What is the difference between using a Glass Ionomer Cement (GIC) dome and a stainless steel band for temporizing between root canal treatments?

Temporizing Between Root Canal Treatments: GIC Dome vs Stainless Steel Band

For most posterior teeth requiring temporization between root canal appointments, a GIC dome overlay provides adequate protection with significantly lower risk of unfavorable fractures compared to traditional MOD GIC restorations, while stainless steel bands should be reserved for extensively broken-down teeth or patients with parafunctional habits. 1

Key Structural Differences

GIC Dome Overlay

• Provides cuspal coverage by overlaying the entire occlusal surface with reduced cuspal height and occlusal inclines 1
• Creates a protective shell that distributes occlusal forces across the entire tooth structure 1
• Can be placed with or without filling the access cavity (using intermediate restorative material like IRM) 1
• Avoids the aesthetic concerns, gingival irritation, and proximal tooth structure loss associated with bands 1

Stainless Steel Band

• Provides circumferential reinforcement by encircling the tooth at the cervical margin 1
• Offers the highest mean fracture resistance among temporization methods 1
• Results in significantly fewer unfavorable (non-restorable) fractures compared to all GIC methods 1
• May cause gingival irritation, aesthetic concerns, and requires removal of additional proximal tooth structure for placement 1

Clinical Performance Data

Fracture Resistance

• Stainless steel bands demonstrate significantly higher mean fracture forces compared to GIC dome overlays (p = 0.03) and GIC dome with IRM (p < 0.001) 1
• Traditional MOD GIC interim restorations show the lowest fracture resistance of all methods, with significantly higher risk of failure compared to SS bands (p < 0.001), GIC overlays (p < 0.001), and GIC-IRM combinations (p = 0.001) 1

Fracture Pattern Quality

• Stainless steel bands produce significantly fewer unfavorable fractures compared to GIC alone (p = 0.001), GIC overlays (p = 0.007), and GIC-IRM (p < 0.001) 1
• Unfavorable fractures extend below the cemento-enamel junction, making teeth non-restorable and requiring extraction 1

Clinical Decision Algorithm

Choose GIC Dome Overlay When:

• Moderate tooth structure loss with intact or minimally compromised cusps 1
• Normal occlusal forces without parafunctional habits 1
• Aesthetic concerns are present (anterior-visible posterior teeth) 1
• Avoiding gingival irritation is a priority 1
• Preserving remaining proximal tooth structure is important 1

Choose Stainless Steel Band When:

• Extensively broken-down teeth with significant loss of coronal structure 1
• Presence of parafunctional habits (bruxism, clenching) that generate excessive occlusal forces 1
• Maximum protection against catastrophic fracture is the priority 1
• The tooth will undergo definitive crown restoration regardless of temporization method 1

Additional Considerations for GIC Materials

Advantages in Endodontic Applications

• Chemical bonding to dentin enhances seal and reinforces remaining tooth structure 2
• Fluoride release provides antimicrobial effects against residual root canal infection 2
• Good biocompatibility in the periradicular area 2
• Can serve multiple functions: sealing pulp chamber, temporary restoration, and structural support 2

Material Limitations

• Moisture sensitivity during setting requires careful isolation 3
• Long-term wear and strength are not as adequate as resin-based materials 3
• Inherent opacity may affect aesthetics in some cases 3

Common Pitfalls to Avoid

• Do not use traditional MOD GIC interim restorations as the sole temporization method for posterior teeth—they have the highest failure risk and lowest fracture resistance 1
• Avoid placing stainless steel bands when adequate tooth structure exists, as this unnecessarily sacrifices proximal tooth structure and creates aesthetic/gingival concerns 1
• When using GIC dome overlays, ensure adequate reduction of cuspal height and occlusal inclines to prevent excessive occlusal forces 1
• Consider that EDTA treatment or calcium hydroxide dressing can improve the seal when using GIC materials in the root canal system 4

Follow-Up Protocol

• Radiographic monitoring should occur at 3 months, 6 months, 1 year, and then annually for 3 years following completion of root canal treatment 5, 6
• Clinical assessment should evaluate the integrity of the temporary restoration and any signs of fracture or leakage at each appointment 5