High irradiance curing and anomalies of exposure reciprocity law in resin-based materials

The impact of inorganic fillers, organic content, and polymerization mode on the degree of conversion of monomers in resin-matrix cements for restorative dentistry: a scoping review

PURPOSE

The main aim of the present study was to carry out a scoping review on the differences in degree of conversion of monomers regarding several types resin cements, indirect restorative materials, and light-curing procedures used in dentistry.

METHOD

A bibliographic review was performed on PubMed using the following search items: "degree of conversion" OR "filler" AND "resin cement" OR "inorganic cement" AND "organic" OR "radiopacity" OR "refractive" OR "transmittance" OR "type" AND "resin composite." The search involved articles published in English language within the last thirteen years. A research question has been formulated following the PICO approach as follow: "How different is the degree of conversion of monomers comparing several types of resin-matrix cements?".

RESULTS

Within the 15 selected studies, 8 studies reported a high degree of conversion (DC) of the organic matrix ranging from 70 up to 90% while 7 studies showed lower DC values. Dual-cured resin-matrix cements revealed the highest mean values of DC, flexural strength, and hardness when compared with light- and self-polymerized ones. DC mean values of resin-matrix cements light-cured through a ceramic veneer with 0.4 mm thickness were higher (~ 83%) than those recorded for resin-matrix cements light-cured through a thicker ceramic layer of 1.5 mm (~ 77%).

CONCLUSIONS

The highest percentage of degree of conversion of monomers was reported for dual-cured resin-matrix cements and therefore both chemical and light-induced pathways promoted an enhanced polymerization of the material. Similar degree of conversion of the same resin-matrix cement were recorded when the prosthetic structure showed a low thickness. On thick prosthetic structures, translucent materials are required to allow the light transmission achieving the resin-matrix cement.

CLINICAL RELEVANCE

The chemical composition of resin-matrix cements and the light-curing mode can affect the polymerization of the organic matrix. Thus, physical properties of the materials can vary leading to early clinical failures at restorative interfaces. Thus, the analysis of the polymerization pathways of resin-matrix cements is significantly beneficial for the clinical performance of the restorative interfaces.

A Historical Perspective on Dental Composite Restorative Materials

This review article will discuss the origin of resin-based dental composite materials and their adoption as potentially useful adjuncts to the primary material used by most dentists for direct restorations. The evolution of the materials, largely driven by the industry's response to the needs of dentists, has produced materials that are esthetic, strong, and versatile enough to be used in most areas of the oral cavity to replace or restore missing tooth structures. Significant advancements, such as the transition from chemical to light-curing materials, refinements in reinforcing particles to produce optimum polishing and wear resistance, formulating pastes with altered viscosities to create highly flowable and highly stiff materials, and creating materials with enhanced depth of cure to facilitate placement, will be highlighted. Future advancements will likely reflect the movement away from simply being a biocompatible material to one that is designed to produce some type of beneficial effect upon interaction within the oral environment. These new materials have been called "bioactive" by virtue of their potential effects on bacterial biofilms and their ability to promote mineralization of adjacent tooth structures.

Compressive modulus, translucency, and irradiance transmittance of clear PVS materials used for resin injection molding technique

OBJECTIVES

To evaluate the compressive modulus, translucency, and light curing irradiance transmittance of four clear polyvinyl siloxane (PVS) materials used for the injection molding technique at varying thicknesses, and to assess the correlation between color parameters and irradiance transmittance.

MATERIALS AND METHODS

Four clear PVS materials (Exaclear, Clear Bite Matrix, Affinity Crystal, and Memosil 2) were used in this study. Compressive modulus was measured by compressing cylindrical PVS specimens (n = 9; d = 10 mm; t = 6 mm) up to 30% strain using a universal testing machine. For the translucency analysis and irradiance transmittance, specimens (n = 5) were fabricated with five different thicknesses (d = 12 mm and t = 2, 4, 6, 8 and 10 mm). The L*, a, *b* values of specimens were obtained using a CIELab spectrophotometer (CMD-700, Konica Minolta) with calibrated white and black tiles; the translucency parameter was calculated. The same specimens were placed onto a spectrophotometer (MARC Light Collector) to measure irradiance transmitted through the specimens from a light curing unit (Valo Corded, Ultradent). Data were analyzed using analysis of variance (ANOVA) with Tukey post hoc test and the correlation between translucency and irradiance transmittance of materials for each thickness was evaluated using Pearson's correlation.

RESULTS

Compressive modulus differences in PVS materials were significant (one-way ANOVA: df = 3, F = 76.27, p < 0.001); Affinity and Memosil 2 were highest with no significant difference between them (Tukey: t = -1.62; p = 0.382). Clear Bite was higher than Exaclear (Tukey: t = -3.70; p = 0.004). Exaclear was lowest. Translucency decreased with thickness (Two-way ANOVA: df = 3, F = 586.53, p < 0.001; thickness: df = 4, F = 1389.34, p < 0.001). Exaclear was most translucent at all thicknesses. L*, a*, b* values varied by material and thickness (L*: df = 3, F = 1213.32, p < 0.001; a*: df = 3, F = 10766.8, p < 0.001; b*: df = 3, F = 3260.42, p < 0.001). Memosil 2 had lowest b* values. Irradiance transmittance was affected by material and thickness (Two-way ANOVA: df = 4, F = 2388.86, p < 0.001). Exaclear had highest irradiance transmission, surpassing control at >6 mm. Violet/blue irradiance ratio decreased with thickness; Exaclear maintained a constant ratio, indicating preserved violet irradiance. There was a strong positive correlation between translucency and light irradiance (Pearson's r = 0.97, R2 = 0.86-0.96). Radiant exposure analysis suggests adjusting the curing time based on PVS thickness for optimal exposure (10 J/cm2) is achievable within 13-14 s for <2 mm and 21-30 s for 8-10 mm with Clear Bite, Affinity, and Memosil 2; whereas Exaclear requires less time.

CONCLUSIONS

Compressive modulus in clear PVS materials varied by type; Affinity and Memosil 2 demonstrate higher modulus, offering more stability of the clear mold. Translucency and irradiance transmission through clear PVS materials decreased as their thickness increased, yet Exaclear exceled in maintaining high translucency and superior light transmission capabilities. Additionally, there is a strong positive linear correlation between translucency and light irradiance transmittance, offering a method to adjust curing times effectively based on material translucency.

CLINICAL SIGNIFICANCE

The light curing time to adequately polymerize composite through clear impression material may need to be increased, particularly with thicker matrices or less translucent materials.

The power of light - From dental materials processing to diagnostics and therapeutics

Harnessing the power of light and its photonic energy is a powerful tool in biomedical applications. Its use ranges from biomaterials processing and fabrication of polymers to diagnostics and therapeutics. Dental light curable materials have evolved over several decades and now offer very fast (≤ 10 s) and reliable polymerization through depth (4-6 mm thick). This has been achieved by developments on two fronts: (1) chemistries with more efficient light absorption characteristics (camphorquinone [CQ], ~30 L mol-1 cm1 [ʎmax 470 nm]; monoacylphosphine oxides [MAPO], ~800 L mol-1 cm-1 [ʎmax 385 nm]; bisacylphosphine oxide [BAPO], ~1,000 L mol-1 cm-1 [ʎmax 385 nm]) as well mechanistically efficient and prolonged radical generation processes during and after light irradiation, and; (2) introducing light curing technologies (light emitting diodes [LEDs] and less common lasers) with higher powers (≤ 2 W), better spectral range using multiple diodes (short: 390-405 nm; intermediate: 410-450 nm; and long: 450-480 nm), and better spatial power distribution (i.e. homogenous irradiance). However, adequate cure of materials falls short for several reasons, including improper selection of materials and lights, limitations in the chemistry of the materials, and limitations in delivering light through depth. Photonic energy has further applications in dentistry which include transillumination for diagnostics, and therapeutic applications that include photodynamic therapy, photobiomodulation, and photodisinfection. Light interactions with materials and biological tissues are complex and it is important to understand the advantages and limitations of these interactions for successful treatment outcomes. This article highlights the advent of photonic technologies in dentistry, its applications, the advantages and limitations, and possible future developments.

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 irradiance and exposure time on the adhesive properties of universal adhesives after 2 years of storage

OBJECTIVE

This study aims to evaluate the effects of exposure time and irradiance on the dentin bonding properties (microtensile bond strength (μTBS) and nanoleakage (NL)) of the Clearfil Universal Bond Quick (CUQ) adhesive and Scotchbond Universal Adhesive (SBU) immediately and after 2 years of water storage.

MATERIAL AND METHODS

Hence, 128 human molars were randomly assigned to 16 groups based on adhesive strategy, irradiance/exposure times, and storage time for each universal adhesive tested. The adhesives were applied using the etch-and-rinse and self-etch strategies and were light-cured using four different irradiance/exposure times: 1400 mW/cm2 for 5 s (1400 × 5), 1400 mW/cm2 for 10 s (1400 × 10), 3200 mW/cm2 for 5 s (3200 × 5), and 3200 mW/cm2 for 10 s (3200 × 10). Then, each sample was restored and sectioned into a resin-dentin bonded stick to be tested for μTBS and NL (immediately and after 2 years of water storage). The mean μTBS and NL of all resin-dentin bonded sticks from the same hemi-tooth (factor time) were statistically analyzed using a three-way ANOVA and Tukey's test (a = 0.05).

RESULTS

Despite a significant decrease in the μTBS values for all groups after 2 years of water storage, the 3200 × 5 group showed higher μTBS values, whereas the 3200 × 10 group showed lower μTBS values for both universal adhesives tested. Although a significant increase in the NL values was observed for all groups after 2 years of water storage, the 3200 × 10 group showed higher NL values than the other groups (p < 0.001).

CONCLUSION

Results indicate that light-curing the adhesive layer with 14-16 J/cm2 led to an improvement in the stability of the resin-dentin adhesive interface. A longer exposure time (10 s) coupled with a higher irradiance (3200 mW/cm2) resulted in a greater degree of degradation of the adhesive interface.

CLINICAL SIGNIFICANCE

To guarantee better stability of the adhesive interface, clinicians could be preferred a light-cured universal adhesive layer with 14-16 J/cm2. Higher irradiances should be avoided.

Proposition of New Testing Procedure for the Mechanical Properties of Bulk-Fill Materials

This study analysed flexural properties, microhardness, and the degree of conversion (DC) of five bulk-fill composites under clinically relevant conditions (4 mm thick specimens) in comparison to 2 mm specimens according to ISO 4049. Additionally, the effect of rapid polymerisation on 4 mm specimens was evaluated after accelerated aging. DC was measured using Fourier transform infrared spectrometry at 2 and 4 mm thick layers, while flexural properties and Vickers microhardness were tested using 16 × 2 × 2 mm or 16 × 2 × 4 mm specimens. Three polymerisation protocols were used: (I) "ISO": 2 mm thickness, 1000 mW/cm², double-sided; (II) "10 s": 4 mm thickness, 1000 mW/cm², one-sided; and (III) "3 s": 4 mm thickness, 2600 mW/cm², one-sided. Mechanical properties were tested after 1 day, after 10,000 thermocycles, and after 10,000 thermocycles followed by a 7-day immersion in absolute ethanol. The "ISO" protocol produced a higher DC and microhardness of all materials. Elastic modulus was significantly higher for the "ISO" protocol compared to the 4 mm specimens. The differences in flexural strength for all polymerisation protocols were equalised after thermocycling and immersion in absolute ethanol. All tested materials met the ISO 4049 flexural strength requirement (80 MPa) for all polymerisation methods and all aging conditions. Rapid polymerisation achieved nearly optimal properties (ISO), except for elastic modulus, which was significantly reduced in 4 mm samples.

Assessment of Microhardness of Conventional and Bulk-Fill Resin Composites Using Different Light-Curing Intensity

(1) Background: This study evaluates the effect of a conventional/low-voltage light-curing protocol (LV protocol) (10 s with 1340 mW/cm²) and high-voltage light-curing protocol (HV protocol) (3 s with 3440 mW/cm²) on the microhardness (MH) of dental resin-based composites (RBCs). Five resin composites were tested: conventional Evetric (EVT), Tetric Prime (TP), Tetric Evo Flow (TEF), bulk-fill Tetric Power Fill (PFL), and Tetric Power Flow (PFW). (2) Materials and Methods: Two tested composites (PFW and PFL) were designed for high-intensity light curing. The samples were made in the laboratory in specially designed cylindrical molds; diameter = 6 mm and height = 2 or 4 mm, depending on the type of composite. Initial MH was measured on the top and bottom surfaces of composite specimens 24 h after light curing using a digital microhardness tester (QNESS 60 M EVO, ATM Qness GmbH, Mammelzen, Germany). The correlation between the filler content (wt%, vol%) and the MH of the RBCs was tested. For the calculation of depth-dependent curing effectiveness, the bottom/top ratio for initial MH was used. (3) Conclusions: MH of RBCs is more dependent on material composition than on light-curing protocol. Filler wt% has a greater influence on MH values compared to filler vol%. The bottom/top ratio showed values over 80% for bulk composites, while for conventional sculptable composites, borderline or suboptimal values were measured for both curing protocols.

The effect of high-irradiance rapid polymerization on degree of conversion, monomer elution, polymerization shrinkage and porosity of bulk-fill resin composites

OBJECTIVE

The purpose was to compare the degree of conversion (DC), monomer elution (ME), polymerization shrinkage (PS) and porosity of two addition-fragmentation chain transfer (AFCT) modified resin-based composites (RBC) light-cured with rapid- (RP), turbo- (TP) or conventional polymerization (CP) settings.

METHODS

Cylindrical samples (6-mm wide, 4-mm thick) were prepared from Tetric PowerFill (TPF) and Filtek One Bulk (FOB). Four groups were established according to the polymerization settings: 3s-RP, 5s-TP, 10s-CP and 20s-CP. Samples in 1 mm thickness with 20s-CP settings served as controls. The DC at the top and bottom surfaces was measured with micro-Raman spectroscopy. ME was detected with high-performance liquid chromatography. PS and porosity were analyzed by micro-computed tomography. ANOVA and Tukey's post-hoc test, multivariate analysis and partial eta-squared statistics were used to analyze the data (p < 0.05).

RESULTS

FOB showed higher DC values (61.5-77.5 %) at the top compared to TPF (43.5-67.8 %). At the bottom TPF samples achieved higher DCs (39.9-58.5 %) than FOB (18.21-66.18 %). Extending the curing time increased DC (except the top of FOB) and decreased ME. BisGMA release was the highest among the detected monomers from both RBCs. The amount was three-fold more from TPF. The factor Material and Exposure significantly influenced DC and ME. PS (1.8-2.5 %) did not differ among the groups and RBCs except for the lowest value of TPF cured with the 3s_RP setting (p = 0.03). FOB showed 4.5-fold lower porosity (p < 0.001). Significantly higher pore volume was detected after polymerization in 3s_RP (p < 0.001).

SIGNIFICANCE

High-irradiance rapid 3-s curing of AFCT modified RBCs resulted in inferior results for some important material properties. A longer exposure time is recommended in a clinical situation.

Light-curing dental resin-based composites: How it works and how you can make it work

Aim

Clinicians may become quite familiar with the rapid transformation of composite pastes to rigid solids, as a routine phenomenon in operative dentistry. But they may still lack scientific understanding of how and why this happens. Efforts to learn scientifically about the interaction between light beams and resin-composites can significantly promote effective clinical placement of restorations. Neglect of such study can result in practical procedures of light-curing that are inadequate or even seriously defective.

Method

This review addresses the underlying science and technology to elucidate how light curing works, for dental resin-based composites, including—but not limited to—bulk fill types. This involves questions concerning: (a) the particle-wave understanding of light; (b) how photons can penetrate sufficiently deeply into bulk fill composites; (c) the necessary technology of LED light-curing units (LCUs); (d) the criteria for absorption of photons by photo initiators to initiate free-radical addition polymerisation.

Conclusions

The implications for clinical practice are surveyed. These include design variables and selection criteria for LED-LCUs and guidelines on their use. This is to guide practitioners towards safe and effective light-curing procedures so that they can achieve optimal result for their patients.

Ability of short exposures from laser and quad-wave curing lights to photo-cure bulk-fill resin-based composites

OBJECTIVE

This study investigated the ability of a laser, and a 'quad-wave' LCU, to photo-cure paste and flowable bulk-fill resin-based composites (RBCs).

METHODS

Five LCUs and nine exposure conditions were used. The laser LCU (Monet) used for 1 s and 3 s, the quad-wave LCU (PinkWave) used for 3 s in the Boost and 20 s in the Standard modes, the the multi-peak LCU (Valo X) used for 5 s in the Xtra and 20 s in the Standard modes, were compared to the polywave PowerCure used in the 3 s mode and for 20 s in the Standard mode, and to the mono-peak SmartLite Pro used for 20 s. Two paste consistency bulk-fill RBCs: Filtek One Bulk Fill Shade A2 (3 M), Tetric PowerFill Shade IVA (Ivoclar Vivadent), and two flowable RBCs: Filtek Bulk Fill Flowable Shade A2 (3 M), Tetric PowerFlow Shade IVA (Ivoclar Vivadent) were photo-cured in 4-mm deep x 4-mm diameter metal molds. The light received by these specimens was measured using a spectrometer (Flame-T, Ocean Insight), and the radiant exposure delivered to the top surface of the RBCs was mapped. The immediate degree of conversion (DC) at the bottom, and the 24-hour Vickers Hardness (VH) at the top and bottom of the RBCs were measured and compared.

RESULTS

The irradiance received by the 4-mm diameter specimens ranged from 1035 mW/cm² (SmartLite Pro) to 5303 mW/cm² (Monet). The radiant exposures between 350 and 500 nm delivered to the top surface of the RBCs ranged from 5.3 J/cm² (Monet in 1 s) to 26.4 J/cm² (Valo X), although the PinkWave delivered 32.1 J/cm² in 20 s 350 to 900 nm. All four RBCs achieved their maximum DC and VH values at the bottom when photo-cured for 20 s. The Monet used for 1 s and the PinkWave used for 3 s on the Boost setting delivered the lowest radiant exposures between 420 and 500 nm (5.3 J/cm² and 3.5 J/cm² respectively), and they produced the lowest DC and VH values.

CONCLUSIONS

Despite delivering a high irradiance, the short 1 or 3-s exposures delivered less energy to the RBC than 20-s exposures from LCUs that deliver> 1000 mW/cm². There was an excellent linear correlation (r > 0.98) between the DC and the VH at the bottom. There was a logarithmic relationship between the DC and the radiant exposure (Pearson's r = 0.87-97) and between the VH and the radiant exposure (Pearson's r = 0.92-0.96) delivered in the 420-500 nm range.

Effect of thickness on the degree of conversion of two bulk-fill and one conventional posterior resin-based composites at high irradiance and high temporal resolution

OBJECTIVES

This study: 1) measures the effect of sample thickness and high irradiance on the depth-dependent time delay before photopolymerization reaction onset; 2) determines if exposure reciprocity exists; 3) measures the conversion rate at four irradiance levels; 4) determines the time, t0, at which the maximum DC rate is reached for two bulk-fill and one conventional posterior resin-based composites (RBCs).

METHODS

Tetric PowerFill IVA shade (Ivoclar Vivadent) and Aura bulk-fill ultra universal restorative (SDI), and one conventional posterior resin-based composite (RBC), Heliomolar A3 (Ivoclar Vivadent), that were either 0.2 mm, 2 mm, or 4 mm thick were photocured using a modified Bluephase G4 (Ivoclar Vivadent) light-curing unit (LCU) that delivered a single emission band (wavelength centered at 449 nm). The same radiant exposure of 24 J/cm2 was delivered at irradiances ranging from 0.5 to 3 W/cm2 by adjusting the exposure time. PowerFill was also photocured for 3 s or 6 s using a Bluephase PowerCure LCU (Ivoclar Vivadent) on the 3 s mode setting. The degree of conversion (DC) was measured in real-time at a high temporal resolution at 30 °C using Attenuated Total Reflection (ATR) FTIR spectroscopy with a sampling rate of 13 DC data points per second. The DC data were analyzed using a phenomenological autocatalytic model. The RBC viscosity was measured at 21 °C and 30 °C. Light transmission through the RBC samples at 22 °C was monitored with time to calculate the extinction coefficients of the RBCs.

RESULTS

The time delay before photopolymerization started increased as the RBC thickness increased and the irradiance decreased. An autocatalytic model described the DC data. The time t0 was less than 77 ms for the 0.2 mm thick samples of PowerFill irradiated using the highest irradiance of 3 W/cm2. Among the three RBCs for each sample thickness and irradiance level, the PowerFill had the smallest time t0. There was a time delay of 0.59 s and 1.25 s before the DC started to increase at the bottom of 4 mm thick samples for the PowerFill and Aura, respectively, when an irradiance of 1 W/cm2 was delivered. The time delay increased to 3.65 s for the Aura when an irradiance of 0.5 W/cm2 was delivered. The extinction coefficients near 449 nm were 0.78 mm-1, 0.76 mm-1, and 1.55 mm-1 during the first 2 s after the start of photocuring of PowerFill, Aura, and Heliomolar, respectively. Only PowerFill followed exposure reciprocity. At T = 30 °C, the viscosity was 3400, 17000, and 5200 Paˑs for PowerFill, Aura, and Heliomolar, respectively.

SIGNIFICANCE

The time delay between when photopolymerization starts at the top and bottom of 2- or 4-mm thick RBC restorations may affect the structural integrity of the bond between the tooth and the bottom of the restoration. Only PowerFill followed exposure reciprocity between irradiance levels of 0.5 to 3 W/cm2. Exposure reciprocity did not occur for Aura or Heliomolar, neither of which are optimized for short light exposure or high irradiance conditions.

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.

Influence of Irradiance and Exposure Times on the Mechanical and Adhesive Properties of Universal Adhesives with Dentin

OBJECTIVES

This study evaluated the influence of irradiance/exposure time on the Knoop hardness (KHN) and polymer cross-linking density (PCLD), as well as microtensile bond strength (μTBS), nanoleakage (NL), and in situ degree of conversion (DC) of universal adhesives.

METHODS AND MATERIALS

Two universal adhesive systems, Clearfil Universal Bond Quick (CUQ) and Scotchbond Universal Adhesive (SBU), were light-cured using various irradiance/exposure times: 1400 mW/cm2 for 5 s (1400*5); 1400 mW/cm2 for 10 s (1400*10); 3200 mW/cm2 for 5 s (3200*5); and 3200 mW/cm2 for 10 s (3200*10). Adhesive disks from each group were used to measure PCLD by KHN. One hundred and twenty-eight human molars were randomly assigned to 16 groups according to the following variables: adhesive system vs adhesive strategies vs radiance/exposure times. After restoration, specimens were sectioned into resin-dentin sticks and tested for μTBS, NL, and DC. The data from PCLD (%), KHN, μTBS (MPa), NL (%), and DC (%) data were subjected to ANOVA and Tukey's test (α=0.05).

RESULTS

Significant reductions in KHN, μTBS, and DC (p=0.00001) values and an increase in NL and PCLD (p=0.00001) values were observed for 3200*10 when compared with other groups. Higher KHN, μTBS, and DC (p=0.000001) values were observed for 3200*5 in comparison with the other groups. The 1400*5 (7 J/cm2) and 1400*10 (14 J/cm2) groups showed intermediate values (p=0.000001).

CONCLUSION

Although similar results in terms of hardness, polymer cross-linking density and nanoleakage were observed when 5 seconds at 3200 mW/cm2 and 10 seconds at 1400 mW/cm2 groups were compared, the use of higher irradiance (3200 mW/cm2) for only 5 seconds showed better results in terms of bond strength and degree of conversion for both universal adhesives to dentin. The prolonged exposure time (10 seconds) at the higher irradiance (3200 mW/cm2) showed the worst results.

Evaluation of irradiance and radiant exposure on the polymerization and mechanical properties of a resin composite

The objective of the present study was to evaluate the effect of irradiance and radiant exposure on the chemical-mechanical properties of a resin composite. A micro-hybrid resin composite (Clearfil AP-X, Kuraray) was investigated under two different irradiances: low (300 mW/cm2) and high (800 mW/cm2) and radiant exposures: 8 and 16 J/cm2. Four groups, named Low 8 J/cm2, High 8 J/cm2, Low 16 J/cm2, and High 16 J/cm2 were tested, and their flexural strengths, elastic moduli, depths of cure, and degrees of conversion were evaluated. Data were analyzed using two-way ANOVA and Tukey's test. A multiple linear regression model was used to correlate the irradiance and radiant exposure with dependent variables (α = 0.05). Irradiance and radiant exposure were found statistically significant for all dependent variables. The interaction between the factors was statistically significant only for the degree of conversion and elastic modulus. Group Low 16 J/cm2 exhibited a significantly superior performance in all the evaluated properties. Barring the degree of conversion, no significant differences were observed among the properties evaluated between the Low 8 J/cm2 and High 8 J/cm2 groups. The adjusted R2 values were high for the depth of cure and degree of conversion (0.58 and 0.96, respectively). Both irradiance and radiant exposure parameters play an important role in establishing the final properties of a micro-hybrid resin composite. Irradiance has a greater influence under higher radiant exposures.

Developments in resin-based composites

With the phasing down of dental amalgam use in response to the Minamata Convention, it is likely that resin-based composite restoratives will be the dental material of choice for the direct restoration of compromised dentition in the UK, at least for the foreseeable future. The current materials have a finite lifespan, with failures predominately due to either secondary caries or fracture. Consequently, there is considerable in vitro research reported each year with the intention of producing improved materials. This review describes the recent research in materials designed to have low polymerisation shrinkage and increased mechanical properties. Also described is research into materials that are either antimicrobial or are designed to release ions into the surrounding oral environment, with the aim of stimulating remineralisation of the surrounding dental tissues. It is hoped that by describing this recent research, clinicians will be able to gain some understanding of the current research that will potentially lead to new products that they can use to improve patient treatment in the future.

Provides an overview of recent research developments aimed at improving the performance of resin-based composites.

Details the recent developments in monomers and fillers to produce resin-based composites that either have lower polymerisation shrinkage or better mechanical properties compared to current commercially available products.

Describes recent research on developing resin-based composites that can act as potential sources of antimicrobial or remineralising agents.

Depth of cure of 10 resin-based composites light-activated using a laser diode, multi-peak, and single-peak light-emitting diode curing lights

OBJECTIVES

To evaluate the depth of cure (DOC) of ten contemporary resin-based composites (RBCs), light-cured using different LCUs and exposure times.

METHODS

The power, radiant emittance, irradiance, radiant exposure (RE), and beam profiles from a laser (M, Monet), a multi-peak (V, Valo Grand), and single-peak (S, SmartLite Pro) LCU were measured. The DOC was measured using a 6-mm diameter metal mold and a solvent dissolution method to remove the uncured RBC. The length of the remaining RBC was divided by 2. The exposure times were: 1s and 3s for M, 10s and 20s for V, and 10s and 20s for S. Data were analyzed using: Bland-Altman distribution, Pearson's Correlation, and an artificial neural network (ANN) to establish the relative importance of the factors on the DOC (α=0.05; β=0.2).

RESULTS

Significant differences were found in the DOC of the different LCUs and composites. The laser LCU emitted the highest power, radiant emittance, and irradiance. However, this LCU used for 1 s delivered the lowest RE and produced the shortest DOC in all ten RBCs. The ANN demonstrated that the RE is the most critical factor for the DOC. Bland-Altman comparisons showed that the DOCs achieved with the laser LCU used for 1s were between 17 - 34 % shorter than the other conditions.

CONCLUSIONS

Although the laser LCU cured all 10 RBCs when used for 1s, it produced the shallowest DOC, and some RBCs did not achieve the minimum DOC threshold. The RE and not the irradiance was the most important factor in determining the DOC of RBCs.

CLINICAL SIGNIFICANCE

Despite delivering high power and irradiance, the laser used for l s delivered a lower radiant exposure than the conventional LCUs used for 10 s. This resulted in a shorter DOC.

Polymer characteristics and mechanical properties of bulk-fill, giomer, fiber-reinforced and low-shrinkage composites

Introduction/Objective. The objective was to determine the degree of conversion (DC), cross-link density, percentage of leachable monomers, flexural strength (FS), and hardness (HV) of nanohybrid, nanofilled bulk-fill, giomer, fiber-reinforced, and low-shrinkage composites. Methods. Standardized specimens (n = 5/group) of Tetric EvoCeram Bulk Fill, Filtek Bulk Fill, Beautifil, EverX posterior, Kalore, Filtek Z250 (microhybrid control), and Tetric EvoCeram (nanohybrid control) were subjected to micro-Raman spectroscopy, three-point bending, and HV. Cross-linking density and leachable monomers were ascertained based on the ratio of HV and DC before and after immersion in absolute ethanol. Results. DC was in the range 50.4?70.5%, the highest for Filtek Bulk and the lowest for Kalore. The highest %DC change was in Beautifil (10.3%) and the lowest in Filtek Bulk (1.4%) and Z250 (1.28%). FS ranged between 78.9 MPa (TEC) and 126.7 MPa (Filtek Bulk). HV ranged between 58.6 (Kalore) and 113.9 (Z250) and significantly decreased post-immersion (19?55%). HV48h inversely correlated to HV% loss (r = -0.761), whilst DC positively correlated with FS (r = 0.893). Conclusion. Filtek Bulk, EverX, and Z250 showed the highest DC. The lowest DC and mechanical properties were observed for Kalore. The greatest cross-link density was shown by Filtek Bulk. There were up to 10% of leachable monomers. DC and FS positively correlated.

Transmission of violet and blue light and current light units through glass-reinforced ceramics with different thicknesses

Purpose To evaluate the effect of glass-reinforced ceramics (leucite and lithium disilicate) with different thicknesses (1, 2, and 3 mm) on the wavelength and irradiance spectrum of blue and violet lights. In addition, the effect of the ceramics on four current light-curing units (LCUs) was evaluated: a halogen lamp, a single peak LED, and two multi-peak LEDs.Methods Ceramic discs of different thicknesses (1, 2, and 3 mm) were obtained from computer-aided design and computer-aided manufacturing (CAD-CAM) blocks. The irradiance, radiant exposure, and emission spectrum of the four LCUs were analyzed using a spectrometer-based instrument. To evaluate the violet and blue lights, a specific device that provides a narrow emission spectrum was used.Results The ceramics reduced the irradiance of all the tested LCUs. However, the wavelength of the transmitted light was only altered slightly. The effect of leucite and lithium disilicate varied according to the type of LCU and thickness of the ceramic disc evaluated .Conclusions From the results, it could be concluded that the thickness of the leucite and lithium disilicate ceramic significantly reduced the irradiance of the light emitted by the LCUs, with minimal changes on the wavelength spectrum of the lights. The effects of the ceramic on irradiance and transmitted wavelengths of the blue and violet lights was slightly different.

Applicability of Exposure Reciprocity Law for Fast Polymerization of Restorative Composites Containing Various Photoinitiating Systems

OBJECTIVES

The exposure reciprocity law (ERL) has been used to calculate the optimal irradiation time of dental composites. This study examined the applicability of ERL for fast polymerization of restorative composites containing various photoinitiating systems using a high-power multi-peak light-emitting diode (LED) lamp.

METHODS

Three commercial composites differing in photoinitiating systems were tested: Filtek Ultimate Universal Restorative (FU) with a camphorquinone-amine (CQ-A) photoinitiating system, Tetric EvoCeram (TEC) with CQ-A and (2,4,6-trimethylbenzoyl)phosphine oxide (TPO), and Estelite Σ Quick (ESQ) with CQ and a radical amplified photopolymerization (RAP) initiator. Specimens 2-mm thick were polymerized using a high-power multipeak LED lamp (Valo) at 3 pairs of radiant exposures (referred to as low, moderate, and high) ranging from 15.8-26.7 J/cm2. They were achieved by different combinations of irradiation time (5-20 seconds) and irradiance (1300-2980 mW/cm2) as determined with a calibrated spectrometer. Knoop microhardness was measured 1, 24, and 168 hours after polymerization on specimen top (irradiated) and bottom surfaces to characterize the degree of polymerization. The results were statistically analyzed using a three-way analysis of variance and Tukey's post hoc tests, α = 0.05.

RESULTS

Microhardness increased with radiant exposure and except for ESQ, top-surface microhardness was significantly higher than that on bottom surfaces. Combinations of high irradiance and short irradiation time significantly increased the top-surface microhardness of TEC at low and moderate radiant exposures, and the bottom-surface microhardness of FU at a low radiant exposure. In contrast, the microhardness of ESQ on both surfaces at high radiant exposure increased significantly when low irradiance and long irradiation time were used. With all tested composites, bottom-surface microhardness obtained at low radiant exposure was below 80% of the maximum top-surface microhardness, indicating insufficient polymerization.

CONCLUSION

Combinations of irradiance and irradiation time had a significant effect on microhardness, which was affected by photoinitiators and the optical properties of composites as well as spectral characteristics of the polymerization lamp. Therefore, ERL cannot be universally applied for the calculation of optimal composite irradiation time. Despite high irradiance, fast polymerization led to insufficient bottom-surface microhardness, suggesting the necessity to also characterize the degree of polymerization on the bottom surfaces of composite increments when assessing the validity of ERL.

Utilizing Light Cure Units: A Concise Narrative Review

The use of photo-curable resin composite restorations is an essential treatment modality in modern dental practice. The success and longevity of these restorations depend on achieving predictable and effective polymerization. Understanding the dynamics of the polymerization and the effect of light cure units (LCUs) on this process is paramount. The goal of this concise narrative review is to provide a simplified presentation of basic principles of composite chemistry, polymerization reactions, and photo-curing with relevant terminologies. Clinical guidelines for choosing and maintaining LCUs, as well as safety precautions and factors under the control of the clinician are listed. Finally, clinical recommendations of LCUs’ usage and monitoring are included to aid practitioners in achieving predictable polymerization during the placement of direct resin composite restorations.

Minimum Radiant Exposure and Irradiance for Triggering Adequate Polymerization of a Photo-Polymerized Resin Cement

This study aimed to establish the minimum radiant exposure and irradiance to trigger an adequate polymerization of a photo-polymerized resin cement. In total, 220 disc-shaped specimens (diameter of 10 mm and thickness of 0.1 mm) were fabricated using a photo-polymerized resin cement (Variolink N-transparent, Ivoclar Vivadent). To investigate the minimum radiant exposure, the specimens were polymerized with radiant exposures of 1, 2, 3, 4, 5, 6, and 18 J/cm² (n = 20). During polymerization, the irradiance was maintained at 200 mW/cm². To investigate the minimum irradiance, the specimens were polymerized with irradiances of 50, 100, 150, and 200 mW/cm² (n = 20). During polymerization, the radiant exposure was maintained at the previously determined minimum radiant exposure. The Vickers microhardness (HV) and degree of conversion (DC) of the carbon double bond of the specimens were measured to determine the degree of polymerization of the specimens. The results were analyzed using one-way analysis of variance (ANOVA) and Tukey’s test (p < 0.05). In the investigation of the minimum radiant exposure, the HV and DC of the specimens polymerized with a radiant exposure from 1 to 5 J/cm² were significantly lower than those with 18 J/cm² (all p < 0.05). However, no significant difference in HV and DC was found between the specimens polymerized with 6 J/cm² and 18 J/cm² (p > 0.05). In the investigation of the minimum irradiance, the specimens polymerized with an irradiance of 50 mW/cm² had significantly lower HV and DC than the specimens polymerized with an irradiance of 200 mW/cm² (p < 0.05). However, no significant difference in the HV and DC was found among the specimens cured with irradiances of 100, 150, and 200 mW/cm² (p > 0.05). In conclusion, the minimum radiant exposure and irradiance to trigger an adequate polymerization of the light-cured resin cement were 6 J/cm² and 100 mW/cm², respectively.

Effect of LED Light-Curing Spectral Emission Profile on Light-Cured Resin Cement Degree of Conversion

CLINICAL RELEVANCE

The use of multipeak LED light-curing guarantees efficiency on light activation of Ivocerin-containing light-cured resin cement.

SUMMARY

Rapid 3 s Curing: What Happens in Deep Layers of New Bulk-Fill Composites?

This study assessed the influence of rapid 3 s light curing on the new generation of bulk-fill resin composites under the simulated aging challenge and depths up to 4 mm. Four bulk-fill materials were tested: two materials designed for rapid curing (Tetric PowerFill—PFILL; Tetric PowerFlow—PFLW) and two regular materials (Filtek One Bulk Fill Restorative—FIL; SDR Plus Bulk Fill Flowable—SDR). Three-point bending (n = 10) was used to measure flexural strength (FS) and flexural modulus (FM). In the 3 s group, two 2 mm thick specimens were stacked to obtain 4 mm thickness, while 2 mm-thick specimens were used for ISO group. Specimens were aged for 1, 30, or 30 + 3 days in ethanol. The degree of conversion (DC) up to 4 mm was measured by Raman spectroscopy. There was no difference between curing protocols in FS after 1 day for all materials except PFLW. FM was higher for all materials for ISO curing protocol. Mechanical properties deteriorated by increasing depth (2–4 mm) and aging. ISO curing induced higher DC for PFLW and FIL, while 3 s curing was sufficient for PFILL and SDR. The 3 s curing negatively affected FM of all tested materials, whereas its influence on FS and DC was highly material-specific.

Effect of high-irradiance light curing on exposure times and pulpal temperature of adequately polymerized composite

This study investigated the effect of high-irradiance light-curing on exposure time and pulpal temperature of adequately-cured composite. Composite placed in a molar preparation was cured using high-irradiance light-curing units (Flashmax P3, Valo, S.P.E.C. 3 LED, Cybird XD) and tested for hardness occlusal-gingivally. The first group had exposure times set according to manufacturer settings (recommended), second group to yield 80% of maximum hardness at the 2 mm depth (experimental), and third group was set at 20 s (extended). Exposure time necessary to adequately polymerize the composite at 2 mm depth was 9 s for the Cybird XD and Valo and 12 s for S.P.E.C. 3 LED and Flashmax P3. None of the high-irradiance light-curing units adequately polymerized the composite at the manufacturer-recommended minimum-exposure times of 1-3 s. Exposure times necessary to adequately polymerize composite at 2 mm resulted in a maximum pulpal-temperature increase well below the temperature associated with possible pulpal necrosis.

New bulk-fill composite system with high irradiance light polymerization: Integrity and degree of conversion

OBJECTIVE

The study used optical coherence tomography (OCT) and micro Raman microscopy (mRM) to investigate internal defect (ID) and degree of conversion (DC) of two bulk-fill composite systems with high-irradiance or conventional light polymerization settings.

METHODS

The ID and DC of the new bulk-fill composites; Tetric PowerFill (PwrPst) and Tetric PowerFlow (PwrFlw) were compared with the predecessor bulk-fill composites; Tetric EvoCeram Bulkfill (EvoPst) and Tetric EvoFlow Bulkfill (EvoFlw), using LED light curing unit in two settings; normal (LED-Nrm: 1000 mW/cm², 10-s) or PowerCure (LED-Pwr: 3000 mW/cm², 3-s). ID formation was observed in bonded cylindrical composite cavities (4-mm depth, 3-mm diameter) using Yoshida Dental OCT. From the vertically projected 2D image, ID area percentage (ID-A%) was calculated. DC at the top and bottom and bottom/top DC ratio (DC-R%) of 4-mm thick discs was calculated using mRM. All data were statistically analyzed at significance level of α = 0.05.

RESULTS

Flowable composites in LED-Pwr showed smaller ID frequencies than other groups (PwrFlw: 0/8, EvoFlw: 2/8) (p < 0.05). Composite type significantly affected ID-A%, DC and DC-R% (p < 0.001), while light settings significantly affected ID-A% but not DC and DC-R% (p > 0.05). In both light settings, EvoPst showed the lowest DC-R% (<80%).

SIGNIFICANCE

Internal defect and degree of conversion of bulk-fill composites were affected by their composition and light settings. There was a tendency for less defects and better polymerization for the flowable bulk-fills. The new flowable bulk-fill composite with 3-seconds high irradiance light curing showed no defect formation.

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

OBJECTIVE

Resin-Composites are now available designed for polymerization using 3 s of intense light irradiation. The aim was to develop an experimental method to probe their surface viscoelastic integrity immediately following such rapid photo-cure via macroscopic surface indentation under constant stress as a function of time.

METHODS

Two bulk-fill composites (Ivoclar AG) were studied: Tetric PowerFill (PFill) and PowerFlow (PFlow). Split molds were used to fabricate cylindrical {4 mm (dia) × 4 mm} paste specimens, irradiated at 23 °C at 0 mm from the top surface with a BluephasePowerCure LED-LCU, with 3 s or 5 s modes, emitting 3 and 2 W/cm², respectively. Post-irradiation specimens were immediately transferred to an apparatus equipped with a flat-ended indentor of 1.5 mm diameter. 14 MPa compressive stress at the indentor tip was applied centrally in < 2 min and maintained constant for 2 h. Indentation (I) magnitudes were recorded in real-time (t), with I(t) data re-expressed as % indentation relative to the 4 mm specimen height. After 2 h, the indentor was unloaded and indentation recovery was monitored for a further 2 h. Parallel sets of measurements were made where indentation was delayed for 24 h. Further measurements were made with more conventional composites: EvoCeram Bulk Fill (ECeram) and Tetric EvoFlow Bulk Fill (EFlow). These were irradiated for 20 s at 1.2 W/cm². Kinetic data were curve-fitted to exponential growth functions and key parameters analyzed by ANOVA and post-hoc tests (α = 0.05).

RESULTS

I(t) plots looked initially similar to bulk creep/recovery: rapid deformation plus viscoelastic response; then, upon unloading: rapid (elastic) recovery followed by partial viscoelastic recovery. However, unlike multiply irradiated and stored bulk-creep specimens, the present specimens were exposed to only 3 or 5 s "occlusal" irradiation; generating "hard" surfaces. Subsequently, during the 2 h indentation, the polymer matrix network continued to harden and consolidate. Upon initial loading, I(t) reached 2-3% indentation, depending upon the formulation. Upon unloading at 2 h, elastic recovery was only ca. 1 %. Delayed loading for 24 h, generated I(t) plots of significantly reduced magnitude. Most importantly, however, the I(t) plots for ECeram and EFlow, after 20 s irradiation, showed I(t) magnitudes quite comparable to the PFill and PFlow rapid-cure composites.

SIGNIFICANCE

Macroscopic indentation creep has been shown to be a workable procedure that can be applied to rapid-cure materials to assess their immediate surface integrity and developing viscoelastic characteristics. The applied stress of 14 MPa was relatively severe and the indentation/recovery profiles of PowerFill materials with only 3 or 5 s irradiation demonstrated comparability with their established 20 s cure siblings, evidencing the suitability of the PowerCure system for clinical application.

Bis(4-methyl phenyl)iodonium as an alternative component to diphenyliodonium in camphorquinone-based ternary initiating systems

OBJECTIVE

To evaluate the influence of different co-initiators (diphenyliodonium hexafluorophosphate - DPI - and bis(4-methyl phenyl)iodonium hexafluorophosphate - BPI) on chemical and mechanical properties of resins.

METHODS

Nine experimental resins (50% Bis-GMA and 50% TEGDMA, w/w) with 60 wt% filler particles were formulated. The initiating system used was camphorquinone (CQ-1 mol%) and ethyl dimethylaminobenzoate (EDAB-2 mol%). Experimental groups were established according to DPI and BPI quantities (0.25, 0.5, 0.75, and 1 mol%). The control group was a resin containing only CQ-EDAB. Light transmission through the resin during polymerisation was analysed with a UV-vis spectrophotometer. Real-time polymerisation of the systems was evaluated using an FTIR spectrometer. Real-time polymerisation shrinkage strain was evaluated, and the flexural strength and modulus of materials were obtained by 3-point bending. Experimental groups were statistically analysed by Analysis of Variance and Tukey's test (α = 0.05). Dunnett's test was applied to compare experimental groups with control.

RESULTS

Light transmission rapidly increased initially for resins containing DPI or BPI. After 30 s cure, the irradiance on the lower surface of resin specimens was similar for all groups. After 10 s of light irradiation, groups containing DPI and BPI had higher conversion than the control. However, conversion after 120 s post-irradiation was similar for all groups. The rate of polymerisation, shrinkage strain, and the maximum strain rate were higher for groups containing DPI/BPI. The use of iodonium salts increased the flexural strength and flexural moduli of resins.

SIGNIFICANCE

DPI and BPI increased resin reactivity similarly. Increased rate of polymerization influenced light transmission through the resin in the first seconds of polymerisation and increased resin shrinkage and rate of shrinkage, as well as flexural strength and moduli.

The effect of rapid high-intensity light-curing on micromechanical properties of bulk-fill and conventional resin composites

Rapid high-intensity light-curing of dental resin composites is attractive from a clinical standpoint due to the prospect of time-savings. This study compared the effect of high-intensity (3 s with 3,440 mW/cm²) and conventional (10 s with 1,340 mW/cm²) light-curing on micromechanical properties of conventional and bulk-fill resin composites, including two composites specifically designed for high-intensity curing. Composite specimens were prepared in clinically realistic layer thicknesses. Microhardness (MH) was measured on the top and bottom surfaces of composite specimens 24 h after light-curing (initial MH), and after subsequent immersion for 24 h in absolute ethanol (ethanol MH). Bottom/top ratio for initial MH was calculated as a measure of depth-dependent curing effectiveness, whereas ethanol/initial MH ratio was calculated as a measure of crosslinking density. High-intensity light-curing showed a complex material-dependent effect on micromechanical properties. Most of the sculptable composites showed no effect of the curing protocol on initial MH, whereas flowable composites showed 11–48% lower initial MH for high-intensity curing. Ethanol/initial MH ratios were improved by high-intensity curing in flowable composites (up to 30%) but diminished in sculptable composites (up to 15%). Due to its mixed effect on MH and crosslinking density in flowable composites, high-intensity curing should be used with caution in clinical work.

Comparison of the Depth of Cure of Flowable Composites Polymerized at Variable Increment Thicknesses and Voltages: An In vitro Study

Objectives

The aim of this study is to compare the depth of cure of two composite materials (SDR and Filtek bulk-fill) cured at variable increment depths (2, 4, and 6 mm) and voltages (180 and 220 volts).

Materials and Methods

Each sample of the composite material was packed in a mold of 2 mm, 4 mm, and 6 mm and curing light (quartz tungsten halogen) of optimal intensity was exposed for 20 s at 2 different voltages on each specimen. After curing, the specimens were removed and the composite on the nonexposed end was scraped with a plastic instrument. The remaining composite thickness was measured using a digital Vernier caliper. The reading was divided by half to follow the ISO 4049 method. Independent sample t-test, one-way ANOVA, and linear regression analysis were applied. Level of significance was kept at 0.01.

Results

The mean DOC of SDR and Filtek were 1.93 ± 0.82 and 1.77 ± 0.65 mm. Lowering the voltage from 220 to 180 volts reduced the depth of Filtek from 1.87 ± 0.74 to 1.67 ± 0.54 mm, whereas the DOC of SDR remained unchanged at 1.93 mm at the two voltages. The adjusted R ² for the depth of cure was 0.93 when the increment thickness, voltage, and restorative material were taken together in the regression model.

Conclusions

There was no statistically significant difference between SDR and Filtek for the depth of cure at 2 and 4 mm increments. However, at 6 mm increment, the SDR cured significantly deeper than the Filtek. Around 91% variation in the depth of cure of these composites materials is explained by increment thickness alone.

Origin of micro-scale heterogeneity in polymerisation of photo-activated resin composites

Photo-activated resin composites are widely used in industry and medicine. Despite extensive chemical characterisation, the micro-scale pattern of resin matrix reactive group conversion between filler particles is not fully understood. Using an advanced synchrotron-based wide-field IR imaging system and state-of-the-art Mie scattering corrections, we observe how the presence of monodispersed silica filler particles in a methacrylate based resin reduces local conversion and chemical bond strain in the polymer phase. Here we show that heterogeneity originates from a lower converted and reduced bond strain boundary layer encapsulating each particle, whilst at larger inter-particulate distances light attenuation and monomer mobility predominantly influence conversion. Increased conversion corresponds to greater bond strain, however, strain generation appears sensitive to differences in conversion rate and implies subtle distinctions in the final polymer structure. We expect these findings to inform current predictive models of mechanical behaviour in polymer-composite materials, particularly at the resin-filler interface.

Resin-based-composites are widely used in industry and medicine but the influence of the filler particles on the reactive group conversion in photocurable resins is yet to be elucidated. Here the authors observe reduced local conversion and chemical bond strain in silica filler acrylate composite using synchrotron-based wide-field IR imaging.

Resin viscosity determines the condition for a valid exposure reciprocity law in dental composites

OBJECTIVE

To provide conditions for the validity of the exposure reciprocity law as it pertains to the photopolymerization of dimethacrylate-based dental composites.

METHODS

Composites made from different mass ratios of resin blends (Bis-GMA/TEGDMA and UDMA/TEGDMA) and silanized micro-sized glass fillers were used. All the composites used camphorquinone and ethyl 4-dimethylaminobenzoate as the photo initiator system. A cantilever beam-based instrument (NIST SRI 6005) coupled with NIR spectroscopy and a microprobe thermocouple was used to simultaneously measure the degree of conversion (DC), the polymerization stress (PS) due to the shrinkage, and the temperature change (TC) in real time during the photocuring process. The instrument has an integrated LED light curing unit providing irradiances ranging from 0.01W/cm² to 4W/cm² at a peak wavelength of 460nm (blue light). Vickers hardness of the composites was also measured.

RESULTS

For every dental composite there exists a minimum radiant exposure required for an adequate polymerization (i.e., insignificant increase in polymerization with any further increase in the radiant exposure). This minimum predominantly depends on the resin viscosity of composite and can be predicted using an empirical equation established based on the test results. If the radiant exposure is above this minimum, the exposure reciprocity law is valid with respect to DC for high-fill composites (filler contents >50% by mass) while invalid for low-fill composites (that are clinically irrelevant).

SIGNIFICANCE

The study promotes better understanding on the applicability of the exposure reciprocity law for dental composites. It also provides a guidance for altering the radiant exposure, with the clinically available curing light unit, needed to adequately cure the dental composite in question.

Influence of Bulk-Fill Composites, Polimerization Modes, and Remaining Dentin Thickness on Intrapulpal Temperature Rise

Objectives

The aim of this study was to compare the effects of different bulk-fill resin composites, polimerization modes, and the thickness of remaining dentin on the increase of intrapulpal temperature.

Methods

Human-extracted upper premolar teeth (n = 10) were used to design a single-tooth model with remaining dentin thicknesses of 1 mm and 0.5 mm. Estelite Bulk-fill Flow (Tokuyama, Japan), Surefil SDR™ Flow (Dentsply Caulk, Brazil), Filtek Bulk-Fill Posterior (3M, USA), and SonicFill™ 2 Bulk-fill (Kerr, USA) composites were applied according to the manufacturer's instructions. The standard and high modes of a light emitted diode (LED) light curing unit (LCU) (VALO™ Utradent, USA), were used for polymerization. In order to mimic the in vivo conditions of pulpal circulation, digital flowmetry (SK-600II, SK Medical, China) was used. Intrapulpal temperature rise was measured using K type thermocoupling (CEM DT 610B, Robosem Engineering, China). Data were analyzed using three-way variance analysis (ANOVA) and the independent t-test.

Results

No significant statistical differences in intrapulpal temperature rise between low viscosity bulk-fill composites (SDR and Estelite) were found. The lowest intrapulpal temperature rise was found in groups which used the Filtek Bulk-fill composite. Decreases in the remaining dentin thickness increased the intrapulpal temperature rise.

Significance

This study demonstrated that remaining dentin thickness, filler ratio of bulk-fill composites, and power and application time of the LED-LCU may affect intrapulpal temperature rise.

Light energy transmission through six different makes of ceramic orthodontic brackets

OBJECTIVE

To measure Total Light Energy (TLE) Transmission through six makes of ceramic orthodontic brackets alone and bracket-plus-adhesive samples, using the MARC™-Resin Calibrator (RC).

METHODS

Six makes, three each monocrystalline (M) and polycrystalline (P) were used; PureSapphire (M), SPA Aesthetic (M), Ghost (M), Mist (P), Reflections (P), and Dual Ceramic (P). The Ortholux™ Light Curing Unit (LCU) was used to cure the orthodontic adhesive Transbond™XT. The LCU's tip irradiance was measured and TLE transmitted through the ceramic bracket was obtained, then adhesive added to the bracket, and transmitted TLE measured through bracket-plus-adhesive samples. The LCU was set at five seconds as recommended for curing adhesive through ceramic brackets.

RESULTS

Mean tip irradiance was 1859.2±16.2mW/cm². The TLE transmitted through brackets alone ranged 1.7 to 3.9J/cm², in the descending order: Ghost>Pure Sapphire>Reflections>Mist>SPA Aesthetics>Dual Ceramic. The TLE transmitted through bracket-plus-adhesive samples ranged 1.6 to 3.7J/cm², in the descending order: Ghost>Mist>Reflections>Pure Sapphire>SPA Aesthetics>Dual Ceramic. TLE was reduced with the addition of adhesive (range -0.1 to -0.7J/cm²). There was a significant difference for Pure Sapphire, Reflections, and Mist (P<0.05), but not for SPA Aesthetics, Ghost, and Dual Ceramic. There was no overall significant difference between the monocrystalline and polycrystalline makes. The two best makes were of the monocrystalline type, concerning TLE transmission, but with the exception of polycrystalline Dual Ceramic; the next worst make was a monocrystalline bracket, SPA Aesthetics.

CONCLUSION

Light energy attenuation through ceramic orthodontic brackets is make-dependent, with no overall difference between monocrystalline and polycrystalline brackets. Light energy is further attenuated with the addition of resin-based orthodontic adhesive.

Examining the Effect of Radiant Exposure on Commercial Photopolimerizable Dental Resin Composites

The objective of this study was to evaluate the effect of radiant exposure on the chemical and physical properties of four commercial dental resin composites. The four dental resin composites used were Kalore, Admira, Tetric N-Ceram Bulk Fill, and Filtek Z350 XT. The composites were subjected to three curing protocols: 1000 mW/cm² for 5 s, 1000 mW/cm² for 10 s, and 400 mW/cm² for 25 s. The flexural strength, elastic modulus, water sorption, water solubility, degree of conversion, and polymerization shrinkage were evaluated. The results were analyzed by means of ANOVA and Tukey tests. For Admira and Kalore, significant differences between light exposure protocols were observed for the elastic modulus (p < 0.001), which was higher when a higher amount of radiant exposure was used. For Filtek Z350, differences were only observed for the degree of conversion (p < 0.001), and a higher amount of radiant exposure allowed us to obtain higher values. The Tetric N-Ceram Bulk Fill analysis showed significant differences for the elastic modulus and water sorption (p < 0.001), and specimens that had been subject to a radiant exposure of 10 J/cm² showed a higher elastic modulus. In most cases, the physical and mechanical properties analyzed were not affected by different radiant exposure values. Other resin-based composite (RBC) characteristics seem to have a greater influence on material properties.

An Evaluation of the Light Output from 22 Contemporary Light Curing Units

This study measured the radiant power (mW), irradiance (mW/cm2) and emission spectra (mW/cm2/nm) of 22 new, or almost new, light curing units (LCUs): - Alt Lux II, BioLux Standard, Bluephase G2, Curing Light XL 3000, Demetron LC, DX Turbo LED 1200, EC450, EC500, Emitter C, Emitter D, KON-LUX, LED 3M ESPE, Led Lux II, Optilight Color, Optilight Max, Optilux 501, Poly Wireless, Radii cal, Radii plus, TL-01, VALO Cordless. These LCUs were either monowave or multiple peak light emitting diode (LED) units or quartz-tungsten-halogen LCUs used in anterior and posterior teeth. The radiant power emitted by the LCUs was measured by a laboratory grade laser power meter. The tip area (cm²) of the LCUs was measured and used to calculate the irradiance from the measured radiant power source. The MARC-Patient Simulator (MARC-PS) with a laboratory grade spectrometer (USB4000, Ocean Optics) was used to measure the irradiance and emission spectrum from each LCU three times at the sensor located on the facial of the maxillary central incisors and then separately at the occlusal of a maxillary second molar. The minimum acceptable irradiance level was set as 500 mW/cm2. Irradiance data was analyzed using two-way ANOVA and the radiant power data was analyzed by one-way ANOVA followed by Tukey test (a=0.05). In general, the irradiance was reduced at the molar tooth for most LCUs. Only the Valo, Bluephase G2 and Radii Plus delivered an irradiance similar to the anterior and posterior sensors greater than 500 mW/cm2. KON-LUX, Altlux II, Biolux Standard, TL-01, Optilux 501, DX Turbo LED 1200 LCUs delivered lower irradiance values than the recommended one used in molar region, KON-LUX and Altlux II LCUs used at the maxillary incisors. Bluephase G2 and Optilight Max delivered the highest radiant power and KON-LUX, Altlux II and Biolux Standard delivered the lowest power. The emission spectrum from the various monowave LED LCUs varied greatly. The multi-peak LCUs delivered similar emission spectra to both sensors.

Effects of three silane primers and five adhesive agents on the bond strength of composite material for a computer-aided design and manufacturing system

Objective

The objective of this study was to evaluate the effects of combinations of silane primers and adhesive agents on the bond strength of a composite block for a computer-aided design and manufacturing system.

Material and Methods

Three silane primers [Clearfil Ceramic Primer (CP), Super-Bond PZ Primer (PZ), and GC Ceramic Primer II (GP)] were used in conjunction with five adhesive agents [G-Premio Bond (P-Bond), Repair Adhe Adhesive (R-Adhesive), Super-Bond D-Liner Dual (SB-Dual), Super-Bond C&B (SB-Self), and SB-Dual without tributylborane derivative (SB-Light)]. The surface of a composite block (Gradia Block) was ground with silicon carbide paper. After treatment with a silane primer, a adhesive agent was applied to each testing specimen. The specimens were then bonded with a light-curing resin composite. After 24 h, the shear bond strength values were determined and compared using a post hoc test (α=0.05, n=8/group). We also prepared control specimens without primer (No primer) and/or without adhesive agent (No adhesive).

Results

PZ/SB-Dual and GP/SB-Dual presented the highest bond strength, followed by GP/P-Bond, CP/SB-Dual, CP/R-Adhesive, No primer/SB-Dual, GP/R-Adhesive, CP/P-Bond, No primer/R-Adhesive, PZ/R-Adhesive, CP/SB-Self, PZ/P-Bond, PZ/SB-Self, and GP/SB-Self in descending order of bond strength. No primer/P-Bond, No primer/SB-Self, and all specimens in the SB-Light and No adhesive groups presented the lowest bond strengths.

Conclusion

A dual-curing adhesive agent (SB-Dual) containing a tributylborane derivative in combination with a silane primer (GP or PZ) presents a greater bond strength between the composite block and the repairing resin composite than the comparators used in the study.

Guidelines for the selection, use, and maintenance of LED light-curing units - Part 1

Light curing is a critical step in the restorative process when using light-activated resin-based composites, but it is frequently not given the attention it deserves. The selection of a reliable light curing unit (LCU) that meets the practitioner's needs is an important equipment purchase. Using an inappropriate LCU may seriously compromise the quality of care without the practitioner realising their mistake until years later. The importance of the subject is reflected by the rapidly increasing use of light-cured composites and the decline in the use of amalgam. Many changes have occurred in the equipment and materials available for making light-cured restorations in the last twenty years. This article is part of a two-part series that will describe those changes and recommend guidelines for the selection, use, and maintenance of light emitting diode light-curing units (LED LCUs). This paper (Part 1) discusses terminology, clinical studies, the development of LCUs in dentistry, the aims of light-curing, and the need to deliver an adequate amount of energy. The interaction between light source and material is briefly described to demonstrate the complex nature of the resin photopolymerisation process.

Light Curing in Dentistry

The ability to light cure resins 'on demand' in the mouth has revolutionized dentistry. However, there is a widespread lack of understanding of what is required for successful light curing in the mouth. Most instructions simply tell the user to 'light cure for xx seconds' without describing any of the nuances of how to successfully light cure a resin. This article provides a brief description of light curing. At the end, some recommendations are made to help when purchasing a curing light and how to improve the use of the curing light.

Impact of Material Shade and Distance from Light Curing Unit Tip on the Depth of Polymerization of Composites

Abstract This study aimed to evaluate the effect of the composite shade and distance from the light-curing unit (LCU) tip on the irradiance reaching the bottom of composite disks and on the depth of polymerization. Composites of three shades (opaque - OXDC, bleach - BXL, and A2) were inserted into molds with 3-mm of thickness positioned over a spectrometer and photo-activated with the LCU (Bluephase) tip placed at 0 or 1 cm from the composite surface. The mean irradiance reaching the bottom of composite was recorded during the entire photo-activation (30 s). Specimens (2 x 2 x 4 mm) were polymerized and used to map the degree of conversion achieved in different depths from irradiated surface. Specimens were sectioned into slices that were positioned over the platform of the infra-red microscope connected to the spectrometer to map the conversion. The conversion was measured in eight different depths every 500-µm. Increasing the distance of LCU tip reduced the irradiance only for A2. Interposing OXDC disks resulted in lowest values of irradiance and A2 the highest one. A tendency to decrease the conversion was observed towards the bottom of specimens for all experimental conditions, and the slope was more accentuated for OXDC. Differences among shades and distances from LCU tip were evident only beyond 1.5-2.0 mm of depth. In conclusion, both composite shade and distance from LCU tip might affect the light-transmission and depth of polymerization, while the effect of last was more pronounced.