Scoping an interdisciplinary model of student dental therapists in maxillofacial trauma.

Introduction This paper outlines a short pilot programme to assess the feasibility of an interdisciplinary model of involving student dental therapists in the management of maxillofacial trauma patients. It involved dental therapy students attending an oral and maxillofacial surgery trauma review clinic at a major trauma hospital in London, UK.Approach The small cohort of 15 second-year dental hygiene and therapy (BSc in Oral Health) students attended the trauma clinic once a week in pairs, over a period of six weeks, after which they completed a survey questionnaire.Findings No students had previous experience of dealing with trauma patients. The majority (81.8%) had learnt something by attending the clinic. Almost all (91.7%) had not thought previously about the importance of oral hygiene in maxillofacial trauma patients. By the end of the pilot programme, ten students (83.3%) felt that they had a role to play in the care of these trauma patients and they felt valued as members of the wider team.Conclusion These initial findings suggest that the scheme has potential for incorporation of maxillofacial trauma experience within the formal dental therapy curriculum. This would prepare them for future involvement in the management of maxillofacial trauma patients to promote oral health benefits and more widely, to work as a team member in interprofessional health care.

Biomechanical consideration in tooth-supported glass-ceramic restorations: A systematic review and meta-analysis of survival rates and irreparable failures.

STATEMENT OF PROBLEM: Knowledge on the biomechanical behavior of glass-ceramics, their survival rate over time, and their potential failures is essential for decision-making in clinical practice. Systematic reviews and meta-analysis of their survival rates and irreparable failures are lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the survival rates and irreparable failures of various monolithic glass-ceramic dental restorations to help determine biomechanical indications. MATERIAL AND METHODS: A comprehensive literature search was conducted across the PubMed, Scopus, Web of Science, and EMBASE databases based on the population, intervention, comparison, and outcome (PICO) question, risk of bias assessment, data extraction, subgroup analysis, and meta-analysis. Both randomized and nonrandomized clinical trials that reported survival rate and irreparable failure were screened. The risk, with a 95% confidence interval, was calculated by using the Mantel-Haenszel method. RESULTS: A total of 46 articles met the inclusion criteria: 8 for laminate veneers, 20 for partial coverage restorations, 11 for single crowns, and 6 for fixed partial dentures, encompassing 1715 participants rehabilitated with 4209 restorations. The estimated cumulative survival rate for partial coverage restorations was 90% over an average span of 6.2 years, with an irreparable failure occurrence of n=5.9. Laminate veneers had a survival rate of 90.2% over 6.5 years, with an irreparable failure occurrence of n=8.2. Single crowns had a survival rate of 96% over 4.6 years and an irreparable failure of n=2.7. Conversely, fixed partial dentures had a survival rate of 76.1% over 6.5 years with an irreparable failure of n=5.2. CONCLUSIONS: Glass-ceramic materials demonstrate relatively high survival rates, indicating that they provide a safe and reliable option for partial coverage restorations, laminate veneers, and single crowns. However, fixed partial dentures had a higher proportion of irreparable failures and a lower survival rate, and caution is required.

Can glass polyalkenoate (glass-ionomer) dental cements be considered bioactive? A review.

Objectives: This paper reviews the chemical behaviour of glass polyalkenoate (glass-ionomer) dental cements, both conventional and resin-modified, in contact with natural tissues, with the aim of determining whether these materials can be considered to be bioactive. Data: Relevant papers describing the behaviour of bioactive glasses and ceramics, and glass-ionomer (glass polyalkenoate) cements have been identified using PubMed and Science Direct. This has allowed a comparison to be made between the behaviour of glass-ionomers and the speciality glasses and ceramics that are widely classified as bioactive, a designation considered valid for over fifty years. More recent papers concerning bioactive metals and polymers have also been studied and both in vitro and in vivo studies are included. Sources: Have included general papers on the chemistry and biological behaviour of bioactive glasses and ceramics, as well as papers on glass-ionomers dealing with (i) ion release, (ii) bonding to the surface of teeth, (iii) influence on surrounding pH and (iv) interaction with bone. Conclusion: The literature shows that glass-ionomers (glass polyalkenoates) have three types of behaviour that are similar to those of bioactive glasses as follows: Formation of direct bonds to living tissue (teeth and bones) without fibrous capsule; release of biologically beneficial ions; and change of the local pH. However, in in vitro tests, they do not cause calcium phosphate to precipitate from solutions of simulated body fluid, SBF. Despite this, studies show that, in patients, glass-ionomers interact chemically with hard tissues and this suggests that may indeed be considered bioactive.

Fluoride exchange by glass-ionomer dental cements and its clinical effects: a review.

The topic of fluoride release and uptake by glass-ionomer (glass polyalkenoate) dental cements is reviewed. The study was based on a literature search carried out using PubMed. The main key words used were glass-ionomer and fluoride, and further refinements were made by adding the keywords anti-microbial, anti-caries and remineralization. Papers were selected from the initial search, which concentrated on fundamental aspects of fluoride release, including kinetics and the influence of the cement composition, and resulting clinical performance against caries. Other relevant papers were cited where they added useful and relevant data. From these published papers, it was possible to explain the detailed mechanism of fluoride release by glass-ionomer cements and also its uptake. Fluoride release has been shown to be a two-step process. In neutral solutions, the steps can be divided into early wash-out and long-term diffusion. In acid conditions, the early wash-out remains, though with greater amounts of fluoride released, and the long-term release becomes one of slow dissolution. The effect of fluoride on the viability of oral micro-organisms has been described, and glass-ionomers have been shown to release sufficient fluoride to reduce the size and viability of adjacent populations of oral bacteria. The effect of low levels of fluoride on the remineralization of tooth tissue has been considered. Levels needed to increase remineralization are much lower than those needed to adversely affect oral bacteria, from which we conclude that glass-ionomers release sufficient fluoride to promote remineralization. Despite this, there remains uncertainty about their overall contribution to sound oral health, given the widespread use of other sources of fluoride, such as toothpastes.

The Attitude of the General Dentist in the Republic of Croatia toward Treating Children.

The aim of this study was to determine the attitude of general dentists in the Republic of Croatia toward working with children. The questionnaire survey involved 361 general dentists. The questionnaire was divided into three parts and contained 34 questions. The first part of the questionnaire survey contained demographic data questions. In the second part, dentists answered questions about the characteristics of the dental offices where they work, the materials that they mostly use, and how they work with children. The third part of the questionnaire referred to attitudes about working and treating young children and consisted of 12 statements, to which the answers were offered on a Likert scale from one to five. This study showed that only 12.46% of dentists have a positive attitude toward treating children and 30.19% of dentists have a negative attitude toward treating children. In addition, the attitude toward working with children correlates with both the knowledge they acquired during dental studies (R = 0.355; p ≤ 0.001) and gender (R = -0.103; p = 0.035). This study confirmed that women have a more often positive attitude toward treating young children. There was a major correlation between the level of education and positive attitudes toward treating children. The child's non-cooperative behavior was the main reason why general dentists refuse to work with children.

Inhibition of Demineralization of Dentin by Fluoride-Containing Hydrogel Desensitizers: An In Vitro Study.

Several desensitizers routinely used clinically for dentin hypersensitivity are expected to inhibit demineralization. This study aimed to evaluate the effectiveness of sealing materials in inhibiting demineralization and increasing fluorine (F) uptake by acid-treated root surfaces. Five noncarious extracted human teeth were used to produce specimens. Three different fluoride-containing materials, namely "MS Coat F" (MS), "MS Coat Hys Block Gel" (HS), and CTX2 Varnish (FV), were used herein. Each material was applied to the demineralized root surface. Single sections were obtained from each specimen. All surfaces of each specimen, except the polished surface, were covered with wax and immersed in an automatic pH cycling system for 2 weeks. Fluorine and calcium distributions in the carious lesions of each specimen were evaluated using proton-induced gamma emission (PIGE) and X-ray (PIXE) techniques, respectively. Dentin demineralization was analyzed using transverse microradiography (TMR) before and after pH cycling. µPIXE/PIGE analysis demonstrated that all sample groups showed increased fluoride uptake on the root surface. TMR analysis revealed that both HS and FV showed significantly lower integrated mineral loss values than the control group. All three samples demonstrated a tendency towards increased fluoride uptake from fluoride-containing hypersensitivity desensitizers and a demineralization inhibition effect on root dentin.

Cause-Effect Relationship of Varying Bonding Thicknesses in Dentin Adhesion of Universal Adhesives.

PURPOSE: To evaluate whether varying thicknesses of universal adhesives utilizing the additional coating strategy would affect their microtensile bond strength (µTBS) to dentin, hardness, and elastic modulus (mechanical properties). MATERIALS AND METHODS: Ninety-nine human maxillary premolars were cut to expose coronal dentin, ground with regular-grit diamond burs, and randomly distributed into 9 groups based on 1. adhesive: Scotchbond Universal Adhesive (SB; universal), G Premio Bond (GP; universal) and Clearfil Megabond 2 (MB; two-step self-etch; control); and 2. application strategy (one, two or three coats; each coat light cured). After adhesive application and resin composite buildup, the bonded teeth were stored in distilled water (37°C; 24 h). Resin-dentin sticks from eight premolars per group (each premolar yielded 3 sticks; n = 24 sticks altogether) were prepared for the µTBS test, followed by measurement of the adhesive thicknesses at their fractured ends using SEM. The mechanical properties of the adhesive layers produced by different coats were evaluated on separate resin-dentin slices (n = 3 teeth per group). RESULTS: Two coats significantly increased the µTBS (p < 0.001) of all the adhesives. The correlation between adhesive thickness and bond strength was positive for GP but negative for SB. MB did not show any correlation. Additional coating significantly increased the mechanical properties of GP (p < 0.05) but did not affect SB and MB (p < 0.05). CONCLUSION: An additional adhesive coating over the manufacturers' recommendations improved the bond strength of all the adhesives tested. However, the increased mechanical properties of the adhesives with additional curing was material dependent.

Potential of Fluoride-Containing Zinc Oxide and Copper Oxide Nanocomposites on Dentin Bonding Ability.

Despite recent advances in bonding restorations, which are the basis of restorative dentistry, secondary caries are still able to form. Previously, a novel fluoride-containing zinc and copper (ZCF) nanocomposite was introduced to prevent the formation of caries due to its antibacterial activity. In this study, we studied the impact of ZCF nanoparticles on the adhesive strength of bonding restorations through micro-tensile bond strength (µTBS) testing. The impact of antibacterial and matrix metalloproteinase (MMP) inhibitors on the nanoparticles was also examined. The nanocomposites were prepared using a simple one-step homogeneous co-precipitation method at a low temperature. A self-etch adhesive was applied to 10 extracted caries-free human molars with (test group) and without (control group) the ZCF nanoparticles. This was followed by composite resin build-up and µTBS testing, MMP activity assays, and evaluation of the antibacterial effects. The results showed no significant differences in the µTBS between the ZCF and the control groups. However, the ZCF exhibited a significant inhibitory effect against MMP-2, MMP-8, and MMP-9, in addition to an antibacterial effect on Streptococcus mutans. Therefore, the present study demonstrated that the addition of ZCF nanoparticles to adhesive systems can result in MMP inhibition and antibacterial action while maintaining the mechanical properties of the bonding restorations.

Interfacial Characterization of a Conventional Glass-Ionomer Cement after Functioning for 1-year In Vivo.

PURPOSE: To morphologically evaluate the interface between a conventional glass-ionomer cement (GIC) and dentin one day after placement, as well as the changes at the interface after one year of aging/functioning in monkey teeth. MATERIALS AND METHODS: On the buccal surfaces of seven intact teeth in each of two monkeys, shallow class V cavities were prepared, which were then filled with Fuji IX GP (GC) to provide 1-year in vivo data. A year later, two more teeth in each monkey were similarly prepared and restored for the 1-day in vivo group. The following day, the restored teeth were extracted and the restoration interfaces observed using transmission electron microscopy (TEM). In addition, restorations were similarly placed in two extracted human teeth (control, 1-day in vitro group) and observed a day after placement using TEM. RESULTS: The 1-day in vivo and in vitro results showed that the GIC appeared to bond to dentin through a demineralized zone similar to the hybrid layer produced by resinous adhesives. However, the interface between GIC and dentin after 1 year in vivo appeared to change over time: many needle-like crystals were detected within the remineralized layer and along the collagen fibrils. Slow diffusion of ions resulted in pores, which filled with mineral crystals and made the pores smaller. CONCLUSION: The interface between GIC and dentin morphologically changes over time, and recrystallization or remineralization at the interface may occur (1 year in vivo).

Evaluation of biofilm formation on acrylic resin surfaces coated with silicon dioxide: an in situ study.

Biofilm on acrylic resin dental prostheses may cause gingival inflammation. This study evaluated the influence of a silicon dioxide coating layer applied onto acrylic resin on the adhesion of microorganisms. Blocks (5 x 5 x 3 mm) of acrylic resin were evaluated for surface roughness and divided into two groups: control (CG) and coated with silicon dioxide (LG group). The specimens were evaluated by scanning electron microscopy (n = 1) and by contact angle analysis (n = 3). For the in situ study, 20 volunteers wore acrylic palatal devices containing three samples from each group (n = 60) for 2 days. The biofilm formed was quantified by metabolic activity and total biomass using the crystal violet assay. The results were subjected to Bartlett's normality test and Gamma model with random effect for the response variable (α = 5%). The mean contact angle of the coated group was significantly lower than that of the uncoated group (p < 0.05). The metabolic activity of microorganisms in the biofilm on the blocks treated with coating was significantly lower than that of control blocks (p = 0.02). Regarding the amount of extracellular matrix produced by the microorganisms, there was no difference between the CG and LG group (p = 0.05). The application of a silicon dioxide coating on acrylic resin reduced the activity of the polymicrobial biofilm formed in situ. This coating may be advantageous for patients with conventional complete dentures or implants made of acrylic resin and who have motor difficulties that prevent them from cleaning their prostheses properly.

Relationship Between Early Childhood Oral Health Impact Scale, Child's Dental Status and Parental Psychological Profiles.

BACKGROUND: The aim of this study was to assess the influence of a child's dental status and parental psychological profiles on parental perception of their child's oral health. MATERIALS: This study involved 164 parents of children under five years of age, who filled out the life quality assessment test regarding oral health (ECOHIS test), and Depression, Anxiety and Stress Scale (DASS) questionnaire. The child's oral status was also examined and recorded. RESULTS: Results of the ECOHIS appeared to correlate positively with the number of active caries (R = 0.457; P <0.001). In addition, the ECOHIS showed a significant correlation with the DASS test results (R = 0.356; P <0.001 for depression, R = 0.247; P <0.001 for anxiety and R = 0.235; P <0.001 for the stress result). CONCLUSION: The dental health of a child affects his/her quality of life and the parental quality of life including their psychological status.

Evaluation of biofilm formation on acrylic resin surfaces coated with silicon dioxide: an in situ study

Abstract Biofilm on acrylic resin dental prostheses may cause gingival inflammation. This study evaluated the influence of a silicon dioxide coating layer applied onto acrylic resin on the adhesion of microorganisms. Blocks (5 x 5 x 3 mm) of acrylic resin were evaluated for surface roughness and divided into two groups: control (CG) and coated with silicon dioxide (LG group). The specimens were evaluated by scanning electron microscopy (n = 1) and by contact angle analysis (n = 3). For the in situ study, 20 volunteers wore acrylic palatal devices containing three samples from each group (n = 60) for 2 days. The biofilm formed was quantified by metabolic activity and total biomass using the crystal violet assay. The results were subjected to Bartlett's normality test and Gamma model with random effect for the response variable (α = 5%). The mean contact angle of the coated group was significantly lower than that of the uncoated group (p < 0.05). The metabolic activity of microorganisms in the biofilm on the blocks treated with coating was significantly lower than that of control blocks (p = 0.02). Regarding the amount of extracellular matrix produced by the microorganisms, there was no difference between the CG and LG group (p = 0.05). The application of a silicon dioxide coating on acrylic resin reduced the activity of the polymicrobial biofilm formed in situ. This coating may be advantageous for patients with conventional complete dentures or implants made of acrylic resin and who have motor difficulties that prevent them from cleaning their prostheses properly.

Determination of chemical species of fluoride during uptake mechanism of glass-ionomer cements with NMR spectroscopy.

OBJECTIVE: The aim of the present study was to determine the chemical species formed inside glass-ionomer cements after fluoride uptake and to investigate the depth of penetration of fluoride ions within the cement matrix. METHODS: An experimental fluoride-free glass with composition 2SiO2-AlO3-CaO was produced. The glass powder was mixed with aqueous poly(acrylic acid) (PAA), and allowed to set. The resulting specimens were stored in 20ml KF solution with 1000ppm fluorine for 24h and then placed into the same amount of water as for 24h. A fluoride selective electrode was used to give the F concentration of the respective solutions. 19F MAS-NMR spectra were recorded on powdered cement specimens using a Bruker AVANCE-NEO 600 spectrometer. In addition, SEM observation and EDX chemical analysis were conducted on the cross-section of a carefully fractured specimen. RESULTS: Fluoride was shown to be mainly present in the surface layers of the specimen after placement in the KF solution, and only a small fraction was re-released into water. 19F NMR spectroscopy showed that AlF complexes were formed within the cement. SIGNIFICANCE: The fluoride taken up by a free-fluoride glass ionomer cement mostly occupies surface layers and is retained because it bonds to aluminum within the matrix. This finding explains why the majority of fluoride taken up by conventional glass ionomer cements is retained.

Kinetics of ion release from a conventional glass-ionomer cement.

Release kinetics for sodium, silicon, aluminium, calcium and phosphorus from conventional glass-ionomer dental cement has been studied in neutral and acid conditions. Specimens (6 mm height × 4 mm diameter) were made from AquaCem (Dentsply, Konstanz, Germany), 6 per experiment. They were matured (37 °C, 1 h), then placed in 5 cm3 storage solution at 20-22 °C. In the first experiment, deionised water, changed daily for 28 days, was used. In the second, deionised water, changed monthly for 21 months, was used. In the third, lactic acid (20 mmol dm-3, pH: 2.7 ± 0.1), changed monthly for 21 months was used. After storage each solution was analyzed by inductively coupled plasma-optical emission spectroscopy (ICP-OES). Results showed that in neutral conditions, no calcium was released, but in acid, significant amounts were released. The other elements (Na, Al, Si and P) were released in neutral as well as acid conditions, with greater amounts in acid. More frequent changes of water gave greater release. In neutral conditions, release over 21 months followed the equation: [E]c = [E]1t/(t + t½) + ß√t ([E]c is the cumulative release of the element). In acid conditions, this became: [E]c = [E]1t/(t + t½) + αt. Hence release of all elements was shown to occur in two steps, a rapid initial one (half-life: 12-18 h) and a longer second one. In neutral conditions, the longer step involves diffusion; in acid it involves erosion. These patterns influence the material's bioactivity.

Consensus on glass-ionomer cement thresholds for restorative indications.

OBJECTIVE: The aim of this paper is to present the results of a consensus meeting on the threshold property requirements for the clinical use of conventional glass-ionomer cements (GICs) for restorative indications. METHODS: Twenty-one experts on GICs evaluated the results of tests on mechanical and optical properties of 18 different brands of restorative GICs: Bioglass R [B], Chemfil Rock [CR], Equia Forte [EF], Gold Label 2 [GL2], Gold Label 9 [GL9], Glass Ionomer Cement II [GI], Ionglass [IG], Ion Z [IZ], Ionomaster [IM], Ionofil Plus [IP], Ionostar Plus [IS], Ketac Molar Easymix [KM], Magic Glass [MG], Maxxion R [MA], Riva Self Cure [R], Vidrion R [V], Vitro Fil [VF] and Vitro Molar [VM]. All experiments were carried out by a team of researchers from Brazil and England following strict protocols, under the same laboratory conditions throughout, and maintaining data integrity. RESULTS: There was consensus on: determining as primary properties of the material: compressive strength, microhardness, acid erosion and fluoride release, and as secondary properties: contrast ratio and translucency parameter, in order to rank the materials. Seven brands were below the thresholds for restorative indications: IZ, IM, IG, MA, VF, B and MG. CONCLUSIONS: Based on the primary properties adopted as being essential for restorative indications, the conventional restorative GICs that met the thresholds and could be considered suitable as long-term restorative materials were: EF, GI, GL9, KM, IP, GL2, IS, CR, V, VM and R. A decision-making process to select the best GIC must also include results from clinical trials. CLINICAL SIGNIFICANCE: This study provides a ranking of GICs that could be considered suitable as long-term restorative materials based on their main properties.

Effect of conditioning and 1 year aging on the bond strength and interfacial morphology of glass-ionomer cement bonded to dentin.

OBJECTIVE: The purpose of this study was to determine the bond stability and the change in interfacial ultra-structure of a conventional glass-ionomer cement bonded to dentin, with and without pre-treatment using a polyalkenoic acid conditioner. METHODS: The occlusal dentin surfaces of six teeth were ground flat. Glass-ionomer cement was bonded to the surfaces either with or without polyalkenoic acid conditioning. The teeth were sectioned into 1-mm2 stick-shaped specimens. The specimens obtained were randomly assigned to two groups with different periods of storage in water: 1 week and 1 year. The micro-tensile bond strength (µTBS) was determined for each storage time. Additional specimens were prepared for Transmission Electron Microscopy (TEM); they were produced with or without prior polyalkenoic acid conditioning in the same way as in the µTBS test. RESULTS: There was no significant difference in µTBS to conditioned dentin and non-conditioned dentin (p > 0.05). The failures appeared to be of a mixed nature, although aging caused more areas of cohesive than adhesive failure in both groups. The TEM observation showed an intermediate layer, a matrix-rich layer and a partially demineralized layer in the polyalkenoic acid conditioned group. SIGNIFICANCE: Aging did not reduce the bond strength of the conventional glass-ionomer cement to dentin with or without the use of a polyalkenoic acid conditioner.

Translucency parameter of conventional restorative glass-ionomer cements.

OBJECTIVE: To evaluate the translucency parameter (TP) and contrast ratio (CR) of different conventional restorative glass-ionomer cements (GICs). MATERIALS AND METHODS: Eighteen brands of GICs were evaluated. Five disks of each material were made following ISO 9917-1. The luminous reflectance and Central Bureau of the International Commission on Illumination parameters of disks were evaluated using a colorimeter, against backings of white and black, to obtain the translucent parameter and contrast ratio of different brands of glass-ionomer cements. The correlation between translucency parameter and contrast ratio was assessed with the Pearson correlation test. The translucent and contrast ratio parameters values were submitted to the one-way ANOVA and Tukey test for multiple comparisons (p < 0.05). RESULTS: There was a strong inverse relationship between CR and TP (r2  = 0.94, p < 0.001). The contrast ratio decreased as translucency increased. There were significant differences in TP and CR among brands (p < 0.001). CONLUSIONS: GICs exhibit different translucency and contrast ratio behavior. Some brands of GICs presented very low TP and this condition would be unacceptable for areas with esthetic demands. In addition, TP and CR showed a strong linear relationship. CLINICAL SIGNIFICANCE: The results found in this study demonstrated that the knowledge of the translucency and CR of different conventional restorative GICs is important in order to guide clinicians in the selection of restorative GICs for anterior teeth.

Effect of Silicon dioxide coating of acrylic resin surfaces on Candida albicans adhesion.

Acrylic resin has been used in the manufacture of prostheses, however, in the oral cavity, this material starts to retain microorganisms capable of causing gingival inflammation due its porosities. The aim of this study was to evaluate the influence of the use of silicon dioxide as a coating layer applied onto acrylic resin, on the adhesion of Candida albicans (Ca). After the incubation period in Sabouraud Dextrose Broth, a total of 1 ml of the Ca suspension was added to plate wells, each well containing a specimen of acrylic resin. The adhesion ability of Ca on acrylic resin was determined by counting colonies. Three groups (n = 6) of acrylic resin were assessed: with polishing (RP); without polishing (RW); with polishing and coating layer of silicon dioxide (RPC). Ca deposited on the surface of the acrylic resin was also observed using Scanning Electron Microscopy (SEM). Statistical assessment by Kruskal-Wallis and Student-Newman-Keuls Method were done (α = 2%). There was significant difference among the groups. The RPC group showed the lowest growth, with an average of 5.59 Log CFU/cm 2 ; there was a statistically significant difference in relation to group RW, which presented a growth of 6.07 Log CFU/cm 2 and to group RP with 5.91 Log CFU/cm 2 (p < 000.1). SEM images demonstrated that in the RP and RPC group, the surface of the resin had greater regularity, and smaller number of microorganisms. The application of silicon dioxide coating on acrylic resin appears to be a promising alternative, and its use can help in reducing the adhesion of Ca in prostheses.

Enhancing the Mechanical Properties of Glass-Ionomer Dental Cements: A Review.

This paper reviews the strategies that have been reported in the literature to attempt to reinforce glass-ionomer dental cements, both conventional and resin-modified. These cements are widely used in current clinical practice, but their use is limited to regions where loading is not high. Reinforcement might extend these applications, particularly to the posterior dentition. A variety of strategies have been identified, including the use of fibres, nanoparticles, and larger particle additives. One problem revealed by the literature survey is the limited extent to which researchers have used International Standard test methods. This makes comparison of results very difficult. However, it does seem possible to draw conclusions from this substantial body of work and these are (1) that powders with conventional particle sizes do not reinforce glass-ionomer cements, (2) certain fibres and certain nanoparticles give distinct improvements in strength, and (3) in the case of the nanoparticles these improvements are associated with differences in the morphology of the cement matrix, in particular, a reduction in the porosity. Despite these improvements, none of the developments has yet been translated into clinical use.