Light-activated restorative materials: a method of determining effective radiation times

Radical photoinitiation with LEDs and applications in the 3D printing of composites

Radical initiation upon LED light irradiation is discussed herein as well as its application in additive manufacturing. The ability of manufacturing complex structures, freedom of design, low energy consumption, fast prototyping, and excellent spatial resolution are the main benefits of the 3D printing technology by photopolymerization. Therefore, the 3D printing of composites through photopolymerization processes is developing rapidly in the academia and industry, and has been a turning point of additive manufacturing (AM). In the present review, an overview of radical initiation with LEDs (i.e., the photopolymerization LED technology, the photoinitiating systems, and the polymerizable media) and of the main 3D printing methods by photopolymerization, materials, and their applications in different fields has been carried out. As a challenging topic, the issue of light penetration in a filled matrix for the access to composites is discussed, including the light transmittance of the composite, the mismatch of the refractive index between the filler and the monomer, the factors of the filler, and the adverse influence of low light penetration on the 3D printing process. In particular, the popular applications of 3D printing by photopolymerization in biomedical science, electronic industry, materials for adsorption, and 4D printing are discussed. Overall, this review gives an overview of the 3D printing of polymer matrix composites through photopolymerization processes as a benchmark for future research and development.

On the inaccuracies of dental radiometers

This study investigated the accuracy of sixteen models of commercial dental radiometers (DR) in measuring the output of thirty-eight LED light curing units (LCUs) compared with a 'gold standard' laboratory-grade spectrometer integrating-sphere (IS) assembly. Nineteen Type I (fiber-bundle light guide) and nineteen Type II (light source in head) LED LCUs were tested, some using different output modes and light guides, resulting in 61 test subsets per radiometer. Gold standard (GS) output measurements (n = 3) were taken using the IS and confirmed with two types of laboratory-grade power meter (PowerMax-Pro 150 HD and PM10-19C; Coherent). One DR (Bluephase Meter II, Ivoclar; BM II) allowed power (mW) as well as irradiance (mW/cm²) recordings. Irradiance readings (n = 3) for each DR/LCU were compared with the IS derived irradiance. Individual LCU irradiance values were normalized against IS data. The GS method yielded reproducible data with a 0.4% pooled coefficient of variation for the LCUs. Mean power values ranged from 0.19 W to 2.40 W. Overall power values for the laboratory-grade power meters were within 5% of GS values. Individual LCU/DR normalized irradiance values ranged from 7% to 535% of the GS; an order of magnitude greater than previous reports. BM II was the only radiometer to average within 20% of normalized pooled GS irradiance values, whereas other radiometers differed by up to 85%. Ten radiometers failed to provide any reading for 1 LCU. When tested with the PowerMax-Pro in high speed (20 kHz) mode, eight LCUs demonstrated pulsing outputs undetectable at the standard (10 Hz) data acquisition rate. Sufficient light exposure is critical for the successful curing of dental resin-based materials. Substantial discrepancies may occur between actual and estimated radiometric data using current DRs. More accurate DRs need to be developed. Manufacturers' accuracy claims for DRs should specify compatible LCUs and testing parameters.

Real-time Light Transmittance Monitoring for Determining Polymerization Completeness of Conventional and Bulk Fill Dental Composites

OBJECTIVES

To monitor the real-time changes in light transmittance during composite curing and to use transmittance data to determine the curing times required for a complete polymerization.

METHODS

Three conventional and three bulk fill composites were cured with two light-emitting diode curing units at layer thicknesses of 2 mm and 4 mm. The real-time light transmittance data were collected by a UV-Vis spectrometer in the wavelength range of 350-550 nm, plotted against time (t) and fitted to an exponential function f(t), whose first derivative ΔT(t) = df(t)/dt represented the rate of transmittance change. As the changing transmittance reflects structural changes that occur during polymerization, ΔT(t) > 0 was considered to indicate an ongoing polymerization, whereas ΔT(t) values approaching zero suggested a complete polymerization. This principle was used to determine times required for a complete polymerization (t_complete) for each material/thickness/curing unit combination.

RESULTS

Light transmittance was significantly influenced by the material type, sample thickness, and curing unit, amounting to 2.9%-27.0% for the bulk fill and 0.7%-16.7% for the conventional composites. The values of t_complete amounted to 15.3-23.3 seconds for the bulk fill composites at 2 mm, 20.2-33.3 seconds for the conventional composites at 2 mm, 26.9-42.1 seconds for the bulk fill composites at 4 mm, and 40.1-59.8 seconds for the conventional composites at 4 mm. Additionally, an exponential relationship was discovered between the light transmittance and t_complete.

CONCLUSIONS

Some of the t_complete values considerably exceeded the curing times recommended by the manufacturers.

Long Term Degree of Conversion of two Bulk-Fill Composites

OBJECTIVES

To investigate the long-term development of the post-cure degree of conversion (DC) for two flowable bulk-fill composites.

MATERIALS AND METHODS

Tetric EvoFlow Bulk Fill (TEFBF) and SDR were chosen due to their distinct compositional modifications that enable the decrease of translucency during polymerization and lower polymerization rate, respectively. DC was assessed using FT-Raman spectroscopy at the post-cure times of 0 h, 24 h, 7 d and 30 d. The post-cure behavior was analyzed by a mixed model ANOVA and partial eta-squared statistics.

RESULTS

DC ranged from 61.3-81.1% for TEFBF and 58.9-81.6% for SDR. The initial (0 h) DC was significantly lower at a depth of 4 mm than at a depth of 1 mm (4.9% for SDR and 11.1% for TEFBF). Both materials presented a significant post-cure DC increase, up to 16.4% for TEFBF and 20.6% for SDR. The post-cure DC development was depth-dependent for TEFBF, but not for SDR. The post-cure DC increase was observed during 24 h for TEFBF and 7 d for SDR.

CONCLUSIONS

Some of the bulk-fill composites may need longer times than the commonly accepted 24 h to reach the final conversion. This may be attributed to their compositional modifications that are mostly undisclosed by manufacturers. Our findings imply that investigations commonly performed 24 h post-cure may underestimate some of the bulk-fill composite properties, if these are affected by the slowly-developing DC. Reactive species may also be available for leaching out of the restoration during an extended time period, with possible implications on biocompatibility.

Impedance changes during setting of amorphous calcium phosphate composites

OBJECTIVES

To investigate the electrical properties of experimental light-curable composite materials based on amorphous calcium phosphate (ACP) with the admixture of silanized barium glass and silica fillers.

METHODS

Short-term setting was investigated by impedance measurements at a frequency of 1kHz, while for the long-term setting the impedance spectra were measured consecutively over a frequency range of 0.05Hz to 1MHz for 24h. The analysis of electrical resistivity changes during curing allowed the extraction of relevant kinetic parameters. The impedance results were correlated to the degree of conversion assessed by Raman spectroscopy, water content determined by gravimetry, light transmittance measured by CCD spectrometer and microstructural features observed by scanning electron microscopy.

RESULTS

ACP-based composites have shown higher immediate degree of conversion and less post-cure polymerization than the control composites, but lower polymerization rate. The polymerization rate assessed by impedance measurements correlated well with the light transmittance. The differences in the electrical conductivity values observed among the materials were correlated to the amount of water introduced into composites by the ACP filler. High correlation was found between the degree of conversion and electrical resistivity. Equivalent circuit modeling revealed two electrical contributions for the ACP-based composites and a single contribution for the control composites.

SIGNIFICANCE

The impedance spectroscopy has proven a valuable method for gaining insight into various features of ACP-based composites. Better understanding of the properties of ACP-based composites should further the development of these promising bioactive materials.

Light transmittance and polymerization kinetics of amorphous calcium phosphate composites

OBJECTIVES

This study investigated light transmittance and polymerization kinetics of experimental remineralizing composite materials based on amorphous calcium phosphate (ACP), reinforced with inert fillers.

MATERIALS AND METHODS

Light-curable composites were composed of Bis-EMA-TEGDMA-HEMA resin and ACP, barium glass, and silica fillers. Additionally, a commercial composite Tetric EvoCeram was used as a reference. Light transmittance was recorded in real-time during curing, and transmittance curves were used to assess polymerization kinetics. To obtain additional information on polymerization kinetics, temperature rise was monitored in real-time during curing and degree of conversion was measured immediately and 24 h post-cure.

RESULTS

Light transmittance values of 2-mm thick samples of uncured ACP composites (2.3-2.9 %) were significantly lower than those of the commercial composite (3.8 %). The ACP composites presented a considerable transmittance rise during curing, resulting in post-cure transmittance values similar to or higher than those of the commercial composite (5.5-7.9 vs. 5.4 %). The initial part of light transmittance curves of experimental composites showed a linear rise that lasted for 7-20 s. Linear fitting was performed to obtain a function whose slope was assessed as a measure of polymerization rate. Comparison of transmittance and temperature curves showed that the linear transmittance rise lasted throughout the most part of the pre-vitrification period.

CONCLUSIONS

The linear rise of light transmittance during curing has not been reported in previous studies and may indicate a unique kinetic behavior, characterized by a long period of nearly constant polymerization rate.

CLINICAL RELEVANCE

The observed kinetic behavior may result in slower development of polymerization shrinkage stress but also inferior mechanical properties.

Cytotoxic effects of halogen- and light-emitting diode-cured compomers on human pulp fibroblasts

OBJECTIVE

The aim of this study was to determine the cytotoxic effects of three different compomers (Dyract AP, Compoglass, and Hytac) cured using a halogen light-curing unit (LCU) and a light-emitting diode (LED) LCU on human pulp fibroblasts.

METHODS

Specimens of three compomers were added to human pulp fibroblast cultures. Cytotoxicity was evaluated over 96 h using the agar overlay method.

RESULTS

All three compomers tested were found to be moderately cytotoxic to human pulp fibroblasts, regardless of whether they were cured using halogen or LED LCUs. The decolorization zone of Hytac was significantly larger than those of the other compomers tested (P < 0.05). Dyract AP and Compoglass specimens showed greater decolorization when cured with LED than with halogen LCUs (P < 0.05).

CONCLUSION

Compomers are potentially toxic to human pulp fibroblasts, and the type of curing unit may affect compomer toxicity.

The effect of different light-curing units on tensile strength and microhardness of a composite resin

The aim of this study was to evaluate the influence of different light-curing units on the tensile bond strength and microhardness of a composite resin (Filtek Z250 – 3M/ESPE). Conventional halogen (Curing Light 2500 – 3M/ESPE; CL) and two blue light emitting diode curing units (Ultraled – Dabi/Atlante; UL; Ultrablue IS – DMC; UB3 and UB6) were selected for this study. Different light intensities (670, 130, 300, and 600 mW/cm², respectively) and different curing times (20s, 40s and 60s) were evaluated. Knoop microhardness test was performed in the area corresponding to the fractured region of the specimen. A total of 12 groups (n=10) were established and the specimens were prepared using a stainless steel mold composed by two similar parts that contained a cone-shaped hole with two diameters (8.0 mm and 5.0 mm) and thickness of 1.0 mm. Next, the specimens were loaded in tensile strength until fracture in a universal testing machine at a crosshead speed of 0.5 mm/min and a 50 kg load cell. For the microhardness test, the same matrix was used to fabricate the specimens (12 groups; n=5). Microhardness was determined on the surfaces that were not exposed to the light source, using a Shimadzu HMV-2 Microhardness Tester at a static load of 50 g for 30 seconds. Data were analyzed statistically by two-way ANOVA and Tukey's test (p<0.05). Regarding the individual performance of the light-curing units, there was similarity in tensile strength with 20-s and 40-s exposure times and higher tensile strength when a 60-s light-activation time was used. Regarding microhardness, the halogen lamp had higher results when compared to the LED units. For all light-curing units, the variation of light-exposure time did not affect composite microhardness. However, lower irradiances needed longer light-activation times to produce similar effect as that obtained with high-irradiance light-curing sources.

Refractive Index Mismatch and Monomer Reactivity Influence Composite Curing Depth

Limited cure depth is a drawback of light-activated composites. We hypothesize that curing light transmission and cure depth are influenced by monomer reactivity and filler/resin refractive index mismatch. Light transmission throughout cure was recorded for composites based on strontium (refractive index 1.51) or barium (refractive index 1.53) glass fillers. Fillers were mixed (70 wt%) with 4 bisphenol-A diglycidyl-ether-dimethacrylate (bis-GMA):triethylene glycol dimethacrylate (TEGDMA) formulations with refractive indices ranging from 1.4703 to 1.5370. Following polymerization, cure depth and pre- and post-cure translucency parameters were determined. Transmission changes and cure depths related to monomer reactivity and filler/resin refractive index mismatch with significant interaction. Composites became more opaque or translucent on curing. Optimizing filler/resin refractive index mismatch provides increased curing depth and assists shade-matching.

The Effect of Curing Units and Staining Solutions on the Color Stability of Resin Composites

The color stability of resin composites did not vary based on the type of light curing unit. The effect of staining solutions on color changes in resin composites was resin composite and immersion time-dependent.

Photoinitiation chemistry affects light transmission and degree of conversion of curing experimental dental resin composites

INTRODUCTION

The effect of photoinitiator and co-initiator chemistry on the setting reaction and degree of conversion of dental resin-based composites (RBCs) has rarely been determined explicitly. This work examines the effect of type and concentration of photoinitiator and co-initiator on the rate of change of light transmission throughout polymerisation and degree of conversion of model RBC formulations.

METHODS

Bisphenol-A diglycidyl ether dimethacrylate (bis-GMA) and triethylene glycol dimethacrylate (TEGDMA) (6:4 molar ratio) resins filled with silanized glass filler (74wt.%) and containing various photoinitiators (camphorquinone; CQ, 1-phenyl-1,2-propanedione; PPD, benzil; BZ), co-initiator types (N,N-dimethyl-p-amino benzoic acid ethyl ester; DABE, N,N-cyanoethyl methylaniline; CEMA, N,N-diethanol-p-toluidine; DEPT) and concentration (0.0-0.3% DABE) were polymerised using a halogen or LED light curing-unit (LCU) for 10, 20 and 40s. The setting reaction was monitored in real-time by measuring the light transmittance through the curing specimen and bulk degree of conversion (DC) evaluated using Fourier transform infra-red spectroscopy.

RESULTS

Specimens containing CQ and PPD cured with the halogen LCU did not have a significant effect on DC or changes in light transmission, although a significant increase in DC was observed for CQ compared with PPD specimens cured with the LED LCU. DABE and CEMA were more effective co-initiators than DEPT. Although DC was not limited by co-initiator concentration, the absence of a co-initiator resulted in marked differences in light transmission and decreased DC throughout 40s irradiation with each LCU type.

CONCLUSIONS

The spectral range emitted from different types of LCU and absorption characteristics of the photoinitiator chemistry of light-activated resin-based composites play a critical role in the efficiency of polymerisation.

Time-resolved simultaneous measurement of group index and physical thickness during photopolymerization of resin-based dental composite

Light-activated resin-based dental composites are increasingly replacing dental amalgam. However, these materials are limited by inefficient setting reactions as a function of depth that constrain the maximum extent of cure. Insufficient curing can contribute to an overall reduction in biocompatibility of the material. We demonstrate dynamic refractive index measurements of a commercial dental composite throughout cure using spectral domain low coherence interferometry. Our results show a linear relationship between the change in refractive index and polymerization-induced reduction in physical thickness during light-activated curing. This relationship between the optical and physical density demonstrates the potential of this technique as a unique noninvasive tool for measurement of the conversion degree of curing dental composite materials.

Polymerization efficiency of different photocuring units through ceramic discs

This study compared the ability of a variety of light sources and exposure modes to polymerize a dual-cured resin composite through ceramic discs of different thicknesses by depth of cure and Vickers microhardness (VHN). Ceramic specimens (360) (Empress 2 [Ivoclar Vivadent], color 300, diameter 4 mm, height 1 or 2 mm) were prepared and inserted into steel molds according to ISO 4049, after which a dual-cured composite resin luting material (Variolink II [Ivoclar Vivadent]) with and without self-curing catalyst was placed. The light curing units used were either a conventional halogen curing unit (Elipar TriLight [3M/ESPE] for 40 seconds), a high-power halogen curing unit (Astralis 10 [Ivoclar Vivadent] for 20 seconds), a plasma arc curing unit (Aurys [Degré K] for 10 seconds or 20 seconds) or different light emitting diode (LED) curing units (Elipar FreeLight I [3M/ESPE] for 40 seconds, Elipar FreeLight II [3M/ESPE] for 20 seconds, LuxOmax [Akeda] for 40 seconds, e-Light [GC] for 12 seconds or 40 seconds). Depth of cure under the ceramic discs was assessed according to ISO 4049, and VHN at 0.5 and 1.0 mm distance from the ceramic disc bottom was determined (ISO 6507-1). Medians and the 25th and 75th percentiles were determined for each group (n=10), and statistical analysis was performed using the Mann-Whitney-U-test (p < or = 0.05). The results showed that increasing ceramic disc thickness had a negative effect on the curing depth and hardness of all light curing units, with hardness decreasing dramatically under the 2-mm thick discs using LuxOmax, e-Light (12 seconds) or Aurys (10 seconds or 20 seconds). The use of a self-curing catalyst is recommended over the light-curable portion only, because it produced an equivalent or greater hardness and depth of cure with all light polymerization modes.

The effect of light-curing modes on the microleakage of cervical resin composite restorations

OBJECTIVE

This study investigated the effect of light-curing modes on the microleakage of cervical resin composite restorations.

METHODS

Eighty wedge-shaped cervical cavities, C-factor approximately 1.3, were prepared on the labial surface of bovine incisors. The cavities were treated with a two-step experimental self-etching primer adhesive system containing an antibacterial monomer (ABF), according to the manufacturer's instructions, and filled with a single increment of a hybrid resin composite. The restorations were allocated randomly into four groups of 20: Group 1-the restorations were light-cured for 40 s with a conventional light-curing unit (New Light VL-II); Group 2-the restorations were cured with Candelux using a two-step mode; Group 3-the restorations were cured with Astralis 7 using a ramping mode; Group 4-the restorations were light-cured for 3 s with a plasma arc light-curing unit (Wave Light). Half of the specimens from each group were subjected to thermocycling (5-60 degrees C, 15 s dwell time, 5000 cycles) prior to immersion in 0.5% basic fuchsin. The teeth were sectioned and the degrees of dye penetration were scored. The data were analyzed with either the Kruskal-Wallis test or the Mann-Whitney U-test (p < 0.05)

RESULTS

No significant differences were found in the microleakage scores among the light-curing modes used. The restorations tended to display more microleakage when they were subjected to thermocycling, but the differences were not statistically significant.

CONCLUSIONS

These findings suggest that light-curing modes may have no effect on the microleakage of cervical cavities with a small C-factor, as is the case in this study.

Effect of exposure intensity and post-cure temperature storage on hardness of contemporary photo-activated composites

OBJECTIVES

The effect of variation in post-exposure storage temperature (18 vs. 37 degrees C) and light intensity (200 vs. 500mW/cm(2)) on micro-hardness of seven light-activated resin composite materials, cured with a Prismetics Mk II (Dentsply) light activation unit, were studied.

METHODS

Hardness values at the upper and lower surfaces of 2mm thick disc shaped specimens of seven light-cured resin composite materials (Herculite XRV and Prodigy/Kerr, Z100 and Silux Plus/3M, TPH/Dentsply, Pertac-Hybrid/Espe, and Charisma/Kulzer), which had been stored dry, were determined 24h after irradiation with a Prismetics Mk II (Dentsply) light activation unit.

RESULTS

Hardness values varied with product, surface, storage temperature, and curing light intensity. In no case did the hardness at the lower surface equal that of the upper surface, and the combination of 500mW/cm(2) intensity and 37 degrees C storage produced the best hardness results at the lower surface.

CONCLUSIONS

Material composition had a significant influence on surface hardness. Only one of the seven products (TPH) produced a mean hardness values at the lower surface >80% of the maximum mean upper surface hardness obtained for the corresponding product at 500mW/cm(2) intensity/37 degrees C storage temperature when subjected to all four test regimes. Despite optimum post-cure storage conditions, 200mW/cm(2) intensity curing for 40s will not produce acceptable hardness at the lower surface of 2mm increments of the majority of products tested.

The application of magnetic resonance microimaging to the visible light curing of dental resins. 3. Stray-field nuclear magnetic resonance imaging (STRAFI)

OBJECTIVE

To investigate the application of stray-field nuclear magnetic resonance imaging (STRAFI) to the visible light curing of dental restorative materials. STRAFI can overcome peak broadening associated with the conventional magnetic resonance microimaging (MRM) of glassy polymers, and has the potential to image dental restorative resins at both low and high degrees of conversion.

METHODS

Cylindrical composite specimens were light-cured from one end to produce some that were fully cured throughout their length and others that were fully cured at one end and uncured at the other. A one-dimensional probe was used to measure the magnetisation in 40 microm thick slices at 100 microm intervals along the length of the specimen. A quadrature pulse sequence was applied and the magnetisation decay recorded in a train of eight echoes.

RESULTS

A value for T(2) could be obtained only for the polymer (59+/-16 microms), therefore the echoes were summed to give an approximate indication of the degree of conversion. The echo sum for the monomer was significantly higher than that for the polymer. Differences in composite shade and cure time produced changes in the cure profiles.

SIGNIFICANCE

STRAFI produced measurements for both monomer and polymer in all stages of conversion that allowed cure profiles to be produced. Summing the decay echoes produced a qualitative measure of the condition of the material in the selected slice. The same data can be used to calculate T(2), a quantitative parameter. This first investigation has demonstrated that STRAFI is well suited to polymerisation studies.

Curing Dental Resins and Composites by Photopolymerization

The development and continued evolution of photopolymerizable dental materials, particularly dental composite restoratives, represent a significant, practical advance for dentistry. The highly successful integration of the light-activated curing process for dental applications is described in this review. The basic mechanisms by which the photoinitiators efficiently convert monomers into polymers are discussed along with the variety of factors that influence the photopolymerization process. The conventional camphorquinone-amine visible light photoinitiator system used in most dental restorative materials is illustrated in addition to some alternative initiator systems that have been studied for dental materials applications.

CLINICAL SIGNIFICANCE

Photopolymerization has become an integral component of the practice of dentistry. A better appreciation of the photopolymerization process as well as its potential and limitations may aid the dentist in the delivery of both esthetic and restorative dental care.

Temperature rise during polymerization of light-activated resin composites

There has been a steady rise in the use of resin-based composites in the restoration of large posterior cavities. Visible light-activated materials have come to dominate the market for direct posterior composites because of the convenience offered to the operator by their command set nature. Manufacturers have produced more powerful light-activation units in response to concerns over inadequate depth of cure. However, some authors have warned of the danger to the dental pulp induced by excessive heat generated during polymerization. Variables governing heat generation include output intensity of the light-activation unit, quality of light filter, irradiation time, material composition and material surface-light guide exit window distance, residual dentine thickness and cavity dimensions. This in vitro study assessed the relative influence of some of these factors under controlled conditions. The findings suggest that minimum irradiation times should be used when curing bonding agents in unlined cavities where residual dentine thickness is limited and high output intensity light-activation units are employed. Material composition is identified as an important variable in determining the magnitude of the temperature rise.