Failure of a Glass Ionomer to Remineralize Apatite-depleted

[Anonymous]

Failure of a Glass Ionomer to Remineralize Apatite-depleted Dentin

Remineralization of demineralized dentin lesions adjacent to glass-ionomer cements (GICs) has been reported in the literature.

This study tested the hypothesis that a strontium-based GIC can remineralize completely demineralized dentin by nucleation of new apatite crystallites within an apatite-free dentin matrix. Human dentin specimens were acid-etched, bonded with Fuji IXGP, and immersed in a calcium-and-phosphate-containing 1.5X simulated body fluid (SBF) for 1–4 months. Polyacrylic acid and polyvinylphosphonic acid biomimetic analogs were added to the SBFs to create 2 additional remineralization media. Specimens were processed by transmission electron microscopy (TEM). No apatite deposition could be identified in the completely demineralized dentin in any of the specimens immersed in the 3 remineralization media, despite TEM/EDX evidence of diffusion of ions specific to the strontium-based GIC into the demineralized dentin.

The hypothesis was rejected; mineral concentration alone is not a sufficient endpoint for assessing the success of contemporary remineralization strategies.

        

[sushantpatel_doc]

Glass ionomers: The words sound boring — like something out of a dusty dental materials textbook from the 1940s. Nothing could be further from the truth. Today’s glass ionomer materials are highly advanced, tooth-saving materials that behave in an almost supernatural way. They are dimensionally stable, fluoride-releasing cements, liners, restoratives, sealants, and all-around good guys. Glass ionomers are available in self-cure, light-cure and dual-cure forms. Today, the variety of materials includes the conventional glass ionomer, resin reinforced glass ionomer (RRGI) and compomers.

The problem? Too many choices. More than 118 varieties of glass ionomers exist, all claiming unique and superior function. Choosing the right glass ionomer can be a bit confusing at best. Read on to discover some real, in-the-trenches restorative warfare and how simplistic the selection process can be.

Glass Ionomer true confession No. 1: The cop

About five years ago, a colleague went on vacation, and I agreed to cover his emergencies. One of his patients, a burly, 6’5″ policeman walked into my office with a cracked, very decayed upper first premolar. Ideally, this square-jawed giant needed a root canal, post/core and crown. However, the first commandment in the Covering for Your Colleague rulebook is, “Thou shalt not steal a crown procedure from thy fellow dentist.” What to do, what to do…?

After pondering the intraoral image and radiograph, there was one excellent solution: Resin reinforced glass ionomer (RRGI). It was simply a matter of removing the caries, injecting the resin reinforced glass ionomer (Vitremer, 3M; Fuji II, G C America) and holding the split segments together. Problem solved, right?

Well, sort of. The next week, I phoned my colleague (who by then had returned from vacation) and related this wonderful glass ionomer story to him. Instead of being overjoyed, he was absolutely furious. The problem was, this patient only appeared for emergencies and now that the tooth was “repaired” he would only return when the next crisis occurred. I inadvertently treated this tooth too well — all due to the magic of glass ionomer.

        

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