Thermal risks from LED- and high-intensity QTH-curing units during polymerization of dental resins

Thermal Sensing of Photo-Activated Dental Resin Composites Using Infrared Thermography

OBJECTIVE

The goal of this study was to compare the pulp temperature increase during light curing of different composite thicknesses in deep class I cavities using two thermal sensing tools.

METHODOLOGY

Round occlusal class I cavities with a remaining dentin thickness (RDT) of 1 mm from the cavity floor were performed on 15 extracted sound molars. Samples were divided into three groups (n = 5). In group A, cavities were restored using the Filtek Z350 XT conventional composite through the incremental filling technique, whereas group B cavities were restored using the Filtek Bulk-Fill flowable composite through the bulk-fill technique. Specimens of the Filtek Bulk-Fill flowable composite using the incremental filling technique were used to restore cavities in group C. An infrared thermal camera (IRT; Flir, Wilsonville, OR, USA) and K-type thermocouple (Perfect Prime TC0520, New York, NY, USA) were used to measure the heat generated during composite photo-polymerization.

RESULTS

There were no significant differences within the same group using either the thermocouple or IRT (p > 0.05). One-way ANOVA showed no significant differences between groups A and C (p > 0.05), whereas group B was significantly different from groups A and C with each sensing tool (p < 0.05).

CONCLUSION

IRT and thermocouple heat readings were comparable. Based on the current findings, the bulk-fill technique resulted in the lowest heat generation among the groups. Therefore, increasing the light-curing time and the number of composite increments was directly correlated with increases in intra-pulpal temperature.

Real-time multispectral transmission of hard tooth tissues and dental composites with their heating

The objective of the study was to investigate the real-time transmission of Violet, Blue, Red and Near Infra-Red (NIR) irradiation through 2 or 4 mm thick dental composites and tooth tissue samples at varying positions of Light Curing Unit (LCU) with polymerization temperature monitoring.

METHODS

The composites tested were: Filtek Universal Restorative (FUR), Filtek One Bulk Fill (FBF), Tetric EvoCeram (TEC), Tetric Bulk Fill (TBF) and Tetric PowerFill (TPF). The new LCU Pinkwave (a four-wavelength source manufactured by Vista Apex, USA) was placed either centrally or eccentrically for 3 mm above the sample. A Fiber spectrometer detected irradiation and Infrared Thermal camera polymerization temperatures.

RESULTS

All eccentric LCU positions significantly weaken transmitted spectra for all composites in both thickness, jeopardizing Blue light. The LCU position did not affect transmitted irradiation for tooth tissues. The reduction in wavelength intensity when penetrating through thicker compared to thinner composite samples was 62%, 50% and 31% for Blue, NIR and Red, respectively, and 90%, 50% and 35% for tooth tissue samples, respectively. The temperature of bulk fill composites with additional photoinitiators rises faster. Eccentric LCU positions cause a significant decrease in both speed and the maximal value of temperature rise. Red and NIR irradiations contribute to the polymerization temperature.

SIGNIFICANCE

Tested LCU source cause considerable inhomogeneity in the emitted and transmitted spectra. Tooth tissues homogenize irradiation, but drastically attenuates it. Red light has better potential than Blue light concerning penetration and could be further investigated as the wavelength for activation of an adjusted photoinitiator.

Pulp chamber temperature rise in light-cure bonding of brackets with and without primer, in intact versus restored teeth

OBJECTIVE

To evaluate the pulp chamber temperature rise (PCTR) in light-cure bonding of brackets with and without primer, in intact and restored mandibular central incisors (M1), maxillary first premolars (Mx4), and mandibular third molars (M8).

MATERIAL AND METHODS

Ninety human teeth were included: M1 (n=30), Mx4 (n=30), and M8 (n=30). Light-cure bonding of brackets was performed in intact (n=60) and restored (n=30) teeth, with primer (n=60) or without (n=30) primer. PCTR was defined as the difference between initial (T0) and peak temperatures (T1), recorded with a thermocouple during light-cure bonding. Differences on PCTR between bonding techniques (primer vs. no primer), teeth types (M1 vs. Mx4 vs. M8), and teeth condition (intact vs. restored) were estimated by ANCOVA, with α=5%.Results: PCTR was significantly higher with the use of primer (2.05 ± 0.08oC) than without primer (1.65 ± 0.14oC) (p=0.02), and in M1 (2.23 ± 0.22oC) compared to Mx4 (1.56 ± 0.14oC) (p<0.01). There was no difference in the PCTR in M8 (1.77 ± 0.28oC) compared to M1 or Mx4 (p>0.05), and no difference between intact (1.78 ± 0.14oC) and restored (1.92 ± 0.08oC) teeth (p=0.38). There was no influence of dentin enamel thickness in the PCTR (p=0.19).

CONCLUSION

PCTR was higher in light-cure bonding of brackets with primer, especially in M1. Light-cure bonding seems less invasive without primer.

Effect of Ceramic and Dentin Thicknesses and Type of Resin-Based Luting Agents on Intrapulpal Temperature Changes during Luting of Ceramic Inlays

The adhesive cementation of ceramic inlays may increase pulpal temperature (PT) and induce pulpal damage due to heat generated by the curing unit and the exothermic reaction of the luting agent (LA). The aim was to measure the PT rise during ceramic inlay cementation by testing different combinations of dentin and ceramic thicknesses and LAs. The PT changes were detected using a thermocouple sensor positioned in the pulp chamber of a mandibular molar. Gradual occlusal reduction obtained dentin thicknesses of 2.5, 2.0, 1.5, and 1.0 mm. Light-cured (LC) and dual-cured (DC) adhesive cements and preheated restorative resin-based composite (RBC) were applied to luting of 2.0, 2.5, 3.0, and 3.5 mm lithium disilicate ceramic blocks. Differential scanning calorimetry was used to compare the thermal conductivity of dentin and ceramic slices. Although ceramic reduced heat delivered by the curing unit, the exothermic reaction of the LAs significantly increased it in each investigated combination (5.4–7.9 °C). Temperature changes were predominantly influenced by dentin thickness followed by LA and ceramic thickness. Thermal conductivity of dentin was 24% lower than that of ceramic, and its thermal capacity was 86% higher. Regardless of the ceramic thickness, adhesive inlay cementation can significantly increase the PT, especially when the remaining dentin thickness is <2 mm.

The role of the light source in antimicrobial photodynamic therapy

Antimicrobial photodynamic therapy (APDT) is a promising approach to fight the growing problem of antimicrobial resistance that threatens health care, food security and agriculture. APDT uses light to excite a light-activated chemical (photosensitiser), leading to the generation of reactive oxygen species (ROS). Many APDT studies confirm its efficacy in vitro and in vivo against bacteria, fungi, viruses and parasites. However, the development of the field is focused on exploring potential targets and developing new photosensitisers. The role of light, a crucial element for ROS production, has been neglected. What are the main parameters essential for effective photosensitiser activation? Does an optimal light radiant exposure exist? And finally, which light source is best? Many reports have described the promising antibacterial effects of APDT in vitro, however, its application in vivo, especially in clinical settings remains very limited. The restricted availability may partially be due to a lack of standard conditions or protocols, arising from the diversity of selected photosensitising agents (PS), variable testing conditions including light sources used for PS activation and methods of measuring anti-bacterial activity and their effectiveness in treating bacterial infections. We thus sought to systematically review and examine the evidence from existing studies on APDT associated with the light source used. We show how the reduction of pathogens depends on the light source applied, radiant exposure and irradiance of light used, and type of pathogen, and so critically appraise the current state of development of APDT and areas to be addressed in future studies. We anticipate that further standardisation of the experimental conditions will help the field advance, and suggest key optical and biological parameters that should be reported in all APDT studies. More in vivo and clinical studies are needed and are expected to be facilitated by advances in light sources, leading to APDT becoming a sustainable, alternative therapeutic option for bacterial and other microbial infections in the future.

Emissivity evaluation of human enamel and dentin

Background: Human enamel and dentin temperatures have been assessed with non-contact infrared imaging devices for safety and diagnostic capacity and require an emissivity parameter to enable absolute temperature measurements. Emissivity is a ratio of thermal energy emitted from an object of interest, compared to a perfect emitter at a given temperature and wavelength, being dependent on tissue composition, structure, and surface texture. Evaluating the emissivity of human enamel and dentin is varied in the literature and warrants review. The primary aim of this study was to evaluate the emissivity of the external and internal surface of human enamel and dentin, free from acquired or developmental defects, against a known reference point. The secondary aim was to assess the emissivity value of natural caries in enamel and dentin.

Method: Fourteen whole human molar teeth were paired within a thermally stable chamber at 30°C. Two additional teeth (one sound and one with natural occlusal caries–ICDAS caries score 4 and radiographic score RB4) were sliced and prepared as 1-mm-thick slices and placed on a hot plate at 30°C within the chamber. A 3M Scotch Super 33 + Black Vinyl Electrical Tape was used for the known emissivity reference-point of 0.96. All samples were allowed to reach thermal equilibrium, and a FLIR SC305 infrared camera recorded the warming sequence. Emissivity values were calculated using the Tape reference point and thermal camera software.

Results: The external enamel surface mean emissivity value was 0.96 (SD 0.01, 95% CI 0.96–0.97), whereas the internal enamel surface value was 0.97 (SD 0.01, 95% CI 0.96–0.98). The internal crown-dentin mean emissivity value was 0.94 (SD 0.02, 95% CI 0.92–0.95), whereas the internal root-dentin value was 0.93 (SD 0.02, 95% CI 0.91–0.94) and the surface root-dentin had a value of 0.84 (SD 0.04, 95% CI 0.77–0.91). The mean emissivity value of the internal enamel surface with caries was 0.82 (SD 0.05, 95% CI 0.38–1.25), and the value of the internal crown-dentin with caries was 0.73 (SD 0.08, 95% CI 0.54–0.92).

Conclusion: The emissivity values of sound enamel, both internal and external, were similar and higher than those of all sound dentin types in this study. Sound dentin emissivity values diminished from the crown to the root and root surface. The lowest emissivity values were recorded in caries lesions of both tissues. This methodology can improve emissivity acquisition for comparison of absolute temperatures between studies which evaluate thermal safety concerns during dental procedures and may offer a caries diagnostic aid.

Composite Pre-heating: A Novel Approach in Restorative Dentistry

Resin composite pre-heating is a novel approach that might improve handling and marginal adaptation of the unset material paste in clinical application. The goal of this review article is to compile all laboratory experiments on resin composite preheating and see how it impacts the mechanical properties of the material. Results have shown that preheating composite resins improves the degree of conversion, stiffness, marginal adaptability, and microhardness. While flexural strength is unbothered, polymerization shrinkage is hindered, and the microleakage results are unknown.

Pulp chamber temperature variation evaluation using fiber Bragg grating sensor

The present in vitro study proposes a novel (to the best of our knowledge) methodology employing a fiber Bragg grating sensor for the evaluation of pulp chamber temperature increase during the polymerization of the composite resin induced by the light-curing process. A fiber Bragg grating temperature sensor (FBGTS) has been developed in view of its ease of insertion into the pulp chamber with minimal widening of the pulpal canal. The temperature increase in the pulpal chamber during the polymerization of the composite resin by light curing has been characterized with varying depths of cavities of 1 mm, 1.5 mm, and 2 mm employing FBGTS. Also, the increase in temperature of the pulpal chamber during the polymerization of the composite resin has been studied with variants of the light-curing device. The obtained results are expected to be an indicator towards the potential hazard caused by heat induced pulpal injuries during the polymerization of composite resins using a light-curing device.

Heat Development in the Pulp Chamber During Curing Process of Resin-Based Composite Using Multi-Wave LED Light Curing Unit

Objective

The study aimed to investigate factors contributing to heat development during light curing of a flowable bulk-fill resin-based composite (SDR^TM, Lot # 602000876, Dentsply Sirona, Konstanz, Germany) (RBC).

Materials and Methods

Temperatures were measured with calibrated thermocouples. A multi-wave light-emitting diode (LED) light curing unit (LCU) was used (Ivoclar Vivadent, Schaan, Lichtenstein). In all experiments, the RBC was first cured (cured) for 30 s and, after 5 min of recovery time, received a second LCU irradiation (post-cured) for 30 s. The exothermic reaction was measured by calculating the Δ temperature between cured and post-cured RBC. In a cylinder-shaped polymer mold, temperature was recorded inside of RBC during curing (part 1) and light transmission through RBC during curing was investigated (part 2). Pulpal temperatures were assessed in an extracted third molar during light curing (part 3). Data were statistically analyzed using one-way ANOVA (α=0.05).

Results

Increased thickness of RBC led to decreased pulp chamber temperatures. Inside RBC, there was a large variation in heat development between the cured and post-cured groups (p<0.05). The cured group absorbed more LCU irradiation than the post-cured group.

Conclusion

The irradiance of the LCU seemed to be a more important factor than exothermic reaction of RBCs for pulp chamber heat development. Flowable bulk-fill RBCs can act as a pulpal insulator against LCU irradiation, despite their exothermic curing reaction.

[Effect of preheating on the properties of resin composite]

Resin composite, which is commonly used as a dental filling material, has some problems, such as poor wear resistance, polymerization shrinkage, and poor dentin marginal adaptability. Preheating of resin composite improves its pro-perties. This paper reviewed the effects of resin composite preheating on its monomer conversion, marginal microleakage, mechanical properties, and irritation on dental pulp.

Effectiveness of photopolymerization in composite resins using a novel 445-nm diode laser in comparison to LED and halogen bulb technology

Challenges especially in the minimal invasive restorative treatment of teeth require further developments of composite polymerization techniques. These include, among others, the securing of a complete polymerization with moderate thermal stress for the pulp. The aim of this study is to compare current light curing sources with a blue diode laser regarding curing depth and heat generation during the polymerization process. A diode laser (445 nm), a LED, and a halogen lamp were used for polymerizing composite resins. The curing depth was determined according to the norm ISO 4049. Laser output powers of 0.1, 0.5, 1, and 2 W were chosen. The laser beam diameter was adapted to the glass rod of the LED and the halogen lamp (8 mm). The irradiation time was fixed at 40 s. To ascertain ΔT values, the surface and ground area temperatures of the cavities were simultaneously determined during the curing via a thermography camera and a thermocouple. The curing depths for the LED (3.3 mm), halogen lamp (3.1 mm) and laser_{(0.5/1 W)} (3/3.3 mm) showed no significant differences (p < 0.05). The values of ΔT_surface as well as ΔT_ground also showed no significant differences among LED, halogen lamp, and laser_{(1 W)}. The ΔT_surface values were 4.1_LED, 4.3_{halogen lamp}, and 4.5 °C for the laser while the ΔT_ground values were 2.7_LED, 2.6_{halogen lamp}, and 2.9 °C for the laser. The results indicate that the blue diode laser (445 nm) is a feasible alternative for photopolymerization of complex composite resin restorations in dentistry by the use of selected laser parameters.

Thermal Scanning of Dental Pulp Chamber by Thermocouple System and Infrared Camera during Photo Curing of Resin Composites

Introduction:

Due to thermal hazard during composite restorations, this study was designed to scan the pulp temperature by thermocouple and infrared camera during photo polymerizing different composites.

Methods and Materials:

A mesio-occlso-distal (MOD) cavity was prepared in an extracted tooth and the K-type thermocouple was fixed in its pulp chamber. Subsequently, 1 mm increment of each composites were inserted (four composite types were incorporated) and photo polymerized employing either LED or QTH systems for 60 sec while the temperature was recorded with 10 sec intervals. Ultimately, the same tooth was hemisected bucco-lingually and the amalgam was removed. The same composite curing procedure was repeated while the thermogram was recorded using an infrared camera. Thereafter, the data was analyzed by repeated measured ANOVA followed by Tukey’s HSD Post Hoc test for multiple comparisons (α=0.05).

Results:

The pulp temperature was significantly increased (repeated measures) during photo polymerization (P=0.000) while there was no significant difference among the results recorded by thermocouple comparing to infrared camera (P>0.05). Moreover, different composite materials and LCUs lead to similar outcomes (P>0.05).

Conclusion:

Although various composites have significant different chemical compositions, they lead to similar pulp thermal changes. Moreover, both the infrared camera and the thermocouple would record parallel results of dental pulp temperature.

Mechanical and Thermal Properties of Dental Composites Cured with CAD/CAM Assisted Solid-State Laser

Over the last three decades, it has been frequently reported that the properties of dental restorative composites cured with argon laser are similar or superior to those achieved with conventional halogen and light emitting diode (LED) curing units. Whereas laser curing is not dependent on the distance between the curing unit and the material, such distance represents a drawback for conventional curing units. However, a widespread clinical application of this kind of laser remains difficult due to cost, heavy weight, and bulky size. Recently, with regard to the radiation in the blue region of the spectrum, powerful solid-state lasers have been commercialized. In the current research, CAD (computer-aided design)/CAM (computer-aided manufacturing) assisted solid-state lasers were employed for curing of different dental restorative composites consisting of micro- and nanoparticle-reinforced materials based on acrylic resins. Commercial LED curing units were used as a control. Temperature rise during the photopolymerisation process and bending properties were measured. By providing similar light energy dose, no significant difference in temperature rise was observed when the two light sources provided similar intensity. In addition, after 7 days since curing, bending properties of composites cured with laser and LED were similar. The results suggested that this kind of laser would be suitable for curing dental composites, and the curing process does not suffer from the tip-to-tooth distance.

Light-curing units used in dentistry: factors associated with heat development-potential risk for patients

Objectives

To investigate how heat development in the pulp chamber and coronal surface of natural teeth with and without cusps subjected to irradiance using light-emitting diode (LED)–light-curing units (LCUs) is associated with (i) irradiance, (ii) time, (iii) distance, and (iv) radiant exposure.

Materials and methods

Three different LED-LCUs were used. Their irradiance was measured with a calibrated spectrometer (BlueLight Analytics Inc., Halifax, Canada). An experimental rig was constructed to control the thermal environment of the teeth. The LED-LCU tip position was accurately controlled by a gantry system. Tooth surface temperature was measured by thermography (ThermaCAM S65 HS, FLIR Systems, Wilsonville, USA) and pulp chamber temperature with a thermocouple. LED-LCU tip distance and irradiation times tested were 0, 2, and 4 mm and 10, 20, and 30 s, respectively. Ethical permission was not required for the use of extracted teeth.

Results

Maximum surface and pulp chamber temperatures were recorded in tooth without cusps (58.1 °C  ± 0.9 °C and 43.1 °C ± 0.9 °C, respectively). Radiant exposure explained the largest amount of variance in temperature, being more affected by time than irradiance.

Conclusions

At all combinations of variables tested, repeated measurements produced consistent results indicating the reliability of the method used. Increased exposure time seems to be the factor most likely to cause tissue damage.

Clinical relevance

Risk of superficial tissue damage at irradiances >1200 mW/cm² is evident. There is a risk of pulp damage when only thin dentin is left at higher irradiances (>1200 mW/cm²). Clinicians should be aware of LED-LCU settings and possible high temperature generated.

Analysis and simulation of heat transfer in human tooth during the curing of orthodontic appliance and food ingestion

The aim of this study was to analyze and simulate the heat transfer in the human tooth undergoing fixed orthodontic appliances and food intake. An in vivo representative mathematic model of a layered thermographic profile was developed during the LED curing of Gemini bracket 0.022 in slot (conventional ligating system) and Transbond XT adhesive. The characterization of the layered thermic response allowed to identify if during the LED curing process, according to manufacturer’s specification (light curing unit, adhesive) can induce pulpar necrosis. The profile’s thermographic model was the simulation basis of many conditions such as food intake, due to in vivo metrology is affected by the impossibility of a correct apparatus position and the physiologic function of the oral cavity which is exposed to uncontrollable temperature changes. The metrology was carried out with a T-440 thermographic camera during LED curing bracket, using a LED curing light (Elipar S10) placed at 3 ± 1 mm for 5 s at each mesial and distal surface. The thermography outcomes were analyzed in the FLIR Tools Software, Microsoft Excel 2013 and SPSS 22. To adjust the mathematic model error, in vitro studies were performed on third molars for the purpose of realizing extreme exposition temperature condition tests caused by the LED curing unit without jeopardizing the human tooth vitality as would it be on in vivo experimentation. The bracket curing results according to manufacturer’s conditions reached 39°C in vivo temperatures and 47°C on in vitro tests, which does not jeopardize human tooth vitality as said by previous researches, although, an LED curing precise protocol established by the manufacturer’s LED curing light is sustained.

Influence of a heating device and adhesive temperature on bond strength of a simplified ethanol-based adhesive system

Abstract Introduction Increased adhesive temperature has been reported to promote solvent evaporation, reduce viscosity, and improve monomeric permeation into dentin. Objective The aim of this study was to determine the influence of different heating methods on the microtensile bond strength of an etch-and-rinse adhesive to dentin. Material and method Twenty-four caries-free extracted human third molars were transversally sectioned to expose a flat dentinal surface. The samples were etched with 37% phosphoric acid gel and divided into three groups (n = 8): 1) Control - the adhesive system (Adper Single Bond 2; 3M ESPE) was applied at room temperature; 2) Warming device - the adhesive was warmed to 37°C in a custom device before application; and 3) Warm air - the adhesive was warmed to 50°C with an air jet after application on dentin. The specimens were restored with a composite resin (Filtek Z250 A2, 3M ESPE) and prepared for microtensile bond strength testing, after 24 h in water storage. The data were subjected to one-way ANOVA and Tukey's test (p < 0.05). Result There was no significant difference among the groups (p > 0.05). The mean bond strength values in the control, the warming device, and the warm air groups were 48.5 (± 5.2), 40.35 (± 4.9), and 47.2 (± 5.3) MPa, respectively (p = 0.05). Conclusion The different heating methods had no significant influence on the immediate microtensile bond strength of an etch-and-rinse ethanol-based adhesive to dentin.

Light-Curing Units

For improved interstudy reproducibility, reduced risk of premature failures, and ultimately better patient care, researchers and dentists need to know how to accurately characterize the electromagnetic radiation (light) they are delivering to the resins they are using. The output from a light-curing unit (LCU) is commonly characterized by its irradiance. If this value is measured at the light tip, it describes the radiant exitance from the surface of the light tip, and not the irradiance received by the specimen. The value quoted also reflects only an averaged value over the total measurement area and does not represent the irradiance that the resin specimen is receiving locally or at a different moment in time. Recent evidence has reported that the spectral emission and radiant exitance beam profiles from LCUs can be highly inhomogeneous. This can cause nonuniform temperature changes and uneven photopolymerization within the resin restoration. The spectral radiant power can be very different between different brands of LCUs, and the use of irradiance values derived from dental radiometers to describe the output from an LCU for research purposes is discouraged. Manufacturers should provide more information about the light output from the LCU and the absorption spectrum of their resin-based composite (RBC). Ideally, future assessments and research publications should include the following information about the curing light: 1) radiant power output throughout the exposure cycle and the spectral radiant power as a function of wavelength, 2) analysis of the light beam profile and spectral emission across the light beam, and 3) measurement and reporting of the light the RBC specimen received as well as the output measured at the light tip.

Temperature changes under demineralized dentin during polymerization of three resin-based restorative materials using QTH and LED units

Objectives

Light-curing of resin-based materials (RBMs) increases the pulp chamber temperature, with detrimental effects on the vital pulp. This in vitro study compared the temperature rise under demineralized human tooth dentin during light-curing and the degrees of conversion (DCs) of three different RBMs using quartz tungsten halogen (QTH) and light-emitting diode (LED) units (LCUs).

Materials and Methods

Demineralized and non-demineralized dentin disks were prepared from 120 extracted human mandibular molars. The temperature rise under the dentin disks (n = 12) during the light-curing of three RBMs, i.e. an Ormocer-based composite resin (Ceram. X, Dentsply DeTrey), a low-shrinkage silorane-based composite (Filtek P90, 3M ESPE), and a giomer (Beautifil II, Shofu GmbH), was measured with a K-type thermocouple wire. The DCs of the materials were investigated using Fourier transform infrared spectroscopy.

Results

The temperature rise under the demineralized dentin disks was higher than that under the non-demineralized dentin disks during the polymerization of all restorative materials (p < 0.05). Filtek P90 induced higher temperature rise during polymerization than Ceram.X and Beautifil II under demineralized dentin (p < 0.05). The temperature rise under demineralized dentin during Filtek P90 polymerization exceeded the threshold value (5.5℃), with no significant differences between the DCs of the test materials (p > 0.05).

Conclusions

Although there were no significant differences in the DCs, the temperature rise under demineralized dentin disks for the silorane-based composite was higher than that for dimethacrylate-based restorative materials, particularly with QTH LCU.

Temperature increase during orthodontic bonding with different curing units using an infrared camera

AIM

To evaluate the effects of different curing units and light-tip tooth surface distances on the temperature increase generated during orthodontic bonding, using an infrared camera (IR) and artificial neural networks (ANN).

MATERIALS AND METHODS

Fifty-two freshly extracted human premolar teeth were used. Metallic orthodontic brackets were bonded to the buccal surfaces of the teeth and thermal records were taken using an IR camera and ANN. Brackets were cured with a light-emitting diode (LED) and high intensity halogen (HQTH). Teeth were divided into four groups according to the curing units (LED and HQTH) and curing distances (from tooth surface and 10 mm away from tooth surface). The results were analyzed with analysis of variance (ANOVA) and the Tukey HSD test.

RESULTS

The ANOVA and Tukey HSD tests revealed that temperature changes were influenced by the type of light source and exposure times. All groups revealed significant differences between each other (p < 0.001). The highest surface temperature increase was gained from curing with a LED unit from the tooth surface (11.35°C ± 0.91°C). The lowest surface temperature increase was gained from curing with a HQTH unit 10 mm away from the tooth surface (2.57°C ± 0.6°C).

CONCLUSION

The LED unit induced significantly higher temperature changes than did the HQTH. The temperature increase during orthodontic bonding was increased with long exposure time. A shorter light-tip tooth surface distance leads to greater increases in temperature.

Overview of Clinical Alternatives to Minimize the Degradation of the Resin-dentin Bonds

The incorporation of hydrophilic and acidic resin monomers substantially improved the initial bonding of contemporary etch-and-rinse (ER) and self-etch (SE) adhesives to intrinsically wet dental substrates, providing quite favorable immediate results, regardless of the bonding approach used. However, in the long term, the bonding effectiveness of most simplified ER and SE adhesives drop dramatically. This review examines the fundamental processes that are responsible for the aging mechanisms involved in the degradation of the resin-bonded interfaces and some possible clinical approaches that have been effective in minimizing or even preventing the degradation of the adhesive interfaces produced with simplified adhesives. The incorporation of some of the feasible approaches - described in this review - may improve the quality of the adhesive restorations performed in clinical practice, while manufacturers develop bonding materials that are less susceptible to the aging mechanisms present in the oral environment.

Interaction of LED light with coinitiator-containing composite resins: effect of dual peaks

OBJECTIVES

Recently the colour stability of composite resins has been an issue due to the emphasis on the aesthetics of restored teeth. The purpose of the present study was to investigate how dual-peak LED units affect the polymerization of coinitiator-containing composite resins.

MATERIALS AND METHODS

Five composite resins [coinitiator-containing: Aelite LS Posterior (AL), Tetric EvoCeram (TE), and Vit-l-escence (VI); only CQ-containing: Grandio (GD) and Filtek Z350 (Z3)] were light cured using four different light-curing units (LCUs). Among them, Bluephase G2 (BP) and G-light (GL) were dual-peak LED LCUs. Microhardness, polymerization shrinkage, flexural, and compressive properties were measured.

RESULTS

BP and GL had no consistent effect on the microhardness of AL, TE, and VI on the top and bottom surfaces of resin specimens. Among the specimens, AL and VI showed the least (9.86-10.41 μm) and greatest (17.58-19.21 μm) polymerization shrinkage, respectively. However, the effect of BP and GL on the shrinkage of specimens was not consistent. Among the specimens, GD showed the greatest flexural properties [strength (FS) and modulus (FM)] and TE showed the lowest flexural and compressive properties [strength (CS) and modulus (CM)]. In same resin product, maximum FS and CS differences due to the different LCUs were 10.3-21.0% and 3.6-9.2%, respectively. Furthermore, the influences of BP and GL on FS and CS were not consistent.

CONCLUSION

The tested dual-peak LED LCUs had no consistent synergic effect on the polymerization of coinitiator-containing composite resins as compared with QTH and single-peak LED LCUs.

CLINICAL SIGNIFICANCE

The dual-peak LED LCUs achieve a similar degree of polymerization in coinitiator-composite resins as QTH and single-peak LED LCUs did. Choice of LCU does not appear to be a determinant of the light curing of coinitiator-composite resins.

Characterization of heat emission of light-curing units

OBJECTIVES

This study was designed to analyze the heat emissions produced by light-curing units (LCUs) of different intensities during their operation. The null hypothesis was that the tested LCUs would show no differences in their temperature rises.

METHODS

FIVE COMMERCIALLY AVAILABLE LCUS WERE TESTED: a "Flipo" plasma arc, "Cromalux 100" quartz-tungsten-halogen, "L.E. Demetron 1" second-generation light-emitting diode (LED), and "Blue Phase C5" and "UltraLume 5" third-generation LED LCUs. The intensity of each LCU was measured with two radiometers. The temperature rise due to illumination was registered with a type-K thermocouple, which was connected to a computer-based data acquisition system. Temperature changes were recorded in continues 10 and 20 s intervals up to 300 s.

RESULTS

The Flipo (ARC) light source revealed the highest mean heat emission while the L.E. Demetron 1 LED showing the lowest mean value at 10 and 20 s exposure times. Moreover, Cromalux (QTH) recorded the second highest value for all intervals (12.71, 14.63, 14.60) of heat emission than Blue Phase C5 (LED) (12.25, 13.87, 13.69), interestingly at 20 s illumination for all intervals the highest results (18.15, 19.27, 20.31) were also recorded with Flipo (PAC) LCU, and the lowest (6.71, 5.97, 5.55) with L.E. Demetron 1 LED, while Blue Phase C5 (LED) recorded the second highest value at the 1st and 2nd 20 s intervals (14.12, 11.84, 10.18) of heat emission than Cromalux (QTH) (12.26, 11.43, 10.26). The speed of temperature or heat rise during the 10 and 20 s depends on light intensity of emitted light. However, the QTH LCU was investigated resulted in a higher temperature rise than LED curing units of the same power density.

CONCLUSION

The PAC curing unit induced a significantly higher heat emission and temperature increase in all periods, and data were statistically different than the other tested groups (p < .05). LED (Blue Phase C5) was not statistically significant (p < .05) (at 10 s) than QTH units, also LED (Blue Phase C5, UltraLume 5) generates obvious heat emission and temperature rises than QTH units (at 20 s) except for those which have lower power density of LED curing units (first generation). Thus, the null hypothesis was rejected.

FLUID DYNAMICS ANALYSIS OF SHEAR STRESS ON NERVE ENDINGS IN DENTINAL MICROTUBULE: A QUANTITATIVE INTERPRETATION OF HYDRODYNAMIC THEORY FOR DENTAL PAIN

Noxious thermal and/or mechanical stimuli applied to dentine can cause fluid flow in dentinal microtubules (DMTs). The fluid flow induces shear stress (SS) on intradental nerve endings and may excite pulpal mechanoreceptors to generate dental pain sensation. There exist numerous studies on dental thermal pain, but few are mathematical. For this, we developed a computational fluid dynamics (CFD) model of dentinal fluid flow (DFF) in innervated DMTs. Based on this model, we systematically investigated the effects of various parameters (e.g., biological structure, DFF velocity, and fluid properties) on the SS experienced by intradental nerve endings and thus provide a quantitative interpretation to the hydrodynamic theory. The dimensions of biological structures, odontoblastic process (OP) movement, dentinal fluid velocity, and viscosity were found to have significant influences on the SS while dentinal fluid density showed negligible influence under conditions studied. The results indicate that: (i) dental pain study of animal models may not be directly applied to human being and the results may even vary from one person to another and (ii) OP movement caused by DFF changes the dimension of the space for the fluid flow, affecting thus the SS on nerve endings. The present work enables better understanding of the mechanisms underlying dental pain sensation and quantification of dental pain intensity resulted from clinical procedures such as dentine sensitivity testing and dental restorative processes.

Effect of diode-pumped solid state laser on polymerization shrinkage and color change in composite resins

A diode-pumped solid state (DPSS) laser emitting at 473 nm was used to test its influence on the degree of polymerization of composite resins. Eight composite resins were chosen and light cured with three different light-curing systems [a quartz-tungsten-halogen (QTH) lamp-based unit, a light-emitting diode (LED) unit, and a DPSS laser]. Polymerization shrinkage and color change in specimens were measured. According to the statistical analysis, each light-curing system produced a significantly different value of maximum polymerization shrinkage. In most specimens, the DPSS laser induced the least polymerization shrinkage. After being immersed in distilled water for 10 days, specimens light-cured by the DPSS laser had undergone less color change than those cured by the other units. In conclusion, the DPSS laser induced better or similar polymerization in terms of polymerization shrinkage and color change in composite resins compared with those of the QTH lamp-based and LED units.

Effect of light curing unit on resin-modified glass-ionomer cements: a microhardness assessment

Objective:

To evaluate the microhardness of resin-modified glass-ionomer cements (RMGICs) photoactivated with a blue light-emitting diode (LED) curing light.

Material and Methods:

Thirty specimens were distributed in 3 groups: Fuji II LC Improved/GC (RM1), Vitremer/3M ESPE (RM2) and Filtek Z250/ 3M ESPE (RM3). Two commercial light-curing units were used to polymerize the materials: LED/Ultrablue IS and a halogen light/XL3000 (QTH). After 24 h, Knoop microhardness test was performed. Data were submitted to three-way ANOVA and Tukey's test at a pre-set alpha of 0.05.

Results:

At the top surface, no statistically significant difference (p>0.05) in the microhardness was seen when the LED and QTH lights were used for all materials. At the bottom surface, microhardness mean value of RM2 was significantly higher when the QTH light was used (p<0.05). For RM1, statistically significant higher values (p<0.05) were seen when the LED light was used. No statistically significant difference (p>0.05) was seen at the bottom surface for RM3, irrespective of the light used. Top-to-bottom surface comparison showed no statistically significant difference (p>0.05) for both RMGICs, regardless of the light used. For RM3, microhardness mean value at the top was significantly higher (p<0.05) than bottom microhardness when both curing units were used.

Conclusion:

The microhardness values seen when a LED light was used varied depending on the restorative material tested.

The effects of one-step self-etch adhesives on the induction of oxidative stress and production of TGF-beta1 and BMP-2 by human gingival fibroblasts

The aim of this study was to evaluate and compare the effects of two self-etch adhesive materials on the induction of oxidative stress and production of transforming growth factor-beta1 (TGF-beta1) and bone morphogenetic protein-2 (BMP-2) by cultured human gingival fibroblasts (HGF). Inflammation-free attached gingiva was obtained from healthy donors under informed consent. Following 24- and 72-h exposure of HGF to two different elutes of the test materials, cell viability was determined using the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl tetrazolium bromide (MTT) assay. Lipid peroxidation, a major indicator of oxidative stress, was measured by the thiobarbituric acid reactive substance (TBARS) assay. TGF-beta1 and BMP-2 levels in cell-free culture media were determined by enzyme-linked immunosorbent assay (ELISA). Cell viability of the test groups was significantly lower than those of control at 24 and 72 h (P < 0.001), but showed an increase at 72 h (P < 0.001). The TBARS levels of both test groups were significantly greater than that of control (P < 0.05), and displayed similar values at 72 h (P > 0.05). For both materials, the levels of TGF-beta1 and BMP-2 were significantly greater than that of control (P < 0.05). Both test groups showed increased TGF-beta1 levels. These results indicate that the tested self-etch adhesives might be capable of inducing production of TGF-beta1 and BMP-2 in cultured HGF, despite their cytotoxic and oxidative stress-producing potential.

Effects of adhesive temperature on the early and 6-month dentin bonding

OBJECTIVES

The aim of this study was to test the effect of adhesive temperature on the bond strength to dentin (muTBS) and silver nitrate uptake (SNU) of an ethanol/water (Adper Single Bond 2 [SB]) and an acetone-based (Prime&Bond 2.1 [PB]) etch-and-rinse adhesive system.

METHODS

The bottles of each adhesive were kept in various temperatures (5 degrees C, 20 degrees C, 37 degrees C and 50 degrees C) for 1h previously to its application in the occlusal demineralized dentin of 40 molars. Bonded sticks (0.8 mm(2)) were tested in tension (0.5 mm/min) immediately (IM) or after 6 months (6 M) of water storage. Two bonded sticks from each hemi-tooth were immersed in silver nitrate and analyzed by SEM. Data were analyzed by two-way repeated measures ANOVA and Tukey's test (alpha=0.05).

RESULTS

No significant difference in muTBS was detected for both adhesives at 5 degrees C and 20 degrees C. The highest bond strength for PB was observed in the 37 degrees C group while for SB it was in the 50 degrees C. Significant reductions of bond strengths were observed for PB at 37 degrees C and SB at 50 degrees C after 6 M of water storage. Silver nitrate deposition was seen in all hybrid layers, irrespective of the group. Lower silver nitrate deposition (water trees) in the adhesive layer was seen for PB and SB at higher temperatures.

CONCLUSIONS

The heating or refrigeration of the adhesives did not improve their resin-dentin bond resistance to water degradation over time.

Kinetics of light-cure bracket bonding: power density vs exposure duration

INTRODUCTION

Recent technologic advances make it possible to increase the light power density to reduce the necessary exposure duration. The kinetics of polymerization are complex. The special case of indirectly curing the thin layler of composite below the metallic bracket base further increases this complexity. It was hypothesized that the concept of "total energy,"--the reciprocity between power density and exposure duration--does not hold for orthodontic light-cure bracket bonding.

METHODS

Stainless steel brackets were bonded on deciduous bovine incisors with a standard light-cured composite. A calibrated, powerful halogen lamp allowed for modification of power density from 300 to 3000 mW/cm2. Metallic brackets were bonded in 8 groups of 20 incisors each with various combinations of power densities and exposure durations to obtain 3 levels of energy density (6000, 12000, and 24000 mJ/cm2). Another group of 20 incisors served as the positive control with a conventional powerful halogen lamp (1000 mW/cm2) for 40 seconds. After storage for 24 hours at 37 degrees C in water, the bracket shear bond strength (SBS) and the adhesive remnant index (ARI) were measured.

RESULTS

It was confirmed that bracket SBS mainly depends on the energy density of the light cure. All groups with an energy density of 6000 mJ/cm2 had significantly lower SBS than the groups with higher energy densities (P <0.01). The dependence of SBS on exposure duration for the same energy density followed an exponential model of nonlinear regression (r2 = 0.98).

CONCLUSIONS

The concept of "total energy" does not hold for orthodontic light-cure bracket bonding. An exposure time of less than 4 seconds, irrespective of the power density, cannot guarantee sufficient bracket bond strength. There seems to be an advantage of power density over exposure duration in the context of metallic bracket bonding. These results show that, for an efficient light-cure bracket bonding, there is an absolute lower limit of exposure duration (4 seconds) and an upper limit of useful power density (3000 mW/cm2).

Effects of light curing modes and resin composites on temperature rise under human dentin: an in vitro study

The influence of three curing modes of a high-powered LED curing unit on temperature rise under 2-mm-thick dentin was investigated during the polymerization of resin composite samples of Admira, Filtek P60, Premise, Tetric Flow, Tetric Ceram, and Filtek Z250. Ninety standard specimens were prepared. The bonding agents and resin composites were cured with standard, pulse, or soft-start mode (n=5 for each curing mode). Temperature rise was measured using a type L thermocouple. Data were analyzed by two-way ANOVA and Tukey's test. Soft-start curing led to statistically higher temperature rises compared than the other two modes. The highest temperature rise was observed for Admira and Tetric Flow cured with soft-start mode. The lowest temperature rise was observed for Premise cured with pulse mode. However, temperature rise did not reach the critical value that can cause pulpal damage by virtue of a prominent safety feature of the high-powered LED LCU, which ensures that no excessive heat is produced by all the three curing modes.

Temperature excursions at the pulp-dentin junction during the curing of light-activated dental restorations

OBJECTIVES

Excessive heat produced during the curing of light-activated dental restorations may injure the dental pulp. The maximum temperature excursion at the pulp-dentin junction provides a means to assess the risk of thermal injury. In this investigation we develop and evaluate a model to simulate temperature increases during light-curing of dental restorations and use it to investigate the influence of several factors on the maximum temperature excursion along the pulp-dentin junction.

METHODS

Finite element method modeling, using COMSOL 3.3a, was employed to simulate temperature distributions in a 2D, axisymmetric model tooth. The necessary parameters were determined from a combination of literature reports and our measurements of enthalpy of polymerization, heat capacity, density, thermal conductivity and reflectance for several dental composites. Results of the model were validated using in vitro experiments.

RESULTS

Comparisons with in vitro experiments indicate that the model provides a good approximation of the actual temperature increases. The intensity of the curing light, the curing time and the enthalpy of polymerization of the resin composite were the most important factors. The composite is a good insulator and the greatest risk occurs when using the light to cure the thin layer of bonding resin or in deep restorations that do not have a liner to act as a thermal barrier.

SIGNIFICANCE

The results show the importance of considering temperature increases when developing curing protocols. Furthermore, we suggest methods to minimize the temperature increase and hence the risk of thermal injury. The physical properties measured for several commercial composites may be useful in other studies.

The applicability of DPSS laser for light curing of composite resins

The applicability of diode-pumped solid state (DPSS) laser for light curing the composite resins was tested with a quartz-tungsten-halogen lamp-based unit and a light emitting diode unit. The emission spectra of the light-curing systems used match with the absorption spectrum of camphorquinone. Among the light-curing systems, DPSS laser showed the narrowest emission bandwidth. The light intensity of DPSS laser was approximately 64% of the other two light-curing units. In most specimens, DPSS laser showed the least attenuation of the number of incident photons. On the top surface, specimens cured with DPSS laser showed similar microhardness values compared to the specimens cured with the other two light-curing units. During the light curing, DPSS laser induced the lowest temperature rise (25.5-35.5 degrees C) in the specimens compared to the other two light-curing units (34.2-41.7 degrees C). In conclusion, DPSS laser has high potential to be an alternative to the other light-curing units or a new light-curing unit.

Effects of two multi-step self-etch primer/adhesives on apoptosis in human gingival fibroblastsin vitro

Various in vitro studies have shown induction of apoptosis by monomers incorporated to dental restorative materials and adhesive resins, while information regarding the effect of monomer combinations as commercially available products on apoptosis is limited. The aim of this study was to investigate the effects of two multi-step self-etch primer/adhesive systems on apoptosis of cultured primary human gingival fibroblasts. Cells were treated up to 48 h with Clearfil SE Bond (Kuraray, Japan) and FL Bond (Shofu, Japan) at 1:1000 v:v ratio to determine cell proliferation, using 0.02 mM staurosporine as positive control. Apoptosis was assessed using propidium iodide/acridine orange (PI/AO) staining, compared to nontreated controls. When compared to FL Bond, exposure of gingival fibroblasts to Clearfil SE Primer and Clearfil SE Bond resulted in a higher degree of cell proliferation. PI/AO staining revealed typical morphological features of apoptosis in FL Bond and Staurosporine groups, while some cells cultured in the presence of primer and adhesive components of Clearfil SE Bond showed nuclear fragmentation, indicative of early apoptosis. Our results indicate that apoptotic potential of the multi-step self-etch adhesives were material-dependent within the 48 h test period.

Polymerization efficiency of different photocuring units through ceramic discs

This study compared the ability of a variety of light sources and exposure modes to polymerize a dual-cured resin composite through ceramic discs of different thicknesses by depth of cure and Vickers microhardness (VHN). Ceramic specimens (360) (Empress 2 [Ivoclar Vivadent], color 300, diameter 4 mm, height 1 or 2 mm) were prepared and inserted into steel molds according to ISO 4049, after which a dual-cured composite resin luting material (Variolink II [Ivoclar Vivadent]) with and without self-curing catalyst was placed. The light curing units used were either a conventional halogen curing unit (Elipar TriLight [3M/ESPE] for 40 seconds), a high-power halogen curing unit (Astralis 10 [Ivoclar Vivadent] for 20 seconds), a plasma arc curing unit (Aurys [Degré K] for 10 seconds or 20 seconds) or different light emitting diode (LED) curing units (Elipar FreeLight I [3M/ESPE] for 40 seconds, Elipar FreeLight II [3M/ESPE] for 20 seconds, LuxOmax [Akeda] for 40 seconds, e-Light [GC] for 12 seconds or 40 seconds). Depth of cure under the ceramic discs was assessed according to ISO 4049, and VHN at 0.5 and 1.0 mm distance from the ceramic disc bottom was determined (ISO 6507-1). Medians and the 25th and 75th percentiles were determined for each group (n=10), and statistical analysis was performed using the Mann-Whitney-U-test (p < or = 0.05). The results showed that increasing ceramic disc thickness had a negative effect on the curing depth and hardness of all light curing units, with hardness decreasing dramatically under the 2-mm thick discs using LuxOmax, e-Light (12 seconds) or Aurys (10 seconds or 20 seconds). The use of a self-curing catalyst is recommended over the light-curable portion only, because it produced an equivalent or greater hardness and depth of cure with all light polymerization modes.

Reducing, by Pulse Width Modulation, the Curing Temperature of a Prototype High-power LED Light Curing Unit

Third-generation LEDs have high irradiance and efficiency, but the associated temperature rise is potentially hazardous to the pulp of teeth. We evaluated, during composite polymerization, the irradiance and temperature rise of a prototype high-power LED light curing unit (LCU) with optimal pulse width modulation (PWM), and then compared the results with four off-the-shelf high-power LCUs. A cavity was prepared in a tooth, and a composite resin layer was applied and cured. For each LCU, the irradiance and temperature changes at the pulp-dentin junction were measured. Microhardness (Vickers hardness) of cured composite samples was measured for each LCU. Our prototype had a final temperature of 36.4 +/- 1.3 degrees C and irradiance of 1,182 +/- 1 mW/cm2. The unit with the highest temperature had a temperature of 48.7 +/- 1.2 degrees C and an irradiance of 1,194 +/- 1 mW/cm2. Based on the results of the present study, it was shown that PWM technology reduced the curing temperature while retaining the polymerization effectiveness of a high-power LED LCU.