Composite Filling or Glass Ionomer in Children?

Composite Filling or Glass Ionomer Filling in Children?

When a cavity is detected in your child’s tooth, one of the most common questions parents ask is, “Which is better for children, composite filling or glass ionomer filling?” Both materials are restorative options that have been used for many years in pediatric dentistry; however, they differ in terms of their intended use, durability, aesthetic properties, sensitivity to moisture, and the teeth to which they can be applied.

Therefore, it is not correct to define a single material as the “best filling” in all cases when choosing a dental filling for children. Many factors should be evaluated together, such as the child’s age, the tooth where the cavity is located, the size of the cavity, how many surfaces the filling will cover, the expected duration of the primary tooth in the mouth, the child’s cooperation during treatment, whether saliva control can be ensured, and the level of caries risk.

Pediatric dentistry (pedodontics) in the examination carried out within this scope, the pediatric dentist first evaluates the depth of the decay and the general condition of the tooth. If deemed necessary, after a radiographic examination is performed, the appropriate option among composite resin, glass ionomer cement, resin-modified glass ionomer, or a different restorative method is determined.

In short, while composite fillings offer significant advantages in terms of aesthetics and mechanical durability, glass ionomer fillings hold an important place in pediatric dentistry due to their fluoride release, chemical bonding ability to tooth tissue, and in some cases, easier application.

Why Are Dental Fillings Done in Children?

The belief that primary teeth will fall out in later years can lead to the misconception that cavities in these teeth do not need to be treated. However, primary teeth play important roles in a child’s chewing, speaking, balanced nutrition, and maintaining the necessary space for permanent teeth.

An untreated primary tooth cavity can progress over time, leading to sensitivity, pain, pulp infection, abscess, and premature tooth loss. As explained in detail in Melsadent’s why do tooth cavities occur in children? guide, detecting decay as early as possible allows for more conservative treatment options to be utilized.

If the decay is no longer only at the initial stage and a cavity has formed in the tooth tissue, after evaluating the damaged tissues, a filling can be made to restore the shape and function of the tooth. The filling material to be used should be evaluated separately for each child and each tooth.

What is Composite Filling?

Composite filling is one of the modern restorative materials based on resin and available in tooth color. It is often referred to as white filling or esthetic filling among the public.

Composite material is bonded to the tooth surface with special adhesive systems and is mostly light-cured. The ability to choose a color close to natural teeth provides a significant aesthetic advantage, especially for front teeth and visible areas.

Composite fillings can be used not only in adults but also in the restoration of primary and young permanent teeth when suitable conditions are met. However, for a successful composite restoration, it is crucial to isolate the working area from saliva as much as possible.

What are the Advantages of Composite Fillings in Children?

One of the main features that make composite fillings preferred in pediatric dentistry is their aesthetic appearance. Especially in primary or permanent teeth located in the anterior region, results close to natural tooth color can be achieved.

• Aesthetic appearance: Can be applied in shades close to tooth color.
• Adhesive bonding to tooth tissue: Can bond to tooth tissue thanks to modern bonding systems.
• Protective preparation: In suitable cases, it can help preserve as much healthy tooth tissue as possible.
• Good surface appearance: A look similar to natural tooth anatomy can be created with shaping and polishing.
• Good durability in suitable cases: It can be a strong option, especially in restorations where isolation is successful.

In the American Academy of Pediatric Dentistry’s restorative dentistry guidelines, resin-based composite materials are also considered among the restorative options that can be used in children’s primary and permanent teeth. The scientific guideline on this topic can be accessed from the AAPD Pediatric Restorative Dentistry page.

Are There Disadvantages of Composite Fillings in Children?

Despite the significant advantages of composite fillings, one of the main reasons why they may not be ideal for every child and every cavity is their sensitivity to moisture control.

During filling, contamination of the tooth surface with saliva or blood can negatively affect the success of the adhesive bond. The difficulty small children have in keeping their mouths open for long periods or their continuous movement during treatment can make successful isolation challenging in some cases.

Furthermore, the application of composite fillings may require more clinical steps compared to some alternatives, due to tooth preparation, adhesive procedures, layering the material, light-curing, and finishing processes.

Therefore, instead of choosing a material based solely on the aesthetic appearance of the filling’s color, the child’s cooperation with the treatment and the clinical conditions of the affected tooth should also be taken into consideration.

What is a Glass Ionomer Filling?

Glass ionomer cement is a restorative material that has been used in dentistry for many years and holds a significant place, especially in pediatric dentistry. Among the most notable features of the material are its ability to chemically interact with tooth tissues and release fluoride.

Glass ionomers can be produced in different formulations. Therefore, the term “glass ionomer” should not be thought of as representing a single group of materials. In addition to traditional glass ionomers, options such as high-viscosity glass ionomer and resin-modified glass ionomer (RMGIC) are also available.

The physical properties and clinical applications of these materials can differ from each other. Therefore, it is beneficial for parents to ask their pediatric dentist which type of material is planned when they hear the term “glass ionomer filling.”

What Are the Advantages of Glass Ionomer Fillings in Children?

Glass ionomer fillings can provide significant advantages in pediatric dentistry, especially under certain clinical conditions.

• Fluoride release: This is one of the most well-known features of glass ionomer materials.
• Chemical bonding to tooth tissue: It can chemically interact with enamel and dentin.
• Advantage in some cases where moisture control is difficult: Its application may be more tolerant in certain clinical situations compared to composite.
• Use in minimally invasive treatments: High-viscosity glass ionomers can be utilized in approaches such as ART and temporary therapeutic restorations.
• Area of use in children with high caries risk: It can be preferred in specific clinical scenarios due to fluoride release.
• Fewer steps: Depending on the selected system, it can help manage the treatment duration.

AAPD states that high-viscosity glass ionomers have a significant area of use in minimally invasive restorative approaches. Especially in some children with very small cavities, limited cooperation, or where traditional restorative procedures cannot be immediately applied, an interim therapeutic restoration approach may be considered.

AAPD’s current approach on this topic can be examined in detail in their Interim Therapeutic Restorations policy.

What Are the Disadvantages of Glass Ionomer Fillings?

One of the most significant limitations of traditional glass ionomers is that their mechanical strength can be lower than some composite resin systems. Especially in large restorations involving intense chewing forces and covering multiple tooth surfaces, material selection must be made more carefully.

AAPD’s restorative dentistry assessments state that there are limitations regarding the long-term use of traditional glass ionomers in some multi-surface restorations in primary molars. In contrast, the clinical performance of resin-modified or high-viscosity glass ionomers may differ from traditional materials.

Therefore, making a general judgment like “glass ionomer is not durable” is also incorrect. The type of material, cavity shape, number of restoration surfaces, the child’s chewing forces, and the application technique can significantly affect the outcome.

What Are the Differences Between Composite Fillings and Glass Ionomer Fillings?

So, Which is Better for Children: Composite or Glass Ionomer?

The most accurate answer to this question is that “it varies according to the condition of the tooth and the child.”

If the child’s treatment compliance is good, the tooth can be adequately isolated, the aesthetic appearance of the restoration is important, and the need for mechanical strength is high, then composite filling can be a strong option.

In contrast, in some cases where treatment time needs to be kept as short as possible, isolation is difficult, the risk of caries is high, or a minimally invasive approach is planned, glass ionomer or resin-modified glass ionomer may be considered.

In a systematic review published in 2024 comparing high-viscosity glass ionomer and composite resin in primary teeth, it was reported that no statistically significant superiority was observed between the clinical effectiveness of the two materials across the evaluated clinical studies. The study also states that single-surface restorations demonstrated higher survival rates than multi-surface restorations for both materials. The relevant systematic review can be accessed via PubMed.

This result indicates that material selection should not be reduced solely to the question of “which filling is stronger?”

Composite Filling or Glass Ionomer in Primary Teeth?

When choosing a filling for primary teeth, how much longer the tooth is expected to remain in the mouth is particularly important. For example, the restorative needs of a primary tooth that is very close to its natural exfoliation time are not the same as those of a primary molar expected to remain in the mouth for many more years.

While composite restorations may be preferred in small and properly isolated primary tooth cavities, glass ionomer-based materials may be more suitable in some cases where moisture control is difficult or the child’s treatment compliance is limited.

Especially in large cavities involving multiple surfaces in posterior primary molars, choosing only between composite and glass ionomer may not be sufficient. Different restorative treatments or full coverage options may come into consideration depending on the extent of tooth substance loss.

Which Filling is Preferred in Permanent Teeth?

During childhood, there are not only primary teeth. Starting from around six years of age, the first permanent molars and subsequently other permanent teeth begin to emerge in the mouth.

Since permanent teeth are expected to remain in the mouth for many years, long-term durability gains more importance in restoration selection. Composite resins are one of the frequently used options in many permanent restorations where adequate isolation can be achieved.

Glass ionomers, on the other hand, can be considered for various purposes such as temporary restorations, caries control, restoration repair, or specific clinical needs. The final choice is again made based on the tooth’s condition and the child’s caries risk.

Does a Child’s Age Affect Filling Selection?

Yes. More than the child’s chronological age, their cooperation level during treatment can be important in material selection.

For example, it might be difficult for a three or four-year-old child to keep their mouth open for a long time. In such a case, a restorative approach that can be applied quickly and requires fewer procedural steps might offer an advantage.

In older children with high cooperation, the application of composite restorations might be easier as the necessary isolation can be achieved more readily.

Melsadent’s Tuzla pediatric dentistry content also emphasizes the importance of behavior guidance and age-appropriate communication during children’s treatment process.

Which Filling is Used for Children with High Caries Risk?

In children with high caries risk, merely filling the existing cavity is not sufficient. Factors that increase the formation of new caries also need to be controlled.

Frequent sugar consumption, inadequate oral hygiene, a history of numerous cavities, nighttime feeding, and lack of regular check-ups can be associated with a high caries risk.

The ability of glass ionomer to release fluoride may lead to the evaluation of this material in some children with a high risk of caries. However, the fluoride released from the filling alone does not eliminate the caries problem.

Regular tooth brushing, the use of age-appropriate fluoridated toothpaste, control of dietary habits, professional preventive applications, and regular pediatric dentistry examinations should be carried out together.

Is There Pain When Performing Fillings in Children?

How the filling procedure will be performed depends on the depth of the caries and the treatment method. In necessary cases, local anesthesia is administered to reduce the feeling of discomfort during the procedure.

Some superficial or minimally invasive procedures can be performed using different methods. In pediatric dentistry, what is important is not just treating the tooth, but creating a positive experience that will prevent the child from developing a fear of the dentist in the future.

If your child has an existing toothache, you can also review the content on toothache in children and treatment solutions for its causes and possible treatments.

What Affects the Lifespan of a Filling?

The material used is not the only factor that determines how long a filling in children will last.

• The size of the caries,
• whether the filling covers one or more surfaces,
• teeth clenching and grinding habit,
• the child’s oral hygiene,
• dietary habits,
• whether the risk of caries persists,
• the success of isolation during application,
• the use of the material with the correct indication,
• regular checking of the restoration

can affect the clinical success of the filling.

Therefore, evaluating the success of a restoration solely by asking “composite or glass ionomer?” would be incomplete.

The Place of Glass Ionomer in Minimally Invasive Pediatric Dentistry

One of the main goals in modern pediatric dentistry is to preserve as much healthy tooth tissue as possible. This approach is called minimally invasive dentistry.

In AAPD’s policy on minimally invasive dentistry, it is emphasized that caries should be managed not only by performing restorations, but by evaluating the entire disease process. Fluoride applications, fissure sealants, control of caries activity, and temporary therapeutic restorations in appropriate patients can be parts of this approach.

For more detailed information on the scientific approach, the AAPD Policy on Minimally Invasive Dentistry resource can be reviewed.

Why Can Glass Ionomer Be Used in ART Treatment?

Atraumatic restorative treatment (ART) is one of the minimally invasive approaches where carious tissue is mostly removed with hand instruments and the cavity is restored with an adhesive material.

High-viscosity glass ionomers are among the materials frequently used in this approach. ART can be particularly considered in some children where traditional treatment methods are difficult to apply or in special clinical conditions.

A systematic review indexed in PubMed in 2025 also evaluated the restorative materials used in the ART method and their clinical outcomes in children. The research can be accessed via PubMed.

Does Glass Ionomer Filling Release Fluoride?

Yes. One of the important properties of glass ionomer-based materials is their ability to release fluoride ions. This property is particularly noteworthy in pediatric dentistry.

However, an important distinction must be made here: The presence of a fluoride-releasing filling does not mean that the child will no longer develop new cavities.

Cavities are a multi-factorial disease. New cavities can form if factors such as oral hygiene, frequency of eating, sugar consumption, salivary characteristics, and existing bacterial plaque are not controlled.

Is Composite Filling Safe for Children?

Composite materials used in dentistry have been utilized in clinical applications for many years. When selecting a restorative material for children, the pediatric dentist evaluates the child’s age, the location of the restoration, and clinical requirements.

Regarding material safety, scientific guidelines from professional dental organizations should be considered, rather than generalized or fear-mongering content found on the internet.

Is Composite Filling More Durable?

Composite restorations, when performed with proper isolation and for the correct indications, can exhibit strong mechanical properties. However, it cannot be automatically assumed that composite will be more successful in every primary tooth restoration.

In a systematic review of clinical studies comparing high-viscosity glass ionomers with composite resins, it was reported that satisfactory results could be obtained with both materials.

The number of surfaces a cavity involves is a particularly important factor for restoration success. In multi-surface and large primary tooth restorations, different restorative options may need to be evaluated.

Which Filling is More Aesthetic for Front Teeth?

In anterior regions where aesthetic expectations are high, composite resin can generally provide a more natural color and surface appearance. Therefore, in suitable cases where isolation can be successfully achieved, composite may be preferred for anterior tooth restorations.

However, in very young children or in cases where isolation is not sufficient, different restorative options may be needed.

What Should Be Considered After Fillings in Children?

After a filling treatment, the pediatric dentist’s recommendations should be followed. If local anesthesia was applied, special care should be taken to ensure children do not bite their lips, cheeks, or tongue until the numbness completely wears off.

After a filling is placed:

• Teeth should continue to be brushed regularly.
• The frequency of consuming sugary and sticky foods should be reduced.
• Recommended check-up appointments by the dentist should not be missed.
• If the filling breaks or falls out, a dentist should be consulted as soon as possible.
• If there is persistent tooth pain, swelling, or nighttime pain, do not wait for the next check-up.

Who Should Choose the Filling Material for Children?

The choice of filling material should not be made solely based on the parent’s aesthetic preference or comparisons read on the internet. The dentist who clinically evaluates the child and the tooth should decide on the most suitable restorative material.

During the examination;

• the depth of the decay,
• the vitality of the tooth,
• the remaining healthy tooth tissue,
• the exfoliation time of the primary (milk) tooth,
• the number of cavity surfaces,
• the child’s caries risk,
• oral hygiene,
• compliance with treatment, and
• isolation conditions

should be evaluated together to make a decision.

Children’s Dental Filling Treatment at Melsadent

At Melsadent Oral and Dental Health Polyclinic, children’s oral and dental health problems are evaluated with a pedodontic approach. A personalized treatment plan is created by considering the child’s age, tooth development, caries risk, and compliance with treatment.

If you have noticed tooth decay in your child, see a brown or black area on the tooth, if sensitivity to hot and cold has started, or if your child avoids eating using a particular tooth, it is important to evaluate the problem before it progresses.

Especially in primary teeth, postponing treatment with the thought of “it will fall out anyway” can lead to the progression of decay, pain, or infection. During a pediatric dentist examination, it can be determined whether the tooth can be restored and which of composite, glass ionomer, resin-modified glass ionomer, or a different treatment is more suitable.

For more information on preventive and restorative applications for children, you can visit the Melsadent Pediatric Dentistry (Pedodontics) page.

Frequently Asked Questions

In children, which is better: composite filling or glass ionomer filling?

There isn’t a single correct option for every child. While composite fillings can be advantageous for their aesthetic and mechanical properties, glass ionomers can provide fluoride release and ease of application in certain clinical conditions. The most suitable material is chosen based on the tooth’s condition and the child’s compliance with treatment.

Can composite fillings be done on primary teeth?

Yes. Composite fillings can be done on primary teeth in appropriate cases. Especially in situations where the working area can be well isolated, composite resin can be a successful restorative option.

Can a glass ionomer filling be applied to primary teeth?

Yes. Glass ionomer and resin-modified glass ionomer materials are used for various purposes in pediatric dentistry. The type of glass ionomer used may vary depending on the treatment goal and the cavity.

Is a glass ionomer filling temporary?

Not every use of glass ionomer is temporary. Depending on the type of material and its indication, it can be used for temporary or longer-term restorative purposes. Especially high-viscosity and resin-modified glass ionomers have different clinical application areas.

Is a composite filling more long-lasting?

With proper isolation and correct indication, composite can exhibit high durability. However, the lifespan of the filling depends not only on the material but also on the size of the cavity, oral hygiene, caries risk, and how many surfaces the restoration covers.

Why is a glass ionomer filling preferred in children?

Its ability to release fluoride, chemically bond to tooth tissues, and provide an advantage in clinical conditions where moisture control is difficult in some cases are among the important reasons.

Which is the white filling for children?

Composite resins are commonly referred to as white or aesthetic fillings. Glass ionomer materials can also be light-colored, but composites generally offer a wider aesthetic option in terms of mimicking natural tooth color.

Does a filling hurt in children?

Local anesthesia can be used in cases deemed necessary according to the depth of the decay. In pediatric dentistry, the aim is to carry out the treatment as comfortably as possible and for the child to have a positive dental experience.

How long does a filling last in children?

Duration varies depending on the size of the cavity, the filling material, the tooth’s location, and the child’s cooperation with the treatment. Some restorative materials may require more clinical procedural steps.

Do glass ionomer fillings release fluoride?

Yes. Glass ionomer-based materials have the property of releasing fluoride. However, this feature does not replace regular tooth brushing and cavity prevention habits.

If a filling is not done, can one wait until the primary tooth falls out on its own?

Waiting is not advisable in every case. The decay can progress, leading to pain, infection, abscess, or premature loss of the primary tooth. Whether treatment is necessary should be determined by a pediatric dentist’s examination.

What should be done if a filling falls out?

A tooth with a lost filling should be re-evaluated by a pediatric dentist. Leaving the tooth open can lead to food accumulation, sensitivity, and progression of decay.

Do children need root canal treatment instead of a filling?

If the decay has progressed to the pulp tissue of the tooth, a filling alone may not be sufficient. Depending on the tooth’s vitality and radiographic findings, appropriate pulp or root canal treatment may be necessary for the primary tooth.

Is composite filling or glass ionomer more aesthetic?

Generally, composite resins have a higher aesthetic potential in terms of color, surface polish, and harmony with natural teeth.

Is glass ionomer better for children with high caries risk?

Due to fluoride release, glass ionomers may offer advantages in some patients with high caries risk. However, material selection is not based solely on caries risk; the size, location, and mechanical requirements of the restoration are also evaluated.

The Most Appropriate Filling Choice for Children is Personalized

The answer to the question of whether to use composite or glass ionomer fillings in children is not as simple as choosing a single material. While composite fillings offer an aesthetic appearance and strong mechanical performance under suitable conditions, glass ionomers stand out with their fluoride release, chemical bonding, and areas of use in minimally invasive treatments.

Scientific studies also do not show that one of the materials is absolutely superior in all primary tooth restorations. The size of the cavity, whether it is single or multi-surface, isolation conditions, the child’s cooperation, and whether the risk of decay persists can be decisive for success.

Therefore, the most appropriate approach is for your child’s tooth to be examined by a pediatric dentist and the restorative material to be determined according to clinical need. Thanks to early diagnosis, it may be possible to preserve more healthy tooth tissue and benefit from simpler treatment options.

If you think your child has decay, toothache, or a need for a filling, you can get detailed information about Melsadent Oral and Dental Health Polyclinic’s pediatric dentistry services and apply for a pedodontic evaluation.