EQUIA is a tooth-colored filling material based on a modern glass ionomer cement (GIZ) that, within its range of indications, represents a time-saving and cost-effective alternative to costly tooth-colored resin fillings or aesthetically unsatisfactory amalgam fillings. Due to its long durability and comparatively simple application, amalgam is still the standard material for basic posterior restorations. After the FDI (Féderation Dentaire Internationale, International Dental Federation) passed a resolution in 2010 to gradually abandon amalgam as a filling material, the question of an alternative durable material suitable for basic restorations without co-payment inevitably arises. However, posterior composites (plastics suitable for the restoration of molar teeth) are not an option for this purpose due to their complex and time-consuming processing. Conventional glass ionomer cements (conventional GIZ) as restorative materials are widely accepted in the sector of semi-permanent restorations (short- to medium-term restorations) due to their easy and fast processing. However, they have not been suitable for permanent (durable) restorations due to their low flexural strength and high abrasion (wear). Due to these weaknesses, conventional GIZ are therefore mainly used for temporary fillings or in pediatric dentistry for Class I fillings of the 1st dentition (on the occlusal surface in deciduous teeth). EQUIA, as the latest generation of GIZ, represents an innovation in that the interaction between the restorative material and a so-called coating (protective varnish) results in significantly improved physical properties such as flexural strength and abrasion stability, which justify its use as a material for permanent fillings within a limited range of indications. All GIZ achieve their final material properties only after passing through two setting phases. The quality of the placed filling is crucially dependent on the moisture balance during these phases. While the cement component in EQUIA is based on a conventional GIZ, the innovative approach focuses on the protection of the filling surface by the coating, a light-curing thin-flowing acrylate-based composite (resin). On the one hand, the coating protects the GIZ during the sensitive initial setting phase, and on the other hand, it seals superficial pores with resin and thus improves the mechanical properties of the filling: the Vickers hardness of the GIZ is increased by approx. 30% by the coating. Composition of EQUIA (according to Lohbauer et al. ):
| Material | Material type | pH | Composition | |
| Fuji IX GP Extra | X-ray opaque GIZ | – – |
|
10-15 %70-80 %10-15 % |
| G-Coat Plus | Nano-filled, self-adhesive, light-curing protective coating | 2,5 |
|
40-50 %10-15 % > 1 %30-40 % < 5 % |
EQUIA combines the advantages of conventional GIZ with the improved properties resulting from coating:
Conventional GIZ:
- Bulk filling: the filling material is placed in a single layer. Time-consuming layering as with composites is not required.
- Self-adhesion: GIZ adhere chemically to the tooth structure.
- Aesthetics: Although the GIZ are inferior to the composites (plastics) due to lack of translucency (light transmission) in aesthetic terms, but are clearly advantageous over an amalgam filling due to their tooth-like color.
- Finishing: Finishing is limited to finishing with finishing (fine-grained rotary instruments). GIZ are, unlike composites (plastics), not polishable, so this step is not necessary.
- Fluoride release: fluorides are released from GIZ – an effect that inhibits the development of caries in the marginal areas of the filling.
- Marginal tightness: GIZ show a thermal expansion behavior favorable for the marginal tightness of the filling.
EQUIA:
- Flexural strength: The flexural strength of conventional GIZ is only about one fifth of that of composites (acrylics), resulting in a high loss rate due to fractures (filling breakage). Due to the coating (plastic-based), the flexural strength and thus load capacity is increased by the chewing pressure.
- Application time: Only three and a half minutes elapse before the hardened filling is finished. EQUIA is therefore particularly suitable for lack of compliance (cooperation – eg in pediatric dentistry).
- Abrasion behavior: conventional GIZ show 5 to 10 times higher abrasion than composites (plastics). As long as the coating (resin-based) itself is not yet abraded (rubbed off), EQUIA is thus significantly more abrasion resistant and less prone to fracture. The coating thus extends the service life (period over which the filling remains functional).
- Moisture tolerance: thereby less technique sensitive during processing.
Indications (areas of application)
- For the restoration of Class I defects (on the occlusal surface).
- For the restoration of unloaded Class II defects (on the occlusal surface and another surface in the interdental space).
- For the restoration of smaller Class II defects loaded by chewing pressure, the occlusal extent of which is less than 50% of the intercuspid space (space or distance between the cusp tips of a tooth located towards the cheek or tongue)
- As core build-up material (build-up of a deeply destroyed tooth before provision of a crown).
- Interdental restorations (in the interdental spaces).
- Class V defects (tooth neck fillings).
- Care of root caries
Within the scope of the above-mentioned application possibilities EQUIA – fillings are suitable for basic care and are covered by the GKV (statutory health insurance).
Contraindications
- Permanent restoration of large-area defects
- Pulp capping (direct contact with exposed pulp).
- Sensitization to any of the ingredients
The procedure
- Preparation of the cavity without additional mechanical retentions (preparation of the hole without undercuts to improve the mechanical retention of the filling).
- If necessary, pulp capping (covering of possibly exposed pulp) with a calcium hydroxide preparation.
- Application of conditioner (polyacrylic acid 10% for 20 sec or 20% for 10 sec).
- Rinse conditioner thoroughly with water and gently air dry. Dentin (dental bone) must still shine moist.
- Activation of the mixing capsule (contains liquid and powder phase initially separated from each other).
- Mixing: 10 sec in the shaker. The processing time from the start of mixing is 75 sec.
- Filling: Immediately after completion of the mixing process, introduce capsule contents into the cavity (hole in the tooth). Form contours with tamping instruments.
- Setting: In the first two and a half minutes after mixing begins, the material must neither become too moist nor dry out. If this can not be guaranteed: immediately apply the coating for protection and light cure.
- Finishing: Two and a half minutes after mixing begins, the filling can be finished with superfine diamond finishers.
- Preparation for coating: remove drilling dust and saliva with water spray. Carefully dry filling surface with air flow, but do not overdry.
- Coating: Apply EQUIA Coat with microtip (mini brush) and immediately photopolymerize (light-cure) from all sides for 20 sec each. Polymersiationslampe thereby bring as close as possible to the filling.
- Patient instruction: The filling should not be loaded for one hour.
Possible complications
- Avoid contact with skin and mucous membranes. If necessary, remove with cotton pellet and rinse thoroughly with water after finishing the filling.
- In case of eye contact, rinse thoroughly and consult an ophthalmologist.
- The mucous membrane may turn white or form blisters after contact with the coating. The signs disappear after 1-2 weeks. In this phase, leave the mucosa alone if possible.
- Do not use at the same time as desensitizers (varnishes against hypersensitive dentin) or eugenol-containing (containing clove oil) preparations, as the curing of the coating may be inhibited (inhibited).