Electron probe microanalysis of ion exchange of selected elements between dentine and adhesive restorative materials

BACKGROUND: There have been numerous attempts to demonstrate the phenomenon of ion exchange between auto cure glass ionomer cements (GICs) and dentine. The purpose of this study was to employ an electron probe microanalysis (EPMA) technique to examine the interchange of elements between non-demineralized dentine and two types of restorative material, auto cure GICs and a resin composite. METHODS: Restorations of auto cure GICs (Riva Fast, Fuji IX Fast, Ketac Molar Quick and Fuji VII) and a bonded composite resin were placed in each of 10 recently extracted human third molar teeth. After two weeks the restorations were sectioned and prepared for EPMA. Percentage weights of calcium, phosphorus aluminum, strontium and fluoride were calculated in the restorations 200 microm from the restorative interface and 200 microm into the dentine at 5 microm intervals. RESULTS: There was evidence of calcium and phosphorus in all five auto cure GICs to a depth of 50 microm. Aluminum and strontium ions were also present in dentine except subjacent to Ketac Molar restorations. There was evidence of element transfer into composite resin and resin-bonded dentine. CONCLUSIONS: The findings of this paper support the concept of ion exchange as a bonding mechanism between auto cure GIC and dentine. Element penetration into tooth structure and GIC exceeded beyond the "ion exchange layer" observed in scanning electron microscopy studies. Penetration of calcium and phosphorus into composite resin from dentine likely occurred as a result of the self-etching process dissolving calcium and phosphorus and incorporating these elements into the hybrid layer. The presence of Al and Sr ions in dentine were likely to be associated with resin tags extending into the dentine.     

Inhibition of demineralization in vitro around fluoride releasing materials

Replacement of restorations because of secondary caries is a continuing problem in restorative dentistry. This investigation assessed the capacity of fluoride-releasing restorative materials to resist caries in vitro when used in roots. Class 5 cavities were prepared in buccal and lingual surfaces of 30 extracted premolars and restored with one of three polyacid modified resin composites (F-2000, Hytac and Compoglass F), a resin modified glass-ionomer cement (Fuji II LC) a conventional glass ionomer (Ketac-Fil), and a resin composite (Z-100). After 5 weeks in an acid gel for caries-like lesion formation, the teeth were sectioned longitudinally and examined with polarized light. The results showed that restoration of caries with polyacid modified resin composites and resin modified glass ionomer cements may be of great importance in the prevention of secondary caries around the restorations in roots. Clinical Relevance Light cured fluoride-releasing restorations may inhibit caries-like lesions. Inhibition of demineralization in vitro around fluoride releasing materials.     

Posterior resin composite restorations with or without resin‐modified,glass‐ionomer cement lining: a 1‐year randomized,clinical trial

Aim: To investigate the effect of resin‐modified, glass‐ionomer cement lining on the quality of posterior resin composite restorations, bonded with a two‐step, total‐etch or self‐etching adhesive, at 1 year. Methods: Patients with 1–4 moderate‐to‐deep, primary occlusal caries in molars were informed and recruited. A total of 110 composite restorations were placed in 75 participants, with one of four restorative procedures: (a) bonded with a total‐etch adhesive (Single Bond 2); (b) lined with glass‐ionomer cement (Fuji Lining LC), and then bonded with total‐etch adhesive; (c) bonded with a self‐etching adhesive (Clearfil SE Bond); and (d) lined with glass‐ionomer cement, and then bonded with self‐etching adhesive. Results: At 1 year, 57 patients (86 restorations) attended the recall. Each of the restorations was evaluated and scored from 1 (clinically excellent) to 5 (clinically poor) using the following criteria: (a) patient satisfaction; (b) fracture and retention; (c) marginal adaptation; (d) recurrent caries; and (e) post‐operative sensitivity. At 1 year, the qualities of the restorations were not significantly affected by the placement of glass‐ionomer cement lining, regardless of the adhesive used (P > 0.05). Most of the restorations were scored 1 for all criteria. Conclusions: The benefit of placing a glass‐ionomer cement liner in resin composite restoration is questionable.     

A clinical evaluation of the restoration of root surface caries

Root surface caries is of growing importance because its prevalence increases with age, and the population of the United States is growing older while edentulism and tooth loss rates have declined. Few clinical studies have evaluated materials used for the restoration of active root caries lesions. This study evaluated a Type II glass ionomer cement and a microfilled composite resin, both placed in preparations without mechanical retention or acid etching of enamel, in the restoration of root caries.
Fifty adult volunteers with active root caries received one or both materials with the material chosen randomly. Patients were recalled after 24 months to evaluate restorations for retention, additional caries, marginal integrity, and overall clinical acceptability. Seventy-seven restorations were available for re-evaluation.
Forty-five percent of the glass ionomer and 73% of the composite restorations were clinically acceptable after 24 months. Of the glass ionomers, 39% were fully retained compared with 73% of composite restorations. Among those partially or fully retained, 25% of the glass ionomer restorations had minimal loss of marginal integrity and 30% had extensive loss while 53% and 9% of composite restorations had minimal and extensive loss, respectively. Most restorations were clinically unacceptable because of restorative material loss.
Substantial numbers of glass ionomer cement and composite resin restorations were lost. This may be the result of difficulties in maintaining isolation and obtaining a proper gingival seal. Thus, routine use of mechanical retention is still highly recommended to reduce the loss of restorative material.     

Demineralization around orthodontic brackets bonded with resin-modified glass ionomer cement and fluoride-releasing resin composite.

PURPOSE: Enamel demineralization adjacent to orthodontic brackets is one of the risks associated with orthodontic treatment. Glass ionomer cements have been shown to decrease enamel demineralization adjacent to brackets and bands but do not exhibit bond strengths comparable to resin composites. The purpose of this in vitro study was to compare a fluoride-releasing resin composite versus a resin-modified glass ionomer cement for inhibition of enamel demineralization surrounding orthodontic brackets. METHODS: Forty-five teeth were randomly assigned to 3 groups of 15 teeth. Fifteen were bonded with Concise (3M), a non-fluoride-releasing resin composite (control); 15 teeth were bonded with Light Bond (Reliance), a fluoride-releasing resin composite; and 15 teeth were bonded with Fuji Ortho LC (GC Corporation), a resin-modified glass ionomer cement. The teeth were placed in an artificial caries solution to create lesions. Following sectioning of the teeth in a buccolingual direction, polarized light microscopy was utilized to evaluate enamel demineralization adjacent to the orthodontic bracket. The area of the lesion was measured 100 microns from the orthodontic bracket and bonding agent. RESULTS: MANOVA (P < .0001) and Duncan's test (P < .05) indicated the resin-modified glass ionomer cement (Fuji Ortho LC) and the fluoride-releasing resin composite (Light Bond) had significantly less adjacent enamel demineralization than the non-fluoride-releasing resin composite control. However, there was no significant difference between the resin-modified glass ionomer cement and the fluoride-releasing resin composite. CONCLUSIONS: Based on the results of this in vitro study, it can be concluded that Fuji Ortho LC and Light Bond exhibit significant inhibition of adjacent demineralization compared to the non-fluoride-releasing control.     

The effect of silver fluoride and potassium iodide on the bond strength of auto cure glass ionomer cement to dentine

BACKGROUND: Diamine silver fluoride (Ag(NH3)2F), referred to as AgF, has been shown to reduce the incidence of caries in primary dentitions. The clinical application of this material has been limited by staining associated with both teeth and restorative materials. The application of potassium iodide (KI) after AgF eliminates stain formation. There is a lack of information as to how the addition of AgF followed by KI may affect the bond strength to dentine. The purpose of this study was to compare the bond strengths of auto cure glass ionomer cement to dentine surfaces that had been treated with AgF and KI and without treatment. METHODS: Ten recently extracted human third molars were embedded into methyl methacrylate resin and sliced to form a square block of exposed dentine surfaces. Each of the four surfaces were treated by one of the following procedures: (a) etching with 37 per cent phosphoric acid; (b) applying GC dentine conditioner; (c) etching, followed by application of AgF/KI then washing off the precipitate and air drying; and (d) etching, applying AgF/KI and air drying the reaction products on the surface. Fuji VII auto cure glass ionomer cement was bonded onto each sample and fracture tested. RESULTS: The dentine samples treated with AgF/KI followed by washing away the precipitate and air drying had bond strengths (2.83 MPa) not significantly different from samples that had been conditioned (2.40 MPa). Samples where the AgF/KI precipitate had been air dried onto the dentine surface had significantly lower bond strengths (1.49 MPa) than the washed samples. Samples that were etched had significantly lower bond strengths (1.91MPa) than the conditioned samples. CONCLUSIONS: This study found that the application of AgF/KI to etched dentine samples followed by washing off the precipitate, created bond strengths that were not significantly different to conditioned samples. Leaving the AgF/KI precipitate on the dentine surface significantly reduced the bond strength of auto cured glass ionomer cement to dentine. Washing away the reaction products and air drying is recommended as the clinical protocol for using AgF and KI on dentine surfaces prior to application of an auto cure glass ionomer cement.     

Influence of different transitional restorations on the fracture resistance of premolar teeth

Controversy exists over the most favorable material and type of restoration to be used to transitionally restore teeth destined to be crowned. This in vitro study uses fracture resistance testing to compare eight different transitional restorations in maxillary premolars. Ninety sound maxillary premolars were randomly selected and allocated to nine groups, each comprising 10 teeth. One group remained unrestored and was used as the control. Teeth in the remaining groups were prepared to a standard cavity form using: a copy milling process removing the palatal cusp. Restorations were placed using amalgam with dentin pins and cavity varnish; amalgam with an amalgam bonding agent; resin composite with dentin pins and a dentin bonding agent; resin composite with a dentin bonding agent only; resin-modified glass ionomer with dentin pins; resin-modified glass ionomer cement alone and cermet with dentin pins and cermet alone. Each restored tooth was then subjected to axial loading via a bar contacting the buccal and restored palatal cusps until failure of the restored tooth occurred. The mean load-to-fracture values were statistically compared and the modes of failure recorded. It was found that the choice of restorative material and type of restoration had little effect on the fracture resistance of the restored tooth with the exception of those teeth restored with reinforced glass ionomer cement alone, which exhibited a significantly lower resistance to fracture than the other restored teeth. However, the choice of restorative material/technique did influence the mode of failure. Failure in teeth restored with resin-modified glass ionomer cement alone produced the least damage to the remaining tooth tissue when failure occurred. Consequently, this material may offer the most favorable range of properties for the transitional restoration of extensively broken-down maxillary premolar teeth destined to be crowned. Furthermore, the findings of this study fail to support the use of dentin pins in the placement of bonded build-up restorations.     

Conventional versus resin-modified glass-ionomer cement for Class II restorations in primary molars. A 3-year clinical study

Summary. Objective. To compare the clinical performance of two glass‐ionomer cements (GICs)for Class II restorations in primary molars: a conventional cement (Fuji II®) and a resin‐modified cement (Vitremer®). Design. Split mouth and random assignment to the two materials were used for the majority of the molars. Sample and methods. Forty consecutive 4–7‐year‐old children were included. One operator made 115 restorations: 53 with Vitremer and 62 with Fuji II. The restorations were evaluated clinically, radiographically and from colour photographs. Results. The cumulative success rate of the Vitremer restorations was 94% and that of the Fuji II restorations 81%. The difference is statistically significant. The risk of a failed restoration was more than five times higher with Fuji II than with Vitremer as the restorative material. Of the 13 unsuccessful restorations, seven had lost their retention, four had secondary caries, and two were fractured. Conclusions. The resin‐modified GIC offered advantages over the conventional GIC for restoring approximal caries in primary molars.     

Microleakage of several class V anterior restorative materials: a laboratory study.

The study was designed to evaluate the marginal leakage of abraded gingival areas in extracted teeth using five anterior composite resin acid-etch restorative materials and a glass ionomer cement, ASPA. In using three of the composite resin restorative materials, Simulate, Cervident, and Concise, there was a layer of unfilled resin between the etched tooth surface and the composite resin. Restodent and Enamelite were placed directly on the etched tooth surface. The results of the study indicate that there is a significantly greater degree of marginal leakage at the gingival margin than there is at the occlusal or incisal margin of composite restorations. In addition, greater marginal leakage was observed in those restorations where no layer of unfilled resin was placed between the etched tooth surface and the composite resin. The glass ionomer cement showed no marginal leakage at intervals of one day, three months, and six months; however, a small amount of leakage was observed at the incisal or occlusal and gingival margins at a year on half of the autoradiographs. A study has been initiated to determine leakage patterns around composite resin restorations placed in teeth with naturally occurring cervical erosion or abrasion.     

Smooth Surface Glass lonomer Restoration for Primary Teeth

Glass ionomer restorative cement offers the clinician an alternative to bonded composite resin for restoration of certain lesions in primary teeth. This article details a step-by-step procedure for restoration of a smooth surface carious lesion in a primary incisor using an encapsulated glass ionomer restorative material and reviews advantages and limitations of the cement. A light-hardened glass ionomer liner/base that has proven useful as an enamel and dentin restorative is also described.     

Smooth surface glass ionomer restoration for primary teeth

Glass ionomer restorative cement offers the clinician an alternative to bonded composite resin for restoration of certain lesions in primary teeth. This article details a step-by-step procedure for restoration of a smooth surface carious lesion in a primary incisor using an encapsulated glass ionomer restorative material and reviews advantages and limitations of the cement. A light-hardened glass ionomer liner/base that has proven useful as an enamel and dentin restorative is also described.     

The Class V lesion — Aetiology and restoration*

The aetiology of non-carious cervical lesions is discussed. These have been variously described as ‘abrasion’, ‘erosion’, ‘abrasion/erosion’, and ‘idiopathic cervical’. However, many lesions do not fit the classical appearance or location of an erosive and/or abrasive origin, and there is increasing interest in the possible role of occlusal stress in their aetiology. Non-carious cervical lesions often require restoration, and there are essentially three options using tooth-coloured materials: a restorative glass ionomer cement, a liner/base glass ionomer cement over-layed with a resin composite, or a resin composite bonded by an enamel/dentine-adhesive. The materials and techniques used in these options are discussed, indicating their advantages and disadvantages. Results of available clinical trials of these systems are given, and the link with the stress theory of cervical tooth loss is described. The preferred restorative approaches in order are: resin-modified restorative glass ionomer; resin-modified liner/base glass ionomer with a microfine resin composite overlay; enamel/dentine bonding agent with a micro-fine resin composite.     

Restoration of permanent teeth in young rural children in Cambodia using the atraumatic restorative treatment (ART) technique and Fuji II glass ionomer cement

Several recent studies have demonstrated the success of the ART (atraumatic restorative treatment) technique under field conditions in developing countries. The ART technique involves removal of caries using only hand instruments, and placing a glass ionomer cement (GIC) restoration.
Objectives. To estimate the longevity of Fuji II GIC ART restorations placed in permanent teeth by dental nurse students under field conditions in rural Cambodia.
Design . Clinical field trial.
Setting . One high school in rural Cambodia.
Sample and methods . 53 subjects between the ages of 12 and 17 who had dental caries were selected to participate. Subjects were randomly assigned to a dental nurse student for cavity preparation and placement of ART restorations (without cavity conditioning).
Results . 92·1% of the carious lesions required class I or class V restorations, and 85·4% were in the lower molars. 89 teeth were filled. At 1 and 3 years 86·4% and 79·5% of restorations were still present. Restorations were assessed by one dentist according to standard criteria. 76·3% of the restorations were judged to be successful at 1 year, and 57·9% at 3 years.
Conclusions . Factors which may have affected the success rates included: the material used, technical factors, failure to condition the cavity prior to restoration, and inexperience of the operators. The results suggest that ART restorations in permanent teeth using Fuji II GIC are only moderately successful after 3 years. Better results could be expected by using a dentine conditioner in conjunction with one of the newer stronger glass ionomer cements.     

Artificial formed caries-like lesions around esthetic restorative materials

Dental restorations fail for a variety of reasons. Secondary caries is one of the primary causes of failure of dental restorations. One method for reducing frequency and severity of this problem is the use of fluoride containing restorative materials. The ability of a material to inhibit secondary caries formation is an important clinical therapeutic property. This investigation assessed the capacity of esthetic restorative materials to resist caries in vitro. Class V cavities were prepared in buccal and lingual surfaces of 50 extracted sound third molars. The occlusal and gingival cavosurface margin of each preparation was on enamel surface. The five materials were used: Conventional glass ionomer cement Ceramfil beta (PSP), two polyacid modified resin composites Compoglass (Vivadent) and Dyract (Dentsply/DeTrey), non fluoride releasing composite resin Valux Plus (3M) and fluoride releasing composite resin Tetric (Vivadent). After 10 weeks in an acid gel for caries-like lesion formation, the teeth were sectioned occluso-gingivally through the middle of the restorations and examined by polarized light microscopy, while immersed in water. The statistical analysis of the results showed that secondary caries initiation and progression might be reduced significantly when fluoride-containing materials were placed. The conventional glass ionomer cement (Ceramfil beta) provided the highest protection against caries attack and the non-fluoride releasing composite resin (Valux Plus) restoration provided the least (p<0.05).     

The bonding of an adhesive resin cement to single and combined adherends encountered in resin-bonded bridge work: an in vitro study.

Although resin-bonded bridges should ideally be bonded to enamel, abutment teeth may present with dentine or restorations at the bonding sites. This study assessed the influence of bonding to such adherends on bridge retention by using tensile bond strength measurements as the criteria for judgement. An adhesive resin cement (Panavia Ex) was bonded to single adherends of enamel, dentine, composite resin, glass ionomer or amalgam, and to combined adherends of enamel/dentine or enamel/restorative material. The bond strength to enamel (28 MPa) was comparable with that to composite resin (25 MPa), but significantly higher than to dentine (8 MPa), amalgam (8 MPa) and glass ionomer (13 MPa). When the bonding area was half enamel and half restorative material, the bond strength was only equivalent to that obtained when the entire bonding area consisted of restorative material, the less favourable adherend. A similar trend was observed with specimens of enamel/dentine. This indicated that the magnitude of the bond between the resin cement and combined adherends was limited by the strength of the bond to the less favourable adherend. It appears that extending a bridge retainer to cover exposed dentine, a glass-ionomer filling or an amalgam filling, could adversely affect the bridge retention.     

Five-year study of Class II restorations in permanent teeth using amalgam, glass polyalkenoate (ionomer) cermet and resin-based composite materials

The aim of this study was to compare the clinical performance of an amalgam, a glass polyalkenoate (ionomer) cermet material and a resin-based composite material used in small Class II cavities in permanent teeth. All restorations were inserted under rubber dam. They were examined yearly for 3 years. One clinician continued the study up to 5 years. The clinical examination focused on two criteria: clinically acceptable and failure. In addition, impressions were taken of the prepared cavities immediately before restoration and at each clinical examination using an elastomeric material. The study comprised 274 Class II restorations (88 amalgams, 95 cermets and 91 resin composites) placed in 142 adolescent patients. One hundred and sixty-seven restorations were in molar and 107 in premolar teeth. Patient dropout after 5 years resulted in the loss of 161 restorations, evenly distributed for restorative material and type of tooth involved. Four amalgam restorations, 22 glass ionomer cermet and nine resin composite restorations failed. The glass ionomer cermet and amalgam restorations failed primarily due to bulk fractures, while the resin composite restorations failed due to secondary caries and bulk fractures.     

Microtensile bond strengths to caries-affected dentine treated with Carisolv

BACKGROUND: Little information is available regarding the bonding performance of adhesive restorative materials to caries-affected dentine after the use of Carisolv. The aim of this study was to compare the microtensile bond strengths of two resin-based adhesives, a conventional glass ionomer cement and resin modified glass ionomer cement to 'normal' dentine and caries-affected dentine after Carisolv treatment. METHODS: Specimens were prepared using molar teeth with small carious lesions. Caries was removed with the Carisolv solution and the whole surface was bonded with either SE Bond, One Coat Bond, Fuji IX or Fuji II LC. After 24 hours, specimens were prepared for the microtensile bond strength test and stressed in tension at 1 mm/min until rupture of the bond. Mean bond strengths and mode of failure were determined and analysed with the LSD test and chi square test respectively. RESULTS: The results showed no statistical difference for SE Bond, One Coat Bond or Fuji IX, but a difference was observed for the resin-modified GIC, Fuji II LC. CONCLUSIONS: It was concluded that carious dentine treated with Carisolv did not affect the adhesion of the adhesive restorative materials tested in this study with the exception of Fuji II LC.     

Ion uptake into demineralized dentine from glass ionomer cement following pretreatment with silver fluoride and potassium iodide

BACKGROUND: Diamine silver fluoride (Ag(NH3)2F), referred to as AgF, has been shown to provide a pronounced antimicrobial action against caries. The clinical application of this material has been limited by the staining associated with both teeth and tooth coloured restorative materials. The application of potassium iodide (KI) after AgF eliminates stain formation. The purpose of this study was to determine if a prior application of silver fluoride and potassium iodine to demineralized dentine affected the uptake of strontium and fluoride from a glass ionomer cement restoration. METHOD: Three cavities were prepared in each of five recently extracted human third molars. The cavities were demineralized and treated as follows. In each tooth, one cavity was left as a control, one cavity was restored with glass ionomer cement and one cavity was treated with 1.8M AgF and a saturated KI solution and then restored with glass ionomer cement. The penetration of the various elements into demineralized dentine was measured by their relative percentage weights using electron probe microanalysis (EPMA). RESULTS: Fluoride uptake was significantly higher in the AgF and KI treated samples compared to the other two samples and significantly higher in the glass ionomer restored sample compared to the control. The application of AgF and KI did not significantly interfere with the transfer of strontium from glass ionomer cement into dentine. Silver and iodine deposits were present in the demineralized dentine treated with AgF and KI. CONCLUSIONS: The application of AgF and KI onto dentine prior to the placement of glass ionomer cement did not significantly affect the strontium uptake into the subjacent demineralized dentine and the fluoride levels in this zone were significantly increased.     

Clinical evaluation of three restorative materials applied in a minimal intervention caries treatment approach

OBJECTIVES: This paper reports on a longitudinal evaluation of three materials (glass ionomer, zinc oxide-eugenol cement, and composite) employed in a minimal restorative intervention approach of 81 high caries-active pregnant women selected for a preventive oral health program in Brazil. The aim of the study was to evaluate the clinical behavior of the glass ionomer cement, currently indicated in programs for control of carious lesions. METHODS: The patients were randomly divided into two groups. Both groups were engaged in an oral health promotion approach. In Group 1, 417 glass ionomer restorations were placed in 43 individuals, involving all types and sizes of cavities. In the second group, 213 posterior zinc oxide-eugenol (ZOE) restorations and 127 anterior composite restorations were placed in 38 patients. Minimal cavity preparations were made, in which only soft or infected dentin was removed, on the basis of clinical judgment. RESULTS: After two years, the restorations were clinically evaluated by two examiners for marginal integrity, amount of wear, presence of fracture, carious lesions, and lost restorations. Statistical analysis (chi-square test) identified statistically significant difference between glass ionomer and ZOE (90.6% vs 9.2%). Comparing glass ionomer and composite, similar survival rates were observed. The success rate observed for the glass ionomer cement ranged from 77.1 percent to 92.5 percent, depending on the type and size of cavity in which it was applied. Four teeth restored with glass ionomer cement and one tooth restored with composite showed caries signs. Regarding the ZOE restorations, caries was always associated with other causes of failure such as excessive wear, restoration loss, or marginal defects, with no possibility of separate evaluation. Despite the preventive and therapeutic measurements employed, a mean increase of 2.15 new surfaces with cavities was observed in Group 1, as well as 2.83 surfaces presenting the same status in Group 2. CONCLUSIONS: This study demonstrated that highly viscous glass ionomer cement applied in a minimal intervention approach provided high-quality preventive and restorative care after two years to a population at high risk for caries. The composite was employed in cavities exposed to lower stress, such as in the anterior teeth, and its behavior was comparable to that of the glass ionomer cement. The reinforced ZOE presented a high failure rate, thus contraindicating its use for such purpose.     

Clinical performance and caries inhibition of resin-modified glass ionomer cement and amalgam restorations

BACKGROUND: The authors clinically examined two restorative materials to evaluate their effectiveness in Class II restorations in primary molars and their ability to inhibit recurrent caries. METHODS: Forty subjects, each in need of two Class II restorations in primary molars, took part in this study. Each patient received one Class II restoration of resin-modified glass ionomer cement and one of amalgam. The authors evaluated the restorations at six-month, one-year, two-year and three-year recall appointments. On exfoliation, teeth with experimental restorations were retrieved and microscopically examined for inhibition of demineralization at restoration margins. RESULTS: The results of the clinical evaluation demonstrated no significant differences between the resin-modified glass ionomer cement restorations and the amalgam restorations (P < .05). Polarized light microscopic examination of the returned teeth that were restored as a part of this study indicated that the resin-modified glass ionomer cement had significantly less enamel demineralization at restoration margins than did amalgam (P < .0001). CONCLUSIONS: The resin-modified glass ionomer cement functioned clinically as well as amalgam for Class II restorations in primary molars. However, the resin-modified glass ionomer exhibited significantly less enamel demineralization at restoration margins than did amalgam. CLINICAL IMPLICATIONS: Resin-modified glass ionomer cement restorative material functions well for Class II restorations in primary molars and exhibits less recurrent caries at restoration margins than does amalgam.