# GIC restorations DMD2 Manorika Ratnaweera 2025 # **GIC restorations** **INITIAL LESION** | **CAVITY PREPARATION** | **Caries removal for a small occlusal cavity restored with auto cure glass ionomer cement** | | peripheral moat #3 round bur into sound dentin | | affected dentin | | infected dentin 0.5mm remaining | Note peripheral moat and small amount of slightly stained carious dentin on cavity floor | Cavity preparation # **Cavity Preparation** ## **Caries removal for a small occlusal cavity restored with auto cure glass ionomer cement** <table> <tr> <th style="text-align: left;">INITIAL LESION</th> <th style="text-align: left;">CAVITY PREPARATION</th> </tr> <tr> <td></td> <td> <ul> <li>peripheral moat #3 round bur into sound dentin</li> <li>affected dentin</li> <li>infected dentin 0.5mm remaining</li> </ul> </td> </tr> <tr> <td colspan="2">Note peripheral moat and small amount of slightly stained carious dentin on cavity floor</td> </tr> </table> **Principal setting stages during cement maturation.** ```mermaid graph LR subgraph Input Ingredients A[Glass powder (base)<ul><li>reactive (ionomer) glass</li><li>lyophilized polycarboxylic acid</li></ul>] B[Cement liquid (acid)<ul><li>aqueous polycarboxylic acid</li><li>tartaric acid</li></ul>] end C[Powder liquid ratio > acid-base reaction] D[Liquid state: silica hyrogel forming > water protection (prevents dissolution)] E[Solid state: hardened cement > water addition (prevents dehydration)] A --> C B --> C C --> D D --> E style A fill:#e0f7fa style B fill:#e0f7fa style C fill:#4fc3f7 style D fill:#4fc3f7 style E fill:#4fc3f7 subgraph Time Stages F[Mixing > 45 seconds] G[Net setting time - 3 - 6 minutes] H[Maturation > 24 hours - 1 year] end F --> G G --> H style F fill:#bdbdbd,color:#000000 style G fill:#bdbdbd,color:#000000 style H fill:#bdbdbd,color:#000000 ``` # **Principal setting stages during cement maturation.** ```mermaid graph LR subgraph Input Ingredients A[Glass powder (base)<ul><li>reactive (ionomer) glass</li><li>lyophilized polycarboxylic acid</li></ul>] B[Cement liquid (acid)<ul><li>aqueous polycarboxylic acid</li><li>tartaric acid</li></ul>] end C[Powder liquid ratio > acid-base reaction] D[Liquid state: silica hyrogel forming > water protection (prevents dissolution)] E[Solid state: hardened cement > water addition (prevents dehydration)] A --> C B --> C C --> D D --> E style A fill:#e0f7fa style B fill:#e0f7fa style C fill:#4fc3f7 style D fill:#4fc3f7 style E fill:#4fc3f7 subgraph Time Stages F[Mixing > 45 seconds] G[Net setting time - 3 - 6 minutes] H[Maturation > 24 hours - 1 year] end F --> G G --> H style F fill:#bdbdbd,color:#000000 style G fill:#bdbdbd,color:#000000 style H fill:#bdbdbd,color:#000000 ``` Mechanism of GIC adhesion * The mechanism of GIC adhesion to the tooth's inorganic structure involves a chelation reaction between the carboxyl groups of the polyacrylic acid and the calcium in the hydroxyapatite crystals of the tooth. * In completely set cement, fluoride ions are not an essential part of the matrix and are in an unbound form. These ions are released into the saliva by diffusion. # **Mechanism of GIC adhesion** - The mechanism of GIC adhesion to the tooth's inorganic structure involves a chelation reaction between the carboxyl groups of the polyacrylic acid and the calcium in the hydroxyapatite crystals of the tooth. - In completely set cement, fluoride ions are not an essential part of the matrix and are in an unbound form. These ions are released into the saliva by diffusion. # Preparation and Restoration of the Tooth * **Cleaning:** A pumice slurry should be applied to the tooth surface using a prophy cup. * **Conditioning of tooth:** after rinsing and drying the tooth, 10% polyacrylic acid is applied for 10 seconds to increase the surface energy and wettability of the tooth, which improves chemical bonding. * **Placement of restoration:** the mixed GIC is carried to the cavity with the help of a cement carrier and adapted using a condenser. Cement sticking to the spatula should be avoided as it is difficult to remove. * **Protection of the cement:** the setting cement should be covered by a matrix band during the initial setting and by varnish, cocoa butter, or vaseline after the initial set because GIC is moisture sensitive during the first 24 hours of setting. * **Finishing and polishing:** initial finishing includes the removal of gross excess with a sharp hand instrument. Final finishing is done after 24 hours. # **Preparation and Restoration of the Tooth** - **Cleaning:** A pumice slurry should be applied to the tooth surface using a prophy cup. - **Conditioning of tooth:** after rinsing and drying the tooth, 10% polyacrylic acid is applied for 10 seconds to increase the surface energy and wettability of the tooth, which improves chemical bonding. - **Placement of restoration:** the mixed GIC is carried to the cavity with the help of a cement carrier and adapted using a condenser. Cement sticking to the spatula should be avoided as it is difficult to remove. - **Protection of the cement:** the setting cement should be covered by a matrix band during the initial setting and by varnish, cocoa butter, or vaseline after the initial set because GIC is moisture sensitive during the first 24 hours of setting. - **Finishing and polishing:** initial finishing includes the removal of gross excess with a sharp hand instrument. Final finishing is done after 24 hours. Cervical margin restoration before and after clinical photographs Two close-up dental images showing anterior teeth with visible brownish decay or lesions near the gumline in both cases, labeled A and B. Cervical re-restorations A comparison of two dental restorations, one with visible margin discoloration and another with a more seamless appearance, both involving the cervical area of the teeth. # **Clinical Applications** ## **Cervical re-restorations** Abrasions with recession Two images showing dental abrasions and gum recession. ## **Abrasions with recession** Root caries images showing root caries, with labels A and B ## **Root caries** Cervical Caries two images showing teeth and gums, the top image shows carious lesions at the cervical margin, and the bottom image shows a closer look at the teeth and gums. ## **Cervical Caries** [[W3 GIC.pdf#page=1|W3 GIC, p.1]] [[W3 GIC.pdf#page=2|W3 GIC, p.2]] [[W3 GIC.pdf#page=3|W3 GIC, p.3]] [[W3 GIC.pdf#page=4|W3 GIC, p.4]] [[W3 GIC.pdf#page=5|W3 GIC, p.5]] [[W3 GIC.pdf#page=6|W3 GIC, p.6]] [[W3 GIC.pdf#page=7|W3 GIC, p.7]] [[W3 GIC.pdf#page=8|W3 GIC, p.8]] [[W3 GIC.pdf#page=9|W3 GIC, p.9]] [[W3 GIC.pdf#page=10|W3 GIC, p.10]] [[W3 GIC.pdf#page=11|W3 GIC, p.11]]