Double Take: "This material thrives in a Class V preparation and bonds very well to dentin…”

Resin-Modified Glass ionomers are restorative materials that are excellent for Class I, III and V restorations, primarily cervical fillings and root caries. They are also often used for temporary fillings and core build-ups. Unlike composites, they work well in moist environments. Another bonus is that they release fluoride, which can be helpful in remineralizing carious teeth.

We talked to Dr. Todd Snyder, DDS, a cosmetic dentist in Laguna Niguel, California, about his experience with glass ionomers, specifically VOCO’s Ionolux.

What are Ionolux’s esthetic qualities? What makes it ideal for esthetics?

It’s a resin-modified glass ionomer and unlike conventional glass ionomers, which lack any resin within them. Having resin in the resin-modified glass ionomers, unlike traditional glass ionomers, allows them to be polished, creating a better luster and appearance. And they maintain that great appearance very well over many years. I have cases where cervical lesions were restored with RMGIs that are over 10 years old and still look great, compared to what I see often with composites.

It’s also easy to apply the Ionolux. You just mix the capsule and extrude the material onto the tooth structure, contour or wipe any excess away with your favorite instruments, and polymerize it with your curing light Then clean off any excess material with a fine diamond under water spray, followed by your favorite brand of polishing cup or point, and you get a great-looking restoration. That’s the nice thing about Ionolux; unlike resins, that are hydrophobic, this material thrives in a Class V preparation and bonds very well to dentin in a moist environment where sulcular fluids and blood are often present. It’s no wonder that many studies show RMGIs last better over time compared to composites in Class V restorations.

Tell us about how Ionolux handles.

In my analogy, I compare it to flowable composites. You got everything from Revolution by Kerr, which is one of the runniest flowables ever made, but sold well, and you have others that are thicker, like VOCO’s GrandioSO Heavy Flow, and everything in between. Depending on which dentist you talk to, every dentist has their favorite, based on how it handles. When it comes to Ionolux, it’s a thicker material than some resin-modified glass ionomers. It’s definitely not runny. It has more body, so you can manipulate and contour it more like a traditional composite.
It’s thicker, so it doesn’t run, move or stick to your instrument when you try to adapt it, whereas some of the resin-based glass ionomers are runny when placed and you can’t really adapt or manipulate them much.

How is Ionolux cured?

Resin-modified glass ionomers are going to have both a self-curing acid base reaction as well as the light-cured component. The material will chemically cure if left alone and it will also light-cure, so if you manipulate the material too long, it will begin hardening and adaptation may become more challenging as the material is solidifying. Typically, you want to apply the material quickly to moist tooth structure and briefly contour it, as prolonged contouring may cause poor adaptation to the tooth when exceeding its working time.

Are glass ionomers a good choice for children?

Oh, definitely. You figure you’ve got a squirming, moving target with saliva, blood, and sulcular fluids, so to get in and get out quickly I feel is a huge advantage over traditional resin materials.

If you look at the NIDCR’s report, the average composite lasts 5.7 years due to secondary caries precipitated by bond failure, so why place a hydrophobic composite that’s potentially going to fail earlier and have problems in a child’s tooth? Place a restorative material that works with moisture, so if there is a challenge with gaining proper moisture control, you can have a little moisture there and it won’t harm the material. By the same token, the resin-modified glass ionomer is going to release fluoride and help hypermineralize the tooth, potentially fighting off decay.

The acid base resistant zone that is created by glass ionomers on the tooth surface acts as an insurance plan, so if something does start to leak or break, you have that built-in. Traditional resin composites don’t provide that type of benefit.

Where else might glass ionomers’ fluoride capabilities come in handy?

Glass ionomers, as a whole, are my go-to products for geriatric and pediatric patients. I had a case yesterday where a patient had decay on the root structure of the teeth around the margins of crowns and bridges. The patient has Parkinson’s disease, he can’t clean well and he won’t let his caretakers assist in his oral hygiene. It is very challenging to work on the patient because of his condition, and he will only sit in the chair for half an hour, so what do I have available that can help with that? Well, glass ionomers is one of those materials. I can clean out the Class V cavity and I can put this in there, and it helps to hypermineralize the tooth and fight off cavities. Since it is hydrophilic, it works well in a moist environment where it is challenging to get good moisture control.

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Is there anything else about Ionolux that we didn’t ask?

Ionolux does not use a dentin conditioner, which is unique because the majority of glass ionomers come with a preparation conditioner, which is basically a weak acid that you put on the preparation before applying the glass ionomer. Not that you have to use them for every manufacturer that is out there, but they are recommended to use, because it does give them a little better adaptation and adhesion to the tooth structure. VOCO has created their RMGI, Ionolux, to not need a preparation conditioner, and yet they still get the same or better strength properties, adaptation and adhesion to the tooth as other manufacturers. So, it’s one less step that has to be performed, which saves some time. Ionolux is a fast, easy-to-apply RMGI that provides a durable, esthetic restoration with the added benefit of hypermineralizing the tooth and releasing fluoride.