Effect of Antibacterial Agents on Dentin Bond Strength of Bioactive Restorative Materials

Treating dentin surfaces with antibacterial agents prior to bonding bioactive restorations might affect their mechanical properties. In this study, we evaluated the effect of silver diamine fluoride (SDF) and chlorhexidine (CHX) on the shear bond strength (SBS) of bioactive restorative materials. Dentin discs were treated with SDF for 60 s or CHX for 20 s and bonded with four restorative materials, namely Activa Bioactive Restorative (AB), Beautifil II (BF), Fuji II LC (FJ), and Surefil One (SO). Control discs were bonded without treatment (n = 10). SBS was determined using a universal testing machine, and a scanning electron microscope (SEM) was used for the evaluation of the failure mode and the cross-sectional examination of adhesive interfaces. The SBS of each material between different treatments and of the different materials within each treatment were compared via a Kruskal-Wallis test. The SBS of AB and BF was significantly higher than that of FJ and SO in the control and CHX groups (p < 0.01). In the latter, SBS was higher in FJ than SO (p < 0.01). SO had a higher value with SDF compared to CHX (p = 0.01). The SBS of SDF-treated FJ was higher than that of the control (p < 0.01). SEM showed a more homogenous and improved interface of FJ and SO with SDF. Neither CHX nor SDF compromised the dentin bonding of bioactive restorative materials.

Effect of irradiance from curing units on the microhardness of composite - a systematic review

Purpose The systematic review aims to evaluate the effect of light irradiance from light-curing units on microhardness of composite.Materials and methods The protocol was registered in PROSPERO following which primary search was carried out via MedLine, Scopus and Cochrane Library. A customised tool was used to assess the risk of bias. Among the 303 records retrieved from the databases, only ten articles qualified for qualitative synthesis after meeting all the requirements of the eligibility criteria. Covidence software was used to record the decisions. The studies published until 31 March 2021 were taken up for the review. The articles showed a low-to-moderate risk of bias.Results From a total of 303 articles, ten articles were reviewed for full text. Ten in vitro studies were included for qualitative analysis. There was heterogeneity in sample size, curing time and outcome measured. Therefore, meta-analysis was not performed. Out of ten studies, seven studies reported higher microhardness value for higher intensity than lower intensity of light.Conclusion Despite the fact that the findings of the evaluated studies are quite variable, significant scientific evidence revealed that high light intensity can enhance the hardness of resin composites.

Placement of Posterior Composite Restorations: A Cross-Sectional Study of Dental Practitioners in Al-Kharj, Saudi Arabia

Dental practitioner-related factors can affect the quality of composite restorations. This study aimed to investigate the clinical techniques used by dental practitioners (DPs) while placing direct posterior composite restorations. Methods: A questionnaire survey that sought information related to the placement of posterior composite restorations was delivered to 161 DPs working in the Al-Kharj area, Saudi Arabia. The collected data were statistically analyzed using Pearson’s Chi-square test and Fisher’s exact test considering the DP’s working sector and the answered questions. Results: A total of 123 DPs completed the survey (76.4% response rate). There was a statistically significant difference between DPs working in the private sector and those working in the governmental sector in 7 out of 17 questionnaire items namely: preparing a minimum depth of 2 mm, (p = 0.001); mechanical means of retention, (p = 0.003); operative field isolation, (p = 0.004); adhesive strategy, (p < 0.001); light-curing unit used, (p = 0.013); the use of radiometer, (p = 0.023), and dental matrix selection, (p < 0.001). Conclusion: The clinical techniques applied by DPs working in the private sector in Al-Kharj, Saudi Arabia when placing posterior composite restorations, including the specifications of cavity preparation, operative field isolation, and selection of the dental matrix system, may be substandard compared to those applied by DPs working in the governmental sector.

An Evaluation of the Efficacy of LED Light Curing Units in Primary and Secondary Dental Settings in the United Kingdom

OBJECTIVE

This study aimed to evaluate the irradiance and the quality of LED light curing units (LCUs) in primary and secondary clinics in the UK and to assess the effect of damage, contamination, use of protective sleeves, and distance of light tips to target on the irradiance and performance of LCUs.

METHODS

The irradiance levels (mW/cm2) of 26 LED LCUs from general dental practices and 207 LED LCUs from two dental hospitals were measured using a digital radiometer (Blue Phase II, Ivoclar, Vivadent, Amherst, NY). Ten LED light guide tips (Satelec Mini, Acteon, Merignac, France) were selected to evaluate the effect of chipping, contamination (tip debris), and use of protective sleeves and tips to sensor distance on irradiance (mW/cm2) using a MARC Resin Calibrator (Blue Light Analytics, Halifax, Canada). Homogeneity of the light output was evaluated using a laser beam profiler (SP620; Ophir-Spiricon, North Longan, UT, USA). Statistical analysis was conducted using a one-way analysis of variance (ANOVA) with post hoc Tukey test (α=0.05) and linear regression with stepwise correlation tests.

RESULTS

Thirty-three percent of the LCUs delivered irradiance output less than 500 mW/cm2. The condition of the light curing tips was poor, with 16% contaminated with resin debris, 26% damaged, and 10% both contaminated and damaged. The irradiance output was significantly reduced in contaminated (62%) and chipped (50%) light curing tips and when using protective sleeves (24%) (p<0.05). Irradiance was also reduced when increasing the distance with 25% and 34% reduction at 7 mm and 10 mm, respectively (p<0.05).

CONCLUSION

There remains a lack of awareness of the need for regular monitoring and maintenance of dental LCUs. Damaged and contaminated light curing tips, use of protective sleeves, and increasing the distance from the restoration significantly reduced the irradiance output and the performance of the LCUs.

High-Power LED Units Currently Available for Dental Resin-Based Materials-A Review

The pursuit of less time-consuming procedures led to the development of high-power light-curing-units (LCU) to light-cure dental-resin-based-materials. This review aims to describe high-power light-emitting-diode (LED)-LCUs, by a bibliometric systematization of in vitro and in vivo studies. The research-question, by PICO model, aimed to assess the current knowledge on dentistry-based high-power LED-LCUs by analyzing to what extent their use can promote adverse events on materials and patients' oral condition when compared to low-power LED-LCUs, on daily dental practice. PubMed and B-on database search focused on high-power (≥2000 mW/cm2) LED-LCUs outputs. Studies assessing performance of high-power LED-LCUs for light-curing dental-resin-based-materials were included. From 1822 screened articles, 21 fulfilled the inclusion criteria. Thirty-two marketed units with high levels of radiant emittance (≥2000 mW/cm2 up to 6000 mW/cm2) were identified. Most output values vary on 2000-3000 mW/cm2. The highest output found was 6000 mW/cm2, in FlashMax™P3. Reports suggest that light-curing protocols with lower emittance irradiance and longer exposure outperforms all other combination, however in some clinical procedures high-power LED-LCUs are advocated when compared to low-power LED-LCUs. Moreover, long time exposures and over-curing can be dangerous to the biological vital pulp, and other oral tissues. Evidence showing that high-power LCUs are the best clinical option is still very scarce.

Knowledge and Attitude of Dental Clinicians towards Light-Curing Units: A Cross-Sectional Study

Objectives

Light curing is crucial when applying composite resin restorations. Complete polymerization of the resin depends on delivering adequate light energy to it. Dental clinicians may be unaware of the importance of proper light-curing techniques. This study aimed at evaluating and comparing the level of knowledge of general practitioners (GPs) and specialists (SPs) regarding light-curing units.

Materials and Methods

An electronic survey was conducted online among GPs and SPs of various specialties, working in the governmental sector in Riyadh, Saudi Arabia. Collected data were analyzed for statistical significance.

Results

310 dentists were included in the study. Nearly half of the GPs (45.9%) and more than half of SPs (56.8%) use light-emitting diode (LED) type light-curing units (LCUs). 36.9% of GPs and 29.6% of SPs were unsure about the type of LCUs they use in their dental clinics. 10.8% of GPs and 8.5% of SPs knew the proper term of the power output of LCU. 52.2% of the GPs and 55.7% of SPs were wrong about advancements in technology of LED LCUs. Regarding the use of radiometer, 48.2% of SPs and 35.1% of GPs had responded wrongly, and 37.7% of SPs and 52.3% of GPs were not familiar with the device, showing a statistical significance (p=0.040). There was no statistical significance observed in the responses pertaining to their years of experience, expected for two questions.

Conclusion

Both GPs and SPs displayed inadequate knowledge regarding the use of LCUs. Further educational programs are recommended to spread awareness about the handling of LCUs among dental clinicians.

Utilizing Light Cure Units: A Concise Narrative Review

The use of photo-curable resin composite restorations is an essential treatment modality in modern dental practice. The success and longevity of these restorations depend on achieving predictable and effective polymerization. Understanding the dynamics of the polymerization and the effect of light cure units (LCUs) on this process is paramount. The goal of this concise narrative review is to provide a simplified presentation of basic principles of composite chemistry, polymerization reactions, and photo-curing with relevant terminologies. Clinical guidelines for choosing and maintaining LCUs, as well as safety precautions and factors under the control of the clinician are listed. Finally, clinical recommendations of LCUs’ usage and monitoring are included to aid practitioners in achieving predictable polymerization during the placement of direct resin composite restorations.

Performance of Multiple Light-curing Units used by Dental Students

Aim:

To investigate the performance of multiple Light-curing Units (LCUs) of different manufacturers used in a dental student clinical setting.

Background:

Manufacturers claim that the irradiance values of the LCUs stay stable over time. However, this may not be accurate among the different units.

Objective:

This study investigated the performance in terms of the irradiance, radiant exposure, and DOC of multiple LCUs of different types used in a dental student clinical setting.

Methods:

Four different LCU were investigated (n=5 units/LCU manufacturer): three Light-Emitting-Diodes (LED) units (Demi Ultra, Mini LED, and E-Morlit) and one quartz-tungsten-halogen (QTH) (PolyluxII). Irradiance and radiant exposure were collected [Managing Accurate Resin Curing-Patient Simulator (MARC-PS)](n=5 readings/unit/tooth). Depth of Cure (DOC) was performed (ISO 4049:2009standards) using a micro-hybrid composite (n=5/unit). Data were analyzed using Kruskal-Wallis and ANOVA followed by Student-Newman-Keuls and Tukey post hoc methods, respectively (α=0.05).

Results:

Using the MARC-PS anterior and posterior teeth sensors, respectively, the mean irradiance for Demi Ultra was (1625.7±38.8) and (1250.4±25.2); Mini LED (1381.1±37.8) and (1058.1±27.3); E-Morlit (1831.1±294.7) and (1545.2±176.0); and Polylux II (932.4±368.5) and (840.4±353.4)mW/cm2. The radiant exposure range was 16-38 J/cm2 for all LCUs. LCUs’ mean DOC ranged from 2.9 to 3.1 mm. Significant differences in irradiance and radiant exposure values were detected among the multiple units and manufacturers. Significant differences in DOC values among the Demi Ultra and Polylux II units were detected. DOC met the standards except for onePolylux II unit.

Conclusion:

The irradiance and radiant exposure values were not the same among the different units, regardless of the manufacturers’ claim of the irradiance values stability over time. Polymerization was not compromised except for one QTH unit per the DOC measurements. Itis highly recommended to closely monitor LCUs used in dental student clinical areas due to the high demand in this type of setting.

Assessment of the radiant emittance of damaged/contaminated dental light-curing tips by spectrophotometric methods

Objectives

This study investigated the effects of physically damaged and resin-contaminated tips on radiant emittance, comparing them with new undamaged, non-contaminated tips using 3 pieces of spectrophotometric laboratory equipment.

Materials and Methods

Nine tips with damage and/or resin contaminants from actual clinical situations were compared with a new tip without damage or contamination (control group). The radiant emittance was recorded using 3 spectrophotometric methods: a laboratory-grade thermopile, a laboratory-grade integrating sphere, and a portable light collector (checkMARC).

Results

A significant difference between the laboratory-grade thermopile and the laboratory-grade integrating sphere was found when the radiant emittance values of the control or damaged/contaminated tips were investigated (p < 0.05), but both methods were comparable to checkMARC (p > 0.05). Regardless of the method used to quantify the light output, the mean radiant emittance values of the damaged/contaminated tips were significantly lower than those of the control (p < 0.05). The beam profile of the damaged/contaminated tips was less homogeneous than that of the control.

Conclusions

Damaged/contaminated tips can reduce the radiant emittance output and the homogeneity of the beam, which may affect the energy delivered to composite restorations. The checkMARC spectrophotometer device can be used in dental offices, as it provided values close to those produced by a laboratory-grade integrated sphere spectrophotometer. Dentists should assess the radiant emittance of their light-curing units to ensure optimal curing in photoactivated, resin-based materials.

Training and experience effect on light-curing efficiency by dental practitioners

BACKGROUND

Light-curing is a crucial step during the application of composite resin restorations. Composite's success depends on delivering enough light energy to the resin to achieve adequate polymerization. However, dentists are not recognizing the importance of proper light-curing technique.

OBJECTIVES

To measure light energy delivered to simulated restorations by preclinical dental students and dentists in internship year. To evaluate the effect of experience and training on the clinician's ability to light-cure composite restorations.

METHODS

A group of 50 preclinical dental students and a group of 50 internship dentists light-cured for 10 seconds, a simulated class III and class I restorations positioned in a patient simulator (MARC-Patient Simulator [BlueLight Analytics Inc., Canada]) that measured the irradiance and energy delivered by the curing light. Then participants received individualized training on optimizing their light-curing technique. They were retested after the training. Statistical analysis was done with two-way ANOVA and Tukey's test.

RESULTS

Participants delivered an average of 60% more energy after the instructions, which is a significant improvement (P < 0.05). The number of participants that failed to deliver the minimum amount of energy (6 J/cm²) decreased significantly from 37.5% to 2.5%. There was a significant difference in the amount of energy delivered by the Preclinical and Internship groups (P < 0.05).

CONCLUSION

Initially, many participants were not using the curing light properly. Light-curing technique improved with training and using a patient simulator. Experience can enhance the operator's ability to light-cure composite restorations. However, a training session can improve light-curing performance more than years of experience.

Effect of Contamination, Damage and Barriers on the Light Output of Light-Curing Units

Background:

Light-curing is a crucial step during the application of composite resin restorations. The clinical success of composite depends on the Light-Curing Units (LCU) to deliver adequate light energy to polymerize the resin. However, light-curing usually does not receive the proper awareness it deserves.

Objective:

This study aims to evaluate the effect of contamination and debris of the LCU’s tip on its light output. Determine the effect of damage to the LCU’s tip such as chipping, dents and scratches. Additionally, it evaluates the effect of plastic barrier sleeves.

Methods:

Sixty LED LCUs were tested using MARC™ Resin Calibrator (BlueLight Analytic Inc., Halifax, Canada) to measure their irradiance and energy before and after cleaning their tips. They were also tested with and without a clear plastic barrier. Additionally, four damaged LCUs received new tips and were tested again. Kruskal-Wallis H and One-Way ANOVA tests were used for statistical analysis.

Results:

Cleaning the LCUs’ tips showed significant improvement, an average increase of 8.2%. However, some units increased by up to 47% in irradiance and energy values. Replacing the damaged tip with a new one significantly improved the output of the LCUs, increasing light energy by up to 73%. The barrier used in this study caused 7% reduction in the energy delivered by the LCUs. The statistical analysis showed that cleaning the LCUs and replacing their damaged tips resulted in a significant increase in energy (p<0.05).

Conclusion:

Unclean or damaged LCUs’ tips can drastically reduce the light output of the LCUs, reducing the quality of the composite restorations. Clinicians are strongly recommended to regularly monitor, clean and maintain their curing lights.

Types of polymerisation units and their intensity output in private dental clinics of twin cities in eastern province, KSA; a pilot study

Objectives

Light-cured resin-based composites (RBCs) are the preferred option to restore teeth. Dental light-curing units (LCUs) should deliver adequate light energy to ensure good mechanical properties, dimensional stability, and biocompatibility of the RBC. The aim of this study was to determine the types of LCUs and their intensity output in private dental clinics.

Methods

A form was developed to record information related to the type of curing lights and their intensity output. A total of 400 curing devices were evaluated using a digital radiometer in 58 private dental clinics. For each device, three separate 10-s readings were taken and the average was calculated. For quartz tungsten halogen (QTH) units, a light intensity below 300 mW/cm² was considered unsatisfactory, whereas for light-emitting diode (LED) units, a reading below 600 mW/cm² was considered unsatisfactory.

Results

Out of 400 curing lights, 354 were LEDs and 46 were QTH units. A total of 13% of the lights were considered unsatisfactory. Of the LED units, 12.4% had a light intensity of less than 600 mW/cm², whereas QTH had 17.3% units with an intensity of less than 300 mW/cm².

Conclusion

The frequency of LCUs showed a trend towards LED units in private dental clinics, whereas the mean intensity value from the LED was higher than that from QTH units. Overall, the radiometer is a good tool to assess the intensity output of LCUs.

Efficiency of light curing units in a government dental school

The light intensity of a light-curing unit is a crucial factor that affects the clinical longevity of resin composites. This study aimed to investigate the efficiency of light-curing units in use at a local governmental dental school for curing conventional and bulk-fill resin materials. A total of 166 light-curing units at three locations were examined, and the brand, type, clinic location, diameter of curing tip, tip cleanliness (using a visual score), and the output (in mW/cm² using a digital radiometer) were recorded. Only 23.5% of the units examined had clean tips, with the graduate student clinical area containing the highest percentage of clean tips. Further, tips with poor cleanliness score values were associated with significantly lower output intensities. A small percentage (9.4%) of units was capable of producing intensities higher than 1,200 mW/cm² and lower than 600 mW/cm² (7.6%). The majority of the low intensity units were located in the undergraduate student area, which also contained the highest number of units with intensities between 900 and 1,200 mW/cm². The output of all the units in service was satisfactory for curing conventional resin composites, and most units were capable of curing bulk-fill resin materials.

Variation in composite degree of conversion and microflexural strength for different curing lights and surface locations

BACKGROUND

Lack of irradiance-beam profile uniformity across the emission area of light-curing units (LCUs) may result in suboptimal properties of composite restorations. The authors' objective for this study was to assess the variation in local cure of 1 composite at 3 different LCU emission area locations cured with 3 different LCUs by means of testing the degree of conversion (DC) and microflexural strength.

METHODS

The authors fabricated dual-photoinitiator composite specimens (n = 5), which were cured using either a quartz-tungsten-halogen, a multiple-emission peak, or a single-emission peak light-emitting diode LCU. The specimen's top surfaces received irradiation from either the center, 1.5 millimeters straight to the left of the center, or 1.5 mm straight to the right of the center of the LCU emission area. The authors measured irradiance and DC on top and bottom specimen surfaces using a spectrometer and attenuated total reflection-Fourier transform infrared spectroscopy, respectively. The authors performed micro 3-point bend tests using a universal mechanical testing machine. They used multifactorial analysis of variance (α = 0.05).

RESULTS

The irradiance ranged from 452 through 946 milliwatts per square centimeter, and DC ranged from 49.7% through 65.8% on top surfaces. Microflexural strength ranged from 313 through 458 megapascals.

CONCLUSIONS

The authors did not find correlations among the LCU irradiance-beam profile of the 3 emission area locations and the investigated material properties, although they found variations in the measured properties.

PRACTICAL IMPLICATIONS

The irradiance-beam profile from the different LCUs explored did not have a major influence on the DC and microflexural strength for the investigated composite.

Light intensity output of visible light communication units and clinicians' knowledge and attitude among Riyadh private clinics

Background:

With the evolution of bonded restorations, visible light-curing units became inseparable from the practice of dentistry. This study was designed to evaluate light intensity output of light-emitting diode (LED) units used in private clinics in Riyadh, Saudi Arabia, and to investigate dentists' knowledge and attitude regarding the usage of light-curing units.

Methodology:

Two hundred randomly selected LED units' light intensity output was evaluated using Demetron ^® LED Radiometer-Kerr among evenly distributed private clinics in Riyadh, Saudi Arabia. Three measurements of 20 s were taken, and average values were obtained. Furthermore, Output intensity measurements were subcategorized into three groups; <400 mW/cm²– inadequate intensity, 400–850 – marginal intensity, and more than 850 – adequate intensity. In addition, 100 questionnaires of ten close-ended questions, investigating demographics, knowledge, and attitude toward visible light communication (VLC) units, were filled by the same private clinics' dentists and data were collected and analyzed by SPSS. The investigation was started after official processing and agreement achieved between the investigators and the private clinics' administrators to get their full cooperation.

Results:

Majority of dentists (78%) reported that they do not measure the light intensity output and 9% of the measured light intensity output of LED units was found of inadequate intensity, 40.5% of marginal intensity, and 50.5% of adequate intensity. Moreover, only 31% knew the minimum accepted wavelength of VLC units.

Conclusion:

Dentists among private clinics express poor knowledge, maintenance, and attitude toward VLC units. Educational programs are advisable, and routinely monitoring of VLC units is recommended.

Clinical long-term success of contemporary nano-filled resin composites in class I and II restorations cured by LED or halogen light

OBJECTIVES

The use of LED light-curing units (LED LCUs) for polymerising resin-based composite restorations has become widespread throughout dentistry. Unfortunately, there is a paucity of clinical longitudinal studies that evaluate the comparative efficacy of LED-based polymerisation in direct posterior composite restorations. The aim of the present study was to investigate the performance of class I and II resin composite restorations for two successful composite restorative materials cured with LED versus halogen LCUs.

METHODS

One hundred restorations were placed using the nano-filled composites Grandio® or Filtek™ Supremé. The following test groups were established: LED-Grandio® n = 23 (LG), LED-Filtek™ Supremé n = 21 (LS). As controls were used: Halogen-Grandio® n = 28 (HG), Halogen-Filtek™ Supremé n = 28 (HS). All restorations were evaluated according to the clinical criteria of the CPM index (C-criteria) at baseline and after 6, 12 and 36 months.

RESULTS

After 12 and 36 months, there were no significant differences between restorations polymerised with LED or halogen light. At the end of the study, 97% of the restorations showed sufficient results regardless of the employed LCU or composite. Globally, after 36 months, 56% of all restorations were assessed with code 0 (excellent) and 41% with code 1 (acceptable). In detail, excellent results (code 0) among the criteria surface quality; marginal integrity and marginal discoloration were assigned in 72, 70 and 69%.

CONCLUSIONS

For the current limitations in the clinical trial design, the results showed that LED-polymerisation is appropriate to ensure clinical success of direct posterior resin composite restorations in a range of 3 years.

CLINICAL SIGNIFICANCE

The choice of LCU has no significant influence on the clinical performance of posterior direct resin composite restorations within 3 years of wear.

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.

Battery Charge Affects the Stability of Light Intensity from Light-emitting Diode Light-curing Units

This study investigated the influence of battery charge levels on the stability of light-emitting diode (LED) curing-light intensity by measuring the intensity from fully charged through fully discharged batteries. The microhardness of resin composites polymerized by the light-curing units at various battery charge levels was measured. The light intensities of seven fully charged battery LED light-curing units—1) LY-A180, 2) Bluephase, 3) Woodpecker, 4) Demi Plus, 5) Saab II, 6) Elipar S10, and 7) MiniLED—were measured with a radiometer (Kerr) after every 10 uses (20 seconds per use) until the battery was discharged. Ten 2-mm-thick cylindrical specimens of A3 shade nanofilled resin composite (PREMISE, Kerr) were prepared per LED light-curing unit group. Each specimen was irradiated by the fully charged light-curing unit for 20 seconds. The LED light-curing units were then used until the battery charge fell to 50%. Specimens were prepared again as described above. This was repeated again when the light-curing units' battery charge fell to 25% and when the light intensity had decreased to 400 mW/cm2. The top/bottom surface Knoop hardness ratios of the specimens were determined. The microhardness data were analyzed by one-way analysis of variance with Tukey test at a significance level of 0.05. The Pearson correlation coefficient was used to determine significant correlations between surface hardness and light intensity. We found that the light intensities of the Bluephase, Demi Plus, and Elipar S10 units were stable. The intensity of the MiniLED unit decreased slightly; however, it remained above 400 mW/cm2. In contrast, the intensities of the LY-A180, Woodpecker, and Saab II units decreased below 400 mW/cm2. There was also a significant decrease in the surface microhardnesses of the resin composite specimens treated with MiniLED, LY-A180, Woodpecker, and Saab II. In conclusion, the light intensity of several LED light-curing units decreased as the battery was discharged, with a coincident reduction in the units' ability to polymerize resin composite. Therefore, the intensity of an LED light-curing unit should be evaluated during the life of its battery charge to ensure that sufficient light intensity is being generated.

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.

The effect of curing intensity on mechanical properties of different bulk-fill composite resins

OBJECTIVE

The purpose of this study was to investigate the effects of two curing light intensities on the mechanical properties (Vickers microhardness, compressive strength, and diametral tensile strength) of bulk-fill resin-based composites (RBCs).

MATERIALS AND METHODS

Four commercially available bulk-fill RBCs (Tetric^® N-Ceram, SonicFill™, Smart Dentin Replacement (SDR™) Posterior Flowable Material, and Filtek™ Posterior Restorative) were used in this study. A total of 72 cylindrical specimens of each RBC (n=288) were prepared and subjected to Vickers microhardness, compressive strength, and diametral tensile strength tests at high (1200 mW/cm²) and low (650 mW/cm²) curing light intensities (each n=12). Results were evaluated using independent and paired sample t-tests, one-way analysis of variance, and Tukey's post hoc test. All tests were performed at a significance level of P<0.05.

RESULTS

The highest mean microhardness was observed for SonicFill (58.3 Vickers hardness number [VHN]) cured using high-intensity light. Although having the least mean microhardness values, a significant difference was observed between SDR cured using high-intensity light and that cured using low-intensity light (P<0.05). In the total sample, the highest mean compressive strength was obtained for SonicFill (262.6 MPa), followed by SDR (253.2 MPa), both cured using high-intensity light, and the least was measured for Tetric N-Ceram cured using low-intensity light (214.3 MPa). At high and low curing light intensities, diametral tensile strength for all RBCs except SonicFill was significant (P<0.001).

CONCLUSION

A higher curing light intensity (1200 mW/cm²) had a positive influence on the compressive and tensile strength of the four bulk-fill RBCs and microhardness of two materials tested compared with lower curing light intensity (650 mW/cm²). SonicFill showed the greatest microhardness and compressive strength significantly for both curing light intensities and greater diametral tensile strength with high-intensity light, although not significant. SDR cured with high-intensity light showed the greatest diametral tensile strength among the four materials.

Light-Curing Units

For improved interstudy reproducibility, reduced risk of premature failures, and ultimately better patient care, researchers and dentists need to know how to accurately characterize the electromagnetic radiation (light) they are delivering to the resins they are using. The output from a light-curing unit (LCU) is commonly characterized by its irradiance. If this value is measured at the light tip, it describes the radiant exitance from the surface of the light tip, and not the irradiance received by the specimen. The value quoted also reflects only an averaged value over the total measurement area and does not represent the irradiance that the resin specimen is receiving locally or at a different moment in time. Recent evidence has reported that the spectral emission and radiant exitance beam profiles from LCUs can be highly inhomogeneous. This can cause nonuniform temperature changes and uneven photopolymerization within the resin restoration. The spectral radiant power can be very different between different brands of LCUs, and the use of irradiance values derived from dental radiometers to describe the output from an LCU for research purposes is discouraged. Manufacturers should provide more information about the light output from the LCU and the absorption spectrum of their resin-based composite (RBC). Ideally, future assessments and research publications should include the following information about the curing light: 1) radiant power output throughout the exposure cycle and the spectral radiant power as a function of wavelength, 2) analysis of the light beam profile and spectral emission across the light beam, and 3) measurement and reporting of the light the RBC specimen received as well as the output measured at the light tip.

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.

Contemporary issues in light curing

This review article will help clinicians understand the important role of the light curing unit (LCU) in their offices. The importance of irradiance uniformity, spectral emission, monitoring the LCU, infection control methods, recommended light exposure times, and learning the correct light curing technique are reviewed. Additionally, the consequences of delivering too little or too much light energy, the concern over leachates from undercured resins, and the ocular hazards are discussed. Practical recommendations are provided to help clinicians improve their use of the LCU so that their patients can receive safe and potentially longer lasting resin restorations.

A survey of power density of light-curing units used in private dental offices in Changchun City, China

This study investigated power density and relevant information related to light-curing units used in private dental offices in Changchun City, China. The power density of 196 light-curing units used in private dental offices in Changchun City was measured using a simple random sampling method. Relevant information included the brand, type, years of operation, frequency of use, model numbers and types of light guide, resin buildup on the light guides, damage caused by the light guides, required maintenance of the curing lights, and ratio of the unit and chair number. There were 132 quartz tungsten halogen (QTH) units and 64 light-emitting diode units. The power density range was defined as 0-1,730 mW/cm(2). The mean power density was 453.1 mW/cm(2). The mean years of operation of the light-curing units were 3.96. The majority of dentists never tested the power density of the light-curing units and a considerable number of light guide surfaces showed resin buildup and damage. In Changchun City, the majority of light-curing units were QTH. Some units needed to be replaced due to aging. The majority of dentists were not aware that the light-curing units require periodic testing and maintenance. The data herein indicate the importance of periodic testing of the power density of light-curing units and timely replacement of the components and then guarantee the quality of medical services and their benefits to patients.

Evaluation of light-curing units in rural and urban areas

OBJECTIVES

To evaluate the distribution of light-curing units (LCU) used in an urban area (Riyadh) and a rural area (Kharj) of Saudi Arabia, and to compare their irradiance values.

METHODS

The study involved three dental centers in urban areas and two in rural areas, all of which were parts of a single healthcare institution providing dental services. The light outputs (power mW) from 140 LCUs were measured by laboratory-grade spectrometry, and the irradiance (mW/cm(2)) was calculated from the tip area of each LCU. The minimum acceptable irradiance outputs for the quartz-tungsten-halogen (QTH) and light-emitting diode (LED) units were set at 300 and 600 mW/cm(2), respectively. The ages of these units and the protocol used to light-cure the resins were also determined.

RESULTS

The total number of LCUs was 140, 112 (78%) in urban areas, and 28 (22%) in rural areas. In rural areas, only 7 of the 22 (32%) QTH units delivered irradiances greater than 300 mW/cm(2) and were therefore considered clinically acceptable, whereas 4 of the 6 (66.7%) LED units delivered values greater than 600 mW/cm(2). In urban centers, 43 of 61 (70.5%) LED units and 25 of 61 (49%) QTH units were considered clinically acceptable. Irradiance values for both QTH (P < 0.01) and LED (P < 0.05) units were significantly better in urban than in rural areas.

CONCLUSIONS

Urban areas had a greater distribution of LCUs than rural areas. Overall, irradiance values were significantly higher in urban areas.