Increases in intrapulpal temperature during polymerization of composite resin

Study on New Dental Materials Containing Quinoxaline-Based Photoinitiators in Terms of Exothermicity of the Photopolymerization Process

Modern dentistry places great demands on the dental composites used for filling tooth cavities or treating cavitated tooth decay. The aim of the work was to modify the properties of composites by changing the initiators and co-initiators. This was achieved by using initiators based on a quinoxaline skeleton and co-initiators that are derivatives of acetic acid, which is an advantage of these photoinitiating systems due to the elimination of aromatic amines from the photocurable composition. The composites also differed in dental fillers. The effect of the compounds on the exothermicity of the photopolymerization process, the surface morphology of the obtained materials and the maximum compressive strength were determined. The photoinitiating capacity of the two-component systems was tested by the microcalorimetric method using the multifunctional monomer TMPTA, typical for dental filler compositions. The new photoinitiating systems show particularly good efficiency of free radical polymerization initiation, which occurs by the photoinduced intermolecular electron transfer (PET) mechanism. The comparison of the tested systems with camphorquinone, a photoinitiator traditionally used in dentistry, made it possible to observe a decrease in temperature during photopolymerization without a significant decrease in the polymerization rate or increase in photocuring time, as well as a better homogeneity of the surface of the obtained polymeric materials. This indicates that dye-acetic acid derivative systems may be useful in dental applications.

Comparison of the Amount of Temperature Rise in the Pulp Chamber of Teeth Treated With QTH, Second and Third Generation LED Light Curing Units: An In Vitro Study

Introduction: This in vitro study was designed to measure and compare the amount of temperature rise in the pulp chamber of the teeth exposed to different light curing units (LCU), which are being used for curing composite restorations. Methods: The study was performed in two settings; first, an in vitro and second was mimicking an in vivo situation. In the first setup of the study, three groups were formed according to the respective three light curing sources. i.e. quartz-tungsten-halogen (QTH) unit and two light-emitting diode (LED) units (second and third generations). In the in vitro setting, direct thermal emission from three light sources at 3 mm and 6 mm distances, was measured with a k-type thermocouple, and connected to a digital thermometer. For a simulation of an in vivo situation, 30 premolar teeth were used. Class I Occlusal cavity of all the teeth were prepared and they were restored with incremental curing of composite, after bonding agent application. While curing the bonding agent and composite in layers, the intrapulpal temperature rise was simultaneously measured with a k-type thermocouple. Results: The first setting of the study showed that the heat produced by irradiation with LCU was significantly less at 6 mm distance when compared to 3 mm distance. The second setting of the study showed that the rise of intrapulpal temperature was significantly less with third generation LED light cure units than with second generation LED and QTH light cure units. Conclusion: As the distance from the light source increases, less irradiation heat is produced. Third generation LED lights cause the least temperature change in the pulp chamber of single rooted teeth.

Effect of simulated pulpal blood flow rate on the rise in pulp chamber temperature during direct fabrication of exothermic provisional restorations

AIM

To evaluate ex vivo the effect of several simulated pulpal blood flow rates on the change in pulp chamber temperature during direct fabrication of a provisional restoration using a polymethylmethacrylate (PMMA) resin.

METHODOLOGY

Fifteen noncarious human premolars were prepared for complete coverage restorations. A curved needle connected to a peristaltic pump simulated the pulp blood flow. Two K-type thermocouples connected to a digital thermometer were placed in the pulp chamber, and the assembly was placed in an incubator at 37 °C. Three provisional crowns were made for each specimen using no water flow (group 1), a 1-mL min^-1 flow rate (group 2) and a 0.5-mL/min^-1 flow rate (group 3). The pulp chamber temperature was recorded continuously during polymerization until the temperature increase peaked and started to decrease and reached the baseline temperature (37 °C). The temperature increase was measured for the three water flow conditions. Data were analysed statistically using descriptive statistics, repeated measures one-way analysis of variance (anova) with Greenhouse-Geisser correction and Bonferroni tests. The level of significance was set at P < 0.05.

RESULTS

All of the groups were associated with an increased pulp chamber temperature. Groups with flow rates at 1 and 0.5 mL min^-1 had a significantly lower temperature rise when compared to the group without water flow (P < 0.001).

CONCLUSIONS

Direct fabrication of provisional restorations can cause a critical increase in pulp chamber temperature. However, in the presence of simulated pulpal blood flow rates of 1 or 0.5 mL min^-1 , the increase in pulp chamber temperature did not exceed the critical threshold (5.6 °C).

Pulp Chamber Heating: An In Vitro Study Evaluating Different Light Sources and Resin Composite Layers

Abstract The aim of the present in vitro study was to evaluate the temperature variation inside the pulp chamber during light-activation of the adhesive and resin composite layers with different light sources. Cavities measuring 8x10 mm were prepared on the buccal surface of bovine incisors, leaving a remaining dentin thickness of 1 mm. Specimens were placed in a 37±1 °C water bath to standardize the temperature. The temperature in the pulp chamber was measured every 10 s during 40 s of light activation of the adhesive system (SBMP-3M/ESPE) and in the three consecutive 1-mm-thick layers of resin composite (Z250-3M/ESPE). Three light source devices were evaluated: Elipar 2500 (QTH), LD Max (LED low irradiance) and VALO (LED high irradiance). The results were submitted to one-way ANOVA with repeated measures and Tukey's test, both with p<0.001. The exothermic reaction warming was observed in the Z250 increments, but not in the SBMP. The high irradiance LED showed a higher temperature average (42.7±1.56 °C), followed by the quartz-tungsten-halogen light (40.6±0.67 °C) and the lower irradiance LED (37.8±0.12 °C). Higher temperature increases were observed with the adhesive and the first resin composite increment light-activation, regardless of the employed light source. From the second increment of Z250, the restorative material acted as a dispersive structure of heat, reducing temperature increases. Regardless the light source and restorative step, the temperature increased with the irradiation time. It may be concluded that the light source, irradiation time and resin composite thickness interfered in the temperature variation inside the pulp chamber.

Analysis and simulation of heat transfer in human tooth during the curing of orthodontic appliance and food ingestion

The aim of this study was to analyze and simulate the heat transfer in the human tooth undergoing fixed orthodontic appliances and food intake. An in vivo representative mathematic model of a layered thermographic profile was developed during the LED curing of Gemini bracket 0.022 in slot (conventional ligating system) and Transbond XT adhesive. The characterization of the layered thermic response allowed to identify if during the LED curing process, according to manufacturer’s specification (light curing unit, adhesive) can induce pulpar necrosis. The profile’s thermographic model was the simulation basis of many conditions such as food intake, due to in vivo metrology is affected by the impossibility of a correct apparatus position and the physiologic function of the oral cavity which is exposed to uncontrollable temperature changes. The metrology was carried out with a T-440 thermographic camera during LED curing bracket, using a LED curing light (Elipar S10) placed at 3 ± 1 mm for 5 s at each mesial and distal surface. The thermography outcomes were analyzed in the FLIR Tools Software, Microsoft Excel 2013 and SPSS 22. To adjust the mathematic model error, in vitro studies were performed on third molars for the purpose of realizing extreme exposition temperature condition tests caused by the LED curing unit without jeopardizing the human tooth vitality as would it be on in vivo experimentation. The bracket curing results according to manufacturer’s conditions reached 39°C in vivo temperatures and 47°C on in vitro tests, which does not jeopardize human tooth vitality as said by previous researches, although, an LED curing precise protocol established by the manufacturer’s LED curing light is sustained.

Conversion and temperature rise of remineralizing composites reinforced with inert fillers

OBJECTIVES

Remineralizing experimental composites based on amorphous calcium phosphate (ACP) were investigated. The impact of curing time (20 and 40s), curing depth (1, 2, 3 and 4mm) and addition of inert fillers (barium glass and silica) on the conversion and temperature rise during curing were examined.

METHODS

Five ACP-composites and two control composites were prepared based on the light-curable EBPADMA-TEGDMA-HEMA resin. For temperature measurements, a commercial composite was used as an additional control. Conversion was assessed using FT-Raman spectroscopy by comparing the relative change of the band at 1640 cm(-1) before and after polymerization. The temperature rise during curing was recorded in real-time using a T-type thermocouple.

RESULTS

At 1mm depth, the ACP-composites attained significantly higher conversion (77.8-87.3%) than the control composites based on the same resin (60.5-66.3%). The addition of inert fillers resulted in approximately 5% lower conversion at clinically relevant depths (up to 2mm) for the curing time of 40s. Conversion decline through depths depended on the added inert fillers. Conversion values higher than 80% of the maximum conversion were observed for all of the ACP-composites at depths up to 3mm, when cured for 40s. Significantly higher total temperature rise for the ACP-composites (11.5-13.1 °C) was measured compared to the control composites (8.6-10.8 °C) and the commercial control (8.7 °C).

CONCLUSIONS

The admixture of inert fillers represents a promising strategy for further development of ACP-composites, as it reduced the temperature rise while negligibly impairing the conversion.

CLINICAL SIGNIFICANCE

High conversions of ACP-composites are favorable in terms of mechanical properties and biocompatibility. However, high conversions were accompanied with high temperature rise, which might present a pulpal hazard.

Influence of Cavity Preparation, Light-curing Units, and Composite Filling on Intrapulpal Temperature Increase in an In Vitro Tooth Model

This study examined the effect of both the tooth substance and restorative filling materials on the increase in pulp chamber temperature when using light-curing units with different power densities.

The tip of a temperature sensor was positioned on the pulpal dentinal wall of the buccal side of a maxillary premolar. Metal tubes were inserted in the palatal and buccal root of the tooth, one for water inflow and the other for water outflow. Polyethylene tubes were connected from the metal tubes to a pump to control the flow rate. For the unprepared tooth group (group 1), the tooth was light-cured from the buccal side using two light-curing units (three curing modes): the VIP Junior (QTH, BISCO, Schaumburg, IL, USA) and the Bluephase LED light-curing units (two modes: LEDlow and LEDhigh; Ivoclar Vivadent, Schaan, Liechtenstein). The power densities of each light-curing unit for the LEDlow, QTH, and LEDhigh modes were 785 mW/cm2, 891 mW/cm2, and 1447 mW/cm2, respectively. All light-curing units were activated for 60 seconds. For the prepared tooth group (group 2), a Class V cavity, 4.0 mm in width by 4.0 mm in height by 1.8 mm in depth in size, was prepared on the buccal surface of the same tooth for the temperature measurement. The light-curing and temperature measurements were performed using the same methods used in group 1.

The cavity prepared in group 2 was filled with a resin composite (Tetric N Ceram A3 shade, Ivoclar Vivadent) (group 3) or a flowable composite (Tetric N Flow with A3 shade, Ivoclar Vivadent) (group 4). The light-curing and temperature measurements were performed for these groups using the same methods used for the other groups.

The highest intrapulpal temperature (TMAX) was measured, and a comparison was conducted between the groups using two-way analysis of variance with a post hoc Tukey test at the 95% confidence level.

The TMAX values were as follows: 38.4°C (group 1), 39.0°C (group 2), 39.8°C (group 3), and 40.3°C (group 4) for the LEDlow mode. For the QTH mode, the TMAX values were 40.1°C (group 1), 40.4°C (group 2), 40.9°C (group 3), and 41.4°C (group 4). For the LEDhigh mode, the TMAX values were 43.3°C (group 1), 44.5°C (group 2), 44.7°C (group 3), and 45.3°C (group 4). The statistical analysis revealed the following: the TMAX values were arranged by mode in the following manner: LEDlow &lt; QTH &lt; LEDhigh (p&lt;0.05) and group 1 &lt; group 2 ≤ group 3 ≤ group 4 (p&lt;0.05).

Different laser wavelengths comparison in the second-stage implant surgery: an ex vivo study

The implant surgery consists of two distinct techniques, the transmucosal, also known as "one-stage" and the "two-stage" technique. Lasers represent a possible aid in implant dentistry, especially in the two-stage technique and its main characteristics are represented by a decreased trauma to bone and soft tissues, a reduction of pain as well as a reduction of the risk of postoperative infections. The aim of this study was to analyze in an animal model the thermal elevation induced by four different laser wavelengths (diode, Nd:YAG, Er:YAG, KTP) during the implant uncovering. Four pig jaws were used to carry out this study. Five implants were placed in each anatomical specimen for a total of 20 fixtures. Four wavelengths (532, 810, 1,064 and 2,940 nm) were used to uncover the implants. Two thermocouples were used to measure temperature changes during laser irradiation at bone level, peri-implant tissues and on the fixture surface The thermocouples were connected with two probes of 1.5 mm in diameter, in order to simultaneously recording two temperature variations. Surface temperature was also checked during all procedures with a thermal camera (Thermovision A 800, Flyr Systems, Stockolm, Sweden) connected to a PC. The mean temperatures of each specimen (five fixtures) were calculated (TM1, mean temperature at the beginning; TM2, mean peak temperature). Furthermore, a record of the temperature at 1 min after the end of the surgical procedure was taken (mean: TM3). All the recorded values were statistically evaluated by one-way analysis of variance (ANOVA). The thermocouples recorded a lower increase in temperature for Er:YAG and KTP laser; Nd:YAG and diode laser produced similar increases characterized by higher values. The thermo-camera pointed out the lower increase for Er:YAG and higher for diode laser. KTP laser resulted faster in uncovering implants and diode laser was the one that needed more time. This ex vivo study showed that laser utilization with the recommended parameters gives no risks of dangerous thermal elevation to the tissues and implants.

Laser welded versus resistance spot welded bone implants: analysis of the thermal increase and strength

INTRODUCTION

The first aim of this "ex vivo split mouth" study was to compare the thermal elevation during the welding process of titanium bars to titanium implants inserted in pig jaws by a thermal camera and two thermocouples. The second aim was to compare the strength of the joints by a traction test with a dynamometer.

MATERIALS AND METHODS

Six pigs' jaws were used and three implants were placed on each side of them for a total of 36 fixtures. Twelve bars were connected to the abutments (each bar on three implants) by using, on one side, laser welding and, on the other, resistance spot welding. Temperature variations were recorded by thermocouples and by thermal camera while the strength of the welded joint was analyzed by a traction test.

RESULTS

For increasing temperature, means were 36.83 and 37.06, standard deviations 1.234 and 1.187, and P value 0.5763 (not significant). For traction test, means were 195.5 and 159.4, standard deviations 2.00 and 2.254, and P value 0.0001 (very significant).

CONCLUSION

Laser welding was demonstrated to be able to connect titanium implant abutments without the risk of thermal increase into the bone and with good results in terms of mechanical strength.

Influence of whitening gel on pulp chamber temperature rise by in-office bleaching technique

INTRODUCTION: Dental bleaching is a conservative method for the aesthetic restoration of stained teeth. However, whitening treatments are likely to cause adverse effects when not well planned and executed. OBJECTIVE: This study evaluated the influence of whitening gel on temperature rise in the pulp chamber, using the in-office photoactivated dental bleaching technique. MATERIAL AND METHOD: The root portion of an upper central human incisor was sectioned 3mm below the cemento-enamel junction. The root canal was enlarged to permit the insertion of the K-type thermocouple sensor (MT-401) into the pulp chamber, which was filled with thermal paste to facilitate the transfer of heat during bleaching. Three photosensitive whitening agents (35% hydrogen peroxide) were used: Whiteness HP (FGM), Whiteness HP Maxx (FGM) and Lase Peroxide Sensy (DMC). An LED photocuring light (Flash Lite - Discus Dental) was used to activate the whitening gels. Six bleaching cycles were performed on each group tested. The results were submitted to one-way ANOVA and LSD t-test (α<0.05). RESULT: The lowest mean temperature variation (ºC) was detected for Lase Peroxide Sensy (0.20), while the highest was recorded for Whiteness HP (1.50). CONCLUSION: The Whiteness HP and Whiteness HP Maxx whitening gels significantly affected the temperature rise in the pulp chamber during bleaching, and this variation was dependent on the type of whitening gel used.

Thermal irritation of teeth during dental treatment procedures

While it is reasonably well known that certain dental procedures increase the temperature of the tooth's surface, of greater interest is their potential damaging effect on the pulp and tooth-supporting tissues. Previous studies have investigated the responses of the pulp, periodontal ligament, and alveolar bone to thermal irritation and the temperature at which thermal damage is initiated. There are also many in vitro studies that have measured the temperature increase of the pulp and tooth-supporting tissues during restorative and endodontic procedures. This review article provides an overview of studies measuring temperature increases in tooth structures during several restorative and endodontic procedures, and proposes clinical guidelines for reducing potential thermal hazards to the pulp and supporting tissues.

Thermal increase in the oral mucosa and in the jawbone during Nd:YAG laser applications. Ex vivo study

Objective: Literature reports bactericidal and biostimulant effects for Nd:YAG laser procedures on bone and oral mucosa but the possible overheating can cause damage to anatomical structures. The aim of the study is the evaluation of thermal increase in different levels of oral tissues: mucosa, periosteum and bone during defocused application of Nd:YAG laser at different parameters. Study Design: Superficial thermal evaluation was performed in pig jaws with a thermal camera device; deep thermal evaluation was realized by 4 thermocouples placed at a subperiosteal level and at 1,2 and 4 mm depth in the jaw bone. Laser applications of 1 minute were performed 5 times (with a pause of 1 minute) on a surface of 4 cm2 with a Nd:YAG laser (VSP mode, 320 micrometer fiber, defocused mode) with different parameters. Temperatures were recorded before and after laser applications and after each pause in order to evaluate also the thermal relaxation of tissues. Results: At submucosal level, mean thermal increase was between 1.1°C and 13.2°C, at 1 mm depth between 1.1°C and 8.5°C, at 2 mm depth between 1.1°C and 6.8°C, at 4 mm depth between 1.0°C and 5.3°C. Temperature decrease during the rest time period was variable between 0°C and 2.5°C. Conclusions: Temperatures reached during clinical procedures with parameters reported in the literature in biostimulation protocols (1.25-2 Watts) for the five minutes of application are not dangerous for biological structures. The decrease in temperature during the rest time period is less considerable in the bone in comparison to oral mucosa.

Key words:Nd:YAG laser, thermal increase, thermocouple, thermal camera, low level laser therapy.

Laser-assisted surgery with different wavelengths: a preliminary ex vivo study on thermal increase and histological evaluation

Since the introduction of laser in clinical practice, different wavelengths have been used for oral surgery on the basis of the different characteristics and affinities of each one. The aim of this study was a comparison of different laser wavelengths in relation to both thermal increase and "histological quality" in a model of soft tissue surgery procedures. Thermal evaluation was realized, during laser-assisted surgery excision performed on a bovine tongue, by a thermal camera device to evaluate thermal increase on the surface of the sample and with four thermocouples to evaluate thermal increase on the depth of the specimen; temperature was recorded before starting surgical procedure and at the peak of every excision. The quality of excision, in terms of tissue damage and regularity, was realized by two blind examiners on the basis of established criteria. The highest superficial thermal increase was recorded for Superpulse 5-W CO2 laser, the lowest one for Er:YAG laser. The highest in depth thermal increase was recorded for 5 W Diode laser, the lowest one for Er:YAG laser. The best quality of incision was obtained with a 3-W CO2 laser and 3-W diode laser; epithelial, stromal, and vascular damages were evaluated with different degrees for all the used wavelengths with the best result, in terms of "tissue respect," for Er:YAG laser. In all the surgical procedures performed, thermal increase was evaluated until the end of the procedure; at remaining tissue level, thermal decrease was evaluable in the few seconds after surgery. The Er:YAG laser was the device with a lower influence on thermal increase; CO2 and diode lasers revealed a good histological quality. Further studies may be necessary to test the reliability of laser devices for the excision of all the types of specimens needing histological evaluation and diagnosis.

Influence of various polishing methods on pulp temperature : an in vitro study

OBJECTIVE

After orthodontic debonding, adhesive removal can lead to rises in pulp temperature, causing histological changes or pulp necrosis. The objective of this study was to measure increases in pulp temperature during adhesive removal using different instruments and various cooling procedures.

MATERIALS AND METHODS

A thermoelement was introduced into the pulp chamber of 10 human incisors. The teeth were immersed in a 36°C water bath up to the cementoenamel junction. Two carbide burs, one polishing disk and two rubber points were used for polishing. All measurements were taken over a 10 s period by a single investigator, under slight pressure and with constant motion. Three cooling procedures were examined: no cooling, air cooling and water cooling. Pulp temperatures were measured before polishing and after 10 s of polishing.

RESULTS

Without cooling, the two rubber points revealed clinically relevant temperature increases of 6.1°C and 12.4°C. Cooling with air and with water reduced pulp temperature in conjunction with all polishing methods. Air cooling was most efficient, except in combination with the polishing disk.

CONCLUSION

Under these study conditions, carbide burs and polishing disks can be used safely and without risk to the pulp, even without cooling. On the other hand, rubber points cause a marked increase in pulp temperature when used without cooling.

Intra-oral laser welding: an in vitro evaluation of thermal increase

The neodymium:yttrium-aluminium-garnet (Nd:YAG) laser is currently used in dental laboratories to weld metals on dental prostheses. Recently, the use of Nd:YAG has been suggested so that dentists themselves can repair broken fixed, removable and orthodontic prostheses by welding metals directly in the mouth. This work aimed to evaluate, through a four k-type thermocouple system on calf jaws, the thermal increase in the biological structures close to the metal parts during laser welding. We put two hemispherical metal plates onto mandibular molars and then laser welded them at three points with a four k-thermocouple system to determine the thermal rise in the pulp chamber, sulcus, root and bone. This procedure was carried out on 12 samples, and the results were processed. The highest values of thermal increase were found in the pulp chamber, 1.5 degrees C; sulcus, 0.7 degrees C; root, 0.3 degrees C; and bone, 0.3 degrees C. This study showed that thermal increases in pulp chamber, sulcus, root and bone were biologically compatible and that intra-oral laser welding, at the parameters used in this work, seems to be harmless to the biological structures close to the welding and thermally affected zones.