Abstract
This paper reviews the strategies that have been reported in the literature to attempt to reinforce glass-ionomer dental cements, both conventional and resin-modified. These cements are widely used in current clinical practice, but their use is limited to regions where loading is not high. Reinforcement might extend these applications, particularly to the posterior dentition. A variety of strategies have been identified, including the use of fibres, nanoparticles, and larger particle additives. One problem revealed by the literature survey is the limited extent to which researchers have used International Standard test methods. This makes comparison of results very difficult. However, it does seem possible to draw conclusions from this substantial body of work and these are (1) that powders with conventional particle sizes do not reinforce glass-ionomer cements, (2) certain fibres and certain nanoparticles give distinct improvements in strength, and (3) in the case of the nanoparticles these improvements are associated with differences in the morphology of the cement matrix, in particular, a reduction in the porosity. Despite these improvements, none of the developments has yet been translated into clinical use.
Highlights
Glass-ionomer cements (GICs) are widely used in clinical dentistry with uses including full restorations, liners and bases, luting agents, fissure sealants, and adhesives for orthodontic brackets [1].Their properties are generally attractive for these applications and include biocompatibility towards tooth tissue [2], the ability to release fluoride [3,4], and adhesion to the tooth surface [5,6]
Resin-modified glass-ionomers have mainly the same clinical applications as conventional glass-ionomers [26,27], though they are not recommended for the atraumatic restorative treatment (ART) technique
Results for the hollow-fibre modifications are shown in Table 4 and from these it can be seen that compressive strength was generally unaffected by the inclusion of these fibres, but that flexural strength and fracture toughness increased significantly
Summary
Glass-ionomer cements (GICs) are widely used in clinical dentistry with uses including full restorations, liners and bases, luting agents, fissure sealants, and adhesives for orthodontic brackets [1]. Conventional glass-ionomers are brittle materials with compressive strengths in the range 150–220 MPa and resin-modified glass-ionomers, while tougher and with better flexural strength, have comparable compressive properties. As a result, both types of material have similar limitations for clinical use [1,10]. A few published studies have reported compressive strength values for resin-modified glass-ionomers and flexural strength values for conventional glass-ionomers in attempts to compare the materials. The former study concludes that resin-modified glass-ionomers are stronger in all test modes, but with such a low reported compressive strength for the conventional cement, how can the data be trusted? These differences are attributable to the presence of the polymerized resin component, which toughens the cement and improves its ability to withstand loading in flexure
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