Category: Glass Ionomers

WATCH: Updated Protocols for Provisional and Definitive Cementation of Indirect Dental Restorations

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Duration: 1:10 h

Presenter: Dr Robert Lowe

Most indirect dental restorations are luted to preparations using one of four types of dental cements:

1) Glass Ionomer Cements

2) Resin Modified Ionomer Cements

3) Resin Cements which require the use of total etch technique and dentin adhesives on the tooth structure prior to the luting process

4) Self Etching Resin Cements

Improved properties in this last category of cements including, improvements in self cure mode and bonding to zirconia, will be discussed. It is important to note that no cement will perform to its utmost clinically without an adequate preparation that includes good resistance and retention form.

In this CE webinar, Dr. Lowe will discuss clinical techniques and protocols for indirect cementation of both provisional and definitive restorations. Provisional cementation will be discussed as an integral part of the indirect delivery process for preparation protection and tissue management. The student will come away from this webinar with a more thorough understanding of the cementation process and which cements perform the best when coupled with the variety of restorative materials, both all ceramic and metal based, that are currently available.

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Click here to watch the webinar free of charge

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About Dr Lowe

Robert Lowe

Dr. Robert A. Lowe graduated magna cum laude from Loyola University School of Dentistry in 1982 and was an Assistant Professor in Operative Dentistry until its closure in 1993. Since January of 2000, Dr. Lowe has been in private practice in Charlotte, North Carolina. Dr. Lowe lectures internationally and publishes in well-known dental journals on esthetic and restorative dentistry.

He is a clinical evaluator of materials and products with many prominent dental manufacturers. Dr. Lowe received fellowships in the AGD, ICD, ADI, ACD, and received the 2004 Gordon Christensen Outstanding Lecturers Award at the Chicago Midwinter Meeting. In 2005, he was awarded Diplomat status on the American Board of Aesthetic Dentistry.

 

Resin-modified glass ionomer cements versus resin-based materials as fissure sealants: a meta-analysis of clinical trials

GC America believes in the importance of informing dentists about the evidence available on Minimally Invasive Dentistry topics so they can make scientifically sound choices in the treatment of their patients. In the research-clinical application jigsaw puzzle, it is essential to make all the pieces fit in order to see the whole picture.

Systematic review with meta-analysis

AIM: To quantitatively appraise the current evidence regarding the caries-prevention effect of resin-modified glass ionomer cement (RM-GIC) fissure sealants in comparison to that of resin-based fissure sealants.

METHODS: 8 Anglophone databases and 2 Lusophone databases were searched until 15 April 2009, using a pre- determined search strategy. Clinical trials were considered for inclusion if their titles/abstracts were relevant to the topic, published in English, Portuguese or Spanish and had a two-arm longitudinal study design. The outcome measure of the caries-preventive effect was caries absence on sealed teeth. Two reviewers independently extracted data from the accepted articles in order to complete a 2×2 table for meta-analysis. The unit of interest was the tooth, and the number of caries-free teeth (n) at the end of each time interval (6, 12 and 24 months) was compared against the total number of evaluated teeth (N).

STATISTICS: Datasets were assessed for their clinical and methodological heterogeneity, following Cochrane guidelines, and only homogeneous datasets were combined for meta-analysis, using a random effects model (RevMan 4.2). Differences in the caries-preventive effect were computed on the basis of the combined Relative Risk (RR) with 95% confidence interval (CI).

RESULTS: Of the 212 articles identified, only 6 trials were included. From these, 19 separate datasets were extracted. For the pooled data, equivalent caries-preventive effects were observed at 6 months (RR= 0.98, 95% CI 0.95- 1.00; p = 0.08); 12 months (RR=1.00, 95% CI 0.96-1.04, p = 0.99) and 24 months (RR=1.01, 95% CI 0.84-1.21, p = 0.91). The 36-month data (not pooled) favored resin-based sealants (RR 0.93, 95% CI 0.88-0.97, p = 0.002).

CONCLUSIONS: This meta-analysis found no conclusive evidence that either material was superior to the other in preventing dental caries.
European Archives of Paediatric Dentistry, official journal of the European Academy of Paediatric Dentistry (2010) Volume: 11, Issue: 1, Pages: 18-25

The academic perspective: Dr Steffen Mickenautsch, University of the Witwatersrand, South Africa

What were the main reasons for reviewing this particular area of dental materials?
Steffen Mickenautsch: Resin is still considered to be the material of choice, worldwide, to caries-protect pits and fissures. This begs the question: Why? Is this so because we have overwhelming scientific evidence for its preference? Or overwhelming evidence in the sense that it sweeps any other possible materials asunder? Or is it just because of tradition, because we do not know the merits of other materials, or finally simply: because we have been told so in dental school? It is always interesting (and beneficial to the heart and mind) to find out the truth of things and that is why we embarked on an intensive systematic review programme that also included the comparison of the caries preventive effect between resin-based and resin-modified glass ionomer cement (RM-GIC) based fissure sealants.

What criteria did the articles you selected meet and why is this important?
Steffen Mickenautsch: We aimed to identify all evidence to this topic from all different sources, corners of the world and from as many languages as possible. We did that in a systematic format and from what we found we selected studies that were relevant, i.e. compared the two types of material with each other. Then these studies needed to have been randomized in some way. Randomization assures that patients whose teeth were sealed with either resin or RM-GIC do not substantially differ, thus are comparable. Studies who do not use randomization, cannot tell whether any observed results, e.g. that one material performed better than the other, were due to the material and not due to other factors (like one group of patients may simply had better oral hygiene or used fluoride and thus had less caries activity than the other, regardless what materials was used).

What should the general dental practitioner understand about this particular review?
Steffen Mickenautsch: The general dentist in her/his daily dental practice should have the knowledge that there is simply no scientific evidence that says that resin protects pits and fissures better against caries than RM-GIC.

How should general dentists apply the conclusion of this review to their daily practise of dentistry?
Steffen Mickenautsch: The application of this knowledge would be that if a dentist finds resin not to be a favorable choice to use as fissure sealant, perhaps for reasons of moisture control, material handling, material availability, costs, a personal reason, or reason stated by the patient etc., then RM-GIC can provide a good alternative.

How does this review contribute to the body of evidence on this topic in dentistry?
Steffen Mickenautsch: This is the very first quantitative systematic review and thus offers the best source of current scientific evidence to this topic. It’s the best, simply because: it first and foremost employed a comprehensive systematic sweep through all possible scientific and non-scientific sources of evidence available to answer a particular question. From everything that we found, we selected the best evidence in line with commonly accepted criteria and then we quantified this evidence, using meta-analysis, in order to provide a precise and well weighted answer to whether resin is better than RM-GIC in preventing caries or not. The result showed that it’s not.

Is more evidence needed on this topic? If so, what gaps are there in the research that has been done thus far on it?

Steffen Mickenautsch: From an academic point of view there is always need for more evidence – even just for the purpose to confirm the current state of evidence. It is recommended that future studies to this topic should report in much more detail on their randomization methods, which would remove any last academic shred of doubt. Our team is committed to continuously update current systematic review evidence – to this topic perhaps in about 2-3 years’ time. For now the current evidence from our systematic review is as good as it can get.

Clinician comments: Dr Geoff Knight, private dentist based in Australia

For how long have you been using glass ionomer cements in practice – and what motivated your decision to use them in the first place?
Geoff Knight: I met Dr Jurgen Eberlein at a dental seminar in Melbourne in the late 1970s. He was then with ESPE and gave me some samples of Ketac Fill to use in my practice. I was concerned about the recurrent caries I was seeing with composite resin and was impressed with the anti caries properties, low interface stress and ease of handling and I found myself using it for more and more clinical applications.

What is your preferred protocol for fissure sealing and what materials do you prefer to use for this?
Geoff Knight: I fissure seal with auto-cure glass ionomer cement because the material has relatively good wear resistance, releases abundant fluoride to convert carbonated apatite into fluorapatite and is a semi permeable to enable phosphate and calcium ions in towards the enamel and hydrogen ions to move outwards. Furthermore when the GIC is placed on the enamel surface it has a low pH that dissolves the outer surface of carbonated apatite enamel crystals so as to enable the formation of fluorapatite crystals after the GIC sets and the pH returns to neutral.

I am unaware of any tooth that I sealed with auto-cure glass ionomer cement ever developing a carious lesion beneath the seal. My current gem is Colgate Neutra fluor 5000 plus tooth paste. When patients brush without rinsing twice daily it prevents caries and significantly improves periodontal health.

Before reading the meta-analysis, what was your opinion of resin-modified glass ionomer cements versus resin-based materials as fissure sealants?
Geoff Knight: Resin fissure sealants prevent carbonated apatite from maturing into fluorapatite and have no place in MID. Resin modified glass ionomer cements enable the transfer of carbonated apatite into fluorapatite but do not wear as well as auto-cure GICs.

As a busy clinician, how do you keep yourself updated on developments in clinical evidence in dentistry, particularly in MID?
Geoff Knight: Read the literature, use Google and look at focused resources such as Dental Outlook here in Australia.

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Glass-Ionomer Cement Technology Advances into 21st Century Dentistry

Systematic reviews reveal the continued evolution of dental materials

Results from a recent systematic review suggest high-viscosity glass-ionomer cement (GIC) as safe and economical long-term tooth restorative system in conventional stress bearing Class I and in non-stress bearing Class II and Class V situation. High-viscosity GIC may also be acceptable in Class II stress bearing situations, as long as the isthmus is less than half of the intercuspal distance as stated in the manufacturer’s instruction of use.

Systematic reviews, often including meta-analysis as statistical method, provide the highest form of clinical knowledge in terms of achieving internal validity of results. One systematic review appraised the current clinical evidence regarding the use of high-viscosity GIC for longterm Class I, II and V tooth restorations placed in permanent teeth (1). This systematic review included 14 clinical studies, providing a total of 27 separate study results and concluded as follows:

  • Most of the 27 results show no significant statistical difference between the success rate of high viscosity GIC restoration and amalgam for treatment of the same clinical indications
  • One of the 27 results show that high-viscosity GIC restorations in posterior class V cavities of permanent teeth had a 28% higher chance to be more successful than amalgam after 6.3 years
  • Two of the 27 results indicate that high-viscosity GIC restorations in posterior class I cavities of permanent teeth have a 6% higher chance after 2.3 years and a 9% higher chance after 4.3 years of being more successful than amalgam
  • One of the 27 results show that high-viscosity GIC restorations in posterior class II cavities of permanent teeth have a 61% higher chance of being rated more successful than amalgam (this result requires further confirmation)
  • None of the 27 results indicate high-viscosity GICs being inferior to amalgam in clinic

These results show that high-viscosity GIC is not inferior in comparison to traditional amalgam restorations under similar clinical conditions. In addition, two further systematic reviews revealed the following evidence:

* Tooth margins of single-surface GIC restorations in permanent teeth had significantly less carious lesions after 6 years than on amalgam restorations (2)

* A significantly higher fluoride release (p<0.05) of GIC than from compomers (3)

Further advances have revealed that a resin coating over a GIC restoration may increase its fracture toughness (4) and reduce microleakage (5). This resin layer may also not completely hinder the fluoride release activated by the GIC and thus its external anti-cariogenic effects within the oral cavity (6).

Scientific journal articles for further reading:

1. Systematic review of clinical trials by Mickenautsch et al., Clinical Oral Investigation 2010; v14:pp233-240.

2. Systematic review of clinical trials by Mickenautsch et al., European Journal of Paediatric Dentistry 2009; v10: pp41-46.

3. Systematic review of trials by Oliveira et al., Journal of Minimum Intervention in Dentistry 2010; v3: p23 – abstract 023.

4. Investigation of dental materials by Bagheri et al., American Journal of Dentistry 2010; v23: pp142-146.

5. Investigation of dental materials by Magni et al., Journal of Dentistry 2008; v36: pp885-891.

6. Investigation of dental materials by Mazzaoui et al., Dental Materials 2000; v16: pp166-171.

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Free product tutorial: GC FujiCEM 2

FujiCEM2

Luting cements play an important role in the long-term success of indirect restorations.

This module will introduce you to new GC FujiCem™ 2 Automix, and show how it delivers remarkable strength, fracture toughness, and the versatility of a resin-reinforced glass ionomer—while giving you the confidence of an exact mix for the best possible physical properties.

 

FujiCEM2 1

Here is an overview of GC FujiCem™ 2 Automix properties:

  • Strong Retention

Optimal chemical balance for maximum adhesion to tooth structure. The early, high compressive and flexural strength provides the best possible support for your indirect restorations.

  • Sealing Ability and Marginal Integrity

Superior chemical bonding to tooth structure maintains the marginal seal, minimizing the risk of microleakage and secondary caries.

  • Sustained Fluoride Release

Utilizes glass ionomer technology for a sustained release of desirable fluoride.

  • No Post-Operative Sensitivity

Poses no risk of post-op sensitivity for patients because it is non-irritating to tooth structure and surrounding soft tissue.

  • Extremely Thin Film Thickness

The creamy consistency and low film thickness allows for stressfree seating of restorations

 

To access the free product tutorial with a detailed guide for users, click here

FuijCEM2 tutorial

 

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On-Demand Webinars: Refine your Restorative Techniques

At GC America we understand the demands on dentists as well as the importance of continued education. Refining your restorative techniques and strategies takes time and practice. This is why we have made available a large number of on-demand learning sessions, accessible online for learning on the go.

The following two online classes will be of particular interest to dentists who are wanting to improve their knowledge and skills in minimally invasive dentistry as well as creating natural esthetics with your restorations.

Title: Less is More – Incorporating Minimally Invasive Techniques into your Office Treatment Protocols

Less is More - Incorporating Minimally Invasive Techniques into your Office Treatment Protocols

Presenter: Dr. Daniel Ward, DDS

Duration: 64 minutes

Released: 4/16/14

CE Credits: 1 CEU (Home Study)

Watch the On-demand Class Now

Cost: no charge

It has long been said that “Dentistry begets Dentistry.” In other words the more treatment you do, the more treatment you will need to do in the future. This CE webinar will acquaint you with conservative and minimally invasive techniques to treat your patients.

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Title: Creating Natural Esthetics with Newly Developed Composites: Restoring the Tooth from the Inside Out

Creating Natural Esthetics with Newly Developed Composites

Presenter: Dr. Frank Milnar

Released: 2/11/14

CE Credits: 1 CEU (Home Study)

Watch the On-demand Class Now

Duration: 51 minutes

Cost: no charge

Developing treatment strategies for restoration of anterior maxillary dentition can be challenging. When faced with such cases, a detailed diagnosis and thorough understanding is required to ensure that the most appropriate materials and techniques are considered. In this CE webinar, you will learn how to improve your skills and confidence using a new generation of composites that utilize minimal invasive concepts. Minimally invasive concepts originates from the “inside out”.

About EQUIA

EQUIA by GC

Featured in both online classes is the new restorative system by GC called EQUIA.

EQUIA restorations are based on glass ionomer technology and are known for being aesthetic and translucent, high-performing and economical. EQUIA is the first to combine quick and easy handling with perfect physical and incomparably aesthetic properties.

The advantages of using EQUIA are:

  • No bonding agent needed, chemical adhesion with tooth structure
  • Low moisture sensitivity
  • Bulk placement with only 3’30” in total needed from start to finish
  • Filler content provides wear resistance and fracture toughness
  • Optimal protection of marginal seal for long-lasting restorations
  • Tooth-colored restorative material, with real translucency and natural gloss and smoothness

To find out more about EQUIA visit this page

Click here to watch: Less is More – Incorporating Minimally Invasive Techniques into your Office Treatment Protocols

Click here to watch: Creating Natural Esthetics with Newly Developed Composites: Restoring the Tooth from the Inside Out

EQUIA: one system, multiple indications

Do you want to preserve teeth while using a trusted material for multiple indications?

Do you want to diversify your dentistry to offer your patients more?

EQUIA by GC is a new dimension in restorative dentistry! EQUIA restorations are based on glass ionomer technology and have never been so aesthetic and translucent, high-performing and economical. EQUIA is the first to combine quick and easy handling with perfect physical and incomparably aesthetic properties.

The advantages of using EQUIA are:

  • No bonding agent needed, chemical adhesion with tooth structure
  • Low moisture sensitivity
  • Bulk placement with only 3’30” in total needed from start to finish
  • Filler content provides wear resistance and fracture toughness
  • Optimal protection of marginal seal for long-lasting restorations
  • Tooth-colored restorative material, with real translucency and natural gloss and smoothness

To show you just how versatile EQUIA is in the dental office, GCAmerica has compiled a clinical chart with case study images provided by Dr Mark Cannon. The document details the various indications this system can be used for to perform minimally invasive dentistry with the best aesthetic and functional outcomes for patients. The indications are:

  1. Class I and small Class II
  2. Amalgam replacement
  3. Class V and root surface caries
  4. Occlusal pit primary dentition
  5. Buccal pit primary dentition

The document shows how EQUIA enables the dentist to do minimally invasive preparation design, with shortened preparation time and trauma, preserving as much healthy tooth structure as possible. Due to EQUIA’s self-adhesive adhesive properties, no bonding steps are required. It is also moist field compatible, making it possible to work in the most difficult environments. EQUIA also offers sustained fluoride protection for long lasting restorations, high strength and excellent marginal integrity in addition to creating highly aesthetic restorations.

To download your copy of Five minimally invasive restorative techniques using EQUIA at not cost, simply click here.

On-Demand Webinar: Esthetic Alternatives to Direct Composites

In today’s increasingly competitive market place it is important to find efficient and effective means for streamlining the real bread and butter of your practice – namely, direct restorative dentistry.

To help you diversify your dentistry, GC America hosts a number of on demand online classes with expert presenters. Accessible at no cost, the online classes are ideally suited to busy dentists who want to learn on the go. Read more about one of these top rated online classes below:

On-demand webinar: Esthetic Alternatives to Direct Composites with Mark Pitel, DMD, FAGD, FACD, FIADFE

Duration: 65 minutes

Date: On demand

Class overview:

While many people have some level of knowledge regarding glass ionomers, very few are aware of the advances that have been made since this category first came on the market over 30 years ago. The versatility, vastly improved esthetics, and ease of use over the earliest generations have made this a reemerging and rapidly growing area of dentistry. In fact, some recent studies have shown that properly placed posterior glass ionomer restorations may actually offer a superior clinical life span to direct composites.

Incorporating glass ionomer cement in your clinical practice

Dr Mark Pitel discusses the properties of glass ionomer cements and how the materials have evolved in recent years. He outlines how the features such as adhesion, biocompatibility, easy placement, anti-cariogenicity, and resin modifications make the material a good solution in a number of restorative situations.

Techniques and tips are described on how to achieve esthetic and durable results with glass ionomer cement in a wide range of restorative conditions in comparison to composites available on the market. Clinical cases are shown and academic evidence to support these are also shared.

To access the online class click here

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