Combining the Best Characteristics of Resin Composite and Glass Ionomer
Giomer material not only releases fluoride ions, it can be recharged by fluoride over and over to provide additional protection against carious lesions.
As the population ages, unique clinical conditions become more evident with routine examinations. Many of our patients present with rampant root decay and cervical erosion, often due to the use of medications causing xerostomia, or oral habits that promote tooth loss. Many of these conditions can be minimized by the use of restorative materials that release fluoride into the oral environment. But until now, these materials have been limited to glass ionomers, which are clinically acceptable, but have drawbacks. These include limited shade matching, and difficulty in finishing to a smooth polish that will not attract plaque formation.
A new product has entered the dental field that addresses many of these concerns. Beautifil® II composite by Shofu (www.shofu.com) has a proprietary Surface Pre-Reacted Glass ionomer (S-PRG) filler that gives composite glass-ionomer properties which create a film that inhibits plaque formation around the restorations. Moreover, this Giomer material not only releases fluoride ions, it can be recharged by fluoride over and over. This provides continual protection to the tooth and helps make the tooth more resistant to caries. The composite properties allow the restoration to be finished to a glass-like surface, so plaque accumulation is reduced as well. The S-PRG filler also is shown to neutralize an acidic environment, so patients with erosive conditions can have restorations placed with a long-term prognosis. Shofu’s BeautiBond® bonding agent also has these S-PRG characteristics, so when used in combination with Beautifil II, a long-lasting restoration can be placed that will give the desired characteristics of both composite and glass ionomer.
Case Presentation
During a routine hygiene appointment, a 58-year-old patient was found to have carious lesions and erosion on teeth Nos. 21 through 27 (Figure 1). A review of the patient’s health history and oral habits revealed that she drank a high volume of sweetened iced tea and carbonated soft drinks. This habit existed due to the patient having xerostomia from the many medications she was taking for health-related issues. These findings were consistent with the cervical decay and erosion around the existing restorations. The treatment plan was to restore the teeth following a minimally invasive protocol, using a material that would restore and protect the existing enamel.
Before starting the treatment, the shade was determined by using a Vita® shade guide (www.vident.com) and comparing the desired shade to a small portion of the cured composite material. The patient was anesthetized with Scandonest® 3% Plain (www.septodontusa.com). A slow-speed handpiece with a #6 round bur was used to remove the decay and existing restorations (Figure 2). Following a minimally invasive protocol, a slight bevel was placed on all surface margins with a diamond bur and high-speed handpiece.
Once tooth preparation was complete, a 35% phosphoric acid-etch (Ultra-Etch®, www.ultradent.com) was placed and agitated for 15 seconds, then rinsed and lightly air-dried. A seventh-generation bonding agent (BeautiBond) was placed with a microbrush, and left undisturbed for 10 seconds. The surfaces were lightly air-dried to thin the material, and light-cured for 10 seconds. An A-3 shade of the composite (Beautifil II) was placed using a titanium interproximal carver, and adapted to the internal line angles of each tooth and built to full facial contour (Figure 3). The composite was cured for 20 seconds per the manufacturer’s specifications and the margins were smoothed and blended to final contour using 12 and 30 fluted carbide burs (Brasseler USA, www.BrasslerUSA.com) and abrasive disks (3M ESPE, www.3mespe.com). Final polish was achieved with Enhance® finishing cups and POGO™ flat disks (DENTSPLY Caulk, www.caulk.com). The restorations were easily cleaned and showed little inflammation or acid effects on a 3-month postoperative recall appointment (Figure 4).
Conclusion
There are many choices available to restore decay and erosion, but the characteristics of the material have been limited when used on cervical restorations. Beautifil II composite combines the best characteristics of resin composite and glass ionomer, while incorporating Giomer technology to give a continuous release of fluoride and the neutralization on an acidic environment. This makes Beautifil II an ideal choice for many restorations, especially on patients with a high caries index.
About the Author
John K. Sullivan, DDS
Private Practice
Tulare, California
