Variation of depth of cure and intensity with distance using LED curing lights

A randomized clinical study evaluating the 30-month clinical performance of class II indirect restorations in endodontically treated teeth using ceramic, hybrid, and composite computer-aided design/computer-aided production blocks

Context Background

In the literature, the information about which indirect material is the most appropriate for the restoration of endodontically treated teeth is insufficient. Therefore, studies evaluating the clinical performance of root canal-treated teeth will shed light on this issue for clinicians.

Aim

This clinical study aimed to evaluate the clinical performances of class II indirect restorations using ceramic, hybrid, and composite blocks to endodontically treated teeth.

Materials and Methods

A total of 60 indirect class II restorations were performed in 51 patients using Cerasmart (GC Dental Products Europe, Leuven, Belgium) composite, IPS e.max computer-aided design CAD (Ivoclar Vivadent, Schaan, Liechtenstein) ceramic, and Vita Enamic (Vita Zahnfabrik, Bad Sackingen, Germany) hybrid blocks. All the restored teeth had root canal treatment. The restorations were evaluated using modified FDI criteria for 30 months.

Statistical Analysis Used

The data were analyzed using Kruskal-Wallis analysis and Friedman two-way analysis of variance.

Results

A total of 53 restorations of the 60 restorations could be followed up at the end of 30 months. No statistically significant difference was observed between the groups after 30 months in terms of all criteria evaluated (P > 0.05).

Conclusion

Composite, ceramic, and hybrid blocks showed successful clinical performance in endodontically treated posterior teeth with large material loss.

Effects of different bonding systems with various polymerization modes and root canal region on the bond strength of core build-up resin composite

Purpose The aim of this study was to clarify the effects of different bonding systems (BSs) with various polymerization modes and root canal regions on the bond strength of core build-up resin composite to dentin.Methods Post cavities were prepared in the roots of 54 bovine teeth. Three types of BS with various polymerization modes (light, chemical, and dual-cure) were applied to the walls of the cavities, which were subsequently filled with core build-up resin composite, and stored in 37°C water for 7 days. Each tooth was then sectioned perpendicular to the long axis of the tooth into 9-disk from the coronal to the apical side. Bond strengths were measured on two-thirds of the disks, while dye penetration was examined in the remaining third.Results Statistical analysis revealed significant differences between the bond strengths of BSs with different polymerization modes, indicating chemical-cured BS had higher bond strength than light-cured BS. The chemical-cured BS group showed cohesive failure in both resin composite and dentin regardless of the root canal region, while adhesive failure was observed in the coronal region for dual-cured BS and in the apical region for light-cured BS. Dye penetration was significantly more at the bonding interface at the apical region of the light-cured BS.Conclusions Chemical-cured BS displayed a greater bond strength than light-cured BS. Cohesive failure was observed in both core build-up resin and dentin, indicating that the integration of tooth structure with resin composite was effective for retaining the resin core and sealing the root canal.

Effects of different bonding systems with various polymerization modes and root canal region on the bond strength of core build-up resin composite

PURPOSE

The aim of this study was to clarify the effects of different bonding systems (BSs) with various polymerization modes and root canal regions on the bond strength of core build-up resin composite to dentin.

METHODS

Post cavities were prepared in the roots of 54 bovine teeth. Three types of BS with various polymerization modes (light, chemical, and dual-cure) were applied to the walls of the cavities, which were subsequently filled with core build-up resin composite, and stored in 37ºC water for 7 days. Each tooth was then sectioned perpendicular to the long axis of the tooth into 9-disk from the coronal to the apical side. Bond strengths were measured on two-thirds of the disks, while dye penetration was examined in the remaining third.

RESULTS

Statistical analysis revealed significant differences between the bond strengths of BSs with different polymerization modes, indicating chemical-cured BS had higher bond strength than light-cured BS. The chemical-cured BS group showed cohesive failure in both resin composite and dentin regardless of the root canal region, while adhesive failure was observed in the coronal region for dual-cured BS and in the apical region for light-cured BS. Dye penetration was significantly more at the bonding interface at the apical region of the light-cured BS.

CONCLUSIONS

Chemical-cured BS displayed a greater bond strength than light-cured BS. Cohesive failure was observed in both core build-up resin and dentin, indicating that the integration of tooth structure with resin composite was effective for retaining the resin core and sealing the root canal.

Comparison of Internal Adaptation in Class II Bulk-fill Composite Restorations Using Micro-CT

PURPOSE

This study compared the internal adaptation of bulk-fill composite restorations in class II cavities and explored the relationship between internal adaptation and polymerization shrinkage or stress.

METHODS AND MATERIALS

Standardized mesio-occluso-distal cavities were prepared in 40 extracted human third molars and randomly divided into five groups (n=8). After having been applied by total-etch XP bond (Dentsply Caulk, Milford, DE, USA) and light curing, the teeth were restored with the following resin composites: group 1, Filtek Z350 (3M ESPE, St. Paul, MN, USA); group 2, SDR (Dentsply Caulk, Milford, DE, USA) + Z350; group 3, Venus Bulk Fill (Heraeus Kulzer, Dormagen, Germany) + Z350; group 4, Tetric N-Ceram Bulk Fill (Ivoclar Vivadent, Schaan, Liechtenstein); and group 5, SonicFill (Kerr, West Collins, Orange, CA, USA). After thermo-mechanical load cycling, cross-sectional microcomputerized tomography (micro-CT) images were taken. Internal adaptation was measured as imperfect margin percentage (IM%), which was the percentage of defective margin length relative to whole margin length. On the micro-CT images, IM% was measured at five interfaces. Linear polymerization shrinkage (LS) and polymerization shrinkage stress (PS) were measured on each composite with a custom linometer and universal testing machine. To explore the correlation of IM% and LS or PS, the Pearson correlation test was used.

RESULTS

The IM% of the gingival and pulpal cavity floors were inferior to those of the cavity walls. The IM% values of the groups were found to be as follows: group 5 ≤ groups 1 and 4 ≤ group 2 ≤ group 3. The correlation analysis showed that the p value was 0.006 between LS and IM% and 0.003 between PS and IM%, indicating significant correlations (p<0.05).

CONCLUSION

Flowable bulk-fill composites had a higher IM% and polymerization shrinkage stress than did packable bulk-fill and hybrid composites. In class II composite restoration, the gingival floor of the proximal box and pulpal floor of the cavity had higher IM% than did the buccal and lingual walls of the proximal box. LS and PS, which were measured under compliance-allowed conditions, were significantly related to internal adaptation.

LED Curing Lights and Temperature Changes in Different Tooth Sites

Objectives. The aim of this in vitro study was to assess thermal changes on tooth tissues during light exposure using two different LED curing units. The hypothesis was that no temperature increase could be detected within the dental pulp during polymerization irrespective of the use of a composite resin or a light-curing unit. Methods. Caries-free human first molars were selected, pulp residues were removed after root resection, and four calibrated type-J thermocouples were positioned. Two LED lamps were tested; temperature measurements were made on intact teeth and on the same tooth during curing of composite restorations. The data was analyzed by one-way analysis of variance (ANOVA), Wilcoxon test, Kruskal-Wallis test, and Pearson's χ². After ANOVA, the Bonferroni multiple comparison test was performed. Results. Polymerization data analysis showed that in the pulp chamber temperature increase was higher than that without resin. Starlight PRO, in the same condition of Valo lamp, showed a lower temperature increase in pre- and intrapolymerization. A control group (without composite resin) was evaluated. Significance. Temperature increase during resin curing is a function of the rate of polymerization, due to the exothermic polymerization reaction, the energy from the light unit, and time of exposure.

The effect of polymerization conditions on the amounts of unreacted monomer and bisphenol A in dental composite resins

The aim of this study was to analyze the unreacted monomers of four commonly used composite resins, which were released after curing with different polymerization conditions. Four composite resins, consisting of two hybrid types and two flowable types from two manufacturers, were photopolymerized using different curing times and curing distances. After polymerization, samples were extracted for analysis at different time points up to 24 h. Released monomers were analyzed by reversed-phase liquid chromatography at UV 210 nm. Longer curing times and shorter curing distances resulted in higher polymerization rates and decreased release of TEGDMA and UDMA, but changes in curing time and distance had no significant effect on Bis-GMA. Release of BPA increased with increase in curing time or decrease in curing distance, in contrast to the results of TEGDMA and UDMA. Polymerization conditions need to be differently applied according to both monomer and resin types.

Color Stability Behavior of Methacrylate-based Resin Composites Polymerized with Light-emitting Diodes and Quartz-Tungsten-Halogen

Methods and Materials

Composite discs were fabricated from Tetric EvoCeram, Premise, Artiste, and Beautifil II (nanohybrids); Filtek Supreme Plus and Vit-l-escence (microhybrids); Heliomolar (microfill); and Estelite Sigma Quick (minifill) using a Teflon mold. The specimens were irradiated either with QTH (Elipar 2500; 600 mW/cm2) for 40 seconds or with LED (Bluephase G2; 1200 mW/cm2) for 20 seconds. Color parameters were measured with a colorimeter before and after polymerization and at 24 hours, one week, one month, and three months. Color change was calculated among the different storage periods.

Results

There was a significant effect of the composite, time, and their interaction (p&lt;0.001) but no effect of the polymerization unit on the color stability. Color changes immediately after polymerization and at 24 hours (4.22 and 3.88 for LED; and 4.08 and 3.82 for QTH) were not significantly different from each other but were both significantly higher than changes after one week (0.96 and 0.78), one month (1.12 and 1.02), and three months (1.27 and 1.11) for LED and QTH, respectively (p&lt;0.001).

Conclusions

Color changes were observed for all the materials that were dependent on the type of composite but not on the polymerization unit. These color shifts took place primarily immediately after polymerization and after 24 hours and were additive in nature.

Effect of the irradiance distribution from light curing units on the local micro-hardness of the surface of dental resins

OBJECTIVE

An inhomogeneous irradiance distribution from a light-curing unit (LCU) can locally cause inhomogeneous curing with locally inadequately cured and/or over-cured areas causing e.g. monomer elution or internal shrinkage stresses, and thus reduce the lifetime of dental resin based composite (RBC) restorations. The aim of the study is to determine both the irradiance distribution of two light curing units (LCUs) and its influence on the local mechanical properties of a RBC.

METHODS

Specimens of Arabesk TOP OA2 were irradiated for 5, 20, and 80s using a Bluephase® 20i LCU in the Low mode (666mW/cm(2)), in the Turbo mode (2222mW/cm(2)) and a Celalux® 2 (1264mW/cm(2)). The degree of conversion (DC) was determined with an ATR-FTIR. The Knoop micro-hardness (average of five specimens) was measured on the specimen surface after 24h of dark and dry storage at room temperature.

RESULTS

The irradiance distribution affected the hardness distribution across the surface of the specimens. The hardness distribution corresponded well to the inhomogeneous irradiance distributions of the LCU. The highest reaction rates occurred after approximately 2s light exposure. A DC of 40% was reached after 3.6 or 5.7s, depending on the LCU. The inhomogeneous hardness distribution was still evident after 80s of light exposure.

SIGNIFICANCE

The irradiance distribution from a LCU is reflected in the hardness distribution across the surface. Irradiance level of the LCU and light exposure time do not affect the pattern of the hardness distribution--only the hardness level. In areas of low irradiation this may result in inadequate resin polymerization, poor physical properties, and hence premature failure of the restorations as they are usually much smaller than the investigated specimens. It has to be stressed that inhomogeneous does not necessarily mean poor if in all areas of the restoration enough light intensity is introduced to achieve a high degree of cure.

Comparative study of surface microhardness of methacrylate-based composite resins polymerized with light-emitting diodes and halogen

Objective:

The aim of this study was to evaluate the effect of polymerization with quartz-tungsten-halogen (QTH) and light-emitting diodes (LED) on the surface microhardness of eight commercially available light-polymerized, methacrylate-based composite resins, with different filler particle composition (microfill, minifill, nanohybrids, and microhybrids) immediately after polymerization, after 24 hours, and after three months of storage.

Materials and Methods:

Eighty disk-shaped specimens were prepared using a split Teflon mold (6 × 2 mm) and were irradiated with either the QTH (Elipar 2500; 600 mW/cm²) for 20 seconds or an LED (Bluephase G2; 1,200 mW/cm²) for 40 seconds. The microhardness values were recorded using a Vickers hardness tester at a 300 g load for 15 seconds, immediately after polymerization, after 24 hours, and after three months of dark aging in distilled water at 37°C. Statistical analysis was performed using a two-way analysis of variance (ANOVA) and the Tukey's test.

Results:

The baseline values demonstrated a significant effect of the composite and the interaction composite-LCU on the microhardness (P < 0.05). At 24 hours, only the composite variable showed a significant effect on the hardness values (P < 0.05). After three months, the composite, LCU, and the interaction composite-LCU all demonstrated a significant effect on the microhardness (P < 0.05).

Conclusions:

The effectiveness of polymerization, measured in terms of surface hardness, was shown to be dependent not only on the type of light curing unit, but also on the type of composite. Moreover, the choice of composite was shown to affect the performance of the light curing unit.

Depth of cure and hardness of indirect composite materials polymerized with two metal halide laboratory curing units

The purpose of this study was to evaluate the depth of cure and Knoop hardness of indirect composite materials polymerized with different laboratory curing units. Five composite materials designed for fixed restoration veneer (Artglass, Ceramage, Epricord, Prossimo, and Solidex) were filled into a cylindrical mold and then light-exposed by using the respective proprietary laboratory curing unit or two metal halide curing units (Hyper LII and Twinkle X). Depth of cure was determined by a scraping technique, as described in ISO 4049. Composites also underwent Knoop hardness testing after immersion in water. The results (n = 5) were analyzed with the Kruskal-Wallis test and Dunn's multiple comparison test. For three materials (Prossimo, Artglass, and Epricord), depth of cure after polymerization with the Twinkle X unit was greater than that after polymerization with the respective proprietary units. For the Ceramage and Artglass materials, the Twinkle X unit resulted in the highest Knoop hardness number (KHN), whereas, for the Prossimo material, the Hyper LII unit resulted in the highest KHN. The metal halide units were effective in enhancing the post-polymerization properties of specific composite materials while reducing exposure time.

Evaluation of Vickers hardness and depth of cure of six composite resins photo-activated with different polymerization modes

Aim:

The current in vitro study evaluated Vickers hardness (VK) and depth of cure (hardness ratio) of six resin composites, polymerized with a light-emitting diode (LED) curing unit by different polymerization modes: Standard 20 s, Standard 40 s, Soft-start 40 s.

Materials and Methods:

Six resin composites were selected for the present study: three microhybrid (Esthet.X HD, Amaris, Filtek Silorane), two nanohybrid (Grandio, Ceram.X mono) and one nanofilled (Filtek Supreme XT). The VK of the surface was determined with a microhardness tester using a Vickers diamond indenter and a 200 g load applied for 15 seconds. The mean VK and hardness ratio of the specimens were calculated using the formula: hardness ratio = VK of bottom surface / VK of top surface.

Results:

For all the materials tested and with all the polymerization modes, hardness ratio was higher than the minimum value indicated in literature in order to consider the bottom surface as adequately cured (0.80). Curing time did not affect hardness ratio values for Filtek Silorane, Grandio and Filtek Supreme XT.

Conclusion:

The effectiveness of cure at the top and bottom surface was not affected by Soft-start polymerization mode.

Advances in light-curing units: four generations of LED lights and clinical implications for optimizing their use: Part 2. From present to future

The first part of this series of two described the history of light curing in dentistry and developments in LED lights since their introduction over 20 years ago. Current second- and third-generation LED light units have progressively replaced their halogen lamp predecessors because of their inherent advantages. The background to this, together with the clinical issues relating to light curing and the possible solutions, are outlined in the second part of this article. Finally, the innovative features of what may be seen as the first of a new fourth-generation of LED lights are described and guidance is given for the practitioner on what factors to consider when seeking to purchase a new LED light activation unit.

CLINICAL RELEVANCE

Adequate curing in depth is fundamental to clinical success with any light-activated restoration. To achieve this goal predictably, an appropriate light source needs to be combined with materials knowledge, requisite clinical skills and attention to detail throughout the entire restoration process. As dentists increasingly use light-cured direct composites to restore large posterior restorations they need to appreciate the issues central to effective and efficient light curing and to know what to look for when seeking to purchase a new light-curing unit.

Composite resin color stability: influence of light sources and immersion media

Objective

This study evaluated the influence of light sources and immersion media on the color stability of a nanofilled composite resin.

Material and Methods

Conventional halogen, high-power-density halogen and high-power-density light-emitting diode (LED) units were used. There were 4 immersion media: coffee, tea, Coke^® and artificial saliva. A total of 180 specimens (10 mm x 2 mm) were prepared, immersed in artificial saliva for 24 h at 37±1ºC, and had their initial color measured with a spectrophotometer according to the CIELab system. Then, the specimens were immersed in the 4 media during 60 days. Data from the color change and luminosity were collected and subjected to statistical analysis by the Kruskall-Wallis test (p<0.05). For immersion time, the data were subjected to two-way ANOVA test and Fisher's test (p<0.05).

Results

High-power-density LED (∆E=1.91) promoted similar color stability of the composite resin to that of the tested halogen curing units (Jet Lite 4000 plus - ∆E=2.05; XL 3000 - ∆E=2.28). Coffee (∆E=8.40; ∆L=-5.21) showed the highest influence on color stability of the studied composite resin.

Conclusion

There was no significant difference in color stability regardless of the light sources, and coffee was the immersion medium that promoted the highest color changes on the tested composite resin.

Curing Efficiency of Three Different Curing Modes at Different Distances for Four Composites

Doubling the exposure time of a high-intensity light-emitting diode curing light with a turbo tip and autofocus capability does not predictably compensate for distance in deep cavities.

Influence of zirconia base and shade difference on polymerization efficiency of dual-cure resin cement

PURPOSE

The aim of this study was to investigate the polymerization efficiency of dual-cured resin cement beneath different shades of zirconia-based feldsphathic ceramic restorations.

MATERIALS AND METHODS

Five translucent zirconia (Zirkonzahn) discs (4.0-mm diameter, 1.2-mm height) were prepared. Feldsphathic ceramic (1.2 mm) (Noritake Cerabien Zr) in 5 shades (1M2, 2M2, 3M2, 4M2, 5M2) was applied on the zirconia discs. Twelve dual-cure resin cement specimens were prepared for each shade, using Panavia F 2.0 (Kuraray) in Teflon molds (4.0-mm diameter, 6.0-mm height), following the manufacturer's instructions. Light activation was performed through the zirconia-based ceramic discs for 20 seconds, using a quartz tungsten halogen curing device (Hilux 200) with irradiance of 600 mW/cm(2) . Immediately following light curing, specimens were stored for 24 hours in dry, light-proof containers. Vickers hardness measurements were conducted using a microhardness tester with a 50-g load applied for 15 seconds. The indentations were made in the cross sectional area at four depths, and the mean values were recorded as Vickers hardness number (VHN). Results were statistically analyzed with one-way ANOVA and Tukey HSD test (p < 0.05).

RESULTS

A statistically significant decrease in VHN of the resin cement was noted with increasing depth and darkness of the shade (p < 0.05).

CONCLUSION

Curing efficiency of dual-cure resin cement is mainly influenced by the lightness of the shades selected.

Photoactivated disinfection of Streptococcus intermedius through dentin disc at clinically relevant intervals: an in vitro study

In this present study we have tested the impact of porfimer sodium (Photofrin, AXCAN PHARMA Inc., Quebec, Canada) photoactivated disinfection (PD) on cells of Streptococcus intermedius in suspension. In order to provide basic data to support future clinical studies of PD in dentistry the study used exposure to Quartz-tungsten-halogen (QTH) dental curing light for clinically relevant time periods to activate Photofrin and measured its effectiveness under a variety of conditions including activation through dentin hard tissue. S. intermedius was grown in planktonic suspension for 48h. Nine groups were formed: three control groups (1-3) and six experimental groups (4-9). Groups 4-6 tested the use of Photofrin treatment combined with QTH light at various intervals of irradiation (5, 15 and 60s). Groups 7-9 were similar to groups 4-6 with the exception that irradiation commenced through a dentin disc. Following treatment, bacteria were plated. Colony counts were measured following 72h incubation at 37 degrees C. Statistical analysis was carried out by one-way ANOVA at a 95% confidence level. A significant reduction in S. intermedius colony counts was observed for all experimental groups and one control group. The reduction in numbers of colonies in the experimental groups varied from 79.28 to 99.40% with an average of 94.61%. Reduction in viable bacterial cells indicated a strong relationship between power density and irradiation interval. When curing light energy density was lower due to the irradiation through the 1mm dentin disc, prolonged irradiation interval enhanced bacterial kill. In conclusion, where direct irradiation is not possible for PD treatment, irradiation through dentin may still be done successfully within a clinically relevant interval.

A method of improving marginal adaptation by elimination of singular stress point in composite restorations during resin photo-polymerization

OBJECTIVES

To reduce the effect of stresses due to volumetric shrinkage the authors propose an incremental technique for placing composite restorations.

METHODS

The goal of the method is to reduce the volume of the resin that is polymerized and eliminate a stress singular point in the resin that is positioned at the geometric center of the cavity. This is achieved by a two step type incremental technique. In the first step the resin is placed in the cylindrical cavity with a metal pin embedded in the middle of the composite restoration. After polymerization, the metal pin is removed and the cylindrical hole is filled with the second layer of composite. Finally, the second layer in the center of the composite restoration is polymerized.

RESULTS

This study confirmed that the proposed incremental type placement technique reduces marginal debonding.

SIGNIFICANCE

The main hypothesis is that the elimination of a stress singular point at the center of the restoration results in the reduction of stresses at tooth-composite interface and therefore improve the marginal adaptation (reduces length of the contraction gap at tooth-composite interface).

The Influence of Plastic Light Cure Sheaths on the Hardness of Resin Composite

Disposable sheaths are now recommended as a method of cross infection control when light curing resin composite. However, these sheaths may affect the depth of cure of the resin composite, resulting in a compromise of the mechanical properties of the restorative material.

Depth of Cure of Dental Resin Composites: ISO 4049 Depth and Microhardness of Types of Materials and Shades

Achieving a high degree of cure throughout a 2 mm thickness of light-activated resin composite did not occur for many types and shades of resin composite. Clinicians should check the depth of cure by using the scraping method.