Hypermineralization of Dentinal Lesions Adjacent to Glass-ionomer Cement Restorations In situ anticariogenic potential of glass ionomer cement. Influence of Fluoride-Releasing Restorative Material on Root Dentine Secondary Caries in situ Effectiveness of a glass ionomer cement used as a pit and fissure sealant in recently erupted permanent first molars. Inhibition of demineralization adjacent to tooth-colored restorations in primary teeth after 2 in vitro challenges. Clinical evaluation of three restorative materials applied in a minimal intervention caries treatment approach. Retention and caries preventive effects of a GIC and a resin-based fissure sealant. Chemical exchange between glass-ionomer restorations and residual carious dentine in permanent molars: an in vivo study. Caries-preventive Effect of Supervised Toothbrushing and Sealants Evaluating the effects of fluoride-releasing dental materials on adjacent interproximal caries. Effect of glass-ionomer cement lining on postoperative sensitivity in occlusal cavities restored with resin composite--a randomized clinical trial. In vivo inhibition of demineralization around orthodontic brackets. A clinical comparison of glass ionomer, resin-modified glass ionomer and resin composite restorations in the treatment of cervical caries in xerostomic head and neck radiation patients. Demineralization around orthodontic brackets bonded with resin-modified glass ionomer cement and fluoride-releasing resin composite. Restoration of permanent teeth in young rural children in Cambodia using the atraumatic restorative treatment (ART) technique and Fuji II glass ionomer cement.
Previous reports have shown a release of fluoride from glass-ionomer cement ( GIC ) restorations into the oral fluids . Fluoride in the ambient fluids has a caries-preventive effect by enhancing remineralization and inhibiting demineralization of the dental hard tissues . Therefore , the current investigation was undertaken to determine whether GIC fillings could contribute to the remineralization of caries lesions in dentin . Small circular preparations were made in disks of dentin which had incipient caries-like lesions in the remaining tissue . The preparations were filled with amalgam or composite material s ( as controls ) or with GIC . The specimens thus contained a restoration close to a dentinal caries-like lesion . The specimens were placed contralaterally in the buccal surfaces of removable partial dentures and were worn intra-orally by volunteers for a 12-week experimental period , after which the specimens were sectioned and analyzed by microradiography . All specimens with GIC restorations exhibited hypermineralization in the tissue bordering the filling and in the wall of the preparation which had been in contact with the restoration . The ( caries-like ) lesions were remineralized , even under conditions of heavy plaque formation . In contrast , specimens with amalgam or composite restorations showed further extensive demineralization . This study demonstrates a significant remineralization potential exerted by the fluoride-releasing GIC restorative material . Consequently , the choice of the restorative material might be crucial for the occurrence or prevention of recurrent caries around restorations The purpose of this study was to compare the amount of fluoride in plaque formed on glass ionomer cement or composite and to evaluate the effects of fluoride released on growth of cariogenic microflora , fluoride uptake , and secondary caries formation under in situ conditions of a high cariogenic challenge . Ten adult volunteers took part in this crossover study performed in two phases of 28 days . Eighty enamel blocks were r and omly restored with glass ionomer cement ( Chelon-Fil-Espe ) or composite ( Silux ) . During each phase of the study , an acrylic resin appliance , containing four enamel blocks restored with the same material , was constructed for each of the volunteers . During the experimental period , all subjects used fluoride-free dentifrice , refrained from brushing the restored enamel blocks , and immersed the appliances into 20 % sucrose solution eight times a day . Fluoride levels , mutans streptococci , and lactobacilli were assessed in dental plaque . Fluoride uptake and microhardness profiles were determined in enamel around the restorations . Statistical analyses indicated a significantly higher level of fluoride ( p < 0.05 ) and a lower level of mutans streptococci plaque formed on glass ionomer cement . Analysis of variance in a split-plot model indicated that in the enamel around the glass ionomer restoration the fluoride uptake was significantly greater ( p < 0.025 ) and the mineral loss significantly lower ( p < 0.01 ) . The results show that glass ionomer cement presents a broad anticariogenic effect and may be of value in preventing secondary caries , even under conditions of a high caries risk The usefulness of fluoride-releasing restorations in  secondary caries prevention may be question ed because of the presence of other common sources of fluoride and because of ageing of the restorations . This study tested the hypothesis that glass-ionomer cement restorations , either aged or unaged , do not prevent secondary root caries , when fluoride dentifrice is frequently used . Sixteen volunteers wore palatal appliances in two phases of 14 days , according to a 2 × 2 crossover design . In each phase the appliance was loaded with bovine root dentine slabs restored with either glass-ionomer or resin composite , either aged or unaged . Specimens were exposed to cariogenic challenge 4 times/day and to fluori date d dentifrice 3 times/day . The fluoride content in the biofilm ( FB ) formed on slabs and the mineral loss ( ΔZ ) around the restorations were analysed . No differences were found between restorative material s regarding the FB and the ΔZ , for either aged ( p = 0.792 and p = 0.645 , respectively ) or unaged ( p = 1.00 and p = 0.278 , respectively ) groups . Under the cariogenic and fluoride dentifrice exposure conditions of this study , the glass-ionomer restoration , either aged or unaged , did not provide additional protection against secondary root caries PURPOSE This study 's purpose was to evaluate the caries-preventive effect of a glass ionomer cement ( GIC ) used as an occlusal sealant on recently erupted permanent first molars . METHODS A double-blind , r and omized , controlled , clinical trial was undertaken that included 36 5- to 8-year-olds ( and 92 permanent first molars ) who were r and omly allocated to the test group ( GIC ) or the control group ( auto-polymerized resin-based sealant [ RBS ] )  . The Mann-Whitney test was used to compare the number of new carious or filled occlusal surfaces in the 2 groups . RESULTS After 6 months , 1 occlusal surface in the test group and 2 occlusal surfaces in the control group showed carious lesions ( P=.15 ) . In the fifth year of follow-up , 2 occlusal surfaces in the test group and 7 occlusal surfaces in the control group were filled or carious ( P=.42 ) , and the mean number of sealed surfaces that became carious or filled was 0.2 ( 95 % confidence interval [CI]=0.02 - 0.70 ) for the GIC-sealed teeth and 0.6 ( 95 % CI=0.20 - 1.30 ) for the RBS-sealed teeth ( P=.30 ) . CONCLUSION High-viscosity glass ionomer cement can provide some level of protection against dental caries when used as a dental sealant in newly erupted permanent first molars PURPOSE As clinical diagnosis of secondary caries is the most common reason for restoration replacement , fluoride-releasing restorative material s have been developed to address this problem . The purpose s of this study were to verify demineralization inhibition produced by 5 restorative material s su bmi tted to two methods of in vitro cariogenic challenge and verify whether these methods influence material behavior by means of polarized light microscopy and microhardness . METHODS Class V cavities were prepared on buccal surfaces of 100 extracted primary molars and r and omly restored with 1 of the 4 fluoride-releasing material s , Fuji IX , Vitremer , Dyract , Tetric Ceram , and Filtek Z250 as control material ( N=10 ) . Specimens were su bmi tted to in vitro caries induction by two different methods , acid gel immersion , and pH cycling . Teeth su bmi tted to gel were then sectioned and prepared for polarized light microscopy in water , while teeth cycled were prepared for microhardness evaluation . RESULTS Polarized light microscopy : Means of demineralization areas ( microm(2 ) ) differed significantly , depending on the restorative material . Tukey 's test revealed the smallest demineralization areas adjacent to Fuji IX and Vitremer restorations , with no difference between them ( P>.05 ) . The greatest demineralization area mean values were verified using Dyract and Filtek Z250 , without differences between them ( P>.05 ) . Microhardness : Glass ionomer cements ( GICs ) performed better on the area of great cariogenic challenge , closer to the surface , than other material s indicating minor mineral loss during pH cycling . The compomer Dyract presented similar performance to GICs and composite resin Tetric Ceram , but it was better than Filtek Z250 . CONCLUSION The experimental model of caries lesion induction may influence material performance . GICs , however , are superior in preventing in vitro demineralization independently of the method OBJECTIVES This paper reports on a longitudinal evaluation of three material s ( glass ionomer , zinc oxide-eugenol cement , and composite ) employed in a minimal restorative intervention approach of 81 high caries-active pregnant women selected for a preventive oral health program in Brazil . The aim of the study was to evaluate the clinical behavior of the glass ionomer cement , currently indicated in programs for control of carious lesions . METHODS The patients were r and omly divided into two groups . Both groups were engaged in an oral health promotion approach . In Group 1 , 417 glass ionomer restorations were placed in 43 individuals , involving all types and sizes of cavities . In the second group , 213 posterior zinc oxide-eugenol ( ZOE ) restorations and 127 anterior composite restorations were placed in 38 patients . Minimal cavity preparations were made , in which only soft or infected dentin was removed , on the basis of clinical judgment . RESULTS After two years , the restorations were clinical ly evaluated by two examiners for marginal integrity , amount of wear , presence of fracture , carious lesions , and lost restorations . Statistical analysis ( chi-square test ) identified statistically significant difference between glass ionomer and ZOE ( 90.6 % vs 9.2 % ) . Comparing glass ionomer and composite , similar survival rates were observed . The success rate observed for the glass ionomer cement ranged from 77.1 percent to 92.5 percent , depending on the type and size of cavity in which it was applied . Four teeth restored with glass ionomer cement and one tooth restored with composite showed caries signs . Regarding the ZOE restorations , caries was always associated with other causes of failure such as excessive wear , restoration loss , or marginal defects , with no possibility of separate evaluation . Despite the preventive and therapeutic measurements employed , a mean increase of 2.15 new surfaces with cavities was observed in Group 1 , as well as 2.83 surfaces presenting the same status in Group 2 . CONCLUSIONS This study demonstrated that highly viscous glass ionomer cement applied in a minimal intervention approach provided high- quality preventive and restorative care after two years to a population at high risk for caries . The composite was employed in cavities exposed to lower stress , such as in the anterior teeth , and its behavior was comparable to that of the glass ionomer cement . The reinforced ZOE presented a high failure rate , thus contraindicating its use for such purpose Abstract Fissure sealing using partially filled resins is an established caries preventive practice . Glass ionomer cement ( GIC ) sealants may offer additional advantages due to their ability to bond chemically to enamel and release fluoride . The aim of this study was to compare the caries preventive effect and retention of a GIC and a resin-based sealant . Ketac-fil ® was tested against a chemically cured resin-based material ( Delton ® ) using a split mouth design . Perth ( Western Australia ) schoolchildren ( n= 465 ) , mean age 7 yr±0.72 ( S.D. ) , received sealants  on the occlusal surfaces of sound homologous permanent first molar pairs .  Test ( GIC ) and control ( resin ) sealants were systematic ally allocated to left and right sides based on the child 's month of birth , and were placed by dental therapists . After 3.64±0.11 yr , 415 children were examined by different clinicians , and the clinical status of the teeth and the extent of sealant retention recorded . Sealants were deemed retained when at least 2/3 of the fissure pattern was still sealed . In 252 tooth pairs , neither sealant was retained to this extent . In 71 pairs , the GIC was not retained and the resin sealant retained . In 40 pairs the reverse occurred ( McNemar 's test , χ2= 8.66 , P < 0.005 ) . Net gain ( additional lesions prevented by the test agent per 100 treatments ) was 6.1%(95 % CI 3.3 % , 8.9 % ) . Effectiveness of the GIC was 80.6 % ( 95 % CI 59.6 % , 90.7 % ) . The relative risk of caries in test teeth was 0.19 ( 95 % CI 0.09 , 0.40 ) . The study suggests that complete retention of GIC sealant is not necessary for caries prevention in newly erupted permanent first molars OBJECTIVE To evaluate the remineralization of carious dentine following the restoration of an extensive lesion in a permanent molar with a high strength glass-ionomer cement ( GIC ) .  MATERIAL S AND METHODS Thirteen first permanent molars , which were scheduled for extraction because of the presence of extensive caries lesions , were selected for this study . They were first restored , according to the ART technique , using encapsulated Fuji IX(GP ) , which contains a strontium glass rather than the traditional calcium glass . The cavities were prepared with a clean enamel margin and minimal removal of the carious dentine around the walls . After a period of 1 - 3 months they were harvested and subsequently sectioned and examined using an electron probe micro analysis ( EPMA ) and scanning electron microscopy ( SEM ) . RESULTS EPMA demonstrated that both fluorine and strontium ions had penetrated deep into the underlying demineralized dentine . The only possible source of these ions was the GIC restoration . CONCLUSION The pattern of penetration of the fluorine and strontium ions into the dentine was consistent with a remineralization process To investigate the effectiveness of 3 caries-preventive measures on high– and low – caries risk occlusal surfaces of first permanent molars over 3 y. This cluster-r and omized controlled clinical trial covered 242 schoolchildren , 6 to 7 y old , from low socioeconomic areas . At baseline , caries risk was assessed at the tooth surface level , through a combination of ICDAS II ( International Caries Detection and Assessment System ) and fissure depth codes . High – caries risk occlusal surfaces were treated according to daily supervised toothbrushing ( STB ) at school and 2 sealants : composite resin ( CR ) and atraumatic restorative treatment – high-viscosity glass-ionomer cement ( ART-GIC ) . Low – caries risk occlusal surfaces received STB or no intervention . Evaluations were performed after 0.5 , 1 , 2 , and 3 y. A cavitated dentine carious lesion was considered a failure . Data were analyzed according to the proportional hazard rate regression model with frailty correction , Wald test , analysis of variance , and t test , according to the jackknife procedure for calculating st and ard errors . The cumulative survival rates of cavitated dentine carious lesion – free , high – caries risk occlusal surfaces were 95.6 % , 91.4 % , and 90.2 % for STB , CR , and ART-GIC , respectively , over 3 y , which were not statistically significantly different . For low – caries risk occlusal surfaces , no statistically significant difference was observed between the cumulative survival rate of the STB group ( 94.8 % ) and the no-intervention group ( 92.1 % ) over 3 y. There was neither a difference among STB , CR , and ART-GIC on school premises in preventing cavitated dentine carious lesions in high – caries risk occlusal surfaces of first permanent molars nor a difference between STB and no intervention for low – caries risk occlusal surfaces of first permanent molars over 3 BACKGROUND The authors examined several restorative material s to evaluate their ability to inhibit demineralization and enhance remineralization of incipient carious lesions on the interproximal enamel of teeth adjacent to those restored with the material s. METHODS Twenty-one subjects in need of a crown on a m and ibular molar and a Class II inlay on an adjacent tooth took part in this six-phase study . Artificial enamel lesions were created and positioned within the interproximal portion of a crown . Lesions were photographed with polarized light microscopy and characterized before and after 30-day intraoral exposures . Each phase included the placement of a new section in the crown model and a new Class II inlay restorative material in the adjacent tooth . RESULTS Results demonstrated that nonfluori date d resin composite , fluori date d resin composite and resin-modified glass ionomer restorative material s , when placed in subjects who brushed with a fluori date d dentifrice , demonstrated significantly ( P < .05 ) less enamel demineralization than the nonfluori date d resin composite control placed in subjects who brushed with a nonfluori date d dentifrice . The resin-modified glass ionomer cement , however , even when brushed with a nonfluori date d dentifrice , exhibited significantly ( P < .05 ) less demineralization than the nonfluori date d resin composite control brushed with a nonfluori date d dentifrice . CONCLUSIONS Resin-modified glass ionomer cement appears to significantly inhibit demineralization of interproximal enamel of teeth adjacent to those restored with the material . CLINICAL IMPLICATION S Resin-modified glass ionomer cement restorations can enhance prevention of enamel demineralization on adjacent teeth This study investigated the ability of a glass-ionomer cement ( GIC ) lining to reduce postoperative sensitivity in occlusal cavities restored with resin composite . In addition , the effects of a total-etch and self-etch adhesive on postoperative sensitivity were also compared . Patients who had moderate to deep occlusal caries of at least one molar were recruited . Overall , 103 restorations were placed in 70 participants , with an average age of 22.8 + /- 3.8 years . Preoperatively , each tooth was evaluated for cold-stimulated tooth sensitivity using a visual analog scale . If present , tooth sensitivity induced by cold/hot drinks or occlusal function was also noted . Caries was stained with a caries detector dye , then removed using slow-speed burs and h and excavators . The cavity was restored with one of four r and omly allocated restorative procedures : 1 ) bonded with a two-step , total-etch adhesive ( Single Bond 2 ) ; 2 ) lined with a resin-modified GIC liner ( Fuji Lining LC ) , then bonded with total-etch adhesive ; 3 ) bonded with a two-step , self-etch adhesive ( Clearfil SE Bond ) and 4 ) lined with the GIC liner , then bonded with self-etch adhesive . The cavities were incrementally filled with a nanofilled hybrid resin composite . At recall , postoperative sensitivity was evaluated at one week and one month . Overall , postoperative sensitivity in daily function was rare . No significant difference in postoperative sensitivity , either in daily function or in response to a cold stimulus , was observed between the restorative procedures with or without the GIC liner , regardless of the adhesive used ( p > 0.05 ) . In addition , no difference in postoperative sensitivity was noted between use of the self-etch and total-etch adhesive Demineralization around orthodontic appliances is a problem . Suboptimal oral hygiene , long intervals between appointments , and potentially poor patient cooperation with using fluoride dentifrices and mouth rinses necessitate a compliance-free means of preventing tooth decay . The hypothesis of this study was that fluoride released by glass ionomer cement inhibits the formation of carious lesions around orthodontic brackets in vivo . Brackets were bonded on 2 first premolars in 21 r and omized , consecutively selected patients 11 to 18 years old . Eleven test-group subjects were bonded with fluoride-releasing glass ionomer cement , and 10 control subjects were bonded with composite resin ( no fluoride ) . The teeth were extracted after 4 weeks , sectioned , and evaluated quantitatively by cross-sectional microhardness testing . Fluoride levels in patient saliva were measured by the Taves diffusion method in sample s taken at days 0 ( baseline ) , 1 , 2 , 3 , 7 , 14 , 21 , and 28 to determine whether fluoride from the glass ionomer cement influenced the overall intraoral fluoride levels . The results demonstrated significantly more demineralization around the brackets of the control patients ( P < .01 , Wilcoxon signed rank test ) . For whole-mouth salivary fluoride levels , no significant overall difference between the groups ( P > .05 ) and no noticeable trend within groups ( P > .05 ) were found . These results indicate that using fluoride-releasing glass ionomer cement for bonding orthodontic brackets successfully inhibited caries in vivo . This cariostatic effect was localized to the area around the brackets and was statistically significant after 4 weeks Controversy exists as to whether there is less secondary caries at the margins of glass ionomer restorations compared with other material s that do not release fluoride . This study examined the incidence of secondary caries for three types of restorative material s in Class V restorations in xerostomic patients . The study group consisted of 45 high caries-risk adult patients who had undergone head and neck irradiation for the treatment of cancer . All were substantially xerostomic and in need of at least three restorations in the same arch . Every patient received a restoration with each of the test material s , a conventional glass ionomer ( GI ) , a resin modified glass ionomer ( RMGI ) and a resin composite ( C ) . Patients were instructed in the daily use of a neutral pH sodium fluoride gel in custom trays . Recall appointments were made at 6 , 12 , 18 and 24 months , and the restorations were examined for material loss , marginal integrity and recurrent caries at the restoration margin . Fluoride compliance was determined at each recall period and recorded as the percentage of recommended use during that interval . Patients were categorized at the end of the study as fluoride non-users if their average compliance was 50 % or less . Those with greater than 50 % compliance were categorized as fluoride users . In the latter group , no recurrent caries was found for any of the restorations , whereas a material -dependent incidence of recurrent caries was found in the fluoride non-user group . None of the GI , one RMGI and eight C restorations failed due to recurrent caries . For the fluoride non-user patients , Fishers exact test ( p=0.05 ) showed no statistical difference between GI and RMGI but statistical differences were found among those material s and resin composite at each recall period . Recurrent caries reductions for GI and RMGI relative to C were greater than 80 % in xerostomic patients not using topical fluoride supplementation PURPOSE Enamel demineralization adjacent to orthodontic brackets is one of the risks associated with orthodontic treatment . Glass ionomer cements have been shown to decrease enamel demineralization adjacent to brackets and b and s but do not exhibit bond strengths comparable to resin composites . The purpose of this in vitro study was to compare a fluoride-releasing resin composite versus a resin-modified glass ionomer cement for inhibition of enamel demineralization surrounding orthodontic brackets . METHODS Forty-five teeth were r and omly assigned to 3 groups of 15 teeth . Fifteen were bonded with Concise ( 3 M ) , a non-fluoride-releasing resin composite ( control ) ; 15 teeth were bonded with Light Bond ( Reliance ) , a fluoride-releasing resin composite ; and 15 teeth were bonded with Fuji Ortho LC ( GC Corporation ) , a resin-modified glass ionomer cement . The teeth were placed in an artificial caries solution to create lesions . Following sectioning of the teeth in a buccolingual direction , polarized light microscopy was utilized to evaluate enamel demineralization adjacent to the orthodontic bracket . The area of the lesion was measured 100 microns from the orthodontic bracket and bonding agent . RESULTS MANOVA ( P < .0001 ) and Duncan 's test ( P < .05 ) indicated the resin-modified glass ionomer cement ( Fuji Ortho LC ) and the fluoride-releasing resin composite ( Light Bond ) had significantly less adjacent enamel demineralization than the non-fluoride-releasing resin composite control . However , there was no significant difference between the resin-modified glass ionomer cement and the fluoride-releasing resin composite . CONCLUSIONS Based on the results of this in vitro study , it can be concluded that Fuji Ortho LC and Light Bond exhibit significant inhibition of adjacent demineralization compared to the non-fluoride-releasing control UNLABELLED Several recent studies have demonstrated the success of the ART ( atraumatic restorative treatment ) technique under field conditions in developing countries . The ART technique involves removal of caries using only h and instruments , and placing a glass ionomer cement ( GIC ) restoration . OBJECTIVES To estimate the longevity of Fuji II GIC ART restorations placed in permanent teeth by dental nurse students under field conditions in rural Cambodia . DESIGN Clinical field trial . SETTING One high school in rural Cambodia . SAMPLE AND METHODS 53 subjects between the ages of 12 and 17 who had dental caries were selected to participate . Subjects were r and omly assigned to a dental nurse student for cavity preparation and placement of ART restorations ( without cavity conditioning ) . RESULTS 92.1 % of the carious lesions required class I or class V restorations , and 85.4 % were in the lower molars . 89 teeth were filled . At 1 and 3 years 86.4 % and 79.5 % of restorations were still present . Restorations were assessed by one dentist according to st and ard criteria . 76.3 % of the restorations were judged to be successful at 1 year , and 57.9 % at 3 years . CONCLUSIONS Factors which may have affected the success rates included : the material used , technical factors , failure to condition the cavity prior to restoration , and inexperience of the operators . The results suggest that ART restorations in permanent teeth using Fuji II GIC are only moderately successful after 3 years . Better results could be expected by using a dentine conditioner in conjunction with one of the newer stronger glass ionomer cements
AND PRACTICAL IMPLICATION S Because new caries lesions in the margins of restorations are the main reason for failure and replacement of restorations in primary teeth , it is important to know whether there is a benefit in using GICs in both occlusal and occlusoproximal cavities
BACKGROUND Fluoride released from glass ionomer cements ( GICs ) is capable of preventing caries lesions .
However , the preventive effect in margins of occlusal and occlusoproximal restorations have not been proved .