Page 15 - GP Fall 2025

Through the utilization of the CAMBRA conventional materials such as resin-based, wet tooth enamel resulting in an increased
process, dental healthcare providers can compomers and glass-ionomer cements to strength, good thermal compatibility with
make an appropriate recommendation and hybrid bioactive class materials like res- the tooth enamel, which limits the coeffi-
develop an individualized treatment plan in-modified glass-ionomer and giomers. cient of shrinkage, which therefore increase
based upon a patient’s own caries risk. A Based on their chemical composition and their longevity, and biocompatibility. Their
written document outlining the risk level physical and mechanical properties, these low mechanical hardness is based on the
and treatment plan should be provided to dental materials can be categorized by difference in the particle sizes of the glass
the patient in addition to the verbal consul- their curing and/or setting methods. For in- powder, the mixing powder-liquid ratio and
tation. This is part of the informed consent stance, resin-based sealants are light cured, the mixing methods (by hand or by ma-
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process. The clinician should address the while compomers and glass-ionomer ce- chine), which can trap air into the mixture
patient, parent and or the caregiver to re- ments involve a 2-stage light curing and resulting in porosity in the cements and
view oral hygiene instructions, reinforce setting process, because they both contain increase their brittleness. However, using
brushing and flossing techniques, review either resins or polyacrylics and self-curing pre-mixed syringe glass-ionomer cements
nutritional counseling and make fluoride or chemically based induced reactions. increases their strength as a restorative ma-
recommendations. terial. 20, 21
Dental sealants are categorized as preven-
In combination with assessments such as tive dental materials and are classified into To increase the strength and maintain their
CAMBRA and ICDAS II, it is possible to four major groups based on the materials fluoride-releasing properties, glass-isomers
identify those teeth that will benefit from used. One of the first restorative materi- can be enhanced by adding methacrylate
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application of sealants. Dental sealants act als used as dental sealants were the res- to form resin-modified glass-ionomers or
as a physical barrier in protecting the oc- in-based or bisphenol A-glycidyl methac- (RMGIs), creating a new class of hybrid
clusal surfaces of the posterior teeth, and rylate composite resins. Depending on their bioactive dental materials. These materials
it starts with the clinician assessing the pa- composition, these resins can be cured ei- contain mostly glass-isomers, such as fluo-
tient’s risk for developing caries. ther by inducing the polymerization process ro-aluminosilicate glasses and hydroxyeth-
by adding an activator, usually a monomer, yl methacrylate (HEMA), which are
The approach of managing dental caries has or by light curing procedure. Because the water-soluble. Compared with glass-iso-
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evolved from the traditional philosophy of resins are primarily used for fillings, one mers, the RMGIs have an increased
“drill and fill” to minimally invasive tech- issue of concern was directly related to working and setting time, allowing better
niques to arrest carious lesions from further how thick the material was on the tooth adaptation. However, because the polymer-
progression. Dental sealants are a preven- and whether an increase or decrease in size ization process (setting time) can last up to
tive method to arrest dental caries on the of the material may change the efficacy of 12 hours, their coefficient of shrinkage is
occlusal surface of the tooth. One of the the sealant. Composite fillings are typically higher compared with other dental sealants.
less-intrusive methods for managing den- much thicker than sealants and are less ef- Their increased strength is generated by
tal caries is placing dental sealants on the fective due to their thickness. Studies show etching and bonding with the tooth struc-
occlusal surfaces according to the ICDAS the efficiency and longevity is increased for ture as well as their improved resistance to
II codes. Clinical studies have produced dental sealants when the etching time is ap- moisture.
contradictory data which demonstrates that propriate, and the thickness of the material
sealants might or might not be able to arrest matches the setting time and shrinkage of The newest class of hybrid bioactive ma-
a carious lesion at code 3 or beyond. How- the sealant. Earlier procedures did not re- terials are the giomers, developed in the
ever, these clinical studies agreed sealants quire etching on the tooth. 17 early 2000s by the Shofu Company, based
are effective in arresting caries identified in Kyoto, Japan. Giomer technology uses a
by codes 1 and 2. 10, 14, 15 Polyacid-modified composite resins or surface pre-reacted glass isomer or S-PRG
Compomers are improved resin-based filler, combined with polyacrylic acid,
Following the clinical examination, the ap- materials in which fluoro-aluminosilicate forming a light-cured dental material. Gi-
propriate sealant material will be chosen glass has been added, which augments omers are self-etching materials, providing
to best meet the needs of the patient. The their strength and esthetics. The two-step strong bonding with the tooth surfaces, and
restorative dental materials used for pit and setting process is based first on the release they present high esthetics because of their
fissure sealants must be efficient and long of free radicals during the light curing stage fluorescence and translucency properties.
lasting. The sealant material must provide a which initiates the polymerization pro- The pre-reacted glass ionomer releases var-
good bond with the tooth structure, be easy cess followed closely by the second stage ious high-concentration ions such as stron-
to use, and allow sufficient working time which occurs when moisture is drawn from tium, borate, fluoride, sodium, silicate, and
before it sets. Their physical, mechanical, the oral environment, thus activating an aluminum, all of which increase the bio-
and chemical properties include increased acid-based reaction for fluoride release. activity of the material by activating the
flexural strength, resistance to wetness, These fluoride-releasing properties con- fluoride-releasing mechanism. Giomers
decreased shrinkage during the setting or tribute to the remineralization of the tooth are classified as smart bioactive materials
curing time, reduced or no microleakage, structure, therefore potentially reducing the because they can auto-recharge with fluo-
and be biocompatible with the oral envi- development of caries throughout the life ride ions from toothpaste and mouthwash,
ronment. Therefore, before using any of of the sealant. 18, 19 perpetuating the fluoride-release process
them, the dental practitioners must become and, thus, providing adequate antibacterial
familiar with the characteristics, properties, Glass-ionomer cements are a combination protection. 22,23 Some studies found that gio-
and clinical instructions for correctly cur- of fluoride salts and other oxides, which mers possess increased microleakage com-
ing these materials. when combined with glass powder, poly- pared to glass-ionomer cements, however,
acrylic acid and water, form the cement. because their fractural strength is greater,
Currently, there are a variety of dental ma- Some of their restorative properties in- the microleakage can be controlled. 24, 25
terials that are used as dental sealants from clude fluoride-releasing ability, adhesion to
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