Decay-inhibiting restorative materials: past and present

Clear differences exist in the fluoride release characteristics and setting reactions of glass-ionomer cements and compomers. Differences in decay inhibition associated with specific materials are less clear. Furthermore, resin added to glass ionomer cement formulations and acids added to composite resins make it difficult to distinguish composite resins from compomers and glass ionomer cements, all of which have reported fluoride release. Optimal fluoride release from a dental restorative depends on several conditions, including oral flora, saliva, diet, mineral content of the dental tissues, and marginal seal of the restoration. Presently, in vitro and in vivo studies suggest that materials which behave similarly to silicate cements in their setting reactions and hydration characteristics will behave as decay-inhibiting restoratives. Until optimal fluoride release from dental restoratives can be quantified, dental clinicians are encouraged to consider clinical outcomes as the best test for decay inhibition. Nearly a century of clinical findings support the anticariogenicity of silicate cements. This article reviews fluoride release and anticariogenicity of restorative materials using silicate cement as a model with a well-defined mechanism for preventing secondary caries. The behavior of newer materials is compared to silicate cement for predicting decay inhibition.