Strategic approaches for enhancing the bioactivity of glass ionomer cement: A mechanistic and clinical perspective in terms of structural and surface modifications

Objectives

To classify and evaluate current methods that increase the bioactivity of (GICs). This will highlight their clinical relevance and mechanism.

Data/Sources

Relevant literature was downloaded from PubMed and ScienceDirect, without consideration for language or publication year. Experiments that examined the surface, composition, and structural modification of GICs were included, both in vitro and in vivo studies.

Study selection

A critical analysis reviewed literature that focused on four main strategies: surface functionalization, liquid phase modification, powder phase modification, and additive addition. The review took into account ion release, apatite formation, antibacterial, and biological response based on reported findings. The results determined powder and liquid phase interventions to improve remineralization and bonding capacity. In contrast to this, bioactive additives like Bioactive Glass (BAG), chitosan, and nanoparticles increased ion exchange and antibacterial activity. While difficult to compare due to the difference in method and lack of long-term evidence, changes at the surface level improved cellular adhesion and apatite deposition.

Conclusions

Our review identified several laboratory methods that increase bioactivity. However, because studies differ in methods and report inconsistent mechanical results—and because long-term clinical data are scarce—it remains unclear which approaches will provide durable advantages for patients.

Clinical Relevance

Revised GICs are promising as restorative materials because they can integrate better with tissue, remineralize, and be resistant to bacteria better. However, when considering using them in the clinic, doctors should also discuss the possible benefits and the current uncertainties with patients. There is no normative evidence, and different modification methods suit different people.