Bonded amalgam restorations: using a glass-ionomer as an adhesive liner

Due to the lack of adhesiveness of amalgam to tooth structure, several adhesive cements have been utilized in bonded amalgam restorations. This study evaluated whether Fuji-II glass-ionomer cement is an appropriate adhesive liner in bonded amalgam restorations. Two adhesive composite luting cements (Amalgambond Plus and Panavia-21) and Copalite cavity liner were compared. The study was conducted in two phases. In the first part, we quantitatively assessed the tensile bond strengths as well as the failure modes of amalgam bonded to human dentin, using different adhesive liners. In each group, the flat dentin surface was treated with the assigned adhesive cement with a Teflon mold, followed by condensation of amalgam (Valiant PhD) onto it. Each group's mean tensile bond strengths were recorded and the statistical analysis by one way ANOVA showed no significant differences among groups (p > 0.05). Similar to the fracture patterns of the Amalgambond Plus and Panavia-21 groups, the failure mode of Fuji-II group was predominantly adhesive fracture. In the second part, the fracture strengths of amalgam restored teeth were measured using different adhesive liners. Standard MOD cavities were prepared in each tooth except for the intact tooth group. After treatment with the assigned adhesives or varnish, the cavities were restored with amalgam. Fracture strengths were then measured and the fractured interfaces examined using a scanning electron microscope. The fracture strengths of the intact tooth, Amalgambond Plus, Panavia-21 and Fuji-II groups were significantly higher than those of the Copalite and prepared cavity without restoration groups (p < 0.01). Accordingly, Fuji-II glass-ionomer cement, when used as an adhesive liner of amalgam restoration, may effectively reinforce the remaining tooth structure and, therefore, enhance the fracture resistance of the amalgam-restored teeth.