Clinical efficacy of various modifications of glass ionomer cement as a restorative material in primary teeth: A systematic review

Bakhtawar Shakil¹ image, Mousumi Goswami2 image, Aditya Saxena3 image, Prachi Pathak4 image, Shruti Balasubramania5 image, Aayushi Sangal6 image, Ajay Khanna7 image

Highlights

Glass ionomer cements are widely used in pediatric dentistry but have limitations, prompting modified formulations with improved clinical performance.

RMGIC, HVGIC, nano-filled, and bioactive materials show better durability, wear resistance, and caries prevention.

The review supports a more tailored selection of restorative materials based on clinical  outcomes, emphasizing the potential of bioactive and nanomodified GICs in improving pediatric dental care.

Abstract

This systematic review aimed to assess the clinical performance of modified glass ionomer cements (GICs) in restoring primary teeth. The focus was on evaluating their longevity, marginal adaptation, wear resistance, caries prevention, and overall durability in primary teeth. Following PRISMA 2020 guidelines and PROSPERO registration, a systematic search was conducted across PubMed, Scopus, and Google Scholar for studies published between 2014 and 2024. Sixteen eligible studies were included. Risk of bias was assessed using the Cochrane ROB 2 tool. Clinical performance was evaluated based on standardized criteria, including USPHS, FDI, and Ryge systems. Resin-modified GIC (RMGIC) and high-viscosity GIC (HVGIC) demonstrated better marginal integrity and wear resistance than conventional GIC. Nano-modified GICs, such as Ketac Nano, showed improved mechanical strength and esthetics. Bioactive and alkasite-based materials (e.g., Cention N) offered therapeutic benefits like fluoride release and remineralization, along with good clinical durability. Conventional GICs showed higher failure rates, particularly marginal breakdown, while modified GICs exhibited reduced failure over 12–36 months. However, variations in evaluation criteria and limited long-term data on newer materials restricted the strength of comparisons. The study concluded that modified GICs, particularly RMGIC, HVGIC, and bioactive formulations, show promising clinical performance in primary teeth restorations. Their selection should consider caries risk and cavity size. While current evidence supports their use, future studies with standardized protocols and long-term follow-ups are necessary to establish their sustained efficacy.

Keywords: Glass Ionomer Cements: Tooth; Deciduous; Dental Restoration; Permanent; Pediatric Dentistry

Author Affiliations

  1. Post Graduate Student, Department of Pediatric and Preventive Dentistry, ITS Dental College Hospital and Research Centre, India (Correspondence:bakhtawarshakil@gmail.com)
  2. Professor, Department of Pediatric and Preventive Dentistry, ITS Dental College Hospital and Research Centre, India 
  3. Professor, Department of Pediatric and Preventive Dentistry, ITS Dental College Hospital and Research Centre, India
  4. Reader, Department of Pediatric and Preventive Dentistry, ITS Dental College Hospital and Research Centre, India
  5. Senior Lecturer,  Department of Pediatric and Preventive Dentistry,  ITS Dental College Hospital and Research  Centre, India
  6. Senior Lecturer,  Department of Pediatric and Preventive Dentistry, ITS Dental College Hospital and Research Centre, India
  7. Post Graduate Student, Department of Pediatric and Preventive Dentistry, ITS Dental College  Hospital and Research
    Centre, India 
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Article Info

Contemp Pediatr Dent 2025:6(3):200-210

Received: 28 June 2025

Accepted: 22 September 2025

Online First: 25 December 2025

DOI: 10.51463/cpd.2025.36

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					Bakhtawar Shakil, Mousumi Goswami, Aditya Saxena, Prachi Pathak, Shruti Balasubramanian, Aayushi Sangal, Ajay Khanna. Clinical efficacy of various modifications of glass ionomer cement as a restorative material in primary teeth: A systematic review. Contemp Pediatr Dent 2025:6(3):200-210

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