Curing efficiency and heat generation of various resin composites cured with high-intensity halogen lights

Efficiency of polymerization of bulk-fill composite resins: a systematic review

This systematic review assessed the literature to evaluate the efficiency of polymerization of bulk-fill composite resins at 4 mm restoration depth. PubMed, Cochrane, Scopus and Web of Science databases were searched with no restrictions on year, publication status, or article's language. Selection criteria included studies that evaluated bulk-fill composite resin when inserted in a minimum thickness of 4 mm, followed by curing according to the manufacturers' instructions; presented sound statistical data; and comparison with a control group and/or a reference measurement of quality of polymerization. The evidence level was evaluated by qualitative scoring system and classified as high-, moderate- and low- evidence level. A total of 534 articles were retrieved in the initial search. After the review process, only 10 full-text articles met the inclusion criteria. Most articles included (80%) were classified as high evidence level. Among several techniques, microhardness was the most frequently method performed by the studies included in this systematic review. Irrespective to the "in vitro" method performed, bulk fill RBCs were partially likely to fulfill the important requirement regarding properly curing in 4 mm of cavity depth measured by depth of cure and / or degree of conversion. In general, low viscosities BFCs performed better regarding polymerization efficiency compared to the high viscosities BFCs.

Light curing in dentistry and clinical implications: a literature review

Contemporary dentistry literally cannot be performed without use of resin-based restorative materials. With the success of bonding resin materials to tooth structures, an even wider scope of clinical applications has arisen for these lines of products. Understanding of the basic events occurring in any dental polymerization mechanism, regardless of the mode of activating the process, will allow clinicians to both better appreciate the tremendous improvements that have been made over the years, and will also provide valuable information on differences among strategies manufacturers use to optimize product performance, as well as factors under the control of the clinician, whereby they can influence the long-term outcome of their restorative procedures.

Assessment of Heat Hazard during the Polymerization of Selected Light-Sensitive Dental Materials

Introduction. Polymerization of light-cured dental materials used for restoration of hard tooth tissue may lead to an increase in temperature that may have negative consequence for pulp vitality. Aim. The aim of this study was to determine maximum temperatures reached during the polymerization of selected dental materials, as well as the time that is needed for samples of sizes similar to those used in clinical practice to reach these temperatures. Materials and Methods. The study involved four composite restorative materials, one lining material and a dentine bonding agent. The polymerization was conducted with the use of a diode light-curing unit. The measurements of the external surface temperature of the samples were carried out using the Thermovision®550 thermal camera. Results. The examined materials significantly differed in terms of the maximum temperatures values they reached, as well as the time required for reaching the temperatures. A statistically significant positive correlation of the maximum temperature and the sample weight was observed. Conclusions. In clinical practice, it is crucial to bear in mind the risk of thermal damage involved in the application of light-cured materials. It can be reduced by using thin increments of composite materials.

Curing characteristics of flowable and sculptable bulk-fill composites

OBJECTIVES

The aim of this study was to determine and correlate the degree of conversion (DC) with Vickers hardness (VH) and translucency parameter (TP) with the depth of cure (DoC) of five bulk-fill composites.

MATERIALS AND METHODS

Six specimens per group, consisting of Tetric EvoCeram Bulk Fill ("TEC Bulk," Ivoclar Vivadent), SonicFill (Kerr), SDR Smart Dentin Replacement ("SDR," Dentsply), Xenius base ("Xenius," StickTech; commercialized as EverX Posterior, GC), Filtek Bulk Fill flowable ("Filtek Bulk," 3M ESPE), and Tetric EvoCeram ("TEC," control), were prepared for DC and VH: two 2-mm-thick layers, each light-cured for 10 s; one 4-mm bulk-fill, light-cured for 10 or 20 s; and one 6-mm bulk-fill, cured for 20 s. DC was measured using a Fourier-transform infrared spectrometer, VH using a Vickers hardness tester. DoC and TP were measured using an acetone-shaking test and a spectrophotometer, respectively. Data were analyzed using ANOVA and Pearson's correlation (α = 0.05).

RESULTS

DC and VH ranged between 40-70 % and 30-80 VHN, respectively. TEC Bulk, Xenius, and SonicFill, bulk-filled as 4-mm-thick specimens, showed bottom-to-top hardness ratios above 80 % after 20 s curing. A positive linear correlation was found for bottom DC and VH. An average DC ratio of 0.9 corresponded to a bottom-to-top VH ratio of 0.8.

CONCLUSIONS

Sculptable bulk-fills require 20 s, whereas 10 s curing time was sufficient for flowable bulk-fills using a high-intensity LED unit.

CLINICAL RELEVANCE

Clinicians should be aware that longer curing times may be required for sculptable than flowable bulk-fill composites in order to achieve optimal curing characteristics.

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.

Effect of mold type, diameter, and uncured composite removal method on depth of cure

OBJECTIVE

This study compared the effects of mold material and diameter on the thickness of cured composite remnants and depth of cure (DOC) of resin-based composites (RBC).

MATERIAL AND METHODS

One Polywave® curing light was used to photo-cure two shades of the same "bulk-fill" RBC in 4, 6, or 10-mm internal diameter metal or white Delrin® molds. For 60 specimens, the uncured RBC was manually scraped away as described in the ISO 4049 depth of cure test. The remaining 60 specimens were immersed in tetrahydrofuran for 48 hours in the dark. Maximum lengths of remaining hard RBC and their DOC values were compared using analysis of variance (ANOVA) and Tukey-Kramer post hoc multiple comparison tests (α = 0.05).

RESULTS

Specimen thickness and DOC were always greater using the white Delrin® molds compared to metal molds (p < 0.001). Increase in mold diameter significantly increased specimen thickness and DOC when made in the metal molds and in the 6-mm diameter Delrin® molds (p < 0.01). Increasing the diameter of the Delrin® molds to 10-mm did not increase specimen thickness or DOC. Sectioning and staining of specimens revealed an internal, peripheral transition zone of porous RBC in the solvent-dissolved specimens only.

CONCLUSION

Mold material and internal diameter significantly influenced cured composite remnant thickness as well as depth of cure. The existence of an outer region of RBC that is hard, yet susceptible to solvent dissolution, requires further investigation.

CLINICAL RELEVANCE

The depth of cure results obtained from a 4-mm diameter metal mold may not represent the true potential for evaluating composite depth of cure. A universally acceptable mold material and diameter size need to be established if this type of testing is to be useful for evaluating the relative performance of a given type of LCU and RBC.

Heat Transfer and Thermal Stress Analysis of a Mandibular Molar Tooth Restored by Different Indirect Restorations Using a Three-Dimensional Finite Element Method

PURPOSE

Daily consumption of food and drink creates rapid temperature changes in the oral cavity. Heat transfer and thermal stress caused by temperature changes in restored teeth may damage the hard and soft tissue components, resulting in restoration failure. This study evaluates the temperature distribution and related thermal stress on mandibular molar teeth restored via three indirect restorations using three-dimensional (3D) finite element analysis (FEA).

MATERIALS AND METHODS

A 3D finite element model was constructed of a mandibular first molar and included enamel, dentin, pulp, surrounding bone, and indirect class 2 restorations of type 2 dental gold alloy, ceramic, and composite resin. A transient thermal FEA was performed to investigate the temperature distribution and the resulting thermal stress after simulated temperature changes from 36°C to 4 or 60°C for a 2-second time period.

RESULTS

The restoration models had similar temperature distributions at 2 seconds in both the thermal conditions. Compared with 60°C exposure, the 4°C condition resulted in thermal stress values of higher magnitudes. At 4ºC, the highest stress value observed was tensile stress (56 to 57 MPa), whereas at 60°C, the highest stress value observed was compressive stress (42 to 43 MPa). These stresses appeared at the cervical region of the lingual enamel. The thermal stress at the restoration surface and resin cement showed decreasing order of magnitude as follows: composite > gold > ceramic, in both thermal conditions.

CONCLUSIONS

The properties of the restorative materials do not affect temperature distribution at 2 seconds in restored teeth. The pulpal temperature is below the threshold for vital pulp tissue (42ºC). Temperature changes generate maximum thermal stress at the cervical region of the enamel. With the highest thermal expansion coefficient, composite resin restorations exhibit higher stress patterns than ceramic and gold restorations.

Real-Time Analysis of Temperature Changes in Composite Increments and Pulp Chamber during Photopolymerization

Objective. The aim of this study was to evaluate the temperature change at various sites within the composite and on the pulpal side of dentin during polymerization of two composite increments. Materials and Methods. Class I cavities prepared in third molars were restored in two composite increments (n = 5). Temperatures were measured for 110 s using eight thermocouples: bottom center of cavity (BC), top center of 1st increment (MC), top center of 2nd increment (TC), bottom corner of cavity (BE), top corner of 1st increment (ME), top corner of 2nd increment (TE), pulpal side of dentin (PD), and center of curing light guide tip (CL). Results. Maximum temperature values (°C) measured during polymerization of 1st increment were MC (59.8); BC (52.8); ME (51.3); CL (50.7); BE (48.4); and PD (39.8). Maximum temperature values during polymerization of 2nd increment were TC 58.5; TE (52.6); MC (51.7); CL (50.0); ME (48.0); BC (46.7); BE (44.5); and PD (38.8). Conclusion. Temperature at the floor of the cavity was significantly higher during polymerization of 1st increment compared to 2nd increment. Temperature rise was higher at the center than at the corner and at the top surface than at the bottom surface of each increment.

Thermal analysis of bulk filled composite resin polymerization using various light curing modes according to the curing depth and approximation to the cavity wall

OBJECTIVE

The purpose of this study was to investigate the polymerization temperature of a bulk filled composite resin light-activated with various light curing modes using infrared thermography according to the curing depth and approximation to the cavity wall.

MATERIAL AND METHODS

Composite resin (AeliteFlo, Bisco, Schaumburg, IL, USA) was inserted into a Class II cavity prepared in the Teflon blocks and was cured with a LED light curing unit (Dr's Light, GoodDoctors Co., Seoul, Korea) using various light curing modes for 20 s. Polymerization temperature was measured with an infrared thermographic camera (Thermovision 900 SW/TE, Agema Infra-red Systems AB, Danderyd, Sweden) for 40 s at measurement spots adjacent to the cavity wall and in the middle of the cavity from the surface to a 4 mm depth. Data were analyzed according to the light curing modes with one-way ANOVA, and according to curing depth and approximation to the cavity wall with two-way ANOVA.

RESULTS

The peak polymerization temperature of the composite resin was not affected by the light curing modes. According to the curing depth, the peak polymerization temperature at the depth of 1 mm to 3 mm was significantly higher than that at the depth of 4 mm, and on the surface. The peak polymerization temperature of the spots in the middle of the cavity was higher than that measured in spots adjacent to the cavity wall.

CONCLUSION

In the photopolymerization of the composite resin, the temperature was higher in the middle of the cavity compared to the outer surface or at the internal walls of the prepared cavity.

Comparison of temperature rise in the pulp chamber with different light curing units: An in-vitro study

Aims/Objectives:

This in vitro study was designed to measure and compare the temperature rise in the pulp chamber with different light curing units.

Materials and Methods:

The study was done in two settings-in-vitro and in-vivo simulation. In in-vitro setting, 3mm and 6mm acrylic spacers with 4mm tip diameter thermocouple was used and six groups were formed according to the light curing source- 3 Quartz-Tungsten-Halogen (QTH) units and 3 Light-Emitting-Diode (LED) units. For the LED units, three modes of curing like pulse-cure mode, fast mode and ramp mode were used. For in-vivo simulation, 12 caries free human third molar tooth with fused root were used. K-type thermocouple with 1 mm tip diameter was used. Occlusal cavity was prepared, etched, rinsed with water and blot dried; bonding agent was applied and incremental curing of composite was done. Thermal emission for each light curing agent was noted.

Results:

Temperature rise was very minimal in LED light cure units than in QTH light cure units in both the settings. Temperature rise was minimal at 6mm distance when compared to 3 mm distance. Among the various modes, fast mode produces the less temperature rise. Temperature rise in all the light curing units was well within the normal range of pulpal physiology.

Conclusion:

Temperature rise caused due to light curing units does not result in irreversible pulpal damage.

Influence of the degree of dentine mineralization on pulp chamber temperature increase during resin-based composite (RBC) light-activation

OBJECTIVES

To analyse the influence of the degree of dentine mineralization on the pulp chamber temperature increase during composite light-activation.

METHODS

Dentine discs (2mm thick) obtained from recently extracted teeth or those with extensive dentine sclerosis were analysed by FT-IR spectrometry in order to choose the two discs with the greatest difference in the degree of mineralization. A model tooth was set up with the dentine discs between a molar with the pulp chamber exposed and a crown with a standardized class II cavity. A K-type thermocouple was introduced into the molar root until it came into contact with the dentine discs and the cavity was filled with P60 resin composite. The temperature rise was measured for 120s after light-activation began: Standard (S) 600 mW/cm(2)/40s; Ramp (R) 0-->800 mW/cm(2)/10s+800 mW/cm(2)/10s; Boost (B) 85 0mW/cm(2)/10s and LED (L) 1.300 mW/cm(2)/40s (n=10). The same protocol was repeated after grinding the dentine discs to 1.0 and 0.5mm thickness.

RESULTS

The temperature increase was significantly higher in dentine with high degree of mineralization (p<0.05). With respect to the dentine thickness, the following result was found: 2mm<1mm<0.5mm (p<0.05). The light-activation mode also presented significant difference as follows: S>R=L>B (p<0.05).

CONCLUSIONS

The higher the degree of dentine mineralization the greater the increase in pulp chamber temperature. The temperature increase was influenced by the light-polymerization mode and dentine thickness.

Effects of light curing modes and resin composites on temperature rise under human dentin: an in vitro study

The influence of three curing modes of a high-powered LED curing unit on temperature rise under 2-mm-thick dentin was investigated during the polymerization of resin composite samples of Admira, Filtek P60, Premise, Tetric Flow, Tetric Ceram, and Filtek Z250. Ninety standard specimens were prepared. The bonding agents and resin composites were cured with standard, pulse, or soft-start mode (n=5 for each curing mode). Temperature rise was measured using a type L thermocouple. Data were analyzed by two-way ANOVA and Tukey's test. Soft-start curing led to statistically higher temperature rises compared than the other two modes. The highest temperature rise was observed for Admira and Tetric Flow cured with soft-start mode. The lowest temperature rise was observed for Premise cured with pulse mode. However, temperature rise did not reach the critical value that can cause pulpal damage by virtue of a prominent safety feature of the high-powered LED LCU, which ensures that no excessive heat is produced by all the three curing modes.

Effect of exposure time on curing efficiency of polymerizing units equipped with light-emitting diodes

A study was conducted to evaluate the top and bottom hardness of two composites cured using polymerizing units equipped with light-emitting diodes [LED] (LEDemetron; Elipar FreeLight, Coltolux LED) and one quartz-tungsten halogen device [QTH] (Optilux 501) under different exposure times (20, 40 and 60 sec). A matrix mold 5 mm in diameter and 2 mm in depth was made to obtain five disc-shaped specimens for each experimental group. The specimens were cured by one of the light-curing units (LCUs) for 20, 40 or 60 sec, and the hardness was measured with a Vickers hardness-measuring instrument (50 g/30 sec). Data were subjected to three-way ANOVA and Tukey's test (alpha = 0.05). LED LCUs were as effective as the QTH device for curing both composites. A significant increase in the microhardness values were observed for all light LCUs when the exposure time was changed from 20 sec to 40 sec. The Z250 composite showed hardness values that were usually higher than those of the Charisma composite under similar experimental conditions. LED LCUs are as efficient for curing composites as the QTH device as long as an exposure time of 40 sec or higher is employed. An exposure time of 40 sec is required to provide composites with a uniform and high Knoop hardness when LED light-curing units are employed.

The Influence of Tip Geometry and Distance on Light-curing Efficacy

Among the factors that significantly influence the depth of cure of resin composite restorations—the distance between the tip of the light source and the restorative material—as well as the geometry of the tip, are crucial parameters. Increasing the ratio between the entry and exit diameter of the tip will result in an improvement in the depth of cure for lower distances between the tip of the light source and the restorative material, while decreasing the ratio of the depth of cure, which will be higher for greater distances.

Effect of composite shade, increment thickness and curing light on temperature rise during photocuring

OBJECTIVES

To examine the effect of composite shade, increment thickness and curing light characteristics on the temperature rise associated with composite photocuring.

METHODS

Four shades (C2, A4, B1 and B3), four sample thicknesses (2, 3, 4 and 5 mm) of a hybrid resin composite and two curing units, one with two modes of curing, were investigated. The composite samples were packed in polytetrafluoroethylene (PTFE) moulds and cured for 40 s. Samples cured with the ramp curing mode were irradiated for only 20 s. Temperature rises on the undersurface of the curing resin composite were measured using an infrared scanning system.

RESULTS

Shade C2 produced the highest maximum temperature of all shades (56.7 degrees C). Thinner samples produced greater temperature rises (2mm induced 60.9 degrees C, 5 mm induced 45.7 degrees C). Samples cured with Optilux 501 unit produced greater temperature rises (60.9 degrees C) than those cured with Dentsply unit (56.2 degrees C).

CONCLUSIONS

There was a quantifiable amount of heat generated during visible light curing of resin composite. The amount of heat generated was influenced by shade selected, thickness of material and characteristics of the light curing unit.

Effect of light-activation methods and water storage on the flexural strength of two composite resins and a compomer

The present study evaluated the flexural strength of three composite resins recommended for direct esthetic restorations: a polyacid modified composite (Dyract AP), a unimodal composite resin (Filtek Z250) and a hybrid composite resin (Point 4). The variation factors, apart from the type of composite resin, were the light activation method and the water storage period. The composite resins were light-cured in continuous mode (40 s, 500 mW/cm²) or in ramp mode (0-800 mW/cm² for 10 s followed by 30 s at 800 mW/cm²) and stored for 24 hours or 30 days in distilled water at 37°C. The data were analyzed by ANOVA and Tukey test for multiple comparisons (alpha = 0.05). The composite resin Z250 presented the highest mean flexural strength (166.74 MPa) and Dyract AP presented the lowest one (129.76 MPa). The storage for 30 days decreased the flexural strength in ramp mode (24 h: 156.64 MPa; 30 days: 135.58 MPa). The light activation method alone did not lead to different flexural strength values.

Reducing, by Pulse Width Modulation, the Curing Temperature of a Prototype High-power LED Light Curing Unit

Third-generation LEDs have high irradiance and efficiency, but the associated temperature rise is potentially hazardous to the pulp of teeth. We evaluated, during composite polymerization, the irradiance and temperature rise of a prototype high-power LED light curing unit (LCU) with optimal pulse width modulation (PWM), and then compared the results with four off-the-shelf high-power LCUs. A cavity was prepared in a tooth, and a composite resin layer was applied and cured. For each LCU, the irradiance and temperature changes at the pulp-dentin junction were measured. Microhardness (Vickers hardness) of cured composite samples was measured for each LCU. Our prototype had a final temperature of 36.4 +/- 1.3 degrees C and irradiance of 1,182 +/- 1 mW/cm2. The unit with the highest temperature had a temperature of 48.7 +/- 1.2 degrees C and an irradiance of 1,194 +/- 1 mW/cm2. Based on the results of the present study, it was shown that PWM technology reduced the curing temperature while retaining the polymerization effectiveness of a high-power LED LCU.

Polymerization contraction of resin composite vs. energy and power density of light-cure

This study measured the polymerization contraction of a resin composite cured at three levels of energy density, each attained at six different levels of power density. The polymerization contraction of the composite was recorded by the method of the deflecting disc (n = 5) for 1 h following the start of irradiation. Power densities of 50, 100, 200, 400, 800 and 1,000 mW cm(-2), as measured on a dental radiometer, were obtained by variation of distance and supply voltage of a commercial light-curing unit. The spectral distribution at each power density was recorded using a spectrophotometer. The absorption spectrum of camphorquinone was also recorded, and the efficiency of the radiation at each power density was calculated as the integral over wavelength of the product of absorption and emission. From the slope of the contraction curves, an approximation to the initial rate of polymerization, Rp, was calculated and was taken as an alternative measure of power density. Statistical analyses showed that polymerization contraction increased significantly with increasing levels of energy density received by the resin composite, and, for each level of energy density, that the contraction decreased significantly with increasing power density.

Temperature rise induced by some light emitting diode and quartz-tungsten-halogen curing units

Because of the risk of thermal damage to the pulp, the temperature rise induced by light-curing units should not be too high. LED (light emitting diode) curing units have the main part of their irradiation in the blue range and have been reported to generate less heat than QTH (quartz-tungsten-halogen) curing units. This study had two aims: first, to measure the temperature rise induced by ten LED and three QTH curing units; and, second, to relate the measured temperature rise to the power density of the curing units. The light-induced temperature rise was measured by means of a thermocouple embedded in a small cylinder of resin composite. The power density was measured by using a dental radiometer. For LED units, the temperature rise increased with increasing power density, in a statistically significant manner. Two of the three QTH curing units investigated resulted in a higher temperature rise than LED curing units of the same power density. Previous findings, that LED curing units induce less temperature rise than QTH units, does not hold true in general.