• Although Black’s system classifies cavities by location, the system does not classify the extent of the lesion or identify crown fracture description. Basrani developed a classification system that accomplishes this goal ² (Table 8-1); however, this system does not distinguish between tooth fractures that go below the gingival margin. In this text we use a more practical system, based on the severity of the injury. Crown fractures can occur as a result of collisions with vehicles, hooved animals, being hit accidentally by a swinging object, catching hard objects, reckless participation in animal sports events such as Flyball or Ringsport tournaments, or chewing hard objects.

• The fracture classification system described in this text simplifies describing the extent of the fracture according to the dental tissue exposed. We have named this classification the Fracture Severity Index (Table 8-2).

Table 8-1 FRACTURE CLASSIFICATION (BASRANI ²)

Class A1	Crown fracture, enamel only
Class A2a	Crown fracture, enamel and dentin
Class A2b	Crown fracture into enamel, dentin, and exposing the pulp tissue
Class B	Crown fracture involving the root only
Class C	Crown and root fracture involving crown and root

Table 8-2 FRACTURE SEVERITY INDEX

Class 1	FX1	Fracture into enamel only
Class 2a	FX2a	Fracture into enamel and dentin only; no pulp exposure or root involvement
Class 2b	FX2b	Fracture into enamel and dentin with root involvement; no pulp exposure
Class 3a	FX3a	Fracture into enamel, dentin, and with pulp exposure; no involvement of root
Class 3b	FX3b	Fracture into enamel, dentin, and with pulp exposure and root involvement
Class 4	FX4	Fracture of the root only; crown intact

Class 1

• A Class 1 fracture is a “chip” fracture that has caused only the loss of, or damaged only, enamel (Fig. 8-2, A). The fracture is charted by the symbols FX1 and a jagged line over the area of the fracture.

Fig. 8-2

Class 2a

• A class 2a fracture involves both enamel and dentin in the crown of the tooth but has not exposed the pulp chamber, and is considered uncomplicated (Fig. 8-2, B). The fracture is charted by the symbols FX2a and a jagged line over the area of the fracture.

Class 2b

• A class 2b crown-root fracture involves enamel and dentin and has not exposed the pulp chamber, but the fracture extends below the gumline (Fig. 8-2, C). The fracture is charted by the symbols FX2b and a jagged line over the area of the fracture.

Treatment

Treatment

Young animal (younger than 1½ years)

(Fig. 8-2, E)

• Vital pulpotomy, followed by glass ionomer, composite resin, or amalgam restoration if the fracture is less than 2 weeks old. If the procedure is successful after 6 months, crown restoration may be performed. If unsuccessful at 6 months, root canal therapy or extraction is indicated.

• Extraction or root canal therapy, restoration with amalgam or composite resin, and reinforced crown techniques if the fracture is open longer than 2 weeks (prognosis guarded; see Chapter 7, Endodontics, p. 350).

Older animal (older than 1½ years)

(Fig. 8-2, F)

• Vital pulpotomy, if pulp exposed less than 48 hours and the bleeding is a healthy color and consistency.

• Root canal therapy followed by glass ionomer, composite resin, amalgam, or crown restoration if pulp is exposed longer than 48 hours.

• For Class 3b fractures additional periodontal treatment, along with the above choices, may be needed to maintain periodontal health (see Chapter 5). Extraction may be the treatment of choice if there is extensive involvement of the root that compromises the tooth’s periodontal health.

GENERAL RESTORATIVE TECHNIQUES

Cutting Techniques

• Cut away from the enamel. When doing a crown preparation, cut with the bur approximately parallel to the long axis of the tooth, in a counterclockwise rotation around the circumference of the tooth (the bur is rotating clockwise) (Fig. 8-3).

• The choice of bur shape will determine the type of margin to be created.

• When drilling into teeth, intermittent pressure is applied. The period is two counts with pressure on to one count with pressure off, to limit heat generation and maintain bur speed.

• The operator should be aware of the change in audible pitch in the handpiece as an indication of changing bur pressure being applied to the tooth surface. A higher pitch indicates a higher speed and less pressure, which is desirable.

• The enamel layer in dogs and cats is significantly thinner than occlusal enamel surfaces in man (<0.1 to 0.3 mm in the cat and <0.1 to 0.6 mm in the dog).³ This means most crown preparations and cavity preparations will expose the dentin layer to allow room for a strong restoration.

Fig. 8-3

RESTORATIVE MATERIALS

General Comments

• Many types of dental materials have evolved.

• The ideal material for restorative work would form a chemical bond to the enamel and dentin, would not distort after placement, would not break or fatigue, would have high impact strength, would have the same coefficient of expansion as dental structures, would match the tooth color, and would wear at the same rate as the teeth. Restorative materials have been improved greatly during recent years but, unfortunately, the ideal material does not yet exist.⁴

• Given the different functions of different teeth and the areas to be restored, obtaining the best results from the materials available requires familiarity with the properties of each material.

• Restorative materials should be chosen according to the functional needs anticipated, so as to maximize the desirable properties and minimize the undesirable properties of the material.

• The restorative materials and techniques discussed in this chapter can be classified as composite resins, glass ionomers, amalgams, and fabricated crown restorative materials.

• It is important to store restorative materials correctly. An improper storage environment can destroy the material rapidly. The first thing one should do when receiving a material is to note the expiration date and read the package insert, paying particular attention to use and storage.

Composite Resins

General Comments

• As in many industries, dentistry has been changed dramatically by the development of synthetic polymers.

• Composite resins are polymers created by a series of chemical reactions combining large numbers of similar smaller molecules (monomers) into a compound of high molecular weight.⁵ The organic polymer matrix is made up of either bisphenol A-glycidyl methacrylate (Bis-GMA) or urethane dimethacrylate (UDMA).⁶

• Throughout the “life” of the material, polymerization continues. It is a continuous reaction that is never entirely complete.

• The polymerization reaction is activated either chemically or by a visible blue light with a wavelength range of 468 to 480 nm.⁶

• Chemical-cure composite resins usually come as two components that, after mixing, cause molecules to join and the material to harden.

• Composite resins can be classified generally as filled or unfilled.

• Unfilled resins do not have fillers; they flow readily, are translucent, and are used to coat “cavity” preparations before application of the filled resins and are applied as a final coat to penetrate microcracks and minimize wear.⁶ The unfilled resins are applied to prevent microleakage and to promote the attachment of the restorative material to the tooth.

• Acid-etching a tooth surface creates effective microprojections and therefore microretention of unfilled resin when applied to the tooth’s crystalline structure.

• The filled resins contain fillers and are more viscous, opaque, harder, and wear better than unfilled resins.

• The filled resin is bonded onto the unfilled resin.

• Fillers added to the filled resins give them hardness, strength, color, resistance to temperature change, wearability, and control of polymerization shrinkage.⁷

• Composite resins contain at least 60% (usually 70% to 80%) inorganic filler (quartz, lithium, or silica) by weight.

• The filler particles are described according to size: (1) conventional (20 to 35 μm), (2) intermediate or macrofilled (1 to 5 μm), (3) microfilled (equal to or less than 0.04 μm), and (4) hybrid (containing either a conventional or an intermediate particle, in addition to a microfilled particle).⁷

• The conventional and macrofilled compounds are more resistant to fracture and can be safely exposed to more abrasive and concussive wear and tear than can microfilled restorative materials.

• Two disadvantages of the macrofilled compounds are a decreased ability to be finely polished, because of larger particle size, and that they become pitted with wear.

• Microfilled compounds polish to a very smooth surface; however, their disadvantage is that they are less strong and so tend to fracture more easily. Therefore, they are best used in areas with less exposure to wear and trauma.

• In an attempt to reach a compromise between the microfilled and macrofilled qualities, hybrid compounds were developed to combine smoothness with durability. Hybrids may be microhybrids designed for use in classes III, IV, and V lesions or posterior hybrids designed more for classes I and II lesions with greater durability.

• Flowable composites have lower filler content and lower modulus of elasticity and are therefore more flexible. They can be injected into a defect and are used as a sandwich layer between the tooth and a hybrid composite resin or in areas of low wear. They have high polymerization shrinkage and low wear resistance.

• Compactable composites have the strength and resistance to wear of amalgam, can be manipulated (packed or condensed) like amalgam, and are esthetic like a standard composite resin. They have low polymerization shrinkage and can be cured to a greater depth than other composite resins.⁸

• Pit and fissure sealants are generally unfilled or lightly filled resins with low viscosity and good wetting properties. They are applied after the enamel surfaces are etched; the sealant is then applied and cured. They are most effective in low-wear areas and protect from decay by sealing small pits and fissures in caries-prone teeth. They may be applied usefully to the maxillary molar surfaces if early staining is noticed. Some products also release fluoride.

• Both filled and unfilled resins are available that cure by either chemical reaction or light exposure. Light-cure products allow greater working time for placement and shaping.

• Polymerization of composite resins creates shrinkage that may exceed the bond between the composite and the enamel or dentin. Bond failure can lead to microleakage, leading to marginal staining, secondary caries, and sensitivity in a vital tooth.

• Shrinkage can be reduced by placing small amounts of material at a time and curing between increments. With light curing, newer methods are being applied with new light guns. These methods include ramp, pulse, or step-up techniques to reduce shrinkage.⁹ Composite resins come in various tooth shades for cosmetic appearance. The shades may vary among products, so it is important to use the shade guide provided with the restorative material to attain the best color match. Checking the color match in natural light is preferable.

• Some products require use of a bonding agent or primer before application of the unfilled resin adhesive in order to improve bonding to the tooth structure. Newer systems are a one-step etch and primer combination, followed by the adhesive or a primer and lightly filled resin adhesive combination used after etching. Many types of systems are used for bonding agents. The practitioner should refer to the instructions on the restorative kit for specific instructions.

• Care should be used with unfilled resins or bonding agents in order to apply only a thin film to the tooth.

Contraindication

• Damage in patients who chew rocks, bones, and other hard objects. Their surface defects should be restored with a stronger material.

Technique

• Although many different applications and variations of chemical and light-cure restorations exist, the following example is a step-by-step method for placement on a two-rooted tooth that has undergone endodontic therapy.

Step 1—Preparation of the Surface

• Preparation of the surface is identical for chemical-cure and light-cure restorations.

Substep 1—Prepare the filling site, considering the following:

• All unsupported enamel should be removed using a handpiece and bur, chisel, or sharp curette (Fig. 8-4, A and B). A beveled edge will increase bonding surface area at the margins of the restoration except on occlusal surfaces.

• Margins should be made at sites least susceptible to caries.

• The preparation may include deep grooves on the side or base for retention.

• The border of the preparation should not terminate on cusps.¹⁰

• If zinc oxide–eugenol was used as a sealer during the endodontic procedure, the access opening should be cleared of residual sealer by using alcohol or other clearing agent applied to cotton pellets or gauze, so as not to interfere with the surface bonding process and to have a nonzinc-eugenol base material in place. In deeper restorations, a base layer of calcium hydroxide, glass ionomer, or a flowable composite may be placed first.

Fig. 8-4

Substep 2—Clean the surface using a prophy cup and flour pumice (not prophy paste, which may contain fluoride and glycerin) (Fig. 8-4, C).

Substep 3—Wash the surface with water and air dry (Fig. 8-4, D).

Substep 4—Acid-etch the enamel with 38% to 50% phosphoric acid solution or gel for 15 to 20 seconds, according to manufacturer’s instructions. Either a sponge (Fig. 8-5, A) or a brush (Fig. 8-5, B) may be used. Gel etchant can be placed with a small blunt needle and does not need to be applied with a brush or sponge.

• Some authorities promote a “total etch” technique, in which both the enamel and dentin are etched, to improve bonding.

• On nonvital teeth, dentin can be etched along with enamel, using phosphoric acid gel.

• On vital teeth, a dentin conditioner, which is a lesser concentration of etching gel (10% to 38% acid), can be used to etch the dentin for 10 to 15 seconds only.

Fig. 8-5

Substep 5—Wash the surface with water for 10 to 20 seconds (Fig. 8-5, C).

Substep 6—Air dry the surface (5 seconds) (Fig. 8-5, D).

• The area to be restored should have a chalky white appearance; if it does not, the surface should be etched again.

• The amount of drying depends on the particular product used. Some require the chalky white dryness. Others recommend blot drying only by using cotton pellets, paper points, gauze, or a 2-second period of air drying, so as not to desiccate the tooth and result in less satisfactory bonding.

• It is important to keep the surface free from chemicals, saliva, blood, and other contaminants that interfere with bonding.

• Contamination is the most common reason for restorative failure.

• Another common reason for failure is incomplete coverage by the cure light.

• If contamination occurs, the surface should be prepared again, although a shorter etching time may be used.

Step 2—Application of the Bonding Agent: Chemical Cure (Light-Cure Gun Not Available)

• The following procedure is for applying a chemical-cured bonding agent followed by applying a chemical-cured restorative resin.

• These steps vary with the manufacturer (Table 8-3). Some first apply a dentin primer to enhance bonding of the unfilled resin; others mix the dentin primer chemical with the unfilled resin.

Table 8-3 BONDING AGENTS

Chemical-Cured Bonding Agents
*Product*	*Manufacturer*
Bonding Agent Self Cure	Dentsply Caulk
Etch-Prep	Henry Schein
Clearfil New Bond	Kuraray America
Encore Bond	Centrix
Dentin Bonding Agents
*Product*	*Manufacturer*
All Bond 2	Bisco
Clearfil Line Bond 2V	Kuraray America
DenTASTIC	Pulpdent
Gluma Solid Bond	Heraeus Kulzer
OptiBond	Kerr
OptiBond FL	Kerr
Scotchbond Multi Purpose	3M ESPE
Tenure	Den-Mat
Syntac	Ivoclar Vivadent
One Up Bond F	Morita
ProBond	Dentsply Caulk
PermaQuick	Ultradent
Wet Bond	Mirage Dental
	Systems/Chameleon Dental Products
Dual-Cure Bonding Agents
*Product*	*Manufacturer*
Scotchbond Multipurpose Plus	3M ESPE
DenTASTIC Uno Duo	Pulpdent
Clearfil Photo Bond	Kuraray America
OptiBond Solo Plus Dual Cure	Kerr
Prime & Bond NT	Dentsply Caulk
Multibond	Centrix
Bond-It	Pentron Clinical
	Technologies
Single-Step Bonding Agents
*Product*	*Manufacturer*
DenTASTIC Uno	Pulpdent
Excite Advanced Adhesive Technology	Ivoclar Vivadent
OptiBond Solo Plus	Kerr
One-Step	Bisco
One-Step Plus	Bisco
Single Bond	3M ESPE
Syntac Single Component	Ivoclar Vivadent
Gluma Comfort Bond	Heraeus Kulzer
Clearfil SE Bond	Kuraray America
Tenure, UniBond	Den-Mat
Xeno	Dentsply Caulk
PQ1	Ultradent
Prime One	Mirage Dental
		Systems/Chameleon
		Dental Products
Bond-1	Pentron, Clinical
	Technologies

Substep 1—Drop(s) of bonding agent solution A are placed in a dappen dish (Fig. 8-6, A).

Fig. 8-6

Substep 2—Bonding agent solution B is added to the same dappen dish (Fig. 8-6, B). Exact proportions of the two solutions are determined by the manufacturer’s recommendations. The solutions are mixed with a brush (Fig. 8-6, C).

Substep 3—A thin coat of bonding agent is applied to the prepared surface (Fig. 8-6, D).

Substep 4—A gentle stream of air is blown over the surface to minimize the thickness and eliminate pooling of the bonding agent. (Some manufacturers recommend repeating these two steps.) The dentin surface should appear shiny.

Substep 5—The unfilled resin is placed on a brush (Fig. 8-6, E) and is brushed onto the tooth (Fig. 8-6, F).

Substep 6—A gentle stream of air is directed onto the unfilled resin-covered tooth surface to thin the layer of resin and to eliminate pooling.

Step 3—Application of the Restorative Agent: Chemical Cure (Light-Cure Gun Not Available)

• The chemical-cured, filled resin (Table 8-4) is mixed as directed by the manufacturer.

Table 8-4 CHEMICAL-CURED COMPOSITE RESINS

Conventional Fillers
*Product*	*Manufacturer*
Concise	3M ESPE
Composite/radiopaque	Henry Schein
Hybrid Fillers
*Product*	*Manufacturer*
P10	3M ESPE
Marathon (hybrid)	Den-Mat
CR Hybrid	Centrix
Bisfil II	Bisco
Core Materials
*Product*	*Manufacturer*
Clearfil Core	Kuraray America
Core Paste	Den-Mat
Encore	Centrix
Core Material	Henry Schein
CompCore	Premier

Substep 1—Equal portions of the filled resin are placed on a mixing slab (Fig. 8-7, A).

Fig. 8-7

Substep 2—The restorative material is mixed in a figure-of-eight motion using a plastic spatula.

• The mixing should be thorough and take 15 to 20 seconds.

Substep 3—The mixed resin is transferred to the site with a plastic filling instrument (Fig. 8-7, B).

• The material may also be transferred to the site by using an injection syringe (Centrix II Syringe, Centrix, Shelton, Conn.).

• The injection syringe is loaded by scooping the material into the wide end of the plastic tip from either the spatula or the glass slab (Fig. 8-7, C).

• The rubber plunger is placed in the plastic tip behind the restorative material (Fig. 8-7, D.

• The material is injected into the restoration site (Fig. 8-7, E).

• The cavity preparation is made to overfill slightly. The composite resin is allowed to harden, usually within 2 to 6 minutes.

Substep 4 (Optional)—A Mylar strip is placed over the site to conform the material better to the tooth shape and to compact the material, lessening the chance of leaving an internal void (Fig. 8-7, F).

Step 3—Application of the Restorative Agent (Light-Cure Gun Available)

General comments

• Some light-cure products require mixing (substeps 1 and 2); others may be used directly without mixing (Table 8-5). Generally, light-cure products come either in a syringe or in a preloaded syringe tip.

• Dual-cure materials cure by both light and chemical reactions.

• The unfilled resin may also need light curing before application of the filled resin.

• An advantage of light-cured restorative materials is the increased time for shaping the filled resin before hardening it with the light gun.

Table 8-5 LIGHT-CURE RESTORATIVE MATERIALS

Light-Cure Microfil Composites
*Product*	*Manufacturer*
Durafill VS	Heraeus Kulzer
Amelogen Microfil	Ultradent
Renamel Microfil	Cosmedent
Esthet-X Micro Matrix Restorative	Dentsply Caulk
HelioProgress	Ivoclar Vivadent
Filtek A110	3M ESPE
Micronew	Bisco
Virtuoso Sculptable	Den-Mat
Light-Cure Hybrid Composites
*Product*	*Manufacturer*
Charisma	Heraeus Kulzer
Tetric	Ivoclar Vivadent
Herculite XR	Kerr
Herculite XRV	Kerr
Prodigy	Kerr
Amelogen Universal	Ultradent
Z100	3M ESPE
Filtek Z250	3M ESPE
Prisma APH	Dentsply Caulk
Prisma TPH	Dentsply Caulk
Clearfil ST Opaquer	Kuraray America
Clearfil AP-X	Kuraray America
Renew	Bisco
Aelite LS	Bisco
Versalite	Centrix
True Vitality	Den-Mat
Vit-1-escence Syringes	Ultradent
Simile	Pentron Clinical Technologies
Flowable Composites
*Product*	*Manufacturer*
Aeliteflo	Bisco
Tetric Flow	Ivoclar Vivadent
Starflow	Danville Materials
Esthet-X Flow	Dentsply Caulk
Flow-It	Pentron Clinical Technologies
Filtek Flow	3M ESPE
Flow Line	Hereaus Kulzer
Heliomolar Flow	Ivoclar Vivadent
Point 4 Flowable	Kerr
Revolution Formula 2	Kerr
PermaFlo	Ultradent
PermaFlo DC	Ultradent
Flows-Rite	Pulpdent
Versaflo	Centrix
Virtuoso Flowable	Den-Mat
Compactable Composites
*Product*	*Manufacturer*
Pyramid	Bisco
Filtek P-60	3M ESPE
SureFil	Denstply Caulk
Alert	Pentron Clinical
Alert	Technologies
Prodigy Condensable	Kerr
Solitare 2	Heraeus Kulzer
Heliomolar HB	Ivoclar Vivadent
Virtuoso Packable	Den-Mat
Compomers
*Product*	*Manufacturer*
F2000	3M ESPE
Dyract AP	Dentsply Caulk
Dyract Flow	Dentsply Caulk
Compoglass F	Ivoclar Vivadent
Light-Cure or Dual-Cure Composite Core Materials
*Product*	*Manufacturer*
Clearfil Photo Core	Kuraray America
Core Restore 2	Kerr
Encore Supercure	Centrix
FluoroCore	Dentsply Caulk
HardCore	Pulpdent
ParaPost, ParaCore	Coltene/Whaledent
HardCore	Pulpdent
Bisfil Core	Bisco
Bis-Core (dual cure)	Bisco

Light-cure technique

Substep 1—The filled resin is dispensed from the syringe onto a plastic working instrument (Fig. 8-8, A). Some products come with small ampules of filled resin and an injection syringe. This material can be deposited directly into the cavity preparation.

Fig. 8-8

Substep 2—The filled resin is applied to the prepared surface (Fig. 8-8, B).

Substep 3—The restorative material is shaped with a plastic working instrument.

• A small amount of unfilled resin on a plastic filling instrument can be used to help shape the filled resin and prevent sticking.

Substep 4 (Optional)—For some sites, a Mylar strip can be drawn taut over the site to compact the material more densely and conform it more exactly to the tooth shape.

Substep 5—The filled resin is hardened with a light-cure gun (Fig. 8-8, C). Hold the tip of the light source within 3 to 4 mm of the surface and cure the restorative material for 30 to 70 seconds, according to the manufacturer’s instructions. The time necessary will vary depending on the darkness of the shade, the thickness of the restoration, the product used, and the strength of the cure light. The thickness of restorative material should be no more than 2 mm at a time without curing to minimize polymerization shrinkage. Large restorations may need to be cured from several directions and have smaller increments placed in sequential layers and cured incrementally to minimize polymerization shrinkage.

Step 3—A coarse diamond bur is used to roughen the entire surface of the remainder of the restoration to eliminate superficial resin that has been exposed to the oral environment.

Step 4—A phosphoric acid gel is spread over the entire preparation for 30 seconds, rinsed with water for 30 seconds, and air dried.

Step 5—An unfilled resin is applied over the surface and blown gently with compressed air to a thin layer. The unfilled resin is light-cured, if required.

Step 6—The filled resin is mixed, placed in an injection syringe, and injected uniformly into the restorative site.

Step 7—The resin is allowed to cure. If using a light-cure restorative material, the curing light is held from the side in an attempt to cure from the restorative margins first.

Step 8—The surface is re-contoured and smoothed as described on p. 438.

Glass Ionomers

General Comments

• Glass ionomers are sold in kits that may contain powder (in various shades), liquid, measuring scoops, varnish, etching agent, and mixing pads.

• They are easy to use and are less technique sensitive than composite restorative materials.

• The powder is an aluminosilicate glass.

• The anhydrous form contains acid in the powder.

• The hydrous form contains acid in the liquid.

• When the powder and liquid are mixed together, chemical reactions bond the restorative material to tooth structure and harden the compound.

• Light-cure and dual-cure glass ionomer restorative materials are available.

• Glass ionomers can be classified as type I (luting-sealing) cement or type II (for lining, restorative site, or core restoration) (Table 8-6).

• Type I glass ionomers are fine grained and are used for cementing (luting) crowns, bridges, and other castings.

• Type II glass ionomers are used as restorative materials.

• Type II glass ionomers are coarser than type I and therefore are not suitable for cementing.

• Restorative glass ionomers can be used as a base or as the sole restorative agent.

• Glass ionomers are biocompatible and do not require placement of obtunding base material to protect the pulp, except in case of direct pulp exposure.

• Nonencapsulated forms are mixed with a spatula and pad.

• The encapsulated form requires a special instrument to break the internal separation between the liquid and powder, an amalgamator to mix the compound, and a special syringe to apply the mixture.

• A consideration with glass ionomer compounds is their lack of wearability. In an attempt to increase wearability, called abrasive resistance, some manufacturers have added metals to the mixture. Most commonly, silver is added; gold, copper, and zinc have been suggested as possible alternatives.

• After mixing nonencapsulated forms, the material is either transferred to an injection syringe and squeezed into the prepared cavity or is installed with a plastic placement instrument.

• With chemical-cure restorative materials, the surface should be protected from loss or gain of moisture by applying a varnish or light-cure sealant.

• Once hardened, the surface can be smoothed with a diamond finishing bur while being irrigated with copious amounts of water.

• The restoration should not be smoothed with a carbide bur.

• If water is not used, cocoa butter can be used as a lubricant.

• Without a lubricant, the material will overheat, desiccate, and weaken.

• Glass ionomer restorative materials have the advantage of forming a chemical bond as well as a mechanical bond to enamel and dentin.

• Glass ionomers release fluoride slowly, which can be an advantage when cementing orthodontic bands or as a base underneath composite resin restorations.

• The expansion coefficient is the same as that of the tooth.

Table 8-6 GLASS IONOMER RESTORATIVE MATERIALS

Type I: Luting or Cementing
*Product*	*Manufacturer*
CX-Plus GlasIonomer Cement	Shofu
Fuji 1	GC America
FujiCEM	GC America
Ketac-Cem	3M ESPE
Vivaglass Cem	Ivoclar Vivadent
GlassLute	Pulpdent
Type II: Core
*Product*	*Manufacturer*
Ketac Silver Applicap	3M ESPE
Ketac-Silver Maxicap	3M ESPE
Miracle Mix	GC America
Fuji II LC Core Material	GC America
EMKA Silver	Henry Schein
CoreShade	Shofu
Vitremer Core Buildup	3M ESPE
GlassCore	Pulpdent
Type II: Lining
*Product*	*Manufacturer*
FujiPlus	GC America
Fuji Lining LC	GC America
Ketac-Bond	3M ESPE
Ketac-Bond, Applicap	3M ESPE
Vitrebond	3M ESPE
RelyX	3M ESPE
GlassLine	Pulpdent
Type II: Restorative
*Product*	*Manufacturer*
Fuji II	GC America
Fuji II LC	GC America
Fuji IX GP	GC America
Ketac-Fil Applicap	3M ESPE
Ketac-Molar Applicap	3M ESPE
Photac-Fil Quick Applicap	3M ESPE
Geristore	Den-Mat
GlassFill	Pulpdent