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 Table of Contents  
Year : 2022  |  Volume : 9  |  Issue : 3  |  Page : 151-156

Cross-sectional survey of resin-modified glass ionomer as dental restoration in Saudi Arabia

1 Department of Dentistry, Batterjee Medical College, Jeddah, Saudi Arabia
2 Department of Dentistry, Batterjee Medical College, Jeddah, Saudi Arabia; Department of conservative Dentistry, Faculty of Dentistry, Cairo University, Cairo, Egypt
3 Department of Dentistry, Batterjee Medical College, Jeddah, Saudi Arabia; Department of Removable Prosthodontics, Ain Shams University, Cairo, Egypt

Date of Submission06-Aug-2022
Date of Acceptance06-Nov-2022
Date of Web Publication31-Dec-2022

Correspondence Address:
Dr. Amr Saad
Department of Dentistry, Batterjee Medical College, Jeddah

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjoralsci.sjoralsci_31_22

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Introduction: Resin-modified glass ionomers (RMGI) were developed to improve the properties of glass ionomer cement.
Aim: The objective is to assess the knowledge of dentists in Saudi Arabia about properties, uses, and manipulation of resin-modified glass ionomer (RMGI).
Materials and Methods: An online questionnaire of 13 close-ended questions was disseminated on the internet. The survey investigated the preference for usage, cavity treatment, and both dentists' and patients' expectations.
Results and Discussion: One hundred and thirty dentists have participated; and more than 99% are using RMGI occasionally with specific cases. The most common clinical use was found to be in cases of root caries and as a temporary filling material (84.6% and 61.5%, respectively). The most noticeable advantage was the fluoride release. However, the most undesirable disadvantage was the inferior esthetic compared to composite resin. It has also shown an average expectation regarding the retention, wear resistance, contouring, handling, and esthetics.
Conclusion: Dentists had a good knowledge about the fluoride release ability of RMGI; however, most of the participating dentists were concerned about the esthetic and the handling of RMGI, and rarely use dentin conditioning and adhesive before RMGI placement.

Keywords: Esthetic restorations, fluoride release, glass ionomer, liner and bases, resin modified glass ionomer, root caries

How to cite this article:
Almutairi MA, Saad A, Mahmoud EH, Abuzenada B. Cross-sectional survey of resin-modified glass ionomer as dental restoration in Saudi Arabia. Saudi J Oral Sci 2022;9:151-6

How to cite this URL:
Almutairi MA, Saad A, Mahmoud EH, Abuzenada B. Cross-sectional survey of resin-modified glass ionomer as dental restoration in Saudi Arabia. Saudi J Oral Sci [serial online] 2022 [cited 2023 Mar 22];9:151-6. Available from: https://www.saudijos.org/text.asp?2022/9/3/151/366524

  Introduction Top

The idea of physicochemical adhesion to tooth structure resulted in the invention of polyacrylic acid cements, starting with zinc polycarboxylate, and subsequently, the glass-ionomer cements (GIC).[1]

These materials were shown to undergo specific adhesion with hydroxyapatite and proved to have satisfactory properties for a variety of clinical applications. The key property of (GIC) is fluoride release over a prolonged period and specific adhesion to enamel and dentine.[1],[2],[3]

However, the limited strength and esthetic appearance of GIC have confined its use to certain cases. In order to improve toughness, speed of setting, and resistance to hydration, hybrid materials in which some of water contents of glass-ionomer system was replaced by water-soluble polymers or monomer systems were formulated in the late 1980s.[1],[4] Hence, the improved form of GIC which is resin-modified glass ionomer (RMGI) had preserved the fluoride-releasing ability of the conventional GIC.[5] It has the components of both conventional glass-ionomer and light-cured resin.[6] Mostly, it is indicated as root caries restoration,[6] as well as Class III and Class V cavities in permanent teeth. Moreover, it has shown a good performance in Class I and Class II cavities in primary molars.[7],[8]

RMGI is also used as a base or liner, and the luting form is considered a good choice for permanent cementation of fixed prosthesis and ceramic-metal crowns.

This modified form of GIC, unlike the old self-hardening type, has a dual curing property, as it partly sets by acid-base neutralization reaction and partly by polymerization reaction.[9],[10]

Therefore, RMGI has the advantage of long working time with short setting time and higher early strength compared to the conventional type. It has also shown an improved esthetics, moisture resistance, and toughness.[10],[11]

Like the conventional GIC, it possesses the property of extended fluoride release and better bonding to tooth structure,[9] and better handling features.[12]

However, the strength and esthetic properties of RMGI are inferior to those of composite, that's why it is not indicated in areas with high-stress areas.[12],[13] Moreover, due to the presence of free resin monomers such as hydroxyethyl methacrylate (HEMA), RMGI is considered to be less biocompatible than the conventional GIC.[13],[14]

As a result of the wide range of RMGI uses as a restorative material, its advantages, disadvantages, and varieties in application methods, this study was conducted to assess the dentists' knowledge and to understand their clinical perspective and expectations of RMGI as a restorative material in Saudi Arabia.

  Materials and Methods Top

All dentists who are holding Saudi commission of health specialists registration, practicing in Saudi Arabia and agreed to participate in the study were included in the study.

An online questionnaire (Google Form) was formulated by the researcher to assess the knowledge of dentists about RMGI properties, uses, and manipulation technique. The questionnaire consists of closed-ended questions to allow easy data entry and analysis.

Study variable

All information regarding the nationality of dentists, years of experience, and level of education were recorded. Furthermore, the frequency of using RMGIC, advantages and disadvantages of RMGIC, techniques, and dentist–patient expectations of RMGIC was assessed.

Ethical clearance

Ethical approval number (RES-202-0046) was provided by the Ethical Committee of Batterjee Medical College, KSA, on 15 August 2021.

  Results Top

One hundred and thirty dentists have participated in the study, most of them were Saudi [68.5%] and only (31.5%) were non-Saudi [Figure 1]. The years of experience have ranged widely from <2 years to more than 10 years for some dentists; however, most of the dentists had 2–5 years of experience [Figure 2].
Figure 1: Nationality of the dentists

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Figure 2: Experience of the dentists

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Regarding the level of education, most of the dentists (72.3%) were general practitioners; only 27.7% were specialists [Figure 3].
Figure 3: Education level of dentists

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Almost all dentists (99.2%) agreed to use RMGIC occasionally, however, the exact uses have differed widely, these included open/close sandwich technique, root caries, temporary or definitive restorative material, and other uses [Table 1], [Table 2], [Table 3], [Table 4].
Table 1: Usage of resin modified glass ionomer cement among dentists

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Table 2: Usage of resin modified glass ionomer cement for sandwich technique

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Table 3: Usage of resin modified glass ionomer cement for root caries

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Table 4: Different uses of resin modified glass ionomer cement among dentists

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Regarding the use of dentin conditioning materials before the placement of RMGIC, more than 76% of the responding dentists are not using dentin conditioner or rarely using it. However, 6.9% did not know about it, only 19 dentists (14.6%) are frequently using it and 1.5% are regularly applying it [Table 5].
Table 5: Usage of dentin conditioner before resin-modified glass ionomer cement placement

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The frequency of using adhesive before RMGIC placement was not better; as more than 82% of dentists rarely used it [Table 6].
Table 6: The frequency of adhesive usage before resin-modified glass ionomer cement placement

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The most noticeable advantages of RMGIC between dentists were the fluoride release and the no-need for incremental placement with a percentage of 90% and 70.8%, respectively, however, the most undesirable disadvantages were the inferior esthetic and difficult handling (97.7% and 93.1%, respectively) [Figure 4] and [Figure 5].
Figure 4: Advantages of RMGIC

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Figure 5: Disadvantages of RMGIC over resin composite restorations. RMGIC

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RMGI cement has shown average results regarding the dentists' expectations in esthetic, handling, retention, contouring, and wear resistance. It has also shown an average of patients' expectations regarding esthetic [Figure 6] and [Figure 7].
Figure 6: Dentist's expectations of (a): Esthetics and (b): Handling

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Figure 7: Dentist's expectations of (a) retention, (b) contouring, and (c) wear resistance (numbers indicate the numbers of dentists)

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Regarding the patient's esthetic expectations, 67.7% of the patients agreed that RMGI met their expectations in average way whereas only 11.5% met their esthetic expectations [Figure 8].
Figure 8: Patient's esthetic expectations

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  Discussion Top

One hundred and thirty dentists had participated in the study, more than 71% of them are considered to be young with <5 years of experience. A larger randomized sample size would be more representative to the knowledge of dentist about RMGI properties and uses.

The use of RMGI in sandwich technique has been reported to relieve the contraction stress of direct composite restorations.[15] Furthermore, the open sandwich technique is considered to cause less microleakage compared to other direct restorative options.

It should be mentioned that a study conducted by Moazzami et al. to evaluate the effect of four different sandwich techniques on gingival microleakage of Class II direct composite restorations, reported that the use of RMGI sandwich technique had resulted in significantly more leakage compared to flowable or self-cure composite sandwich techniques.[16]

In our study, 86.9% of the dentists are rarely using it in open/close class II sandwich technique, 5.4% did not know about the technique and 5.4% have never used it.

The most common uses of RMGI between dentists were in cases of root caries (84.6%), temporary restorative material for adults (61.5%), and definitive restorative material in low load bearing arias in adult dentition (56.2%). This comes in agreement with what was reported in literature regarding the uses of RMGI.[17] However, the most uncommon uses were: restoring abrasion and erosion defects, atraumatic restorative treatment, and fissure sealing with 0.8% for each. This could be due to the popularity of conventional glass ionomers and resin-based sealers as sealing materials, especially that previous studies showed poor survival rate of RMGI sealants over 3 years and suggested its usage as transitional sealant.[18]

The most noticeable advantages for dentist were the fluoride release and easy placement without the need for incremental placement, accounted for 90% and 70.8%, respectively. This was consistent with the studies that declared the key property of GIC is the extended fluoride release, in addition to having initial fluoride release burst as conventional glass ionomers, amount of released fluoride from RMGI was shown to be similar to GIC by some studies, although it is affected by the type and amount of incorporated resin as well as variabilities in matrix and fillers among different RMGI brands.[19],[20]

The most recorded disadvantages were the inferior esthetic compared to composite resin and the contouring difficulty, accounted for 97.7% and 93.1%, respectively.

Only 14.6% of the dentist frequently performing dentin conditioning before RMGI placement and 1.5% are regularly using it. Although previous studies reported that the surface conditioning of dentin resulted in higher bong strength than unconditioned dentin. Dentin conditioning with 20% polyacrylic acid or EDTA partially removes the smear layer and partially demineralizes the underlying dentin, which increases the microporosities and the surface area for bonding, exposing more calcium ions.[21]

Previous studies have shown that adherence to RMGI to dentin can be enhanced with the use of dental adhesives. HEMA and the functional monomers in universal adhesive, self-etch adhesives, or even adhesive primer improve the dentin wettability, spread, and penetration of the RMGI, and binds the hydroxyapatite to the resin component of the RMGI. However, our study reported that only 8.5% of dentist are frequently using self-etch/universal adhesives before RMGI placement and 3.1% regularly using it.[22],[23]

  Conclusion Top

Dentists had a good knowledge about the fluoride release ability of RMGI. However, few of them are using it with composite resin for sandwich technique or in root caries.

Esthetic and handling of RMGI were the most unpopular properties for the participating dentists. Dentin conditioning and adhesive materials are rarely used before RMGI placement. Better knowledge and information about RMGI adhesion should be introduced to both dental students and practicing dentists in KSA.Considering the small sample size, a more randomized larger sample would be more representative for the dentist's knowledge.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Sidhu SK, Nicholson JW. A review of glass-ionomer cements for clinical dentistry. J Funct Biomater 2016;7:16.  Back to cited text no. 1
Menezes-Silva R, Cabral RN, Pascotto RC, Borges AF, Martins CC, Navarro MF, et al. Mechanical and optical properties of conventional restorative glass-ionomer cements – A systematic review. J Appl Oral Sci 2019;27:e2018357.  Back to cited text no. 2
Nakajo K, Imazato S, Takahashi Y, Kiba W, Ebisu S, Takahashi N. Fluoride released from glass-ionomer cement is responsible to inhibit the acid production of caries-related oral streptococci. Dent Mater 2009;25:703-8.  Back to cited text no. 3
Carey CM, Spencer M, Gove RJ, Eichmiller FC. Fluoride release from a resin-modified glass-ionomer cement in a continuous-flow system. Effect of pH. J Dent Res 2003;82:829-32.  Back to cited text no. 4
Zhang L, Tang T, Zhang ZL, Liang B, Wang XM, Fu BP. Improvement of enamel bond strengths for conventional and resin-modified glass ionomers: Acid-etching vs. conditioning. J Zhejiang Univ Sci B 2013;14:1013-24.  Back to cited text no. 5
Saad A, Inoue G, Nikaido T, Ikeda M, Burrow MF, Tagami J. Microtensile bond strength of resin-modified glass ionomer cement to sound and artificial caries-affected root dentin with different conditioning. Oper Dent 2017;42:626-35.  Back to cited text no. 6
Yaman SD, Er O, Yetmez M, Karabay GA. In vitro inhibition of caries-like lesions with fluoride-releasing materials. J Oral Sci 2004;46:45-50.  Back to cited text no. 7
Croll TP, Bar-Zion Y, Segura A, Donly KJ. Clinical performance of resin-modified glass ionomer cement restorations in primary teeth. A retrospective evaluation. J Am Dent Assoc 2001;132:1110-6.  Back to cited text no. 8
Almuhaiza M. Glass-ionomer cements in restorative dentistry: A critical appraisal. J Contemp Dent Pract 2016;17:331-6.  Back to cited text no. 9
Sidhu SK. Glass-ionomer cement restorative materials: A sticky subject? Aust Dent J 2011;56 Suppl 1:23-30.  Back to cited text no. 10
Maño EP, Algarra RM, Fawzy A, Leitune VC, Collares FM, Feitosa V, et al. In vitro bonding performance of modern self-adhesive resin cements and conventional resin-modified glass ionomer cements to prosthetic substrates. Appl Sci 2020;10:8157. [Doi: 10.3390/app10228157].  Back to cited text no. 11
Nicholson JW, Czarnecka B. The biocompatibility of resin-modified glass-ionomer cements for dentistry. Dent Mater 2008;24:1702-8.  Back to cited text no. 12
Carvalho FG, Sampaio CS, Fucio SB, Carlo HL, Correr-Sobrinho L, Puppin-Rontani RM. Effect of chemical and mechanical degradation on surface roughness of three glass ionomers and a nanofilled resin composite. Oper Dent 2012;37:509-17.  Back to cited text no. 13
Provenzi C, Leitune VC, Collares FM, Trommer R, Bergmann CP, Samuel SM. Interface evaluation of experimental dental adhesives with nanostructured hydroxyapatite incorporation. Appl Adhes Sci 2014;2:2.  Back to cited text no. 14
Czarnecka B, Kruszelnicki A, Kao A, Strykowska M, Nicholson JW. Adhesion of resin-modified glass-ionomer cements may affect the integrity of tooth structure in the open sandwich technique. Dent Mater 2014;30:e301-5.  Back to cited text no. 15
Moazzami SM, Sarabi N, Hajizadeh H, Majidinia S, Li Y, Meharry MR, et al. Efficacy of four lining materials in sandwich technique to reduce microleakage in class II composite resin restorations. Oper Dent 2014;39:256-63.  Back to cited text no. 16
Geraldo-Martins VR, Lepri CP, Palma-Dibb RG. Effect of different root caries treatments on the sealing ability of conventional glass ionomer cement restorations. Lasers Med Sci 2012;27:39-45.  Back to cited text no. 17
Baseggio W, Naufel FS, Davidoff DC, Nahsan FP, Flury S, Rodrigues JA. Caries-preventive efficacy and retention of a resin-modified glass ionomer cement and a resin-based fissure sealant: A 3-year split-mouth randomised clinical trial. Oral Health Prev Dent 2010;8:261-8.  Back to cited text no. 18
Wiegand A, Buchalla W, Attin T. Review on fluoride-releasing restorative materials-fluoride release and uptake characteristics, antibacterial activity and influence on caries formation. Dent Mater 2007;23:343-62.  Back to cited text no. 19
Khoroushi M, Keshani F. A review of glass-ionomers: From conventional glass-ionomer to bioactive glass-ionomer. Dent Res J (Isfahan) 2013;10:411-20.  Back to cited text no. 20
Rai N, Naik R, Gupta R, Shetty S, Singh A. Evaluating the effect of different conditioning agents on the shear bond strength of resin-modified glass ionomers. Contemp Clin Dent 2017;8:604-12.  Back to cited text no. 21
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Dursun E, Attal JP. Combination of a self-etching adhesive and a resin-modified glass ionomer: Effect of water and saliva contamination on bond strength to dentin. J Adhes Dent 2011;13:439-43.  Back to cited text no. 22
Khoroushi M, Karvandi TM, Kamali B, Mazaheri H. Marginal microleakage of resin-modified glass-ionomer and composite resin restorations: Effect of using etch-and-rinse and self-etch adhesives. Indian J Dent Res 2012;23:378-83.  Back to cited text no. 23
[PUBMED]  [Full text]  


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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