Polymerization of resin composite restorative materials: exposure reciprocity

Effect of Light Irradiance and Curing Duration on Degree of Conversion of Dual-Cure Resin Core in Various Cavities with Different Depths and Diameters

(1) Background: To compare the degree of conversion of resin cores in various types of cavities and determine an effective irradiation method for achieving a higher degree of conversion. (2) Methods: Four different-sized cavities (narrow-shallow, narrow-deep, wide-shallow, and wide-deep) were simulated using a Teflon mold. The light irradiance reaching the bottom of each mold was measured by positioning a radiometer. The degree of conversion of the dual-cure resin core after irradiation (400 mW/cm2 for 20 s, 400 mW/cm2 for 40 s, and 800 mW/cm2 for 20 s) was measured using Fourier-transform near-infrared spectroscopy. (3) Results: The highest light irradiance was found at the bottom of wide-shallow cavities, followed by wide-deep, narrow-shallow, and narrow-deep ones (p < 0.001). In narrow cavities, irradiation at 800 mW/cm2 for 20 s led to a significantly higher degree of conversion (p < 0.001). In wide cavities, irradiation at 400 mW/cm2 for 40 s and 800 mW/cm2 for 20 s both led to a significantly higher degree of conversion (p < 0.001). (4) Conclusions: Less curing light reaches the bottom of cavities with a smaller diameter and greater depth. Providing a higher irradiance of light can induce a higher degree of conversion of resin composites in narrower cavities.

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.

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.

Effect of Radiant Exposure on the Physical and Mechanical Properties of 10 Flowable and High-viscosity Bulk-fill Resin Composites

OBJECTIVES

To evaluate the effect of the different radiant exposures from a multipeak light curing unit on the physical and mechanical properties of flowable and high-viscosity bulk-fill resin-based composites (RBC).

METHODS

Five flowable bulk-fill RBCs (Tetric N-Flow Bulk-fill, Ivoclar Vivadent; Filtek Bulk Fill Flow, 3M Oral Care; Opus Bulk Fill Flow APS, FGM; Admira Fusion x-base, Voco and; and SDR Plus Bulk Fill Flowable, Dentsply Sirona) and five high-viscosity bulk-fill RBCs (Tetric N-Ceram Bulk-fill, Ivoclar Vivadent; Filtek One Bulk Fill, 3M Oral Care; Opus Bulk Fill APS, FGM; Admira Fusion x-tra, Voco; and SonicFill 2, Kerr) were photo-cured using a VALO Cordless light (Ultradent) for 10, 20, and 40 seconds at an irradiance of 1200, 800, or 400 mW/cm2, resulting in the delivery of 4, 8, 12, 16, 24, 32, or 48 J/cm2. Post-gel shrinkage (Shr) was calculated using strain-gauge test. The degree of conversion (DC, %) was calculated using FTIR. Knoop hardness (KH, N/mm2) and elastic modulus (E, MPa) were measured at the top and bottom surfaces. Logarithmic regressions between the radiant exposures and mechanical properties were calculated. Radiodensity was calculated using digital radiographs. Data of Shr and radiodensity were analyzed using two-way analysis of variance (ANOVA), and the DC, KH, and E data were analyzed with two-way ANOVA using split-plot repeated measurement tests followed by the Tukey test (a = 0.05).

RESULTS

Delivering higher radiant exposures produced higher Shr values (p<0.001) and higher DC values (R2=0.808-0.922; R2=0.648-0.914, p<0.001), KH (R2=0.707-0.952; R2=0.738-0.919; p<0.001), and E (R2=0.501-0.925; R2=0.823-0.919; p<0.001) values for the flowable and high-viscosity RBCs respectively. Lower KH, E and Shr were observed for the flowable bulk-fill RBCs. All bulk-fill RBCs had a radiopacity level greater than the 4-mm thick aluminum step wedge. The radiant exposure did not affect the radiopacity.

CONCLUSION

The Shr, DC, KH, and E values were highly correlated to the radiant exposure delivered to the RBCs. The combination of the higher irradiance for longer exposure time that resulted in radiant exposure between 24 J/cm2 to 48 J/cm2 produced better results than delivering 400 mW/cm2 for 40 s (16 J/cm2), and 800 mW/cm2 for 20 seconds (16 J/cm2) or 1200 mW/cm2 for 10 seconds (12 J/cm2). All the bulk-fill RBCs were sufficiently radiopaque compared to 4 mm of aluminum.

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.

Effects of Material Thickness and Pretreatment on the Interfacial Gap of Translucent Zirconia Restorations with Self-adhesive Resin Cement

Purpose

The first objective was to determine if the dual-curing of self-adhesive resin cement (SAC) with reduced light penetrating through zirconia had an effect on interfacial gap of zirconia restorations. The second purpose was to examine whether pretreatment methods for universal adhesive affected interfacial gap. The last aim was to compare the microhardness of SAC polymerized under different zirconia thicknesses.

Methods and Materials

This study evaluated self-adhesive resin cement (RelyX U200, 3M ESPE) after different pretreatment with universal adhesive (Single Bond Universal, 3M ESPE) under different polymerization conditions. CAD/CAM inlay cavities were prepared on extracted third molars. Translucent zirconia restorations were milled using Katana UTML (Kuraray). The teeth were divided into three groups: Groups I, II, and III in which the restoration thicknesses were 1, 2, and 3 mm. Each Group had three subgroups according to different pretreatment methods. For subgroup-1, no pretreatment was done on the prepared cavity. For subgroup-2, universal adhesive was applied and light-cured before cement placement (precure method). For subgroup-3, universal adhesive was applied; however, light-curing was done after cement placement (cocure method). After thermo-cycling, the interfacial gap at the restoration-tooth interface was investigated using swept-source optical coherence tomography imaging. Finally, microhardness was measured for SAC under different zirconia thicknesses. For statistical analysis, the interfacial gap was analyzed using two-way analysis of variance (ANOVA) to test the effect of cavity depth and pretreatment. In terms of each cavity depth and pretreatment, the interfacial gap was compared using one-way ANOVA and Scheffe’s test. One-way ANOVA was also performed for comparison of the Vickers hardness results.

Results

Different thicknesses of the restoration resulted in differences in interfacial gaps except between the precure method of Groups I and II (p&lt;0.05). The effect of universal adhesive pretreatment was different depending on the restoration thickness with exceptions in Groups I and III (p&lt;0.05). Vickers hardness number decreased as the low radiant exposure of light was applied (p&lt;0.05).

Conclusion

Interfacial gap of zirconia restorations can differ depending on the material thickness, pretreatment, and activation mode. Reduced light intensity penetrating through zirconia may lead to higher interfacial gap percentage and lower microhardness of the self-adhesive resin cement. Application of a universal adhesive showed similar or reduced interfacial gaps in the cement space.

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.

Effect of different curing times and distances on the microhardness of nanofilled resin-based composite restoration polymerized with high-intensity LED light curing units

Purpose

This study examined the effect of different distances and curing times on the microhardness (VHN) of nanofilled resin-based composite (RBC) restorations polymerized with high-intensity LED LCUs.

Materials and methods

Seventy-five RBC specimens (2 mm thickness and 5 mm diameter) were fabricated from Tetric-N-Ceram (Ivoclar Vivadent). Each of the 25 specimens was polymerized by means of one of three types of high-intensity LED LCUs: (B) Blue-Phase-G2 (polywave LED, Ivoclar Vivadent), (E) Elipar S10 ^TM (single-peak, 3 M ESPE), and (P) Planmica Lumion (single-peak, Mectron) at three different distances (0 mm, 2 mm, and 4 mm) at 20 sec, 40 s, and 60 sec. A microhardness tester (NOVA, Innovatest, The Netherlands) was used to measure the VHN from the top and bottom surfaces. Data for VHN were analyzed using mixed ANOVA, followed by post hoc analyses with p-values < 0.05.

Results

A significant difference was found in VHN between all three LED LCUs, where (B) specimens had the highest means, followed by (E) and (P). Bottom surface VHN values were reduced significantly (p < 0.05) compared to top surface values in all LCU types. With increasing distances up to 2 mm and 4 mm, VHN values with (E) and (P) were significantly reduced on the top and bottom surfaces (p < 0.05). When the curing times were increased for 40 and 60 sec, the VHN values were significantly improved (p < 0.05). Meanwhile, increasing the distance with (B) did not significantly reduce the VHN. Moreover, increasing the curing times did not significantly improve the VHN of the bottom surfaces.

Conclusion

High-intensity LCUs have variable effects on the surface (top/bottom) hardness of Tetric-N-Ceram nanofilled RBC restoration. With increasing distance, VHN was reduced; therefore, compensation with more curing time (2 mm/40 sec and 4 mm/60 sec) is highly recommended with Elipar S10 and Planmica Lumion LCUs to improve the material surface hardness.

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.

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.

Structural and mechanical analysis of three orthodontic adhesive composites cured with different light units

OBJECTIVE

To evaluate the effects of three different curing units on the physical and mechanical features of three different orthodontic adhesive resin materials.

MATERIAL AND METHODS

45 specimens (5 mm in diameter, and 2 mm in thickness) of each of the three different adhesive composite resin materials (Transbond XT, Grēngloo™ Adhesive and Light Bond Paste) were cured with three different light units (a polywave third generation (Valo), a monowave (DemiUltra), and a second-generation LED (Optima 10)). To quantify degree of conversion (DC), the Attenuated Total Reflectance Fourier Transform Infrared Spectroscopy was used in transmission mode (ALPHA FT-IR Spectrometer, Bruker Optics, Germany). Vickers hardness value was recorded under constant load 100 g for 10 s with a microhardness tester (HMV M-1, Shimadzu Corp., Kyoto, Japan). The data were statistically analyzed using Kruskal-Wallis and chi-square tests. The level of significance was considered p < 0.05.

RESULTS

The highest DC values were obtained as a result of curing with Optima 10. This rate was followed by Demi Ultra and Valo, respectively. Transbond XT samples showed a lower level of conversion than the samples of Light Bond Paste and Grēngloo™ Adhesive. The top surfaces of each material showed higher hardness values than the bottom surfaces (p < 0.05). The Light Bond Paste showed the highest hardness values both on the top and bottom surfaces among the three materials, followed by Grēngloo™ Adhesive. While the hardness values of the top surfaces of the samples cured with Demi Ultra and Valo light units were similar, higher hardness values are recorded with Valo on the bottom surfaces (Valo; 85.200/75.200 (top/bottom) versus Demi Ultra; 86.100/66.000 (top/bottom)).

CONCLUSIONS

The different DC and the surface hardness properties were recorded for the resin as orthodontic adhesives depending on different light units. Shorter radiation time caused lower DC and surface hardness values.

Correlation of the mechanical and biological response in light-cured RBCs to receiving a range of radiant exposures: Effect of violet light

OBJECTIVE

This study correlates the mechanical and biological response of commercially available resin-based composites (RBCs) to clinically relevant light-curing conditions.

METHODS

Two RBCs (Venus and Venus Pearl; Kulzer) that use different monomer and photo-initiator systems, but have a similar filler volume and shade, were exposed to either just blue light, or violet and blue light from two different LCUs (Translux Wave and Translux 2Wave; Kulzer). Distance and exposure times were adjusted so that both LCUs delivered 5 similar levels of radiant exposures (RE) between 1.5 J/cm²-25 J/cm² in the blue wavelength range. Thus, the violet light was additional light. The top and bottom of 2-mm thick specimens were subjected to a depth-sensing indentation test (Martens hardness/HM, Vickers hardness/HV, indentation modulus/Y_HU, mechanical work/W_total, plastic deformation work/W_plas, creep/Cr). The viability of human gingival fibroblasts was assessed after three days of exposure to RBC eluates. One and multiple-way analysis of variance (ANOVA), the Tukey honestly significant difference (HSD) post-hoc tests (α = 0.05), t-test and a Spearman correlation analysis were used.

RESULTS

As the RE increased, the mechanical properties increased at a greater rate at the top compared to the bottom of the RBCs. Values measured at the bottom of 2-mm increments approached the values measured at the top only when RE > 25 J/cm² of blue light was delivered. Toxicity decreased with RE and elution cycles and was lower for Venus Pearl. Within one RE level, addition of violet light resulted in significantly improved properties (in 131 out of 150 comparisons, p < 0.05). This effect was stronger for Venus Pearl. There was a good correlation between mechanical and biological parameters. This correlation decreased as the number of eluates increased.

CLINICAL SIGNIFICANCE

The mechanical and biological response to variation in RE is interrelated. The addition of violet light has a positive effect, particularly at low RE.

Effect of light-curing distance and curing time on composite microflexural strength

This study investigated the influence of curing distance on µ-flexural strength (µ-FS) of a nano-hybrid composite, cured using the manufacturer-recommended curing time (MCT), compared to a consistent radiant exposure (CRE) using three different light-curing units (LCUs). Beams (6×2×1 mm) were cured using the MCT or CRE with a quartz-tungsten-halogen (QTH); a single-emission-peak light-emitting-diode (SLED), or a multiple-emission-peak light-emitting-diode (MLED) LCU. Specimens were cured at 0-, 2- or 8-mm distances (n=10) and the bottom irradiance and CRE were measured using a Managing Accurate Resin Curing-Resin Calibrator spectrometer. µ-FS testing was performed, and data analyzed using two-way ANOVA and Tukey multiple comparison tests (α=0.05). Mean bottom irradiance was (25.4-99.7 mW/cm²) and CRE (0.31-1.11 J/cm²). µ-FS was 422.1-516.6 MPa (MCT) and 440.4-490.4 MPa (CRE). Comparing CRE to MCT showed that µ-FS significantly decreased using the CRE at 2-mm (QTH) or the MCT at 2- and 8-mm (SLED). µ-FS may be significantly impacted by the curing protocol.

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.

The effect of curing mode of a high-power LED unit on bond strengths of dualcure resin cements to dentin and CAD/CAM resin blocks

The purpose of this study was to investigate the effects of curing mode with a high-power LED curing unit (VALO) in terms of microtensile bond strength (μTBS) to dentin and microhardness of two dual-cure resin cements. Panavia V5 (V5) and Rely X Ultimate (RXU) were polymerized using one of three curing modes with VALO or self-cure mode to bond a CAD/CAM resin block to a flat dentin surface. Specimens were sectioned and subjected to μTBS test. Vickers hardness values of V5 and RXU were also measured. Two-way ANOVA indicated curing mode and resin cement affected μTBS. For self-cure mode, V5 had significantly higher μTBS than RXU (p<0.05). Higher irradiance did not always provide higher μTBS of dual-cure resin cement to dentin. One-way ANOVA indicated the curing modes affected microhardness of each cement. As for microhardness of RXU, there were significant differences between selfcure mode and light cure modes (p<0.05).

Bond durability when applying phosphate ester monomer-containing primers vs. self-adhesive resin cements to zirconia: Evaluation after different aging conditions

PURPOSE

This study aimed to evaluate bond durability when applying 2 phosphate ester monomer-containing self-adhesive resin cements alone, versus a combination of phosphate ester monomer-containing primer conditioning plus 2 conventional resin cements requiring primers, to zirconia after different artificial aging methods.

METHODS

We cemented air-abraded zirconia plates to composite resin cylinders with self-adhesive resin cements (MS; RU) alone or cemented them with traditional resin cements (ZRV; ZVN) after pre-conditioning with a zirconia primer. A shear bond strength (SBS) test were performed after subjecting them to 19 different aging conditions (n = 15) comprising 30,000× thermocycles, air storage at room temperature (RT), water storage at RT, or at 37 °C for 24 h, 1 week, 1, 3, 6, and 12 months. Zirconia powders mixed with zirconia primer or 2 self-adhesive resin cements were characterized by X-ray photoelectron spectroscopy.

RESULTS

Groups MS and ZVN obtained the highest SBS after all of aging methods. SBS after 6 months of storage was similar to SBS after 24 h of storage, while both were higher than SBS after 1 year of storage. Water storage at 37 °C provided higher SBS than RT water storage did. We detected a Zr-O-P bond in both self-adhesive resin cement/zirconia powder mixtures.

CONCLUSIONS

Application of self-adhesive resin cements alone could be an alternative to pre-conditioning with a zirconia primer followed by the application of conventional resin cements. Formation of Zr-O-P bonds contributed to the bonding improvement of self-adhesive resin cements. Different aging conditions affected SBS values.

Light-curing of orthodontic bracket adhesive by transillumination through dentine and enamel

Bonding properties of light-curing adhesive cured by transillumination through the tooth were compared to those achieved by the conventional technique. The study analyzed the degree of cure (DC%), debonding force (DF) and adhesive remnant index (ARI) when light was transmitted through dental hard tissues.

Slices of dentin and enamel of 1 mm in thickness were combined with total thicknesses of 3 or 4 mm to simulate tooth structure without the pulp tissue. DC% with curing time of 20 s, 40 s and 60 s and irradiance power was measured for each group (n = 5). Brackets were bonded using transillumination on extracted incisors (n = 6) and premolars (n = 10), and DF was measured and ARI was scored.

No statistical difference was found in light transmission between the simulated samples and incisors (p > .05). Increasing the curing time from 40 s to 60 s enhanced the DC% only in premolars (p < .05). An adequate DF was achieved through transillumination both in incisors and premolars, but in premolars, the DC% remained low compared to conventionally cured brackets. Most of the bracket failures resulted from weak bracket-adhesive bond.

The Influence of Distance on Radiant Exposure and Degree of Conversion Using Different Light-Emitting-Diode Curing Units

Objectives:

To investigate the influence of curing distance on the degree of conversion (DC) of a resin-based composite (RBC) when similar radiant exposure was achieved using six different light-curing units (LCUs) and to explore the correlation among irradiance, radiant exposure, and DC.

Methods and Materials:

A managing accurate resin curing-resin calibrator system was used to collect irradiance data for both top and bottom specimen surfaces with a curing distance of 2 mm and 8 mm while targeting a consistent top surface radiant exposure. Square nanohybrid-dual-photoinitiator RBC specimens (5 × 5 × 2 mm) were cured at each distance (n=6/LCU/distance). Irradiance and DC (micro-Raman spectroscopy) were determined for the top and bottom surfaces. The effect of distance and LCU on irradiance, radiant exposure, and DC as well as their linear associations were analyzed using analysis of variance and Pearson correlation coefficients, respectively (α=0.05).

Results:

While maintaining a similar radiant exposure, each LCU exhibited distinctive patterns in decreased irradiance and increased curing time. No significant differences in DC values (63.21%-70.28%) were observed between the 2- and 8-mm distances, except for a multiple-emission peak LCU. Significant differences in DC were detected among the LCUs. As expected, irradiance and radiant exposure were significantly lower on the bottom surfaces. However, a strong correlation between irradiance and radiant exposure did not necessarily result in a strong correlation with DC.

Conclusions:

The RBC exhibited DC values &gt;63% when the top surface radiant exposure was maintained, although the same values were not reached for all lights. A moderate-strong correlation existed among irradiance, radiant exposure, and DC.

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.

Effect of Irradiance and Exposure Duration on Temperature and Degree of Conversion of Dual-Cure Resin Cement for Ceramic Restorations

This study investigated the effects of irradiance and exposure duration on dual-cured resin cements irradiated through ceramic restorative materials. A single light-curing unit was calibrated to three different irradiances (500, 1000, and 1500 mW/cm²) and irradiated to three different attenuating materials (transparent acryl, lithium disilicate, zirconia) with 1-mm thicknesses for 20 or 60 seconds. The changes in irradiance and temperature were measured with a radiometer (or digital thermometer) under the attenuating materials. The degree of conversion (DC) of dual-cure resin cement after irradiation at different irradiances and exposure durations was measured with Fourier transform near infrared spectroscopy. Two-way analysis of variance revealed that irradiance ( p<0.001) and exposure duration ( p<0.001) significantly affected temperature and DC. All groups showed higher DCs with increased exposure times ( p<0.05), but there were no statistically significant differences between the groups irradiated with 1000 mW/cm² and 1500 mW/cm² ( p>0.05). Higher-intensity irradiances yielded higher temperatures ( p<0.05), but exposure time did not affect temperature when materials were irradiated at 500 mW/cm² ( p>0.05).

Investigating the limits of resin-based luting composite photopolymerization through various thicknesses of indirect restorative materials

OBJECTIVE

To determine the limitations of using light-curable resin-based luting composites (RBLCs) to bond indirect ceramic/resin-composite restorations by measuring light transmittance through indirect restorative materials and the resulting degree of conversion (DC) of the luting-composites placed underneath.

METHODS

Various thicknesses (0-4mm) and shades of LAVA Zirconia and LAVA Ultimate were prepared and used as light curing filters. A commercial, light curable RBLC, RelyX Veneer (control) was compared with four experimental RBLCs of the following composition: TEGDMA/BisGMA (50/50 or 30/70wt%, respectively); camphorquinone/amine (0.2/0.8wt%) or Lucirin-TPO (0.42wt%); microfillers (55wt%) and nanofillers (10wt%). RBLCs covered with the LAVA filter were light-cured for 40s, either with the dual-peak BluephaseG2 or an experimental device emitting either in the blue or violet visible band. The samples were analyzed by Raman spectroscopy to determine DC. Light transmittance through the filters was measured using a common spectroscopy technique.

RESULTS

All the factors studied significantly influenced DC (p<0.05). RBLCs with increased TEGDMA content exhibited higher DC. Only small differences were observed comparing DC without filters and filters ≤1mm (p>0.05). For thicknesses ≥2mm, significant reductions in DC were observed (p<0.05). Transmittance values revealed higher filter absorption at 400nm than 470nm. A minimal threshold of irradiance measured through the filters that maintained optimal DC following 40s irradiation was identified for each RBLC formulation, and ranged between 250-500mW/cm².

SIGNIFICANCE

This work confirmed that optimal photopolymerization of RBLCs through indirect restorative materials (≤4mm) and irradiation time of 40s is possible, but only in some specific conditions. The determination of such conditions is likely to be key to clinical success, and all the factors need to be optimized accordingly.

Mechanical and Thermal Properties of Dental Composites Cured with CAD/CAM Assisted Solid-State Laser

Over the last three decades, it has been frequently reported that the properties of dental restorative composites cured with argon laser are similar or superior to those achieved with conventional halogen and light emitting diode (LED) curing units. Whereas laser curing is not dependent on the distance between the curing unit and the material, such distance represents a drawback for conventional curing units. However, a widespread clinical application of this kind of laser remains difficult due to cost, heavy weight, and bulky size. Recently, with regard to the radiation in the blue region of the spectrum, powerful solid-state lasers have been commercialized. In the current research, CAD (computer-aided design)/CAM (computer-aided manufacturing) assisted solid-state lasers were employed for curing of different dental restorative composites consisting of micro- and nanoparticle-reinforced materials based on acrylic resins. Commercial LED curing units were used as a control. Temperature rise during the photopolymerisation process and bending properties were measured. By providing similar light energy dose, no significant difference in temperature rise was observed when the two light sources provided similar intensity. In addition, after 7 days since curing, bending properties of composites cured with laser and LED were similar. The results suggested that this kind of laser would be suitable for curing dental composites, and the curing process does not suffer from the tip-to-tooth distance.

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.

Evaluation of fracture resistance and mode of failure of premolars restored with nanohybrid composite, ORMOCER and ceramic inlays

Objectives

To evaluate the fracture resistance and mode of failure of maxillary premolars restorations restored with nanohybrid Composite, ORMOCER and Ceramic Inlays.

Materials and method

100 extracted first maxillary premolar were collected. Samples were divided into five groups. Group I - Intact premolars, Group II -MOD cavities without restorations, Group III - MOD cavities restored with composite restoration, GROUP IV - MOD cavities restored with ORMOCER restoration and GROUP V - MOD cavities restored with ceramic inlays. All the samples were sent for the axial compression test under the universal testing machine. Fracture resistance and fracture modes were recorded.

Result

Highest fracture resistance was achieved in Group V (1324.74 ± 336.78) almost comparable to that of natural tooth (1381.07 ± 259.36) (p < 0.05), followed by Group IV (MOD cavities with ORMOCER restorations) (1082.27 ± 351.27) (p < 0.01) and least fracture resistance in Group III (MOD cavities with composite restorations) (778.35 ± 100.25) (p < 0.0001). Mode of fracture in Group IV and Group V are almost similar and In Group III 65% of the cases showed non-restorable fractures.

Conclusion

ORMOCER fracture resistance along with other groups of clinically restorable fracture stand better than Nanohybrid composite.

Clinical Relevance

Based on the present study, the dentist can utilize the ORMOCER material as a restoration material for the cavities of posterior teeth which is better in terms of fracture resistance and durability of the restoration when compare to nanohybrid composite.

Characterization of Inorganic Filler Content, Mechanical Properties, and Light Transmission of Bulk-fill Resin Composites

OBJECTIVES

The aims of this study were to characterize inorganic content (IC), light transmission (LT), biaxial flexural strength (BFS), and flexural modulus (FM) of one conventional (layered) and four bulk-fill composites at different depths.

METHODS

Bulk-fill composites tested were Surefil SDR flow (SDR), Filtek Bulk Fill (FBF), Tetric EvoCeram Bulk Fill (TEC), and EverX Posterior (EXP). Herculite Classic (HER) was used as a control. Energy dispersive x-ray analysis and scanning electron microscopy were used to characterize filler particle composition and morphology. The LT through different composite thicknesses (1, 2, 3, and 4 mm) was measured using a laboratory-grade spectral radiometer system (n=5). For the BFS and FM tests, sets of eight stacked composite discs (0.5-mm thick) were prepared simulating bulk filling of a 4-mm-thick increment (n=8).

RESULTS

SDR demonstrated larger, irregular particles than those observed in TEC or HER. Filler particles in FBF were spherical, while those in EXP were composed of fiberglass strands. The LT decreased with increased composite thickness for all materials. Bulk-fill composites allowed higher LT than the HER. Furthermore, HER proved to be the unique material, having lower BFS values at deeper regions. SDR, FBF, and TEC bulk-fill composites presented reduced FM with increasing composite depth.

CONCLUSIONS

The bulk-fill composites investigated exhibited higher LT, independent of different filler content and characteristics. Although an increase in composite thickness reduced LT, the BFS of bulk-fill composites at deeper layers was not compromised.

Effectiveness of high-power LEDs to polymerize resin cements through ceramics: An in vitro study

STATEMENT OF PROBLEM

The cementation of ceramic veneers using light-polymerized resin cement is largely dependent on the proper light activation of the cement. Light activation using high irradiance could shorten the time required to lute multiple restorations.

PURPOSE

The purpose of this in vitro study was to evaluate the light transmission of dental light-polymerizing units through ceramic cylinders and its effect on the polymerization kinetics of a resin cement.

MATERIAL AND METHODS

Ceramic ingots (IPS Empress Esthetic, shade ET1) were sectioned to produce cylinders 0.5, 1.0, and 2.0 mm thick. Two light-emitting diode units were evaluated: SmartLite Focus and Valo Cordless, the latter used in either Standard or Xtra Power (XP) modes. Light transmission (average of irradiance, total energy, and light-emission profile) through the cylinders was measured (n=3). The polymerization kinetics of a resin cement light polymerized through the ceramic was monitored for 5 minutes (n=3). The degree of conversion was measured again after 72 hours. Data were individually analyzed with 2-way ANOVA and the Tukey HSD test (α=.05).

RESULTS

Valo at XP presented the highest values of irradiance and SmartLite the lowest, irrespective of the ceramic thickness. Regarding the total energy, XP showed the lowest values. The total energy and irradiance lessened with the increase in ceramic thickness. In general, except for Valo at XP, the ceramic thickness did not affect the degree of conversion. Valo at XP and interposing 2.0 mm ceramic resulted in the lowest values of Rp_max.

CONCLUSIONS

The reduction of total energy and irradiance by ceramic interposition had only a slight effect on polymerization kinetics.

Effect of Insufficient Light Exposure on Polymerization Kinetics of Conventional and Self-adhesive Dual-cure Resin Cements

Objectives: The purpose of this study was to investigate the influence of insufficient light exposure on the polymerization of conventional and self-adhesive dual-cure resin cements under ceramic restorations.

Methods: Two conventional dual-cure resin cements (Rely-X ARC, Duolink) and two self-adhesive resin cements (Rely-X U200, Maxcem Elite) were polymerized under different curing modes (dual-cure or self-cure), curing times (20 and 120 seconds), and thickness of a ceramic overlay (2 and 4 mm). Polymerization kinetics was measured by Fourier transform infrared spectroscopy for the initial 10 minutes and after 24 hours. Data were analyzed using mixed model analysis of variance (ANOVA), one-way ANOVA/Student-Newman-Keuls post hoc test, and paired t-test (α=0.05).

Results: When light-curing time was set to 20 seconds, the presence of the ceramic block significantly affected the degree of conversion (DC) of all resin cements. Especially, the DC of the groups with 20 seconds of light-curing time under 4 mm of ceramic thickness was even lower than that of the self-cured groups at 24 hours after polymerization (p&lt;0.05). However, when light-curing time was set to 120 seconds, a similar DC compared with the group with direct light exposure (p&gt;0.05) was achieved in all dual-cure groups except Maxcem Elite, at 24 hours after polymerization.

Conclusions: For both conventional and self-adhesive dual-cure resin cements, insufficient light exposure (20 seconds of light-curing time) through thick ceramic restoration (4 mm thick) resulted in a DC even lower than that of self-curing alone.

Resin Composite Properties and Energy Density of Light Cure

According to the ‘total energy concept’, properties of light-cured resin composites are determined only by energy density because of reciprocity between power density and exposure duration. The kinetics of polymerization is complex, and it was hypothesized that degree of cure, flexural strength, and flexural modulus were influenced not only by energy density, but also by power density per se. A conventional resin composite was cured at 3 energy densities (4, 8, and 16 J/cm2) by 6 combinations of power density (50, 100, 200, 400, 800, and 1000 mW/cm2) and exposure durations. Degree of cure, flexural strength, and flexural modulus increased with increasing energy density. For each energy density, degree of cure decreased with increasing power density. Flexural strength and modulus showed a maximum at intermediate power density. Within clinically relevant power densities, not only energy density but also power density per se had significant influence on resin composite properties.

Effect of High-Irradiance Light-Curing on Micromechanical Properties of Resin Cements

This study investigated the influence of light-curing at high irradiances on micromechanical properties of resin cements. Three dual-curing resin cements and a light-curing flowable resin composite were light-cured with an LED curing unit in Standard mode (SM), High Power mode (HPM), or Xtra Power mode (XPM). Maximum irradiances were determined using a MARC PS radiometer, and exposure duration was varied to obtain two or three levels of radiant exposure (SM: 13.2 and 27.2 J/cm²; HPM: 15.0 and 30.4 J/cm²; XPM: 9.5, 19.3, and 29.7 J/cm²) (n = 17). Vickers hardness (H_V) and indentation modulus (E_IT) were measured at 15 min and 1 week. Data were analyzed with nonparametric ANOVA, Wilcoxon-Mann-Whitney tests, and Spearman correlation analyses (α = 0.05). Irradiation protocol, resin-based material, and storage time and all interactions influenced H_V and E_IT significantly (p ≤ 0.0001). Statistically significant correlations between radiant exposure and H_V or E_IT were found, indicating that high-irradiance light-curing has no detrimental effect on the polymerization of resin-based materials (p ≤ 0.0021). However, one resin cement was sensitive to the combination of irradiance and exposure duration, with high-irradiance light-curing resulting in a 20% drop in micromechanical properties. The results highlight the importance of manufacturers issuing specific recommendations for the light-curing procedure of each resin cement.

Effect of a third-generation LED LCU on microhardness of tooth-colored restorative materials

OBJECTIVE

To assess the effects of different modes of a third-generation light-curing unit (LCU) (VALO) on the microhardness of restorative materials.

DESIGN

A microhybrid composite resin (Filtek(™) Z550), a giomer (Beautifil II), a compomer (Dyract eXtra) and a RMGIC (Photac(™) Fil) were used in the study. Three different modes of VALO were tested and a second-generation LCU (Elipar S10) was used as a control. The microhardness (VHN) was measured using a Vickers Hardness tester. Data were analyzed using two-way anova and post hoc Tukey's test (P < 0.05).

RESULTS

The Filtek Z550 group had the highest VHN values followed by Photac Fil, Beautifil II and the Dyract eXtra at both top and bottom surfaces, however the difference between Filtek Z550 and Photac Fil was not statistically significant for the bottom surfaces (P > 0.05). Of the different curing protocols tested, the VALO LCU in Mode 3 resulted in the lowest VHN values at both top and bottom surfaces (P < 0.05).

CONCLUSION

Based on the results of this study, it can be concluded that the high-power mode of the VALO LCU can be recommended for clinical applications especially in pediatric patients, as it can shorten the time required to adequately polymerize resin-based tooth-colored restorative materials.

Transmission of Curing Light through Moist, Air-Dried, and EDTA Treated Dentine and Enamel

Objective. This study measured light transmission through enamel and dentin and the effect of exposed dentinal tubules to light propagation. Methods. Light attenuation through enamel and dentin layers of various thicknesses (1 mm, 2 mm, 3 mm, and 4 mm) was measured using specimens that were (1) moist and (2) air-dried (n = 5). Measurements were repeated after the specimens were treated with EDTA. Specimens were transilluminated with a light curing unit (maximum power output 1869 mW/cm(2)), and the mean irradiance power of transmitting light was measured. The transmission of light through teeth was studied using 10 extracted intact human incisors and premolars. Results. Transmitted light irradiance through 1 mm thick moist discs was 500 mW/cm(2) for enamel and 398 mW/cm(2) for dentin (p < 0.05). The increase of the specimen thickness decreased light transmission in all groups (p < 0.005), and moist specimens attenuated light less than air-dried specimens in all thicknesses (p < 0.05). EDTA treatment increased light transmission from 398 mW/cm(2) to 439 mW/cm(2) (1 mm dentin specimen thickness) (p < 0.05). Light transmission through intact premolar was 6.2 mW/cm(2) (average thickness 8.2 mm) and through incisor was 37.6 mW/cm(2) (average thickness 5.6 mm). Conclusion. Light transmission through enamel is greater than that through dentin, probably reflecting differences in refractive indices and extinction coefficients. Light transmission through enamel, dentin, and extracted teeth seemed to follow Beer-Lambert's law.

The Effect of Resin-modified Glass-ionomer Cement Base and Bulk-fill Resin Composite on Cuspal Deformation

Objectives: This study investigated cuspal deformation in teeth restored with different types of adhesive materials with and without a base.

Methods: Mesio-occluso-distal slot cavities of moderately large dimension were prepared on extracted maxillary premolars (n=24). Teeth were assigned to one of four groups and restored with either a sonic-activated bulk-fill resin composite (RC) (SonicFill), or a conventional nanohybrid RC (Herculite Ultra). The base materials used were a flowable nanofilled RC (Premise Flowable) and a high-viscosity resin-modified glass-ionomer cement (RMGIC) (Riva Light-Cure HV). Cuspal deflection was measured with two direct current differential transformers, each contacting a buccal and palatal cusp. Cuspal movements were recorded during and after restoration placement. Data for the buccal and palatal cusp deflections were combined to give the net cuspal deflection.

Results: Data varied widely. All teeth experienced net inward cuspal movement. No statistically significant differences in cuspal deflection were found among the four test groups.

Conclusions: The use of a flowable RC or an RMGIC in closed-laminate restorations produced the same degree of cuspal movement as restorations filled with only a conventional nanohybrid or bulk-fill RC.

Examining exposure reciprocity in a resin based composite using high irradiance levels and real-time degree of conversion values

OBJECTIVE

Exposure reciprocity suggests that, as long as the same radiant exposure is delivered, different combinations of irradiance and exposure time will achieve the same degree of resin polymerization. This study examined the validity of exposure reciprocity using real time degree of conversion results from one commercial flowable dental resin. Additionally a new fitting function to describe the polymerization kinetics is proposed.

METHODS

A Plasma Arc Light Curing Unit (LCU) was used to deliver 0.75, 1.2, 1.5, 3.7 or 7.5 W/cm(2) to 2mm thick samples of Tetric EvoFlow (Ivoclar Vivadent). The irradiances and radiant exposures received by the resin were determined using an integrating sphere connected to a fiber-optic spectrometer. The degree of conversion (DC) was recorded at a rate of 8.5 measurements a second at the bottom of the resin using attenuated total reflectance Fourier Transform mid-infrared spectroscopy (FT-MIR). Five specimens were exposed at each irradiance level. The DC reached after 170s and after 5, 10 and 15 J/cm(2) had been delivered was compared using analysis of variance and Fisher's PLSD post hoc multiple comparison tests (alpha=0.05).

RESULTS

The same DC values were not reached after the same radiant exposures of 5, 10 and 15 J/cm(2) had been delivered at an irradiance of 3.7 and 7.5 W/cm(2). Thus exposure reciprocity was not supported for Tetric EvoFlow (p<0.05).

SIGNIFICANCE

For Tetric EvoFlow, there was no significant difference in the DC when 5, 10 and 15J/cm(2) were delivered at irradiance levels of 0.75, 1.2 and 1.5 W/cm(2). The optimum combination of irradiance and exposure time for this commercial dental resin may be close to 1.5 W/cm(2) for 12s.

Efficiency of Dual-Cured Resin Cement Polymerization Induced by High-Intensity LED Curing Units Through Ceramic Material

Objective

This study aimed to evaluate the ability of high-intensity light-emitting diode (LED) and other curing units to cure dual-cured resin cement through ceramic material.

Methods

A halogen curing unit (Jetlite 3000, Morita), a second-generation LED curing unit (Demi, Kerr), and two high-intensity LED curing units (PenCure 2000, Morita; Valo, Ultradent) were tested. Feldspathic ceramic plates (VITABLOCS Mark II, A3; Vita Zahnfabrik) with thicknesses of 1.0, 2.0, and 3.0 mm were prepared. Dual-cured resin cement samples (Clearfil Esthetic Cement, Kuraray Noritake Dental) were irradiated directly or through one of the ceramic plates for different periods (5, 10, 15, or 20 seconds for the high-intensity LED units and 20, 40, 60, or 80 seconds for the others). The Knoop hardness test was used to determine the level of photopolymerization that had been induced in the resin cement. Data were analyzed by one-way analysis of variance and Dunnett's post-hoc test to identify test-control (maximum irradiation without a ceramic plate) differences for each curing unit (p&lt;0.05).

Results

For all curing units, the curing conditions had a statistically significant effect on the Knoop hardness numbers (KHNs) of the irradiated cement samples (p&lt;0.001). In general, the KHN decreased with increasing plate thickness and increased as the irradiation period was extended. Jetlite 3000 achieved control-level KHN values only when the plate thickness was 1.0 mm. At a plate thickness ≥2.0 mm, the LED units (except for PenCure 2000 at 3.0 mm) were able to achieve control-level KHN values when the irradiation time was extended. At a plate thickness of 3.0 mm, irradiation for 20 seconds with the Valo or for 80 seconds with the Demi were the only methods that produced KHN values equivalent to those produced by direct irradiation.

Conclusion

Regardless of the type of curing unit used, indirect irradiation of dual-cured resin cement through a ceramic plate resulted in decreased KHN values compared with direct irradiation. When the irradiation period was extended, only the LED units were able to achieve similar KHN values to those observed under direct irradiation in the presence of plates ≥2.0-mm thick. High-intensity LED units require a shorter irradiation period than halogen and second-generation LED curing units to obtain KHN values similar to those observed during direct irradiation.

Effect of the irradiance distribution from light curing units on the local micro-hardness of the surface of dental resins

OBJECTIVE

An inhomogeneous irradiance distribution from a light-curing unit (LCU) can locally cause inhomogeneous curing with locally inadequately cured and/or over-cured areas causing e.g. monomer elution or internal shrinkage stresses, and thus reduce the lifetime of dental resin based composite (RBC) restorations. The aim of the study is to determine both the irradiance distribution of two light curing units (LCUs) and its influence on the local mechanical properties of a RBC.

METHODS

Specimens of Arabesk TOP OA2 were irradiated for 5, 20, and 80s using a Bluephase® 20i LCU in the Low mode (666mW/cm(2)), in the Turbo mode (2222mW/cm(2)) and a Celalux® 2 (1264mW/cm(2)). The degree of conversion (DC) was determined with an ATR-FTIR. The Knoop micro-hardness (average of five specimens) was measured on the specimen surface after 24h of dark and dry storage at room temperature.

RESULTS

The irradiance distribution affected the hardness distribution across the surface of the specimens. The hardness distribution corresponded well to the inhomogeneous irradiance distributions of the LCU. The highest reaction rates occurred after approximately 2s light exposure. A DC of 40% was reached after 3.6 or 5.7s, depending on the LCU. The inhomogeneous hardness distribution was still evident after 80s of light exposure.

SIGNIFICANCE

The irradiance distribution from a LCU is reflected in the hardness distribution across the surface. Irradiance level of the LCU and light exposure time do not affect the pattern of the hardness distribution--only the hardness level. In areas of low irradiation this may result in inadequate resin polymerization, poor physical properties, and hence premature failure of the restorations as they are usually much smaller than the investigated specimens. It has to be stressed that inhomogeneous does not necessarily mean poor if in all areas of the restoration enough light intensity is introduced to achieve a high degree of cure.