The clinical use of glass-ionomer cements

The use of glass-ionomer cements in clinical dentistry has expanded greatly over the last decade. Their use in treating early carious or erosion lesions has been investigated widely and established techniques include fissure filling, restoration of erosion lesions without cavity preparation, and the internal or tunnel restoration. Because of their adhesion to moist tooth structure, biologic compatibility, and fluoride release, increasing use also has been made of their anticariogenic properties in treating geriatric patients. Glass-ionomers have proved very successful as dentin substitutes for attaching composites to enamel without involving risk of pulpal damage in the deeper cavity. The deficiencies of glass-ionomer cements are well known, including lack of toughness, early water sensitivity, low abrasion resistance, and porosity, leading to poor surface polish. Solving these problems is formidable because inherently the strength of these cements is related to their water content. The clinician should be aware of these deficiencies and stay within the parameters of the techniques outlined in this article. In particular, clinical success depends on early protection of the cement from hydration or dehydration and the current use of light-cured bonding agents largely has solved this problem. The future probably lies in using laminate techniques in which materials that attach to dentin and form a biologic seal can be covered by tougher and harder enamel veneers, thus mimicking the structure of the tooth. It is possible that future materials will be developed on the lines of these polyelectrolyte cements in which higher molecular weight polymers are used in conjunction with polymers that contain photoinitiators to effect light curing and toughen the matrix. In addition, the possibility of developing laboratory-cured glass-ionomer inlays in which porosity can be reduced and tougher polymers used should be considered.