Hooray for Resin-Modified Glass Ionomer

I was using composite resin too much.

A few months ago I introduced resin-modified glass ionomer (RMGI) into my practice after reading this article by Dr. Howard Strassler.

Here’s the gist about why this material is so great.

(A) It’s more moisture tolerant than traditional glass ionomer and composite resin.

(B) It releases fluoride.

So with those advantages in mind, here are two indications for RMGI in my practice:

(A) Long-term provisional restorations. Patients with generalized severe decay have a lot of fires to put out in the short term.  In the long term, I’d like to assess the patient’s true caries risk.  RGMI allows me to efficiently do caries control while a comprehensive treatment plan can be worked out.  Also, it doesn’t contain eugenol, so there won’t be any bonding concerns for the final restoration.

(B) Class V root surface restorations.  Any time I see root surface decay at or below the level of the gingiva, I’m thinking about RGMI.  RGMI is more moisture tolerant so it works well subgingivally.  In particular, elderly patients can really benefit from the boost of fluoride.

CASE STUDY

A 77 year old male presented with multiple carious lesions on root surfaces throughout his dentition.  Due to his higher caries risk and the subgingival location of the lesions, he was treatment planned for RMGI restorations.

# 26 facial caries extending subgingivally

I remove the decay using standard preparation guidelines.  Then I place retraction cord.

Bim bam boom.

I use Ketac Nano (3M ESPE) for my RMGI.  First I apply the primer, air dry, and cure.  Then place the RMGI paste and shape it using a composite instrument.  The material can get very sticky, so I recommend dipping the composite instrument in the primer and/or waiting a minute for the paste to start to set.  This material is light cured, but it will start to set a little on its own

RMGI before polishing

Polish it up and you’re done.  I forgot to take a picture after I polished this restoration and made it really pretty, so instead here’s a picture of a kitten in a sock:

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