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

Temperature rise in photopolymerized adhesively-bonded resin composite: A thermography study

OBJECTIVES

To assess visually and quantitatively the contributions of the adhesive layer photopolymerization and the subsequent resin composite increment to spatio-temporal maps of temperature at five different cavity locations, subjected to two irradiance curing protocols: standard and ultra-high.

METHODS

Caries-free molars were used to obtain 40, 2 mm thick dentin slices, randomly assigned to groups (n = 5). These slices were incorporated within 3D-printed model cavites, 4 mm deep, restored with Adhese® Universal bonding agent and 2 mm thick Tetric® Powerfill resin composite, and photocured sequentially, as follows: G1: control-empty cavity; G2: adhesive layer; G3 composite layer with no adhesive; and G4 composite layer with adhesive. The main four groups were subdivided based on two curing protocols, exposed either to standard 10 s (1.2 W/cm2) or Ultra high 3 s (3 W/cm2) irradiance modes using a Bluephase PowerCure LCU. Temperature maps were obtained, via a thermal imaging camera, and numerically analyzed at 5 locations. The data were analyzed using two-way ANOVA followed by multiple one-way ANOVA, independent t-tests and Tukey post-hoc tests (α = 0.05). Tmax, ΔT, Tint (integrated area under the curve) and time-to-reach-maximum-temperature were evaluated.

RESULTS

Two-way ANOVA showed that there was no significant interaction between light-curing time and location on the measured parameters (p > 0.05), except for the time-to-reach-maximum-temperature (p < 0.05). Curing the adhesive layer alone with the 10 s protocol resulted in a significantly increased pulpal roof temperature compared to 3 s cure (p < 0.05). Independent T-tests between G3 and G4, between 3 s and 10 s, confirmed that the adhesive agent caused no significant increases (p > 0.05) on the measured parameters. The ultra-high light-curing protocol significantly increased ΔT in composite compared to 10 s curing (p < 0.05).

SIGNIFICANCE

When the adhesive layer was photocured alone in a cavity, with a 2 mm thick dentin floor, the exothermal release of energy resulted in higher temperatures with a 10 s curing protocol, compared to a 3 s high irradiance. But when subsequently photocuring a 2 mm layer of composite, the resultant temperatures generated at pulpal roof location from the two curing protocols were similar and therefore there was no increased hazard to the dental pulp from the immediately prior adhesive photopolymerization, cured via the ultra-high irradiation protocol.

Spatio-temporal temperature fields generated coronally with bulk-fill resin composites: A thermography study

OBJECTIVE

This study aimed to investigate the effects of (i) a high-irradiance (3s) light-curing protocol versus (ii) two standard-irradiance (10s) protocols on 2D temperature maps during intra-dental photo-irradiation within a molar cavity restored with either Ultra-Rapid Photo-Polymerized Bulk Fill (URPBF) composites or a pre-heated thermo-viscous bulk-fill composite, compared to a standard bulk-fill resin-based-composite (RBC). The specific objectives included visual assessment of the temperature maps and quantitative assessment of several temperature/time plots at four different locations.

METHODS

A caries-free lower first molar cavity served as a natural tooth mold. Resin composites were placed without intermediary adhesive. Two URPBF composites (PFill; PFlow) and one pre-heated thermo-viscous bulk-fill composite (Viscalor: VC) were compared to a contemporary bulk-fill composite (One Bulk Fill: OBF). Two LED-LCU devices were used: Bluephase PowerCure (PC) and Elipar S10 (S10), with three light-irradiation protocols (PC-3s, PC-10s and S10-10s). 2D temperature maps over the entire coronal area were recorded for 120 s during and after irradiation using a thermal imaging camera. Changes at four different levels were selected from the data sets: (0, 2 and 4 mm from the cavity top and at 1 mm below the dentin cavity floor). The maximum temperature attained (T_max), the mean temperature rise (ΔT), the time (s) to reach maximum temperature and the integrated areas (°C s) under the temperature/time (T/t) plots were identified. Data were analysed via three-way ANOVA, One-way ANOVA, independent t-tests and Tukey post-hoc tests (p < 0.05).

RESULTS

All RBCs showed qualitatively similar temperature-time profiles. PFlow reached T_max in the shortest time. PC-3s (3000 mW/cm²) generated comparable ΔT to S10-10s, except with PFill, where ΔT was greater. Despite the same irradiance (1200 mW/cm²), Elipar S10 led to higher T_max and ΔT compared to PC-10s. The highest T_max and ΔT were observed at the 2 mm level, and the lowest were at 1 mm depth into the underlying dentin.

SIGNIFICANCE

Coronal 2D temperature maps showed rises largely confined within the bulk-fill RBC materials, with maxima at 2 mm rather than 4 mm depth indicating some extent of thermal insulation for the underlying dentin and pulp. RBCs polymerized via different irradiation protocols showed similar temperature changes. With the PC-3s protocol - also with pre-heated VC - minimal temperature rises at 1 mm within dentin suggest their clinical safety when sufficient remaining dentin thickness is present.

Diagnosis of Temporomandibular Disorders Using Thermovision Imaging

Temporomandibular joint dysfunction (TMD) is a chronic disease of various etiologies. Correct TMD diagnosis enables to apply effective treatment and significantly improves the quality of patients' lives. One of the diagnostic methods subjected to evaluation in recent years is thermography, which enables safe, noninvasive, and quick imaging of the temperature distribution of temporomandibular joint-associated tissues. This paper, based on Medline, Dentistry & Oral Sciences Source, Academic Search Ultimate, Medline Complete databases, presents basic information related to thermovision imaging and outlines the direction of research conducted in recent years which fight with difficulties in the interpretation of thermograms that require specialized, dedicated analysis and processing of the obtained images. The problem concerns also no standardized protocol for measuring masticatory muscle temperature.

Plugger temperature of cordless heat carriers according to the time elapsed

Objective

The purpose of this study was to measure the temperature of the plugger tip of 3 cordless heat carriers set at 200°C.

Materials and Methods

Pluggers of the same taper (0.06, 0.08, 0.10) and similar tip sizes (sizes of 50 and 55) from 3 cordless heat carriers, namely SuperEndo-α² (B & L Biotech), Friendo (DXM), and Dia-Pen (Diadent), were used and an electric heat carrier, System B (SybronEndo), was used as the control. The plugger tips were covered with customized copper sleeves, heated for 10 seconds, and the temperature was recorded with a computerized measurement system attached to a K-type thermometer at room temperature (n = 10). The data were analyzed with 2-way analysis of variance at a 5% level of significance.

Results

The peak temperature of the plugger tips was significantly affected by the plugger taper and by the heat carrier brand (p < 0.05). The peak temperature of the plugger tips was between 177°C and 325°C. The temperature peaked at 207°C-231°C for the 0.06 taper pluggers, 195°C-313°C for the 0.08 taper pluggers, and 177°C-325°C for the 0.10 taper pluggers. Only 5 of the 12 plugger tips showed a temperature of 200°C ± 10°C. The time required to reach the highest temperature or 200°C ± 10°C was at least 4 seconds.

Conclusion

When using cordless heat carriers, clinicians should pay attention to the temperature setting and to the activation time needed to reach the intended temperature of the pluggers.

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.

Polymerization stress evolution of a bulk-fill flowable composite under different compliances

OBJECTIVE

To use a compliance-variable instrument to simultaneously measure and compare the polymerization stress (PS) evolution, degree of conversion (DC), and exotherm of a bulk-fill flowable composite to a packable composite.

METHODS

A bulk-fill flowable composite (Filtek Bulk-fill, FBF) and a conventional packable composite (Filtek Z250, Z250) purchased from 3M ESPE were investigated. The composites were studied using a cantilever-beam based instrument equipped with an in situ near infrared (NIR) spectrometer and a microprobe thermocouple. The measurements were carried out under various instrumental compliances (ranging from 0.3327μm/N to 12.3215μm/N) that are comparable to the compliances of clinically prepared tooth cavities. Correlations between the PS and temperature change as well as the DC were interpreted.

RESULTS

The maximum PS of both composites at 10min after irradiation decreased with the increase in the compliance of the cantilever beam. The FBF composite generated a lower final stress than the Z250 sample under instrumental compliances less than ca. 4μm/N; however, both materials generated statistically similar PS values at higher compliances. The reaction exotherm and the DC of both materials were found to be independent of compliance. The DC of the FBF sample was slightly higher than that of the packable Z250 composite while the peak exotherm of FBF was almost double that of the Z250 composite. For FBF, a characteristic drop in the PS was observed during the early stage of polymerization for all compliances studied which was not observed in the Z250 sample. This drop was shown to relate to the greater exotherm of the less-filled FBF sample relative to the Z250 composite.

SIGNIFICANCE

While the composites with lower filler content (low viscosity) are generally considered to have lower PS than the conventional packable composites, a bulk-fill flowable composite was shown to produce lower PS under a lower compliance of constraint as would be experienced if the composite was used as the base material in clinical procedures.

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.

Anterior composite restorations in clinical practice: findings from a survey with general dental practitioners

Objectives

The aim of this study was to assess technical preferences of general dental practitioners when restoring anterior composite restorations. How the level of clinical experience or post-graduate training infuenced their options was also tested.

Material and Methods

A cross-sectional study was performed using a questionnaire with general dental practitioners (GDPs) (n=276) in Southern Brazil. Information regarding post graduation training (specialization, master's or PhD degree) and linical experience (years since completing graduation) were gathered. The options regarding anterior composite restorations (type of composite, adhesive system, light curing unit, polishing procedures and rubber dam use) were collected. Data were submitted to descriptive analysis and associations were tested.

Results

Response rate was 68% (187). GDPs selected microhybrid composite (52%) and 2-step total etch adhesive system (77%). LED was the preferred method of activation for 72.8%. Immediate polishing was preferred by 75%, using a combination of techniques. Most of the respondents (74.3%) did not use rubber dam. More experienced clinicians used more halogen lights (p<0.022), performed more light monitoring (p<0.001) and were resistant to use rubber dam (p<0.012). Dentists with post-graduation training used 3-etch-and-rinse system more frequently (p<0.04), usually monitored light intensity (p<0.014) and placed rubber dam more frequently (p<0.044).

Conclusions

Hybrid composite, simplifed adhesives, LED units and immediate polishing were preferred by Southern Brazilian dentists for anterior composite restorations. Few dentists used rubber dam to perform composite restorations in anterior teeth. Clinical experience and post-graduation training infuenced the dentists' choices.