The clinical performance of a glass polyalkenoate (glass ionomer) cement used in a 'sandwich' technique with a composite resin to restore Class II cavities

Abstract

The use of glass polyalkenoate (GPA) cement in conjunction with composite resin using an acid etch technique is now well known and a 'sandwich' of tooth/GPA cement/composite resin has been recommended to form the cervical seal at the base of approximal boxes in Class II cavities. This paper reports on the 2-year results of a controlled clinical trial using a commercial GPA lining cement. The trial was designed to evaluate the efficacy of this 'sandwich' technique. Sixty-four restorations in the mouths of 22 patients were evaluated during the 2.5 year period of the trial. The composite resin component of the restorations performed well. Five restorations failed, all in the region of the approximal box. Four failures were related to the exposed GPA cement component of the 'sandwich'. Failure was probably related to placement difficulties of the technique. The use of GPA cement laminated with composite resin when the GPA cement was enclosed within the final restoration appeared to be a successful technique.

Nine-year evaluation of a polyacid-modified resin composite/resin composite open sandwich technique in Class II cavities

“…Improved marginal adaptation was observed initially but also a high clinical failure rate due to continuous loss of the GIC. 10,12 Kemp-Scholte and Davidson showed that materials with lower elasticity modulus can act as an elastic buffer, which relieved contraction stresses and improved marginal integrity. 25 Since PMRC include resins with a modulus of elasticity value between those of RC and GIC, the material may work as a stress breaking barrier between the tooth and the composite.…”

“…The open sandwich technique was preferably recommended in high-caries-risk patients because of the fluoride release from the material. 10,11 The GIC covered most of the exposed dentin and extended to the periphery of the proximal box to form the cervical seal. Clinical failure rates of this technique have been reported between 13 and 35% after 2 years and 75% after 6 years.…”

Adhesive restorative materials: A review

“…The 'cervical lining' technique (also known as the 'open sandwich', a term not favoured by the first author) was described in 1984, 7 and clinical trials are supporting its usefulness, provided that an appropriate GIC is used. [77][78][79][80] Glassionomer cements can be effective fissure sealants and are useful when optimum moisture control for resinbased sealants cannot be achieved. 81 Although clinical retention appears less than for resin-based sealants, prevention of fissure caries is comparable.…”

Stainless steel crown versus modified open‐sandwich restorations for primary molars: a 2‐year randomized clinical trial

“…The original sandwich concept, with the GIC cement element open to the oral environment, has been recommended in high‐caries‐risk patients 20 . Several studies in adult population showed clinical failure rates between 13% and 35% after 2 years, and 75% after 6 years 21–23 . To increase the quality and longevity of the open‐sandwich restoration, a modified open‐sandwich restoration was suggested 24 .…”