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J Dent. 2016 Dec;55:121-123. doi: 10.1016/j.jdent.2016.10.007. Epub 2016 Oct 17.

High-viscosity glass-ionomer cements for direct posterior tooth restorations in permanent teeth: The evidence in brief.

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SYSTEM Initiative, Department of Community Dentistry, Faculty of Health Science, University of the Witwatersrand, 7 York Road, 2193 Parktown, Johannesburg, South Africa. Electronic address:



To provide a brief overview of the current evidence-base for direct posterior tooth restorations in permanent teeth placed using high-viscosity glass-ionomer cement (HVGIC).


The evidence sources: laboratory trials, uncontrolled clinical trials, controlled clinical trials with HVGIC restorations placed after conventional cavity preparation by drill and controlled clinical trials with HVGIC restorations placed following the atraumatic restorative treatment (ART) approach, were assessed based on systematic reviews and meta-analyses, as well as methodological studies.


The precision and validity of evidence from laboratory trials, uncontrolled clinical trials and non-ART controlled clinical trials are insufficient for clinical guidance. Clinical evidence for HVGIC restorations placed using ART, comprises of 38 controlled clinical trials including over 10 000 tooth restorations. Systematic review results of these trials indicate no statistically significant differences (p>0.05) in the failure rates between HVGIC and amalgam restorations in single- and multiple surface tooth cavities after up to six years. Although, many of these trials suffered from too low sample sizes, their results could be pooled in three meta-analyses. The bias risk in all trials was judged to be high.


Controlled clinical trials with HVGIC restorations placed using ART provide the bulk of the available evidence that suggest that the failure rate of direct posterior HVGIC restorations in permanent teeth are comparable to that of dental amalgam restorations.


Controlled clinical trial; Evidence overview; High-viscosity glass-ionomer cement; Laboratory studies; Meta-analysis; Systematic review

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