Characterizing surface viscoelastic integrity of ultra-fast photo-polymerized composites: Methods development

Effect of a 3-second Off-label Exposure on the Depth of Cure of Eight Resin-based Composites

OBJECTIVES

This study evaluated the depth of cure (DoC) of eight resin-based composites (RBCs) photocured using one multipeak light-curing unit (LCU) on the standard output setting for the manufacturer's RBC recommended exposure time and at a higher irradiance for 3 seconds.

METHODS

Three conventional RBCs: Tetric EvoCeram (Evo), Tetric N-Ceram (Cer), Tetric Prime (Pri); and five bulk-fill: Tetric N-Ceram Bulk Fill (CerBF), Opus Bulk Fill APS (OpusBF), Opus Bulk Fill Flow APS (OpusF), Tetric PowerFill (PFill) and Tetric PowerFlow (PFlow) were examined. Only PFill and PFlow are formulated to be photocured in 3 seconds. The RBCs were packed into a metal mold and photocured using a Bluephase PowerCure LCU for the RBC manufacturer's recommended exposure time on the standard mode and using the 3-second high irradiance mode. After photocuring, the specimens were immersed in a solvent for 1 hour. The length of the remaining RBC was measured and divided by 2. Data were analyzed using two-way analysis of variance (ANOVA) followed by the Tukey post hoc multiple comparison test (α=0.05).

RESULTS

There was no significant difference in the DoC values for PFill and PFlow when photocured using the 3-second high irradiance protocol compared to the lower irradiance standard mode protocol. All other RBCs had significantly lower DoC values (p<0.001) when photocured off-label using the 3-second high irradiance mode.

CONCLUSION

Of the eight RBCs tested, only PFill and PFlow achieved the same DoC when the high irradiance 3-second curing method was used compared to when their longer lower irradiance protocol was used.

Short curing time bulk fill composite systems: volumetric shrinkage, degree of conversion and Vickers hardness

This study aimed to evaluate volumetric polymerization shrinkage, degree of conversion and Vickers hardness of four bulk-fill resin composites light-activated with their dedicated light curing units (LCUs). Four groups were evaluated, according to the type of composite and curing mode: Tetric EvoCeram Bulk-fill (TEBO) and Tetric EvoFlow Bulk-fill (TEBF) were light-activated with Bluephase Style 20i (20s, in high-mode), while Tetric Powerfill (TEPO) and Tetric Powerflow (TEPF) were light-activated with Bluephase PowerCure (3s). Volumetric polymerization shrinkage test (n = 6) was performed in standardized box-shaped class-I cavities of extracted third molars (4 x 4 x 4 mm). Teeth were scanned before and after resin composite application by micro-computed tomography, and acquired data were evaluated with Amira software. Degree of conversion (n = 5) was evaluated at the top and bottom surfaces of composite cylindric samples (4 mm diameter, 4 mm thickness) using an FT-IR spectrometer (spectra between 1,500 and 1,800 cm-1, 40 scans at a resolution of 4 cm-1). Three Vickers indentations (50 g / 15 s), spaced 500 μm apart, were performed on the top and bottom composite surfaces and averaged. One-way ANOVA was used for data evaluation. TEPF showed the lowest volumetric polymerization shrinkage (p < 0.05), while the other composites were not significantly different within each other (p > 0.05). All materials presented a significant decrease in degree of conversion and Vickers hardness when compared top to bottom surfaces (p < 0.05). Bottom to top surface ratios for degree of conversion ranged from 0.8 (TEBO and TEPO) to 0.9 (TEBF and TEPF), and from 0.4 (TEPO) to 0.7 (TEBF and TEPF) for hardness. In conclusion, resinous materials present a decrease in hardness and degree of conversion from top to bottom even when a higher power is used, while the flowable material TEPF showed the lowest volumetric shrinkage values compared to the other materials.

Thermography and conversion of fast-cure composite photocured with quad-wave and laser curing lights compared to a conventional curing light

OBJECTIVES

This study investigated effects of the different emittance-mode protocols from three light curing units (LCUs): (i) a Laser (Monet); (ii) a quad-wave (PinkWave); (iii) a conventional LED (Elipar S10) on the temperature rise (ΔT) and degree of conversion (DC) when photo-curing fast or conventional bulk-fill resin-based composites (RBC). The aim was to correlate ΔT and DC, and the radiant exposure delivered to RBC specimens.

METHODS

A 3D-printed resin mold of 4 mm depth was filled with two bulk-fill RBCs: Tetric PowerFill® (fast photo-polymerised composite) (TPF) or Tetric EvoCeram® Bulk-Fill (EVO). Three LCUs were used: (i) Monet laser for 1 s and 3 s (MONET-1 s, MONET-3 s); (ii) PinkWave quad-wave used for 3 s in Boost mode (PW-3 s) and for 20 s in standard mode (PW-20 s); (iii) Elipar S10 for 5 s (S10-5 s) and for 20 s in standard mode (S10-20 s). 2-dimensional temperature maps were obtained before, during and for 60 s after the LCU had turned off using a thermal imaging camera. Thermal changes were analysed at five depths: (0, 1, 2, 3, and 4 mm from the top surface of the RBC). The maximum temperature rise (Tmax) and the mean temperature rise (ΔT) were determined. Cylindrical-shaped specimens were prepared from each material using a stainless-steel split mold (4 × 4 mm) and light-cured with the same protocols. The DC was measured for 120 s and at 1 h after LCU had turned off using Fourier Transform Infrared Spectroscopy (FTIR). Data were analysed using Three-way ANOVA, One-way ANOVA, independent t-tests, and Tukey post-hoc tests (p < 0.05).

RESULTS

Radiant exposures delivered by the various irradiation protocols were between 4.5-30.3 J/cm2. Short exposure times from MONET-1 s and PW-3 s delivered the lowest radiant exposures (4.5 and 5.2 J/cm2, respectively) and produced the lowest ΔT and DC. The longer exposure times in the standard modes of PW-20 s, S10-20 s, and MONET-3 s produced the highest Tmax, ΔT, and DC for both composites. The ΔT range among composites at different depths varied significantly (31.7-49.9 °C). DC of TPF ranged between 30-65% and in EVO between 15.3-56%. TPF had higher Tmax, ΔT for all depths and DC compared to EVO, across the LCU protocols (p < 0.05), except for PW-20 s and MONET-3 s. The coronal part of the restorations (1-2 mm) had the highest ΔT. There was a positive correlation between ΔT and DC at 4-mm depth after 120 s SIGNIFICANCE: Longer, or standard, exposure times of the LCUs delivered greater radiant exposures and had higher DC and ΔT compared to shorter or high-irradiance protocols. The fast photo-polymerised RBC had comparatively superior thermal and conversion outcomes when it received a high irradiance for a short time (1-5 s) compared to the conventional Bulk-Fill RBC.

Temperature rise in photopolymerized adhesively-bonded resin composite: A thermography study

OBJECTIVES

To assess visually and quantitatively the contributions of the adhesive layer photopolymerization and the subsequent resin composite increment to spatio-temporal maps of temperature at five different cavity locations, subjected to two irradiance curing protocols: standard and ultra-high.

METHODS

Caries-free molars were used to obtain 40, 2 mm thick dentin slices, randomly assigned to groups (n = 5). These slices were incorporated within 3D-printed model cavites, 4 mm deep, restored with Adhese® Universal bonding agent and 2 mm thick Tetric® Powerfill resin composite, and photocured sequentially, as follows: G1: control-empty cavity; G2: adhesive layer; G3 composite layer with no adhesive; and G4 composite layer with adhesive. The main four groups were subdivided based on two curing protocols, exposed either to standard 10 s (1.2 W/cm2) or Ultra high 3 s (3 W/cm2) irradiance modes using a Bluephase PowerCure LCU. Temperature maps were obtained, via a thermal imaging camera, and numerically analyzed at 5 locations. The data were analyzed using two-way ANOVA followed by multiple one-way ANOVA, independent t-tests and Tukey post-hoc tests (α = 0.05). Tmax, ΔT, Tint (integrated area under the curve) and time-to-reach-maximum-temperature were evaluated.

RESULTS

Two-way ANOVA showed that there was no significant interaction between light-curing time and location on the measured parameters (p > 0.05), except for the time-to-reach-maximum-temperature (p < 0.05). Curing the adhesive layer alone with the 10 s protocol resulted in a significantly increased pulpal roof temperature compared to 3 s cure (p < 0.05). Independent T-tests between G3 and G4, between 3 s and 10 s, confirmed that the adhesive agent caused no significant increases (p > 0.05) on the measured parameters. The ultra-high light-curing protocol significantly increased ΔT in composite compared to 10 s curing (p < 0.05).

SIGNIFICANCE

When the adhesive layer was photocured alone in a cavity, with a 2 mm thick dentin floor, the exothermal release of energy resulted in higher temperatures with a 10 s curing protocol, compared to a 3 s high irradiance. But when subsequently photocuring a 2 mm layer of composite, the resultant temperatures generated at pulpal roof location from the two curing protocols were similar and therefore there was no increased hazard to the dental pulp from the immediately prior adhesive photopolymerization, cured via the ultra-high irradiation protocol.

Effect of High-radiant Emittance and Short Curing Time on Polymerization Shrinkage Vectors of Bulk Fill Composites

PURPOSE

To evaluate the effect of short curing time using a high-radiant emittance light on polymerization shrinkage vectors in different consistency bulk-fill composites (BFRCs) using micro-computed tomography.

METHODS AND MATERIALS

Radiopaque zirconia fillers were homogeneously incorporated and functioned as radiopaque tracers into two regular-paste: TBFill (Tetric EvoCeram Bulk Fill) and TPFill (Tetric PowerFill), and two flowable (n=6): TBFlow (Tetric EvoFlow Bulk Fill) and TPFlow (Tetric PowerFlow) resin composites. Class I cavities (4 mm depth × 4 mm length × 4 mm width) were 3D-printed and filled in a single increment: TBFill and TBFlow were light-activated using a Bluephase Style 20i (10 seconds in high-mode); TPFill and TPFlow were light-activated using a Bluephase PowerCure (three seconds). The same adhesive system (Adhese Universal) was used for all groups. Microcomputed tomography scans were obtained before and after light-activation. Filler particle movement was identified by polymerization shrinkage vectors at five depths (from 0-4 mm): top, top-middle, middle, middle-bottom and bottom.

RESULTS

TPFlow showed the lowest total vector displacement, followed by TBFlow, TBFill and TPFill, significantly different among each other (p<0.05). Generally, BFRCs showed decreased vector displacement with increased depth, and higher displacement at the top-surface (p<0.05). Qualitative analysis showed a similar pattern of vector magnitude and displacement for groups TBFill and TPFill, with displacement vectors on occlusal (top) surfaces toward the center of the restoration from the top to middle areas, and relatively limited displacement at the bottom. TBFlow and TPFlow showed more displacement on the occlusal (top).

CONCLUSIONS

Short curing time with high-radiant emittance on fast-curing BFRCs was shown to be a feasible option in terms of vector displacement. Flowable BFRCs presented lower vector displacement than their regular-viscosity versions.

Effect of Fast High-Irradiance Photo-Polymerization of Resin Composites on the Dentin Bond Strength

This study investigated the influence of conventional (10 s at 1160 mW/cm²) and fast high-irradiance (3 s at 2850 mW/cm²) light curing on the micro-tensile bond strength (μTBS) of bulk-fill resin composites bonded to human dentin. Sixty-four extracted human molars were ground to dentin and randomly assigned into eight groups (n = 8 per group). After application of a three-step adhesive system (Optibond FL), four different bulk-fill composites (two sculptable and two flowable composites) were placed. Of these, one sculptable (Tetric PowerFill) and one flowable (Tetric PowerFlow) composite were specifically developed for fast high-irradiance light curing. Each composite was polymerized with the conventional or the fast high-irradiance light-curing protocol. The specimens were cut into dentin-composite sticks, μTBS was determined and failure modes were analyzed. Statistical analysis was performed using t-test for independent observations and one-way ANOVA. A statistical difference between the curing protocols was only found for Tetric PowerFlow, where the conventional protocol (23.8 ± 4.2 MPa) led to significantly higher values than the fast high-irradiance light-curing protocol (18.7 ± 3.7 MPa). All other composite materials showed statistically similar values for both polymerization protocols. In conclusion, the use of fast high-irradiation light curing has no negative influence on the μTBS of the investigated high-viscosity bulk-fill composites. However, it may reduce the dentin bond strength of flowable bulk-fill composite.

Polymerization Kinetics and Development of Polymerization Shrinkage Stress in Rapid High-Intensity Light-Curing

This study investigated polymerization kinetics, linear shrinkage, and shrinkage stress development for six contemporary composite materials of different viscosities cured using radiant exitances of 1100–2850 mW/cm². Real-time measurements of degree of conversion, linear shrinkage, and shrinkage stress were performed over 5 min using Fourier-transform infrared spectrometry, a custom-made linometer, and a custom-made stress analyzer, respectively. For most tested variables, the factor “material” had a higher effect size than the factor “curing protocol”. Maximum polymerization rate and maximum shrinkage stress rate were the most affected by changes in curing conditions. In contrast, no significant effects of curing conditions were identified within each material for shrinkage stress values measured at the end of the 5 min observation period. Linear shrinkage and shrinkage stress values measured after 5 min were closely correlated (R = 0.905–0.982). The analysis of polymerization kinetics suggested that the two composites specifically designed for rapid light-curing responded to higher radiant exitances differently than other composites. Polymerization kinetics and shrinkage stress behavior of contemporary restorative composite materials of different viscosities were overall more affected by material type than differences in curing conditions. Subtle differences in polymerization kinetics behavior shown by the two composites specifically designed for rapid high-intensity light-curing did not translate into significant differences in the development of polymerization shrinkage stress.

Post-irradiation surface viscoelastic integrity of photo-polymerized resin-based composites

OBJECTIVE

A class of ultra-rapid-cure resin-based composites (RBCs) exhibited immediate post-irradiation surface viscoelastic integrity using an indentation-creep/recovery procedure. The aim of this study was to determine whether such behavior is more generally characteristic of a wider range of RBCs.

METHODS

Eight representative RBCs were selected based on different clinical categories: three bulkfills (OBF, Filtek One Bulk Fill; VBF, Venus Bulkfill; EBF, Estelite Bulkfill), three conventional non-flowables (XTE, Filtek Supreme XTE; GSO, GrandioSo; HRZ, Harmonize) and conventional flowables (XTF, Filtek Supreme XTE Flow; GSF, GrandioSo Flow). Stainless steel split molds were used to fabricate cylindrical specimens (4mm (dia)×4mm). These were irradiated (1.2W/cm²) for 20s on the top surface. Post-irradiation specimens (n=3), within their molds, were centrally loaded with a flat-ended 1.5mm diameter indenter under 14MPa stress: either immediately (<2min) or after 24h delayed indentation. Stress was maintained for 2h, then - after removal - recovery measurements continued for a further 2h. Indentation depth (%) versus time was measured continuously to an accuracy of <0.1μm. Data were analyzed by One-way ANOVA and Tukey post-hoc tests (α=0.05).

RESULTS

Time-dependent viscoelastic indentation was observed for all RBCs. For immediate indentation, the maximum indentation range was 1.43-4.92%, versus 0.70-2.22% for 24h delayed indentation. Following 2h recovery, the residual indentation range was 0.86-3.58% after immediate indentation, reducing to 0.22-1.27% for delayed indentation. The greatest immediate indentation was shown by VBF followed by XTF and GSF. OBF, HRZ, XTE and GSO had significantly lower indentations (greater hardness). XTE showed a significantly reduced indentation maximum compared to OBF (p<0.05). Indentations delayed until 24h post-irradiation were reduced (p<0.05) for most materials.

SIGNIFICANCE

The indentation-creep methodology effectively characterized resin-based composites within several categories. Viscoelastic properties evaluated by the indentation-creep method confirmed that highly filled RBCs were more resistant to indentation. Indentations were reduced after 24h post-irradiation due to further matrix-network development.

Impact of ultra-fast (3 s) light-cure on cell toxicity and viscoelastic behavior in a dental resin-based composite with RAFT-mediated polymerization

OBJECTIVE

The aim of the study was to determine the effects of ultra-fast (3 s) light-curing on the viscoelastic behaviour at clinically relevant frequencies, and cell toxicity, in a resin-based composite (RBC) with reversible addition-fragmentation-chain transfer (RAFT) mediated polymerization.

METHODS

Three different protocols were used to cure cylindrical samples (height = 4 mm, ϴ = 5 mm), including ultra-fast (3s) cure with high radiant emittance, 10 s and 20 s cure with moderate radiant emittance. The properties of the light curing device were evaluated in all curing protocols by spectrophotometry up to an exposure distance of 10 mm. The light transmission through the samples was determined in real-time with the same spectrophotometer. Absorbance was calculated as a function of wavelength. The quasi-static (indentation hardness/H_IT, indentation modulus/E_IT) and viscoelastic (storage modulus/E', loss modulus/E″, loss factor/tan δ) material behavior was determined in an instrumented indentation test with a DMA (Dynamic Mechanical Analysis) module for 10 frequencies (0.5-5 Hz) by profiling the center of the samples in 330 μm steps from top to bottom. Cellular toxicity on human gingival fibroblast (HGF-1) was assessed using a WST-1 colorimetric assay after incubation time of up to 3 months. One and multiple-way analysis of variance (ANOVA) with Tukey honestly significant difference (HSD) post-hoc tests (α = 0.05) were applied.

RESULTS

The irradiance transmitted through a 4 mm high sample was less than 7% of the incident irradiance, and the absorbance was similar for all curing protocols, showing a decrease with wavelength. Similar quasi-static and viscoelastic parameters were observed regardless of the curing protocol. H_IT increased slightly and E_IT, E', E″ and tan δ decreased with frequency. Occasionally, slightly higher confidence intervals were observed for the ultra-fast curing group, which were related to a potential accumulation of stress. The curing protocol had no effect on cell viability (p = 0.326) but the eluate age (p < 0.001, η_P² = 0.879) did. None of the groups showed cell toxicity at any point in time with respect to the corresponding negative control.

CONCLUSIONS

The ultra-fast curing with high irradiance induced no cell toxicity and an equivalent viscoelastic behavior as with conventional curing protocols in a RAFT-modified RBC.

Spatio-temporal temperature fields generated coronally with bulk-fill resin composites: A thermography study

OBJECTIVE

This study aimed to investigate the effects of (i) a high-irradiance (3s) light-curing protocol versus (ii) two standard-irradiance (10s) protocols on 2D temperature maps during intra-dental photo-irradiation within a molar cavity restored with either Ultra-Rapid Photo-Polymerized Bulk Fill (URPBF) composites or a pre-heated thermo-viscous bulk-fill composite, compared to a standard bulk-fill resin-based-composite (RBC). The specific objectives included visual assessment of the temperature maps and quantitative assessment of several temperature/time plots at four different locations.

METHODS

A caries-free lower first molar cavity served as a natural tooth mold. Resin composites were placed without intermediary adhesive. Two URPBF composites (PFill; PFlow) and one pre-heated thermo-viscous bulk-fill composite (Viscalor: VC) were compared to a contemporary bulk-fill composite (One Bulk Fill: OBF). Two LED-LCU devices were used: Bluephase PowerCure (PC) and Elipar S10 (S10), with three light-irradiation protocols (PC-3s, PC-10s and S10-10s). 2D temperature maps over the entire coronal area were recorded for 120 s during and after irradiation using a thermal imaging camera. Changes at four different levels were selected from the data sets: (0, 2 and 4 mm from the cavity top and at 1 mm below the dentin cavity floor). The maximum temperature attained (T_max), the mean temperature rise (ΔT), the time (s) to reach maximum temperature and the integrated areas (°C s) under the temperature/time (T/t) plots were identified. Data were analysed via three-way ANOVA, One-way ANOVA, independent t-tests and Tukey post-hoc tests (p < 0.05).

RESULTS

All RBCs showed qualitatively similar temperature-time profiles. PFlow reached T_max in the shortest time. PC-3s (3000 mW/cm²) generated comparable ΔT to S10-10s, except with PFill, where ΔT was greater. Despite the same irradiance (1200 mW/cm²), Elipar S10 led to higher T_max and ΔT compared to PC-10s. The highest T_max and ΔT were observed at the 2 mm level, and the lowest were at 1 mm depth into the underlying dentin.

SIGNIFICANCE

Coronal 2D temperature maps showed rises largely confined within the bulk-fill RBC materials, with maxima at 2 mm rather than 4 mm depth indicating some extent of thermal insulation for the underlying dentin and pulp. RBCs polymerized via different irradiation protocols showed similar temperature changes. With the PC-3s protocol - also with pre-heated VC - minimal temperature rises at 1 mm within dentin suggest their clinical safety when sufficient remaining dentin thickness is present.

Impact of Fast High-Intensity versus Conventional Light-Curing Protocol on Selected Properties of Dental Composites

To study the influence of fast high-intensity (3-s) and conventional (20-s) light curing protocols on certain physical properties including light-transmission and surface wear of two nano-hybrid composite resins (Tetric PowerFill and Essentia U) specifically designed for both curing protocols. According to ISO standards, the following properties were investigated: flexural properties, fracture toughness and water sorption/solubility. FTIR-spectrometry was used to calculate the double bond conversion (DC%). A wear test using a chewing simulator was performed with 15,000 chewing cycles. A tensilometer was used to measure the shrinkage stress. Light transmission through various thicknesses (1, 2, 3 and 4 mm) of composite resins was quantified. The Vickers indenter was utilized for evaluating surface microhardness (VH) at the top and the bottom sides. Scanning electron microscopy was utilized to investigate the microstructure of each composite resin. The light curing protocol did not show a significant (p > 0.05) effect on the mechanical properties of tested composite resins and differences were material-dependent. Shrinkage stress, DC% and VH of both composite resins significantly increased with the conventional 20 s light curing protocol (p < 0.05). Light curing conventional composite resin with the fast high-intensity (3-s) curing protocol resulted in inferior results for some important material properties.