3M ESPE’s Ketac Nano: Not the glass ionomer you remember

Glass ionomer cements (GIC) were introduced to restorative dentistry in the late 1970s, featuring a chemistry that differentiated the material from other restoratives.

GICs are self-adhesive to enamel and dentin, provide caries protective fluoride release at the margins, can have the fluoride within their chemical matrix recharged by outside exposure to other fluoride containing materials, and provide moisture tolerance.

Unfortunately, early generation conventional glass ionomers were difficult to manipulate and not esthetic, with colors and opacities rarely seen in the natural dentition. Also, glass ionomers had to be protected with a varnish while the material underwent a 24-hour acid-base setting reaction.

Over the years there were improvements in esthetics with the introduction of resin-modified glass ionomers (RMGIs), which were primarily light cured. Still, even these resin-modified glass ionomer cements required mechanical mixers or capsules, creating challenges in their handling. There had to be a better way.

3M ESPE’sKetac™ Nano Light Curing Glass Ionomer Restorative has paved the way for a new classification in the glass ionomer category: the nano ionomer. This improved formulation provides for a significant change in what was for some dentists a disappointing class of restoratives.

Still, there are plenty of misconceptions about glass ionomers and what they can do for your practice. Here, we dispel some of those myths and highlight what this material has done to prove them wrong.

Misconception: Glass ionomers are not esthetic

Ketac Nano, through nano technology, features a combination of zirconia and silica nanofillers and nanoclusters that incorporate benefits seen with nanohybrid composites-improved esthetics, easy polishability with superior smoothness and luster, better wear resistance and improved physical properties. A nano ionomer is a significant improvement over conventional glass ionomers and past resin-modified glass ionomers. Ketac Nano’s range of shades (A1, A2, A3, A3.5, B2) handles most of the applications a clinician would use for a glass ionomer. Additionally, an A4 shade will be introduced soon, allowing for better matching of the cervical third of the tooth.

Misconception: Glass ionomers require either hand mixing or a mechanical mixer
In the past if you wanted to use a glass ionomer restorative, either you had to dispense to a mixing pad and hand spatulate the restorative material or take a capsule, shake and tap it, activate the capsule and then mix it on an amalgamator-triturator (automatic mixer) that required a minimum speed of 4200 rpm. Many dentists who now have amalgam-free practices don’t have a mechanical mixer and have discarded glass ionomers from their restorative armamentarium. The Quick Mix Capsule solves this problem. This delivery system easily mixes the nano ionomer with a miniaturized, clinically proven, self-mixing technology used with impression materials, composite resin core materials and resin cements. This capsule saves time, eliminates the need for a mechanical mixer taking up valuable counter space and allows for quick placement in significantly less time than traditional triturated capsules.

Misconception: Glass ionomers are only for pediatric and geriatric applications
No longer true. The improved esthetics and physical properties make RMGIs all-purpose restoratives. They are a perfect match for pediatric and geriatric use, but clinicians also should consider using them for patients with Class V carious and non-carious cervical lesions. For patients of all ages with high caries risk and carious lesions, a nano ionomer is an excellent choice. It’s also a good choice for patients with ultra-sensitivity of notched areas on root surfaces. An RMGI bonds via ionic adhesion to enamel and dentin, eliminating etching, which can contribute to even more sensitivity. RMGIs can be used for preventive resin restorations and to repair carious cervical margins of existing restorations. This is a restorative material for patients of any age.

Misconception: Applying a primer prevents fluoride release
One of the significant benefits of any GIC is the release of fluoride at the margins of the restoration and extending 1 mm beyond these margins. Instead of using a polyacrylic acid cavity cleanser that must be rinsed from the tooth surface, a nano ionomer uses a light cured primer as a surface treatment. The primer removes the smear layer and improves surface wettability for better adaptation of the product to the tooth surface when it is placed.