McLean J W
Institute of Dental Surgery, Eastman Dental Hospital, London, England.
Dent Clin North Am. 1992 Jul;36(3):693-711.
The use of glass-ionomer cements in clinical dentistry has expanded greatly over the last decade. Their use in treating early carious or erosion lesions has been investigated widely and established techniques include fissure filling, restoration of erosion lesions without cavity preparation, and the internal or tunnel restoration. Because of their adhesion to moist tooth structure, biologic compatibility, and fluoride release, increasing use also has been made of their anticariogenic properties in treating geriatric patients. Glass-ionomers have proved very successful as dentin substitutes for attaching composites to enamel without involving risk of pulpal damage in the deeper cavity. The deficiencies of glass-ionomer cements are well known, including lack of toughness, early water sensitivity, low abrasion resistance, and porosity, leading to poor surface polish. Solving these problems is formidable because inherently the strength of these cements is related to their water content. The clinician should be aware of these deficiencies and stay within the parameters of the techniques outlined in this article. In particular, clinical success depends on early protection of the cement from hydration or dehydration and the current use of light-cured bonding agents largely has solved this problem. The future probably lies in using laminate techniques in which materials that attach to dentin and form a biologic seal can be covered by tougher and harder enamel veneers, thus mimicking the structure of the tooth. It is possible that future materials will be developed on the lines of these polyelectrolyte cements in which higher molecular weight polymers are used in conjunction with polymers that contain photoinitiators to effect light curing and toughen the matrix. In addition, the possibility of developing laboratory-cured glass-ionomer inlays in which porosity can be reduced and tougher polymers used should be considered.
在过去十年中，玻璃离子水门汀在临床牙科中的应用有了极大的扩展。它们在治疗早期龋损或酸蚀病变方面的应用已得到广泛研究，既定技术包括窝沟充填、无需制备洞形的酸蚀病变修复以及内部或隧道修复。由于它们对潮湿牙体组织的黏附性、生物相容性和氟释放特性，其防龋性能在老年患者治疗中的应用也越来越多。事实证明，玻璃离子水门汀作为牙本质替代物，可在不涉及深龋洞牙髓损伤风险的情况下将复合材料黏附于釉质，非常成功。玻璃离子水门汀的不足之处众所周知，包括韧性不足、早期水敏感性、低耐磨性和孔隙率，导致表面抛光性差。解决这些问题颇具挑战性，因为这些水门汀的强度本质上与其含水量相关。临床医生应了解这些不足之处，并遵循本文所述技术的参数。特别是，临床成功取决于早期防止水门汀水化或脱水，而目前使用光固化黏结剂在很大程度上解决了这个问题。未来可能在于采用层压技术，即附着于牙本质并形成生物密封的材料可被更坚韧、更硬的釉质贴面覆盖，从而模仿牙齿的结构。未来有可能按照这些聚电解质水门汀的思路开发材料，其中使用高分子量聚合物与含有光引发剂的聚合物结合以实现光固化并增强基质。此外，应考虑开发实验室固化的玻璃离子嵌体，其孔隙率可降低，并使用更坚韧的聚合物。
