Use of Glass-ionomer cement as a restorative material: a systematic review

Background: The clinical applications of glass ionomers cements (GICs) are varied: restoration, lining material, sealing, hyper sensibility care and temporary cavity restoration. Due to the lack of physical properties, over time modifications of GICs were experimented and studied by the addition of metals, fibers, ceramics to the GIC powder in the attempt to overcome these problems and improve the material and clinical performance. The aim of this study was to evaluate whether primary and permanent teeth can be definitively restored with glass ionomer cements, based on the PICO(S) question “What is the clinical performance in primary and permanent teeth restored with glass ionomer cements?”, Methods: A systematic search of the studies available in the literature was conducted in the electronic databases MEDLINE/Pubmed, Scopus and Web of Science. Two independent, calibrated examiners. The eligibility criteria were: (1) to be a systematic review (2) to evaluate the clinical longevity of GICs in primary and permanent teeth (3) to be clinical trials. The systematic reviews that met these criteria were reviewed in their entirety and those who presented at least one of the following exclusion criteria were then considered ineligible: (1) not being a systematic review of clinical trials; (2) not evaluating the longevity/clinical performance of GICs; (3) studies of dental restorative materials in teeth with enamel alterations. Results: A systematic literature search in MEDLINE/PubMed, Scopus and Web of Science databases identified 132 references potentially relevant. Twenty-four eligible articles were identified, only 13 articles were included. Methodological quality was measured using the AMSTAR-2 tool and the risk of bias of the included systematic reviews by the ROBIS tool. The level of evidence analysis was performed using the GRADE tool. Conclusions: Glass ionomer cements seems to be a viable choice in both dentitions, but primary dentition presents more evidence, especially regarding the Atraumatic Restorative Treatment (ART) technique. There is conflicting evidence on which type of glass ionomer is the best and comparisons to other dental materials are lacking. In conclusion, more high-quality studies are needed with longer follow up periods (>6 years), especially in permanent teeth.