In vivo temperature rise and acute inflammatory response in anesthetized human pulp tissue of premolars having Class V preparations after exposure to Polywave® LED light curing units

Heat generated during dental treatments affecting intrapulpal temperature: a review

INTRODUCTION

Heat is generated and transferred to the dentine-pulp complex during various dental procedures, such as from friction during cavity preparations, exothermic reactions during the polymerisation of restorative materials and when polishing restorations. For in vitro studies, detrimental effects are possible when intra-pulpal temperature increases by more than 5.5°C (that is, the intra-pulpal temperature exceeds 42.4°C). This excessive heat transfer results in inflammation and necrosis of the pulp. Despite numerous studies stating the importance of heat transfer and control during dental procedures, there are limited studies that have quantified the significance. Past studies incorporated an experimental setup where a thermocouple is placed inside the pulp of an extracted human tooth and connected to an electronic digital thermometer.

METHODS

This review identified the opportunity for future research and develop both the understanding of various influencing factors on heat generation and the different sensor systems to measure the intrapulpal temperature.

CONCLUSION

Various steps of dental restorative procedures have the potential to generate considerable amounts of heat which can permanently damage the pulp, leading to pulp necrosis, discoloration of the tooth and eventually tooth loss. Thus, measures should be undertaken to limit pulp irritation and injury during procedures. This review highlighted the gap for future research and a need for an experimental setup which can simulate pulp blood flow, temperature, intraoral temperature and intraoral humidity to accurately simulate the intraoral conditions and record temperature changes during various dental procedures.

Temperature changes and hardness of resin-based composites light-cured with laser diode or light-emitting diode curing lights

The temperature and Vickers Hardness (VH) at the top and bottom surfaces of three resin-based composites (RBCs) were measured when light-cured using five light-curing units (LCUs). The spectrum, power, and energy delivered to the top of the RBCs and transmitted through the RBCs were measured. Starting at 32℃, the temperature rise produced by the Monet Laser (ML-1 s and 3 s), Valo Grand (VG-3 s and 10 s), DeepCure (DC-10 s), PowerCure, (PC-3 s and 10 s) and PinkWave (PW-10 s) were measured at the bottom of specimens 2 mm deep × 6 mm wide made of Filtek Universal A2, Tetric Evoceram A2 and an experimental RBC codenamed Transcend UB. The VH values measured at the top and bottom of these RBCs were analyzed using ANOVA and Scheffe's post hoc test (p < 0.05) to determine the effects of the LCUs on the RBCs. The transmitted power from the ML was reduced by 77.4% through 2 mm of Filtek Universal, whereas light from PW decreased by only 36.8% through Transcend. The highest temperature increases from the LCU combined with the exothermic reaction occurred for Transcend, and overall, no significant differences were detected between Filtek Universal and Tetric Evoceram (p = 0.9756). Transcend achieved the highest VH values at the top and bottom surfaces. The PinkWave used for 10 s produced the largest temperature increase (20.2℃) in Transcend. The Monet used for 1 s produced the smallest increase (7.8℃) and the lowest bottom:top VH ratios.

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.

In-vitro pulpal temperature increases when photo-curing bulk-fill resin-based composites using laser or light-emitting diode light curing units

OBJECTIVE

To evaluate the in vitro pulpal temperature rise (ΔT) within the pulp chamber when low- and high-viscosity bulk-fill resin composites are photo-cured using laser or contemporary light curing units (LCUs).

MATERIALS AND METHODS

The light output from five LCUs was measured. Non-retentive Class I and V cavities were prepared in one upper molar. Two T-type thermocouples were inserted into the pulp chamber. After the PT values reached 32°C under simulated pulp flow (0.026 mL/min), both cavities were restored with: Filtek One Bulk Fill (3 M), Filtek Bulk Fill Flow (3 M), Tetric PowerFill (Ivoclar Vivadent), or Tetric PowerFlow (Ivoclar Vivadent). The tooth was exposed as follows: Monet Laser (1 and 3 s), PowerCure (3 and 20 s), PinkWave (3 and 20 s), Valo X (5 and 20 s) and SmartLite Pro (20 s). The ΔT data were subjected to one-way ANOVA followed by Scheffe's post hoc test.

RESULTS

Monet 1 s (1.9 J) and PinkWave 20 s (30.1 J) delivered the least and the highest amount of energy, respectively. Valo X and PinkWave used for 20 s produced the highest ΔT values (3.4-4.1°C). Monet 1 s, PinkWave 3 s, PowerCure 3 s (except FB-Flow) and Monet 3 s for FB-One and TP-Fill produced the lowest ΔT values (0.9-1.7°C). No significant differences were found among composites.

CONCLUSIONS

Short 1- to 3-s exposures produced acceptable temperature rises, regardless of the composite.

CLINICAL SIGNIFICANCE

The energy delivered to the tooth by the LCUs affects the temperature rise inside the pulp. The short 1-3 s exposure times used in this study delivered the least amount of energy and produced a lower temperature rise. However, the RBC may not have received sufficient energy to be adequately photo-cured.

Effect of pre-heating methods and devices on the mechanical properties, post-gel shrinkage, and shrinkage stress of bulk-fill materials

This study evaluated the effect of using two different pre-heating methods on the three resin-based composite (RBCs). Three paste viscosity bulk-fill RBCs (VisCalor Bulk [VC]; VOCO; x-tra fil Caps [XF], VOCO; Filtek One Bulk Fill [FO], 3 M) were pre-heated using either a VisCalor Dispenser (VOCO) to 65 °C, or the Caps Warmer (VOCO) to 37 °C, 54 °C, or 68 °C. The temperature inside the capsules and cavity was monitored before and after insertion into the matrix. Within 30 s of inserting the RBC, they were light-activated using a VALO (Ultradent) curing light for 20 s. The post-gel shrinkage (Shr - %), Flexural Strength (FS - MPa), Elastic Modulus (E - MPa), degree of conversion (DC - %), Knoop Hardness (KH - N/mm²), diametral tensile strength (DTS - MPa), and compressive strength (CS - MPa) of the RBCs were measured (10 specimens per group). The shrinkage stress was calculated using three-dimensional finite element analysis. Data were analyzed using one-way, two-way ANOVA and Tukey's test (α = 0.05). The temperature fell rapidly after the RBC was inserted into the cavity. Pre-heating the RBCs did not affect the mechanical properties. FO had the lowest E, DC, and KH values, VC had intermediate values, and XF achieved the highest values. The DTS and CS values were not affected by the various pre-heating methods, the temperature, or RBC. Pre-heating methods at 37 °C produced higher shrinkage for all RBCs. VC pre-heated to 65 °C produced the lowest stress when measured at 10 min after light activation.

Dental Light-Curing-Assessing the Blue-Light Hazard

This article focuses on the current understanding and concerns over the blue-light hazard when using dental light-curing units. It also provides information and safety protocols to guide the practitioner in making important decisions regarding dental personnel's health and the quality of dental restorations.

Intrapulpal temperature changes during the cementation of ceramic veneers

Adhesive cementation of ceramic veneers may increase pulpal temperature (PT) due to the combined effect of heat generated by the curing unit and the exothermic reaction of the luting agent (LA). PT increase may induce pulpal damage. The aim was to determine the PT rise during the luting of ceramic veneers (CV) of different thicknesses with light- or dual-curing (LC, DC) adhesive cements as well as pre-heated restorative resin-based composites (PH-RBC). For this a thermocouple sensor was positioned in the pulp chamber of a prepared maxillary central incisor. LC, DC adhesive cements and PH-RBCs heated to 55 °C were used for the luting of CVs of 0.3, 0.5, 0.7, and 1.0 mm thicknesses. The exothermic reaction of LAs added significantly to the thermal effect of the curing unit. PT change ranged between 8.12 and 14.4 °C with the investigated combinations of LAs and ceramic thicknesses (p ≤ 0.01). The increase was inversely proportional to the increasing CV thicknesses. The highest rise (p ≤ 0.01) was seen with the polymerization of PH-RBCs. Temperature changes were predominantly influenced by the composition of the LA, which was followed by CV thickness.

[Light-curing effectiveness using led lamps: a review]

Introduction

LED lamps have a new light-curing technology which can be monowave or polywave, which allows it to reach more initiators such as camphorquinone, Lucirin TPO and Propanodione, which have a wide variety of advantages and disadvantages. These lamps have evolved over time, as have different ergonomics, longevity, systems and quality standards.

Objective

The objective of this literature review is to improve the clinician on the proper use of different LED lamps and how they influence the efficiency of resin photopolymerization.

Material and methods

Extensive research has been carried out in the existing literature on this topic. From the beginning of this information until April 18, 2022, the bibliographic search carried out includes 86 articles published in the Medline database through PubMed, LILACS, Science Direct and SciELO, and there is no language restriction.

Results

The photopolymerization effects of Polywave and Monowave LED lamps present significant differences between the compressive strength of the light-cured resin, with single-wave and polyvalent LED lamps where the types of light and lamp directly influence the compressive strength of the resin. composite resins.

Conclusion

The type of light and lamp directly affects the efficiency of the photopolymerization of the composite resin, so it is concluded that LED lamps with single wave technology (Monowave) produce a greater depth of photopolymerization than those with multiple wave technology (Polywave).

Highly efficient optical fiber sensor for instantaneous measurement of elevated temperature in dental hard tissues irradiated with an Nd:YaG laser

In this in vitro experiment, the effect of 1.064 µm pulsed laser on both enamel- and dentin-dental tissues has been investigated. A total of fifty-five dental hard tissue samples were exposed to Nd:YAG laser that possesses a pulse width of 9 ns and 850 mJ of total energy. An optical fiber sensor was put behind the samples to measure the temperature instantaneously. A novel, to the best of our knowledge, fiber sensor has been proposed and used to measure the heat generated in dental hard tissues instantaneously after the application of laser irradiation on the tissue surface. This optical sensor exhibits a fast response time of about 1 ms and high sensitivity with about 1.975 nm/°C. The findings of this study in decreasing the probability of pulpal necrosis structure while handling the tooth, whether for ablation, welding, or tooth resurfacing purposes, may establish standards for dentists and laser manufacturers (healthcare professionals) that should be followed.

High-Power LED Units Currently Available for Dental Resin-Based Materials-A Review

The pursuit of less time-consuming procedures led to the development of high-power light-curing-units (LCU) to light-cure dental-resin-based-materials. This review aims to describe high-power light-emitting-diode (LED)-LCUs, by a bibliometric systematization of in vitro and in vivo studies. The research-question, by PICO model, aimed to assess the current knowledge on dentistry-based high-power LED-LCUs by analyzing to what extent their use can promote adverse events on materials and patients' oral condition when compared to low-power LED-LCUs, on daily dental practice. PubMed and B-on database search focused on high-power (≥2000 mW/cm2) LED-LCUs outputs. Studies assessing performance of high-power LED-LCUs for light-curing dental-resin-based-materials were included. From 1822 screened articles, 21 fulfilled the inclusion criteria. Thirty-two marketed units with high levels of radiant emittance (≥2000 mW/cm2 up to 6000 mW/cm2) were identified. Most output values vary on 2000-3000 mW/cm2. The highest output found was 6000 mW/cm2, in FlashMax™P3. Reports suggest that light-curing protocols with lower emittance irradiance and longer exposure outperforms all other combination, however in some clinical procedures high-power LED-LCUs are advocated when compared to low-power LED-LCUs. Moreover, long time exposures and over-curing can be dangerous to the biological vital pulp, and other oral tissues. Evidence showing that high-power LCUs are the best clinical option is still very scarce.

Effects of curing lights on human gingival epithelial cell proliferation

BACKGROUND

Light-emitting diode (LED) and quartz-tungsten-halogen (QTH) curing lights are used commonly in clinics. The aim of this study was to assess the effect of these lights on the proliferation of human gingival epithelial cells.

METHODS

Smulow-Glickman (S-G) cells were exposed to a VALO LED (Ultradent) or an XL3000 QTH (3M ESPE) light at 1 millimeter or 6 mm distance for 18, 39, 60, and 120 seconds. Untreated and Triton X-100 treated cells were used as controls. At 24, 48, and 72 hours after light exposure, cell proliferation was evaluated via a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay.

RESULTS

The authors first evaluated the performances of these 2 lights. Both LED and QTH lights generated heat. The LED light generated less heat than the QTH light and could save approximately two-thirds of the curing time. When used for 18 seconds at a 6 mm distance, the LED light did not inhibit the proliferation of S-G cells. However, if the exposure time was longer (for example, 39, 60, or 120 seconds), the LED light inhibited cell proliferation. The inhibitory effect increased when the exposure time was increased to 39, 60, or 120 seconds. The QTH light did not inhibit S-G cell proliferation if the exposure time was less than 120 seconds.

CONCLUSIONS

Prolonged exposure to a blue curing light (both LED and QTH) inhibits the proliferation of gingival epithelial cells and may cause damages to oral soft tissues.

PRACTICAL IMPLICATIONS

In dental practices, a balance should be struck in consideration of curing time not only to cure the composites completely but also to minimize unnecessarily prolonged light exposure.

Temperature Changes in Composite Materials during Photopolymerization

During polymerization, composite materials cause a temperature rise which may lead to irreversible changes in the dental pulp. The mechanical properties of composite materials depend on a number of factors, such as the composition of the material, the type of polymerization unit, the polymerization mode, and the duration of polymerization. The objective of this study was to assess the temperature rise values and flexural strength of composite materials, as obtained using different modes and times of polymerization. A total of six composite materials were used in the study. Samples of each of the materials were cured using seven polymerization protocols. A CMP-401 digital meter (Sonel, Świdnica, Poland), complete with a type K thermocouple (NiCr-Ni), was used to record the temperature increases during the light curing of the resin composites. Temperature rises were recorded beneath the composite disc in an acrylic matrix. The specimens were tested for flexural strength using a Cometech QC-508M2 testing machine. The lowest results for the increased mean temperature were obtained for Fast-Cure 3 s (39.0 °C), while the highest results were obtained for Fast-Cure 20 s (45.8 °C). The highest average temperature values for all tested protocols were recorded for the Z550 Filtek material. Mean flexural strengths as measured in each test group were higher than the minimum value for composite materials as per the ISO:4049 standard. In the case of deep caries with a thin layer of dentin separating the filling from pulp, a base layer or a short polymerization duration mode is recommended to protect pulp from thermal injury.