Direct measurement of time-dependent anesthetized in vivo human pulp temperature

Influence of light exposure techniques on in vitro pulp temperature rise during bulk fill composite Class I restorations

This in vitro study assessed peak temperature and temperature increase (ΔT) within the pulp chamber during different extended photoactivation techniques (EPT-applying similar radiant exposure values) to resin-based composites (RBCs) placed in a Class I cavity preparation in an extracted human lower third molar. A T-type thermocouple was placed in the pulp chamber and connected to a temperature analysis device (Thermes, Physitemp). The tooth was attached to an assembly simulating the in vivo environment (controlled baseline pulp chamber temperature and fluid flow). The real-time pulp chamber temperature was evaluated throughout the photoactivation (Bluephase N, Ivoclar Vivadent) of two bulk-fill RBCs: Tetric N Ceram Bulk Fill (TBF; shade: IVA; Ivoclar Vivadent); Surefill SDR flow + (SDR, shade: Universal; Dentsply Sirona), which were exposed to different curing techniques: 40 s-occlusal surface; 20 s-occlusal + 10 s-buccal + 10 s-lingual surfaces; 10 s-buccal + 10 s + lingual + 20 s-occlusal surfaces. Each EPT delivered 42.4 J/cm2. Vickers hardness (VHN) was measured on the removed, sectioned RBC restorations at the top and bottom middle areas after curing. ΔT and VHN data were analyzed using 2-way ANOVA followed by Bonferroni post-hoc test (α = 0.05). Peak temperature data were analyzed using one-way ANOVA and Dunnett's post-hoc test (α = 0.05). SDR showed higher ΔT values than TBF (p = 0.008) in some EPTs. Neither technique resulted in ΔT values greater than 5.5 °C. Both composites had acceptable bottom/top hardness ratios (greater than 80%), regardless of the photoactivation technique. The evaluated EPTs may be considered safe as a low-temperature increase was noticed within the pulp chamber.

Pulpal Temperature Variances During Step-by-step Adhesive Restorative Procedure Using Three Different High-irradiance Light-curing Units

The rise in temperature in pulp tissues is related not only to heat transfer by high-irradiance light-curing units (LCUs), but also to restorative procedures. This research aimed to compare the rise in pulp temperature (PT) induced by three LCUs at each restorative step while considering the influence of resin composite shade and thickness. To accomplish this, the investigators used a proposed experimental model replicating pulp fluid circulation with a controlled, simulated intraoral temperature in bovine incisors. The recorded external and internal PT ranged from 36.7°C to 37.1°C and 32.7°C to 33.0°C, respectively. A significant decrease of internal temperature was recorded during class V preparation, followed by a progressive and representative rise of temperature in the subsequent restorative steps. The temperature was significantly higher during light curing of the adhesive system using Valo compared to light curing using Elipar and Radii Cal. However, none of the analyzed devices produced a temperature that exceeded the pulp tolerance limit (a temperature increase over 5.5°C). The paired test showed no significant difference in pulp temperature associated with the thickness of the increment of resin composite. However, shade was found to have more influence on the amount of energy absorbed by pulp tissue-A1 samples showed significantly higher temperature variation compared to samples using the A4 shade of resin composite. To conclude, the microcirculation and the performance of procedures under constant air-water flux dissipate the heat absorbed by the pulp. Additionally, the data suggest that all three LCUs analyzed can be safely used in clinical procedures, and that the resin composite shade may influence the amount of irradiance delivered to the tooth surface and represents a significant factor in pulp temperature variance.

Continuous vs fractionated violet LED light protocols for dental bleaching: evaluations of color change and temperature of the dental pulp and buccal surface

BACKGROUND

Dental color change and the temperature of the pulp chamber and of the buccal surface were evaluated during bleaching with 37% carbamide peroxide (CP) with continuous vs fractionated violet LED light protocols.

METHODOLOGY

Bovine incisors received in-office bleaching for 30 minutes using different light protocols (Bright Max Whitening, MMOptics). Teeth were separated into groups (n=10): HP) 35% hydrogen peroxide (Whiteness HP, FGM)/no light; CP) 37% carbamide peroxide (Whiteness SuperEndo, FGM)/no light; CP10) CP+10 min of continuous light; CP20) CP+20 min of continuous light; CP30) CP+30 min of continuous light; CPF) CP+20 cycles of 60 s light / 30 s no light (fractionated). Color evaluations were performed at different times. Evaluations of pulp and buccal surface temperatures were performed before and throughout the 30 minutes of bleaching.

RESULTS

Generalized linear models for repeated measures over time were applied to the data (α=5%). After the 1st session, CP20 and CP30 had significantly lower b* values ​​than CP and CP10 (p=0.0071). For ΔE_ab and ΔE₀₀, CPF, CP20 and CP30 showed the highest color change among the treatments after the third bleaching (p<0.05). For temperature evaluations, CP30 showed higher pulp and buccal surface temperatures than the other protocols (p<0.0001) after 20 min.

CONCLUSION

Fractionated or continuous application of violet LED for 20 or 30 min leads to greater effectiveness of color change. All protocols with the application of LED led to an increase in pulp and buccal surface temperatures during bleaching, although the fractionated application appeared to be safer than the use of continuous light.

The cooling efficiency of different dental high-speed handpiece coolant port designs

The study investigated the cooling efficiency of different numbers of water coolant ports on high-speed handpieces (HSH) under cooling conditions used in clinical practice.

Twenty-four groove cuts with water on and nine cuts without water were made on extracted human premolars using three HSHs with different port configurations. Thermocouples were placed in the pulp chambers and temperature changes were recorded with 1-, 3- and 4-coolant port handpieces. Cooling rate was calculated for each coolant port design system. Temperature changes were statistically analysed with Kruskal-Willis Test.

All three sample groups resulted in a net temperature decrease during the cutting period with water turned on. There was a pattern of increased cooling rate with increasing number of coolant ports (1-port: -4.27 (±0.94) °C, 3-port: -4.66 (±2.90) °C, 4-port: -5.03 (±1.08) °C). The difference was not statistically significant (p = 0.681). Calculations of cooling rate showed a higher cooling rate with an increase in the number of ports (1-port: 46.13 × 10⁻⁴ K⁻¹, 3-port: 51.36 × 10⁻⁴ K⁻¹, 4-port: 56.32 × 10⁻⁴ K⁻¹). In the dry tooth preparation samples, all resulted in a net increase in temperature (1-port: 4.43 (±3.30) °C, 3-port: 5.13 (±3.27) °C, 4-port: 2.87 (±2.97) °C).

All the three water coolant port configurations showed effective cooling of the tooth during cutting and decreased pulpal temperature with no statistical difference. There are HSH designs with varying numbers of coolant ports available in the market for clinicians. The results of the current study could potentially aid clinicians in making a decision while choosing between different dental handpieces.

Comparison of in vivo and in vitro models to evaluate pulp temperature rise during exposure to a Polywave® LED light curing unit

OBJECTIVES

To measure and compare in vivo and in vitro pulp temperature (PT) increase (ΔTEMP) over baseline, physiologic temperature using the same intact upper premolars exposed to the same Polywave® LED curing light.

METHODOLOGY

After local Ethics Committee approval (#255,945), local anesthesia, rubber dam isolation, small occlusal preparations/minute pulp exposure (n=15) were performed in teeth requiring extraction for orthodontic reasons. A sterile probe of a temperature measurement system (Temperature Data Acquisition, Physitemp) was placed within the pulp chamber and the buccal surface was sequentially exposed to a LED LCU (Bluephase 20i, Ivoclar Vivadent) using the following exposure modes: 10-s low or high, 5-s Turbo, and 60-s high. Afterwards, the teeth were extracted and K-type thermocouples were placed within the pulp chamber through the original access. The teeth were attached to an assembly simulating the in vivo environment, being similarly exposed while real-time temperature (°C) was recorded. ΔTEMP values and time for temperature to reach maximum (ΔTIME) were subjected to two-way ANOVA and Bonferroni's post-hoc tests (pre-set alpha 0.05).

RESULTS

Higher ΔTEMP was observed in vitro than in vivo. No significant difference in ΔTIME was observed between test conditions. A significant, positive relationship was observed between radiant exposure and ΔTEMP for both conditions (in vivo: r2=0.917; p<0.001; in vitro: r2=0.919; p<0.001).

CONCLUSION

Although the in vitro model overestimated in vivo PT increase, in vitro PT rise was close to in vivo values for clinically relevant exposure modes.

Controlling In Vivo, Human Pulp Temperature Rise Caused by LED Curing Light Exposure

Objective:

The objective of this study was to evaluate the in vivo effectiveness of air spray to reduce pulp temperature rise during exposure of intact premolars to light emitted by a high-power LED light-curing unit (LCU).

Methods and Materials:

After local Ethics Committee approval (#255945), intact, upper first premolars requiring extraction for orthodontic reasons from five volunteers received infiltrative and intraligamental anesthesia. The teeth (n=9) were isolated using rubber dam, and a minute pulp exposure was attained. The sterile probe from a wireless, NIST-traceable, temperature acquisition system was inserted directly into the coronal pulp chamber. Real-time pulp temperature (PT) (°C) was continuously monitored, while the buccal surface was exposed to a polywave LED LCU (Bluephase 20i, Ivoclar Vivadent) for 30 seconds with simultaneous application of a lingually directed air spray (30s-H/AIR) or without (30s-H), with a seven-minute span between each exposure. Peak PT values were subjected to one-way, repeated-measures analysis of variance, and PT change from baseline (ΔT) during exposure was subjected to paired Student's t-test (α=0.05).

Results:

Peak PT values of the 30s-H group were significantly higher than those of 30s-H/AIR group and those from baseline temperature (p&lt;0.001), whereas peak PT values in the 30s-H/AIR group were significantly lower than the baseline temperature (p=0.003). The 30s-H/AIR group showed significantly lower ΔT values than did the 30s-H group (p&lt;0.001).

Conclusion:

Applying air flow simultaneously with LED exposure prevents in vivo pulp temperature rise.

Effect of Simulated Pulpal Microcirculation on Temperature When Light Curing Bulk Fill Composites

Objectives:

To evaluate the effect of light curing bulk fill resin composite restorations on the increase in the temperature of the pulp chamber both with and without a simulated pulpal fluid flow.

Methods and Materials:

Forty extracted human molars received a flat occlusal cavity, leaving approximately 2 mm of dentin over the pulp. The teeth were restored using a self-etch adhesive system (Clearfil SE Bond, Kuraray) and two different bulk fill resin composites: a flowable (SDR, Dentsply) and a regular paste (AURA, SDI) bulk fill. The adhesive was light cured for 20 seconds, SDR was light cured for 20 seconds, and AURA was light cured for 40 seconds using the Bluephase G2 (Ivoclar Vivadent) or the VALO Cordless (Ultradent) in the standard output power mode. The degree of conversion (DC) at the top and bottom of the bulk fill resin composite was assessed using Fourier-Transform Infra Red spectroscopy. The temperature in the pulp chamber when light curing the adhesive system and resin composite was measured using a J-type thermocouple both with and without the presence of a simulated microcirculation of 1.0-1.4 mL/min. Data were analyzed using Student t-tests and two-way and three-way analyses of variance (α=0.05 significance level).

Results:

The irradiance delivered by the light-curing units (LCUs) was greatest close to the top sensor of the MARC resin calibrator (BlueLight Analytics) and lowest after passing through the 4.0 mm of resin composite plus 2.0 mm of dentin. In general, the Bluephase G2 delivered a higher irradiance than did the VALO Cordless. The resin composite, LCU, and region all influenced the degree of cure. The simulated pulpal microcirculation significantly reduced the temperature increase. The greatest temperature rise occurred when the adhesive system was light cured. The Bluephase G2 produced a rise of 6°C, and the VALO Cordless produced a lower temperature change (4°C) when light curing the adhesive system for 20 seconds without pulpal microcirculation. Light curing SDR produced the greatest exothermic reaction.

Conclusions:

Using simulated pulpal microcirculation resulted in lower temperature increases. The flowable composite (SDR) allowed more light transmission and had a higher degree of conversion than did the regular paste (AURA). The greatest temperature rise occurred when light curing the adhesive system alone.

Influence of Class V preparation on in vivo temperature rise in anesthetized human pulp during exposure to a Polywave® LED light curing unit

OBJECTIVE

This in vivo study evaluated pulp temperature (PT) rise in human premolars having deep Class V preparations during exposure to a light curing unit (LCU) using selected exposure modes (EMs).

METHODS

After local Ethics Committee approval, intact first premolars (n=8) requiring extraction for orthodontic reasons, from 8 volunteers, received infiltrative and intraligamental anesthesia and were isolated using rubber dam. A minute pulp exposure was attained and sterile probe from a wireless, NIST-traceable, temperature acquisition system was inserted into the coronal pulp chamber to continuously monitor PT (°C). A deep buccal Class V preparation was prepared using a high speed diamond bur under air-water spray cooling. The surface was exposed to a Polywave^® LED LCU (Bluephase 20i, Ivoclar Vivadent) using selected EMs, allowing 7-min span between each exposure: 10-s in low (10-s/L), 10-s (10-s/H), 30-s (30-s/H), or 60-s (60-s/H) in high mode; and 5-s-Turbo (5-s/T). Peak PT values and PT increases over physiologic baseline levels (ΔT) were subjected to 1-way, repeated measures ANOVAs, and Bonferroni's post-hoc tests (α=0.05). Linear regression analysis was performed to establish the relationship between applied radiant exposure and ΔT.

RESULTS

All EMs produced higher peak PT than the baseline temperature (p<0.001). Only 60-s/H mode generated an average ΔT of 5.5°C (p<0.001). A significant, positive relationship was noted between applied radiant exposure and ΔT (r²=0.8962; p<0.001).

SIGNIFICANCE

In vivo exposure of deep Class V preparation to Polywave^® LED LCU increases PT to values considered safe for the pulp, for most EMs. Only the longest evaluated EM caused higher PT increase than the critical ΔT, thought to be associated with pulpal necrosis.