Page 14 - GC America: The GC Experience - eMagazine for Dental Enthusiasts (April 2017)
14 A Recent Reminder of the Benefits of Glass Ionomers TArticle by Dr. James C. Burden, DMD, FAGD here are times in practice when we are reminded of why we do what we do. Over the past 15 years, I have focused on the high risk caries patient. While there is debate in the literature and even amongst ourselves as to what patient fits the category of “high risk”, for me, I tend to look at all patients as potentially “high risk” for caries. My thinking in this is quite simple...I never know when my patient may become “high risk”. I have many patients that present with the classic “low risk” profile and then for one reason or another, they become “high risk” – sometimes overnight it seems. Perhaps it is a pregnancy, a new medication, a different biofilm challenge, development of GERD, and new “sport drink” diet, or an accident that leaves them unable to properly manage their oral hygiene and biofilm. Additionally, we are all born with “high risk anatomy” in the pit and fissure systems of our premolars and molar teeth. All of us can agree that the vast majority of carious lesions begin in the pit and fissure systems of these teeth. As clinicians, we are limited in our lesion diagnosis in these regions due mostly to challenges with anatomy and classic diagnostic modalities. For me, I see these regions of teeth as the “highest risk” in terms of potential lesion development. About 15 years ago, I began using a Diagnodent, caries detection dye, and air abrasion to reduce my diagnostic and anatomical limitations in evaluating the pit and fissure systems of premolar and molar teeth. Additionally, I use a surgical operating microscope when exploring this intricate microanatomy with air abrasion. This process has significantly raised my diagnostic success in these challenging regions. Following this exploration, I will either place a sealant if dentin has not been exposed, or a restoration if a dentinal lesion is discovered and removed. In either case, I use a glass ionomer. For sealants, I use GC Fuji TRIAGE® (pictured on the next page) and for restorations I have used GC Fuji IX GP® (pictured on the next page), and now, GC Fuji IX GP® EXTRA (pictured on the next page) to restore these micro-preparations. Contrary to composite, glass ionomer does not shrink when it sets (no open margins), sets in a wet field, has been shown to have long term fluoride uptake and release, chemically bonds to tooth structure, is radiopaque, can easily be condensed into micro-preparations, and is tooth colored. For me, this material provides the ultimate protection for the highest risk region of the mouth and potentially, the highest risk patient. A recent case has reminded me of why I treat these regions with such vigor. In early 2010, an 11 year old girl presented to our office.