal surfaces of anterior teeth involving the incisal edge.

5. Class V: Gingival third of facial or lingual surfaces.

6. Class VI: Cusp tips or incisal edges.

Factors Influencing Tooth Preparation

1. Extent of the Carious Lesion

o Determines the size and depth of the preparation.

2. Restorative Material

o Amalgam requires mechanical retention, while composite relies on bonding.

3. Tooth Anatomy and Occlusion

o Preservation of cusps and marginal ridges is critical.

4. Aesthetic Requirements

o Especially important for anterior teeth.

5. Patient-Specific Factors

o Age, oral hygiene, and salivary flow influence preparation design.

Conclusion

Tooth preparation is a balance between removing diseased tissue and preserving as much healthy tooth
structure as possible. Each step and design feature ensures the success and longevity of the restoration
while minimizing damage to the tooth.

Dimensions of a Class II Cavity Preparation

The dimensions of a Class II cavity preparation vary depending on the restorative material (e.g., amalgam or
composite resin) and the specific case requirements. However, according to Sturdevant's Art and Science of
Operative Dentistry, general guidelines for dimensions are provided to ensure proper retention, resistance,
and longevity of the restoration.

1. Occlusal Portion Dimensions

 Depth:

o Amalgam: 1.5–2 mm from the cavosurface to the pulpal floor. This ensures sufficient bulk for
strength.

o Composite Resin: Can be shallower (around 1.5 mm) due to adhesive bonding.

 Width: Approximately 1/4th the intercuspal distance. The preparation should avoid excessive cusp
reduction to maintain strength.
2. Proximal Box Dimensions

 Buccolingual Width:

o Should be wide enough to ensure caries removal and access but no wider than necessary to
preserve tooth structure.

o Typically ranges between 1.5–2 mm.

 Gingival Floor:

o Should be 1.0–1.5 mm wide and placed just below the contact area to break the contact
with the adjacent tooth.

o Extend gingivally to sound tooth structure, but avoid excessive extension.

 Axial Depth:

o For amalgam: 1.5–1.7 mm at the gingival floor to ensure sufficient bulk.

o For composite: Can be as shallow as 1.0 mm due to its adhesive properties.

3. Cavosurface Margins

 Amalgam: Should meet the external tooth surface at a 90° angle to ensure maximum strength (butt
joint).

 Composite Resin: Margins can be beveled (typically 0.5 mm at a 45° angle) on enamel to enhance
bonding and aesthetics.

4. Retentive Features

 Retention grooves or coves may be placed at the axiobuccal and axiolingual line angles if additional
retention is required, especially for amalgam restorations.

 These grooves are placed within the dentin, approximately 0.5 mm deep and wide.

Summary of Key Dimensions

Feature Amalgam Composite Resin

Occlusal Depth 1.5–2 mm 1.5 mm (minimum)

Buccolingual Width ~1.5–2 mm ~1.5 mm

Axial Depth 1.5–1.7 mm 1.0–1.5 mm

Gingival Floor Width 1.0–1.5 mm 1.0 mm (minimum)

Cavosurface Margin 90° butt joint Bevel on enamel (0.5 mm, 45°)
Clinical Note

 Dimensions must always be modified based on individual case factors such as the extent of caries,
occlusion, and the restorative material used.

 Avoid overextension or excessive tooth structure removal to ensure preservation and reduce the
risk of fractures.

Wedging Techniques and Applications

Wedging is an essential step in restorative dentistry, particularly for Class II cavity preparations, to achieve
proper isolation, contouring, and contact in the proximal area. According to Sturdevant's Art and Science of
Operative Dentistry, wedging is crucial for separating teeth slightly, stabilizing the matrix, and protecting
the adjacent tooth during preparation and restoration.

Objectives of Wedging

1. Protection: Prevent damage to the adjacent tooth during cavity preparation.

2. Separation: Achieve slight separation of teeth to compensate for the thickness of the matrix band
and ensure proper proximal contact in the final restoration.

3. Matrix Stabilization: Secure the matrix band to avoid displacement during restoration.

4. Gingival Retraction: Retract gingival tissues to improve access and visibility for restorations
extending to the gingival margin.

Types of Wedges

Wedges are made from various materials and come in different shapes and sizes to suit the clinical
scenario:

1. Wooden Wedges

o Most commonly used.

o Provide firm separation and adapt well to the gingival contour.

o Can absorb moisture, causing slight expansion, which improves retention.

2. Plastic Wedges

o More flexible and less likely to damage soft tissues.

o Often used with composite restorations.

3. Pre-wedging Systems

o Include spring-loaded or self-adjusting wedges.

 o Designed for easy placement and consistent separation.

4. Transparent Wedges

o Used with light-cured composite resins to allow light transmission through the wedge.

1. Single Wedge Technique

Definition

 Involves using a single wedge placed in the gingival embrasure.

 Most commonly used in standard proximal restorations where minimal adjustment is needed.

Applications

 Class II cavities with well-defined gingival embrasures and close proximity between teeth.

 Stabilizes the matrix band and separates teeth slightly to restore proper contact.

Advantages

 Simple and quick to implement.

 Effective in cases with normal embrasure contours and contact points.

Disadvantages

 May not adapt well to large gingival embrasures or irregular contours.

 May be insufficient in cases requiring additional stabilization or retraction.

2. Double Wedging Technique

Definition

 Involves placing two wedges on opposite sides of the proximal box, typically one from the buccal
side and another from the lingual side.

Applications

 Wide gingival embrasures or proximal boxes with uneven contours.

 Cases where single wedge placement does not provide adequate seal or matrix stabilization.

Advantages

 Ensures complete adaptation of the matrix band to the gingival margin.

 Provides enhanced stabilization and better control of gingival tissue.

Disadvantages

 May be challenging to place in tight interproximal spaces.

 Can risk damage to gingival tissues if excessive pressure is applied.

3. Piggy-Back Wedging Technique

Definition

 Involves placing one wedge over another in the same embrasure.

 The second wedge enhances the first wedge's effectiveness by increasing separation or stabilization.

Applications

 Deep gingival margins or wide proximal spaces.

 When a single wedge fails to achieve proper separation or matrix stabilization.

Advantages

 Provides additional separation force for broad contact areas.

 Can compensate for wedge deformation in deep cavities.

Disadvantages

 May be uncomfortable for the patient due to increased pressure.

 Requires careful placement to avoid excessive force on the gingival tissue.

4. Wedge-Wedging Technique

Definition

 Involves inserting one wedge first and then placing a second wedge at a slightly different angle or
position within the same embrasure.

 The wedges work together to optimize adaptation and seal.

Applications

 Irregular gingival contours or proximal boxes with complex shapes.

 Where additional stabilization of the matrix band is required.

Advantages

 Offers precise control over the adaptation of the matrix band.

 Useful in cases of difficult gingival tissue retraction.

Disadvantages

 Technically demanding and time-consuming.

 Increased risk of gingival trauma if not placed carefully.

Comparison of Techniques
Technique Key Feature Applications Advantages Disadvantages

One wedge in Standard proximal Limited for wide or

Single Wedge Simple, quick
embrasure restorations irregular spaces

Double Buccal and lingual Wide embrasures, Better stabilization Harder to place in tight
Wedging wedges uneven contours and adaptation spaces

Piggy-Back Two wedges Deep margins, wide Additional separation May increase
Wedging stacked vertically proximal spaces force discomfort

Wedge- Two wedges at Irregular gingival Precise adaptation

Technically demanding
Wedging different angles contours and seal

Clinical Tips for Wedging Techniques

1. Wedge Selection: Choose wedges of appropriate material (e.g., wood, plastic) and size to match the
clinical scenario.

2. Placement Angle: Insert the wedge from the side with a larger embrasure (usually buccal) for easier
placement.

3. Force Control: Apply gentle pressure to avoid tissue trauma while ensuring a secure fit.

4. Check Adaptation: Verify that the matrix band is properly stabilized and adapted to the gingival
margin after wedging.

Applications of Wedging

1. Class II Restorations

o Separates the teeth to ensure proper proximal contact in the final restoration.

o Prevents overhanging margins at the gingival floor.

2. Protection of Adjacent Teeth

o Pre-wedging shields the adjacent tooth surface during cavity preparation and prevents
iatrogenic damage.

3. Matrix Band Stabilization

o Ensures the matrix band remains in position during placement and condensation of the
restorative material.

4. Improved Access to Gingival Margins

o Retracts gingival tissues to allow better visualization and instrumentation.

5. Minimization of Post-Operative Sensitivity

o Proper wedging aids in achieving a tight seal and reducing microleakage.

6. Orthodontic Applications

o Used to create space between teeth for band placement or orthodontic separators.
Clinical Considerations for Wedging

 Size Selection: Choose a wedge size that fits snugly in the embrasure without causing excessive
pressure.

 Adaptation: Ensure the wedge adapts well to the gingival contour without distorting the matrix
band.

 Direction of Insertion: Insert wedges from the larger embrasure, typically from the buccal side, for
easier placement.

 Tissue Protection: Avoid damaging the gingival tissue during wedge insertion and removal.

Instruments Used in Operative Dentistry

Operative dentistry involves the diagnosis, prevention, and treatment of defects in enamel, dentin, and
cementum to restore normal function and aesthetics. The instruments used are classified into hand
instruments and rotary instruments. According to Sturdevant's Art and Science of Operative Dentistry,
these instruments are systematically designed for efficiency and precision.

1. Hand Instruments

Classification

Hand instruments are broadly categorized based on their function:

A. Cutting Instruments

1. Chisels

o Types: Straight chisel, Wedelstaedt chisel, Bin-angle chisel.

o Uses: Planing walls, sharpening line angles, and trimming enamel margins.

2. Hoes

o Uses: Smoothen and refine the floor of a cavity preparation.

3. Hatchets

o Uses: Cutting and planing enamel and dentin walls.

o Special Features: Blade aligned with the handle for controlled cutting.

4. Gingival Margin Trimmers (GMTs)

o Uses: Beveling gingival margins in Class II cavities.

 o Variants: Mesial (distal cutting edge facing outward) and distal (mesial cutting edge facing
inward).

B. Non-Cutting Instruments

1. Explorers

o Uses: Detect caries, calculus, and irregularities in restorations.

2. Probes

o Uses: Assess periodontal health by measuring pocket depth.

3. Condensers (Pluggers)

o Uses: Compress restorative material into cavity preparations.

o Variants: Flat-faced and serrated condensers.

4. Burnishers

o Uses: Polish restorations, contour margins, and remove excess material.

o Types: Ball, football, and beavertail burnishers.

5. Amalgam Carvers

o Uses: Shape and contour amalgam restorations.

o Examples: Hollenback carver, Cleoid-discoid carver.

6. Plastic Filling Instruments (PFIs)

o Uses: Place and shape composite resins or glass ionomers.

2. Rotary Instruments

Classification

Rotary instruments are powered devices used for cutting, shaping, and finishing tooth structures and
restorations.

A. Handpieces

1. High-Speed Handpieces

o Uses: Rapid cutting of enamel and dentin during cavity preparation.

o Features: Rotational speed of 200,000 to 500,000 rpm.

2. Low-Speed Handpieces

o Uses: Polishing, finishing, and caries excavation.

o Features: Rotational speed of 5,000 to 40,000 rpm.

B. Burs

Rotary cutting instruments attached to handpieces for specific purposes.

 1. Carbide Burs

o Uses: Cutting, cavity preparation, and removal of old restorations.

o Shapes: Round, inverted cone, pear-shaped, straight fissure, tapered fissure.

2. Diamond Burs

o Uses: Smoothing and contouring tooth surfaces and restorations.

o Features: Abrasive coating for efficient cutting.

3. Polishing Burs

o Uses: Polishing restorations and teeth for a smooth finish.

o Materials: Rubber, silicon carbide, or felt.

3. Instruments for Isolation and Matrix Placement

Rubber Dam Kit

1. Rubber Dam Sheet

o Isolates the operating field.

2. Punch

o Creates holes for teeth in the dam.

3. Clamp and Forceps

o Secures the dam around the teeth.

4. Frame

o Maintains the rubber dam’s tension.

Matrix Systems

1. Tofflemire Retainers and Bands

o Provides a temporary wall for Class II restorations.

2. Sectional Matrices

o Used for composite restorations with tight contacts.

4. Finishing and Polishing Instruments

1. Finishing Strips

o Uses: Smooth proximal surfaces of restorations.

2. Polishing Points and Cups

o Uses: Polishing amalgam, composite, and glass ionomer restorations.

 3. Discs and Wheels

o Uses: Contouring and polishing restorations.

5. Diagnostic Instruments

1. Mouth Mirror

o Uses: Indirect vision, tissue retraction, and light reflection.

2. Explorers

o Uses: Detect caries and surface irregularities.

6. Miscellaneous Instruments

1. Scalers and Curettes

o Uses: Remove calculus and subgingival deposits.

2. Articulating Paper Holder

o Uses: Check occlusal contacts in restorations.

3. Suction Tips

o Uses: Maintain a dry field during procedures.

Conclusion

Each instrument in operative dentistry is designed for a specific function to enhance efficiency and
precision. Mastery of their usage and understanding their applications is essential for successful restorative
outcomes.

Let me know if you need details on specific instruments or procedures!

4o

You said:

Matricing

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Matricing in Operative Dentistry

Matricing is the technique of placing a matrix band or system to create a temporary wall around the
prepared cavity. This allows the placement, shaping, and contouring of restorative materials, particularly in
Class II, III, and IV restorations.

According to Sturdevant's Art and Science of Operative Dentistry, matricing ensures proper restoration
contour, establishes proximal contact, and confines the material during placement.
Functions of a Matrix

1. Provides a temporary wall for restorative material placement.

2. Ensures proper anatomical contour of the restoration.

3. Maintains tight proximal contact.

4. Prevents overhangs and aids in condensation of the material.

5. Protects adjacent teeth from damage during restoration.

Types of Matrix Systems

1. Tofflemire Matrix System

 Components: Retainer and a matrix band.

 Bands: Pre-contoured or flat stainless-steel bands.

 Uses: Primarily for Class II amalgam restorations.

Technique:

1. Select the appropriate band size and shape.

2. Secure the band in the Tofflemire retainer.

3. Position the band around the tooth and tighten the retainer.

4. Ensure the band extends 1–2 mm above and below the margins.

Advantages: Simple, reusable, and effective for amalgam.

Disadvantages: Limited adaptation to certain tooth contours.

2. Sectional Matrix System

 Components: Sectional band, ring, and wedge.

 Uses: Composite restorations in Class II cavities with tight proximal contact.

Technique:

1. Place the sectional matrix band between the prepared tooth and adjacent tooth.

2. Secure with a sectional ring.

3. Insert a wedge for proper adaptation and sealing.

Advantages: Superior contour and tight proximal contact.

Disadvantages: Complex setup and higher cost.

3. Circumferential Matrix System

  Similar to the Tofflemire but can be used for teeth with missing cusps or extended cavities.

Advantages: Offers full circumferential coverage.

Disadvantages: More challenging to adapt and secure.

4. Clear Mylar Matrix System

 Material: Clear plastic strips.

 Uses: Class III and IV composite restorations.

Technique:

1. Place the strip interproximally and secure with a wedge.

2. Adapt the strip for anatomical contouring.

Advantages: Allows light curing through the strip.

Disadvantages: Limited strength and adaptability for larger restorations.

5. Automatrix System

 Components: Pre-contoured metal bands without a retainer.

 Uses: Teeth with larger or irregular preparations.

Technique:

1. Position the band around the tooth.

2. Tighten with a special wrench.

Advantages: Retainer-less system improves access.

Disadvantages: Costly and single-use.

6. Bioclear Matrix System

 Material: Preformed clear matrices.

 Uses: Modern composite restorations for ideal anatomical contouring.

Advantages: Enhanced aesthetics and contact point formation.

Disadvantages: Requires specific training and higher cost.

Accessories Used in Matricing

1. Wedges

 Material: Wood, plastic, or silicone.

 Purpose:
 o Ensure tight gingival seal.

o Prevent overhangs.

o Separate adjacent teeth slightly for tight proximal contacts.

 Types:

o Single wedge: Used in simpler restorations.

o Double wedge: Two wedges placed for wide preparations.

o Piggyback wedge: One wedge over another to improve gingival seal.

2. Retainers

 Devices like Tofflemire retainer or sectional ring to secure the band.

Advantages of Proper Matricing

1. Prevents overhangs and ensures marginal integrity.

2. Maintains proper anatomical contour.

3. Aids in material placement and curing.

Challenges in Matricing

1. Poor band adaptation can lead to overhangs or voids.

2. Improper wedge placement may result in gingival irritation.

3. Difficulty in achieving tight contacts in large or irregular cavities.

Introduction

Glass ionomer cement (GIC) is a self-adhesive restorative material. Chemically, it combines fluoro-
aluminosilicate glass powder and polyacrylic acid liquid. GIC has a broad spectrum of restorative adult and
pediatric dentistry uses and exhibits potent anti-cariogenic action.

GIC was first described by Wilson and Kent in 1972 and has evolved gradually to improve its properties and
broaden its uses. GIC is used for the cementation of fixed dental prosthesis (FDPs), orthodontic bands, and
brackets, to restore carious and noncarious lesions, and as liners or bases, core build-up material, pit and
fissure sealant, and for atraumatic restorative techniques (ART).

Function

Composition
  Supplied as a powder-liquid system, mixed manually.

o Powder: Fluoro-aluminosilicate glass.

o Liquid: Aqueous solution of polyacrylic acid copolymerized with carboxylic acid, maleic,
tartaric, and itaconic acid to regulate viscosity and stabilize the liquid.

o Liquid exhibits thixotropic behavior.

 Other supply options include capsules, twin syringes, and single-bottle water-settable form (freeze-
dried polyacrylic acid added to GIC powder).

Manipulation

 Mixing: Performed with an agate spatula (not stainless steel).

o Follow manufacturer-recommended powder-to-liquid proportions.

o Powder is divided into two equal increments.

o First increment is mixed using a folding motion for 15 seconds.

o Second increment adjusts consistency. Mixture should have a glossy surface.

 Capsule Activation: Vibrated in an auto-mixer, resulting in a mixed GIC paste ready for clinical use.

Preparation and Restoration of the Tooth

1. Cleaning: Apply a pumice slurry to the tooth surface with a prophy cup.

2. Conditioning: Apply 10% polyacrylic acid for 10 seconds to increase surface energy and wettability.

3. Placement: Carry mixed GIC to the cavity with a cement carrier and adapt using a condenser.

4. Protection: Cover setting cement with a matrix band initially, followed by varnish, cocoa butter, or
vaseline.

5. Finishing and Polishing:

o Initial finishing: Remove excess with a sharp instrument.

o Final finishing: Performed after 24 hours.

Mechanism of Setting

1. Dissolution and Decomposition: Acid dissolves glass particles, releasing SiO44-, Ca2+, Na+, and F-
ions.

2. Initial Setting: Ca2+ reacts with polyacrylic acid, forming a 3-dimensional cross-linked structure.

3. Final Setting:

o SiO44- forms silica gel.

o Al3+ ions cross-link polyacrylic acid chains, increasing cement strength.

4. Maturation: Aluminum and calcium cross-linked polyacrylate chains hydrate over time.

Role of Water
  Water constitutes 11% to 24% of the set cement.

 Roles:

o Initial phase: Reaction medium.

o Later phase: Mediates slow hydration of cross-linked chains.

 Avoid exposure to ambient air or water contamination to prevent weakening of cement. Coat
restoration surface immediately after placement.

Indications

Restorative Material

 Popular in pediatric restorations.

 Indicated for restoring permanent teeth in low stress-bearing areas (Class III and V lesions).

 Material of choice for patients with high caries risk.

Luting Agent

 Used to lute indirect restorations, posts, cores, and orthodontic bands and brackets.

Pulp Protection

 Used as a liner or base beneath metallic and composite restorations (sandwich technique).

Pit and Fissure Sealant

 Temporary sealants in newly erupted permanent teeth.

 Comparable caries prevention to resin-based sealants.

Atraumatic Restorative Technique (ART)

 Minimally invasive procedure using hand instruments without anesthesia.

 Performed where routine dental treatment is inaccessible.

Issues of Concern

Mechanism of Bonding

 Chemically (ionic) bonds to tooth structure.

 Bonds better to enamel than dentin due to higher inorganic content.

 Chelation reaction: Carboxyl groups of polyacrylic acid with calcium in hydroxyapatite crystals.

Fluoride Release

 Fluorides added to GIC powder during manufacture.

 Mechanisms of fluoride release:

 1. Short-term dissolution of fluorides from outer surface.

2. Continuous diffusion of fluoride through cement.

 Influencing factors:

o Intrinsic: Matrix composition, setting mechanism, fluoride content.

o Extrinsic: Saliva pH, plaque, pellicle formation, liquid-to-powder ratio, mixing and curing
time, surface area exposure.

 Surface coverage reduces fluoride release.

Anticariogenic Action

 Mechanisms:

o Decreased demineralization.

o Increased remineralization.

o Hydroxyapatite conversion to fluorapatite.

o Inhibition of enolase enzyme.

 Sustained fluoride release prevents secondary caries.

Biological Activity

 Biocompatible and bioactive.

 Mild pulp response due to:

1. Rapid pH rise within 20 minutes.

2. High molecular weight of polyacrylic acid prevents deep penetration into dentinal tubules.

 No pulpal protection needed if remaining dentinal thickness exceeds 1 mm.

Mechanical Properties

 Compressive strength: Comparable to zinc phosphate cement.

 Tensile strength: Higher than zinc phosphate cement.

 Type I GIC has lower compressive strength than Type II GIC.

 Resilience: Similar to dentin.

 Powder-to-liquid ratio affects mechanical properties:

o Higher powder content increases consistency and strength.

o Over-limit powder content compromises binding and mechanical properties.

Physical Properties

 Thermal expansion coefficient: Similar to enamel and dentin.

 Thermal diffusivity: Similar to dentin, providing pulp insulation.

  Solubility: Higher than zinc phosphate and zinc polycarboxylate.

 Tooth-colored, but not suitable for anterior teeth restoration.

Classification of Glass Ionomer Cement (GIC)

Classification Based on Application:

 Type I: Luting cement used for cementation of crowns and bridges

 Type II: Restorative cement used for aesthetic fillings

 Type III: GIC used as liners and bases

 Type IV: GIC used as pit and fissure sealants

 Type V: GIC used for orthodontic cementation

 Type VI: GIC used for core build-up in highly mutilated teeth

 Type VII: Fluoride-releasing light-cured GIC

 Type VIII: GIC for atraumatic restorative treatment (ART)

 Type IX: GIC used for pediatric and older adult restorations

Classification Based on Generations and Modifications:

First Generation:

 Developed due to poor clinical performance of silicate cement.

 ASPA I (aluminosilicate polyacrylic acid) was the first glass ionomer with sluggish setting and
moisture sensitivity.

 ASPA II, created by adding d-tartaric acid, improved translucency and performance.

Second Generation:

 Polyacid added to powder for easier mixing with water or tartaric acid solution.

 Enhanced shelf life, decreased viscosity, and improved strength.

Reinforced Cement:

 Conventional GICs are suitable for low-stress areas, but their tensile strength (7 to 12 MPa) is
inadequate for high-stress-bearing situations.

 Methods to improve strength:

1. Dispersed Phase Glasses: Strengthened by adding aluminum oxide, titanium oxide,

zirconium oxide.

2. Fiber-Reinforced Glasses: Addition of fibers (e.g., alumina, glass, silica, carbon) increases
flexural strength.

3. Metal Reinforced GIC: A mixture of GIC and amalgam powder, known as "miracle mix."
 4. Cermet Ionomer Cement: Metal and glass powders sintered together for stronger bonds.

5. Highly Viscous Conventional GIC: Used in ART for high viscosity.

6. Resin-Modified GIC: GIC with added resins and photoinitiators for improved properties.

7. Amino Acid Modified GIC: Acrylic acid copolymers substituted with N-methacryloyl-glutamic
acid for improved fracture toughness.

Metal Modified GIC:

 Silver Alloy Admixed GIC: Includes silver alloy powder for enhanced mechanical properties.

 Cermet Mixture: Metal and glass particles sintered at high temperatures for stronger mechanical
properties.

Properties of Metal Modified GIC:

 Improved wear resistance compared to conventional GIC.

 Greater resistance to fracture but slightly less fluoride release.

 Reduced chemical bonding due to silver particles.

 Limited to primary dentition for high-stress areas.

Indications for Metal Modified GIC:

 Core build-up

 Class I cavities in primary teeth

Resin-Modified Glass Ionomer Cement:

 Hybrid ionomer created by adding resins (bisphenol A-glycidyl dimethacrylate or urethane

dimethacrylate) and photoinitiators to GIC.

 Composition:

o Powder: Fluoroaluminosilicate glass, light, and chemical initiators

o Liquid: Aqueous solution of polyacrylic acid and 10% 2-HEMA

 Setting Reaction: Dual-reaction curing mechanism involving acid-base and polymerization reactions.

 Structure: Core of unmixed powder particles and matrix of polyacid and HEMA polymer linked by
hydrogen bonding.

Properties of Resin-Modified GIC:

 Chemically bonds to the tooth but with reduced ionic activity.

 Fluoride release is less than conventional GIC.

 Better wear resistance, fracture toughness, and flexural strength than conventional GIC.

 Slight polymerization shrinkage.

 Indications:
 o Class V restorations

o Non-carious cervical lesions

o Primary teeth Class I and II restorations

o Base under composite restorations (sandwich technique)

Polyacid Modified Glass Ionomer (Compomer):

 A combination of composite resin and GIC, containing ion-leachable glass particles in the composite
matrix.

 Setting Mechanism: Light-induced polymerization, no acid-base setting reaction.

 Properties:

o Superior mechanical properties compared to conventional GIC but inferior to composite

resins.

o Reduced fluoride release compared to conventional GIC but improved esthetics.

o Bonds micro-mechanically to tooth structure, but lacks chemical bonding.

Indications for Compomer:

 Pit and fissure sealants

 Cementation of post and core

 Restoration of deciduous teeth

 Class III and V lesions

Clinical Significance of GIC:

 Known as "man-made dentin", GIC simulates dentin in modulus of elasticity, resilience, coefficient
of thermal expansion, and thermal conductivity.

 Chemically adheres to tooth structure, biologically compatible, and releases fluoride.

 Despite its properties, GIC’s usage is limited by reduced strength, abrasion resistance, and esthetics.

 GIC and its modifications are ideal for high-risk patients due to fluoride release and ability to bond
to dentin without removing the smear layer.

 Uses:

o Restorative Materials: For low-stress areas (Class V, III, and cervical restorations).

o Luting Agent: For crowns, fixed prostheses, space maintainers, orthodontic bands, and
brackets.

o Core Build-Up: Often preferred due to chemical adhesion properties.

o Fissure Sealants: Effective for preventive measures and caries prevention.

GICs and modified GICs continue to evolve, improving their versatility in various clinical scenarios.
1. First Generation (Acid-Etch Technique)

 Date Introduced: 1955

 Key Feature: Acid etching of enamel and dentin.

 Mechanism: The first generation used phosphoric acid to etch enamel, creating micro-porosities,
which were filled with resin to form a bond.

 Limitations: The bonding system was primarily effective on enamel and less effective on dentin. It
did not form durable bonds to dentin, leading to the development of newer generations.

2. Second Generation (Total Etch)

 Date Introduced: 1970s

 Key Feature: Acid-etching of enamel and dentin followed by a primer and adhesive resin
application.

 Mechanism: Acid etching was applied to both enamel and dentin, followed by a primer (hydrophilic)
and resin adhesive, leading to better adhesion to both substrates.

 Limitations: Dentin bonding was still not as reliable, especially in the long term, due to the presence
of water in the dentin, leading to bond degradation.

3. Third Generation (Etch-and-Rinse)

 Date Introduced: Late 1980s

 Key Feature: Separate application of etchant, primer, and adhesive resin.

 Mechanism: The etching, priming, and bonding steps were performed separately, which improved
dentin bonding by more thoroughly conditioning the dentin surface.

 Limitations: The multiple steps increased the complexity of the technique and the potential for
technique sensitivity. The bonds were still prone to degradation over time.

4. Fourth Generation (Etch-and-Rinse, 2-Step)

 Date Introduced: Early 1990s

 Key Feature: Two-step system: etching followed by priming and bonding.

 Mechanism: The bonding system was simplified into two steps, combining the priming and bonding
agents, leading to more reliable and durable bonds to both enamel and dentin.

 Limitations: The system still required the separate application of etching and bonding agents, which
added steps and increased technique sensitivity, particularly in moist conditions.

5. Fifth Generation (Self-Etch, 2-Step)

 Date Introduced: Late 1990s

 Key Feature: Self-etching primers combined with bonding agents.

  Mechanism: The etching and priming steps were combined into a single step, where a self-etching
primer was applied followed by the adhesive resin. This simplified the procedure and reduced
technique sensitivity.

 Limitations: While easier to use, the bonding to enamel was weaker compared to etch-and-rinse
systems. Some concerns about the long-term durability of bonds, especially on dentin, persisted.

6. Sixth Generation (Self-Etch, 1-Step)

 Date Introduced: Early 2000s

 Key Feature: All-in-one self-etching system.

 Mechanism: A single bottle contained both the etching and bonding agents, making it simpler to
apply. The system also used acidic monomers that demineralize and bond to dentin and enamel in
one step.

 Limitations: The bonding to enamel was still weaker than with etch-and-rinse systems, and there
was some concern about the potential for incomplete etching or bonding to dentin.

7. Seventh Generation (Universal Bonding Agents)

 Date Introduced: Late 2010s

 Key Feature: Universal bonding agents that can be used in self-etch, etch-and-rinse, or selective
etching techniques.

 Mechanism: These agents offer versatility in application. They contain both hydrophilic and
hydrophobic components, allowing them to bond to enamel, dentin, and even ceramics, as well as
metal surfaces.

 Limitations: While more versatile, some concerns remain regarding the long-term bond stability and
the complexity of certain techniques.