The use of GIC in special care : state of the art. Prof. Luc A.M. MARKS DDS, MSc, Phd Center of Special Care in Dentistry Ghent University - Belgium

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1 The use of GIC in special care : state of the art Prof. Luc A.M. MARKS DDS, MSc, Phd Center of Special Care in Dentistry Ghent University - Belgium 1

2 glassionomers and special care? Pubmed : 3 hits 2

3 glassionomers and special needs 3

4 glassionomers and special needs? Pubmed : 3 hits 4

5 1999 The use of glassionomer in special needs patients Gryst and Mount Australian dental J

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7 Glass ionomer Resin Composite continuum GIC RM-GIC PAM -C RC Ketac Fil Vitrebond Dyract P50 Ketac Bond Vitremer Dyract AP Z250 Ketac Silver Photac Fil Compoglass HerculiteXRV Ketac Molar (Q) Photac Bond Hytac Prodigy Fuji II Fuji II LC F 2000 Durafil Fuji IX GC Lining LC Twicky star Tetric GC Baseline... I..... Chemfil Chemflex... 7

8 GIC advantages prevention against recurrent caries (Wilson et al. 1988, Verbeeck et al. 1993, De Moor et al. 1996) disadvantages mechanical properties (Beyls et al. 1993, Van Dijken et al. 1993, de Gee et al ) 8

9 CONVENTIONAL GIC 9

10 Type I restorations : Long term Falure of Type I restorations seems to be rather low and the different materials exiting on the market seem to give comparable results 10

11 Type I minimal preparation low occlusal load mechanical properties less important Adhesive materials as resin composite, compomers or glass ionomercements seem to be the materials of choice. 11

12 Type V restoration. Mechanical properties as strenght and wear are not that important in this type of restoration isolation can be a problem! So GIC can be preferred. 12

13 Type II restorations 13

14 GLASS IONOMERS (GIC) * REINFORCED GIC (R-GIC) * POSTERIOR COMPOSITES * RESIN-MODIFIED GIC (RM) * POLY-ACID MODIFIED COMP. (PAM-C) * HIGHLY VISCOUS GIC (HV-GIC) 14

15 Fluoride Release 1.5 F (mg/cm 2 ) KetacFil Chemfil S Fuji II C Ketac Silver time (day) Ketac Molar By courtesy of Prof. Verbeeck Marks et al

16 Fluoride Release F (mg/cm 2 ) Ketac Silver PhotacFil Fuji II LC Vitremer Ketac Molar time (day) Marks et al

17 RESTORATIVE DENTISTRY WITH POLYMERS MECHANICAL PROPERTIES * TENSILE STRENGTH MECHANICAL PROPERTIES * WEAR CHEMICAL PROPERTIES * FLUORIDE RELEASE COMP>PAM-C>RM-GIC>GIC Uno et al. Dent Mater 1998 RM-GIC > GIC PAM-C > COMP Pelka et al. Eur J Oral Sc 1996 GIC > RM-GIC >PAM-C >COMP Verbeeck et al. Biomaterials 1998 Marks et al. Biomaterials

18 FLUORIDE RELEASE??? Ketac Fil (3y) 18

19 CONVENTIONAL GIC REINFORCED GIC HIGHLY VISCOUS GIC 19

20 EEN MOEILIJKE KEUZE L EMBARRAS DU CHOIX ADHESION Mech. Properties Oral environent A DIFFICULT CHOICE 20

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22 major failures of restorations : Mechanical failure (microdentistry) Recurrent caries (Kilpatrick 1993) 22

23 Microdentistry P. Surmont, L. Martens, R. D Hauwers A decision tree for the treatment of caries in posterior teeth Quint Int., 21: ,

24 CARIES!! 24

25 Changing cariespatern Marthaler et al. 1996, Poulsen et al Western world : 80 % caries is found in 20 % of the people (Twetman et al. 2000) Risk groups 25

26 oral environment??? 26

27 oral environment Low ph - regurgitation - saliva flow - soft drinks - irradiation -. 27

28 Low ph oral environment - regurgitation - saliva flow -soft drinks - radiation -. 28

29 - saliva flow -trauma of salivary glands - use of medication (Ferguson, Arch Oral Biol.,1999) 29

30 Low ph oral environment - regurgitation - saliva flow -soft drinks - irradiation -. 30

31 -soft drinks young adults softdrinks sportsdrinks breezers 31

32 erosions!! 32

33 erosions!! 33

34 ph attacks!!! 34

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36 The influence of soft drinks on the Fluoride release of Glasionomer cements and Polyacid modified composites L.A.M. Marks *, C.W. Vercruysse, R.M.H. Verbeeck Ghent University - Belgium Marks et al., Eur. Arch. Paed. Dent

37 Introduction : Glasionomer (GIC) fluoride release Polyacid modified composite (PAM-C ) Compomer fluoride release Fluoride release GIC >> PAM- C Verbeeck et al. Biomaterials

38 Introduction : Fluoride release influenced different environments i.e. - Acid ( low ph) - complex Verbeeck, De Maeyer, Marks et al. - Biomaterials 1998,

39 Aim : Can soft drinks influence the fluoride release of standard restorative materials as GIC an PAM-C? 39

40 Material and Methods : 2 materials Glasionomer : Ketac Fil ( 3M - Espe) PAM- C: Dyract ( Dentsply - de Trey) Monsters : cylindrical specimens 6 mm diam / 3 mm thick 40

41 Material and Methods : 2 softdrinks - Coca cola ( regular) - Minute Maid (orange juice) - 2 x distilled H 2 O ( control) 41

42 Results GIC - Ketac Fil 42

43 µg F/cm² Ketac Fil fluoride 50,00 40,00 30,00 20,00 10,00 Ketac Fil water 0, days

44 µg F/cm² Ketac Fil fluoride 60,00 50,00 40,00 30,00 20,00 10,00 0, days KF water KF cola 44

45 µg F/cm² Ketac Fil 70,00 60,00 fluoride 50,00 40,00 30,00 20,00 10,00 0, KF water KF cola KF cola (2 h) days 45

46 µg F/cm² Ketac Fil fluoride 70,00 60,00 50,00 40,00 30,00 20,00 10,00 0, days KF water KF cola KF cola (2 h) KF minute maid 46

47 Conclusions : - Ketac Fil : 24 h H 2 O versus cola / orange juice ( p < 0.05 ) H 2 O versus cola ( p < 0.05) H 2 O versus orange juice ( p < 0.05) Cola versus orange juice ( p < 0.05) 47

48 Conclusions : Fluoride release is influenced by contact with softdrink! Ketac Fil : 24 h 48

49 Clinical impact : the choice of material! Soft drink users could benefit from the use of GIC by the increased fluoride release. Supported by the scientific grant of the Flemish dental association VVT laureate

50 Low ph oral environment - regurgitation - saliva flow -soft drinks - irradiation -. 50

51 irradiation head / neck region - almost no production of saliva - ph 51

52 Two year clinical performance of GIC and resin composite restorations in Xerostomic head and neck irradiated cancer patients De Moor et al 2011 Clinical Oral Investig., 15:

53 The proper material for each individual oral environment ph low fluoride release of Conventional GIC De Moor et al RM - GIC Verbeeck et al

54 54 Every time the ph Fluoride release On demand

55 Low ph environment 55

56 Resting plaque! Neutral ph Complex formation 56

57 Cumulative fluoride release in citrate ph 7 Marks et al., Biomaterials,

58 58 Resting plaque (neutral ph) Fluoride release of GIC Fluoride release of RM GIC Fluoride release of PAM-C Verbeeck et al., Biomaterials, 1998 Marks et al., Biomaterials, 2000

59 59 Resting plaque Fluoride release On demand

60 Materials increase ph of the environment!! In vitro ph lactic acid : 4.5 (active caries ph 4.9 arrested caries ph 5.7) Hojo et al., Dental Res., 1991, 1994 after 10 minutes Ketac Molar : 5.3 Fuji IX : 5.6 Vitremer 5.9 Nicholson et al., Biomaterials,

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62 Restorative materials and fluoride from the environment Pumpfunction / Storage-function for Fluoride GIC, RM-GIC (Forsten et al. 1996, Verbeeck et al. 1998, De Witte et al. 2000) 62

63 Adhesieve materials Microdentistry The proper SMART material for each patient Oral hygiene Oral habits 63

64 Although prevention still remains fundamental in oral hygiene. Do we really think that we can change the habits of person adicted to softdrinks or an anorexia patient or????? Can it be a suggestion to add this fact into our choise of restorative material. 64

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66 66 High Caries risk patients Special Care patients Prev >> mech. Properties ART???!

67 ART???! The ART approach using Glassionomers in relation to global health care Frencken Dental Materials 2010:

68 Finishing polishing? High speed and water cooling N. Koupis, L. Marks et al. Europ. Archives of Paed. Dent: 8, 22-28,

69 Sealing with GIC??? 69

70 Sealing with GIC??? FUJI VII / FUJI TRIAGE Brisbane

71 GIC + extra s FUJI VII EP ( CCP-ACP) Zraikat et al, Dent Mat. 2011, 27: Reynolds Melbourne - Australia In Vitro! In Vivo?. 71

72 Selection of a material??? 72

73 Selection of a restorative material Microdentistry + Chemical poperties!!! ph low GIC / RM-GIC Neutral ph resting plaque RM-GIC Buffercapacity / Fluoridepump and storage SMART DENTIST 73

74 Selection of a material Patient.. alergy?? / cooperative?? Caries risk. risk group?? Oral environment / frequency of meals / diet / Oral habits. oral hygiene Type of cavity. GV Black, Microdentistry Material properties.. Mechanical / Chemical 74

75 MANAGING CARIES IN A PREVENTIVE PERSPECTIVE * INDIVIDUAL CARIES RISK ASSESMENT * MICRODENTISTRY..within a CAVITY PREPARATION CONTINUUM, with ADHESIVE ( smart ) MATERIALS within a MATERIALS CONTINUUM * ADJUSTED PREVENTIVE STRATEGIES 75

76 DENTAL MATERIALS CONTINUUM GIC RM-GIC PA-COMP COMP 100% FLUORIDE CLINICAL RESULTS 100% VINYL MICRO-MECHANIC. ADHESION (bonding) CARBOXYLATE CHEMICAL ADHESION 0% 0% GIC RM-GIC PA-COMP COMP 76

77 The use of GIC in special care : State of the art Prof. Dr. Luc A.M. MARKS Center of Special Care in Dentistry Ghent University - Belgium luc.marks@ugent.be 77