Glass ionomer cement (GIC) is a versatile dental material that has great potential in caries management. The World Health Organization has included GIC in the Model List of Essential Medicines, which are medicines that satisfy the population's priority healthcare needs [1]. GIC is formed by mixing the calcium fluoro-alumino-silicate glass powder with a polyacid solution. Wilson and Kent invented GIC in the early 1970s [2]. Since then, it had been widely used in dentistry as a restorative material due to its beneficial properties [3,4], including fluoride release, chemical adhesion to tooth surfaces, a thermal expansion coefficient close to that of dentine and good biocompatibility [5,6].

However, GIC has limitations, including its low mechanical strength, sensitivity to moisture, and limited antibacterial effect after setting [7,8,9]. These limitations reduced its clinical application although it presents most favourable properties of a restorative material. The low mechanical strength could lead to microleakage or fracturing of the restoration [6,10]. The sensitivity to moisture could reduce its adhesion to tooth structure, especially when very frequently, moisture control is difficult. The lack of antimicrobial properties increases the risk of secondary caries in the tooth structure adjacent to the restoration and reduces the longevity of the restoration [11].

Researchers have incorporated antibacterial agents into GIC for the prevention of secondary caries. The antibacterial modification of GIC should be achieved without affecting its physical properties. A study showed that the incorporation of bioactive glass decreases GIC's mechanical strength [12]. In another study, researchers modified GIC with zinc, casein phosphopeptide-amorphous calcium phosphate or bioactive glass, but the modification did not enhance GIC's mechanical strength [13].

Zeolite is an aluminosilicate consisting of 3D frameworks of [SiO4]4− and [AlO4]5− tetrahedra with the oxygen atoms’ linkage [14]. It has a porous structure, which facilitates ion exchange [15]. The porosity creates negatively charged channels and cavities that can accommodate cations, hydroxyl groups and water molecules [16]. These unique porous structures allow for ion absorption and release [17]. Previous studies have confirmed the biocompatibility of various types of zeolites [15]. They can be used for the fabrication of medical products. Because zeolite can slowly release the preloaded antimicrobials over long periods of time [18], silver can be incorporated into zeolite [17]. Silver zeolite is a compound with biocompatibility and antimicrobial properties that can absorb and release silver ions. Silver zeolite has the crystalline structure of aluminosilicates with porous molecules, which contain silver in the void spaces [19]. Silver zeolite's antibacterial properties have been confirmed in previous studies [20,21].

Silver zeolite can be incorporated into GIC to enhance its antimicrobial effects. This study was conducted to develop an antimicrobial silver zeolite glass ionomer cement (SZ-GIC) for caries management and to determine its biocompatibility and physical, adhesive and antibacterial properties.