Temperature increase at the light guide tip of 15 contemporary LED units and thermal variation at the pulpal floor of cavities: an infrared thermographic analysis

Effect of different restorative systems and aging on marginal adaptation of resin composites to deep proximal margins

OBJECTIVES

To evaluate and compare the marginal integrity of different restorative systems bonded to proximal gingival dentin, and determine the consistency level of the results obtained by two in vitro methods.

MATERIALS AND METHODS

Thirty molars received occluso-mesial preparations with dentin/cementum gingival margins. They were divided into three groups and restored using different restorative systems with light-cured (Adhese Universal), self-cured (Palfique universal bond), and dual-cured (Futurabond U) adhesives. The restoration/gingival dentin interfaces were observed using scanning electron microscopy (SEM) and evaluated based on the World Dental Federation (FDI) criteria. After 10,000 thermal cycles, the marginal integrity was re-evaluated. Marginal integrity was evaluated by the percentage of continuous margin (% CM) at ×200 for SEM and as the frequency of each score within the FDI ranking.

RESULTS

No significant differences were found between the restorative systems immediately, however, the system with the light-cured adhesive had the lowest marginal integrity after aging. All tested restorative systems were adversely affected by aging. A moderate inverse correlation was identified between evaluation techniques.

CONCLUSION

The tested restorative systems utilizing self-cured and dual-cured adhesives may be preferable for achieving optimal marginal integrity when bonding to deep proximal margins, compared to the tested system with light-cured adhesive.

CLINICAL SIGNIFICANCE

When performing deep margin elevation, it is important to consider the adhesive system being used.

Pulp chamber temperature rise in light-cure bonding of brackets with and without primer, in intact versus restored teeth

OBJECTIVE

To evaluate the pulp chamber temperature rise (PCTR) in light-cure bonding of brackets with and without primer, in intact and restored mandibular central incisors (M1), maxillary first premolars (Mx4), and mandibular third molars (M8).

MATERIAL AND METHODS

Ninety human teeth were included: M1 (n=30), Mx4 (n=30), and M8 (n=30). Light-cure bonding of brackets was performed in intact (n=60) and restored (n=30) teeth, with primer (n=60) or without (n=30) primer. PCTR was defined as the difference between initial (T0) and peak temperatures (T1), recorded with a thermocouple during light-cure bonding. Differences on PCTR between bonding techniques (primer vs. no primer), teeth types (M1 vs. Mx4 vs. M8), and teeth condition (intact vs. restored) were estimated by ANCOVA, with α=5%.Results: PCTR was significantly higher with the use of primer (2.05 ± 0.08oC) than without primer (1.65 ± 0.14oC) (p=0.02), and in M1 (2.23 ± 0.22oC) compared to Mx4 (1.56 ± 0.14oC) (p<0.01). There was no difference in the PCTR in M8 (1.77 ± 0.28oC) compared to M1 or Mx4 (p>0.05), and no difference between intact (1.78 ± 0.14oC) and restored (1.92 ± 0.08oC) teeth (p=0.38). There was no influence of dentin enamel thickness in the PCTR (p=0.19).

CONCLUSION

PCTR was higher in light-cure bonding of brackets with primer, especially in M1. Light-cure bonding seems less invasive without primer.

Determination of microhardness of bulk-fill resins at different depths

The aim of this study was to determine Vickers microhardness (HV) in bulk fill resins at different depths. Test specimens were prepared with different bulk fill resins: Filtek Bulk-Fill (3M ESPE) [FBF], Surefill SDR flow (Dentsply) [SDR], Fill-UP (COLTENE) [FU] and Surefill (Dentsply) [SF]. Semi-cylindrical test specimens were prepared in a mold 6 mm in diameter and 4 mm thick (n=5). A 1000 mW/cm2 light curing unit was applied (Coltolux LED - Coltene) for 20 seconds. HV was determined with three indentations (Vickers Future Tech FM300, 300 g, 8 s) at four depths: 1, 2, 3 and 4 mm from the top surface to the interior. Data were recorded immediately (t0) and 24 hours later (t24). Results were analyzed with two-way ANOVA (p<0.05), and multiple comparisons were performed using Tukey's test. Mean and SD of HV at t0 for each mm were: [FBF] t0: 49.23(4.65) / 48.32(3.36) / 44.38(2.06) / 40.59(2.58); [FBF] t24: 61.37(3.47) / 62.63(3.03) / 57.27(5.22) / 56.37(5.88);[SDR]t0:27.81(3.13) / 28.07(2.4) / 27.24(2.94) / 25.71(3.0); [SDR] t24: 35.11(2.16) / 35.17(1.96) / 35.53(1.81) / 33.18(2.08); [FU] t0: 41.43(1.41) / 39.87(0.88) / 38.11(1.81) / 39.09(1.92); [FU] t24: 49.27(1.54) / 48.77(1.77) / 48.65(1.88) / 46.76(4.93); [SF] t0: 71.35(7.09) / 67.39(9.76) / 68.95(6.21) / 64.1(8.35); [SF] t24: 76.06(6.61) / 75.31(9.37) / 75.2(11.57) / 69.81(12.14). ANOVA showed significant effect of material, depth and recording time (p<0.05), and Tukey's test showed that recording sites (depths) differed significantly, giving four homogeneous groups. Under the conditions of this study, it can be concluded that microhardness of bulk-fill resins can be affected by depth and post-curing time.

Effect of Dentin Bonding Agents, Various Resin Composites and Curing Modes on Bond Strength to Human Dentin

This study investigated the influence of several dentin bonding agents, resin composites and curing modes on push-out bond strength to human dentin. 360 extracted caries-free third molars were prepared, cut into slices, embedded in epoxy resin and perforated centrally. One half of the specimens (180) were treated by using one-step adhesive systems and the other half (180) with multi-step adhesive systems. Subsequently, the cavities were filled with either universal, flowable or bulk-fill resin composite according to the manufactures’ product line and cured with either turbo or soft start program. After storage the push-out test was performed. The data was analyzed using Kolmogorov-Smirnov, three- and one-way ANOVA followed by the Scheffé post-hoc test, unpaired two-sample t-test (p < 0.05). The strongest influence on push-out bond strength was exerted by the resin composite type (partial eta squared η_P² = 0.505, p < 0.001), followed by the adhesive system (η_P² = 0.138, p < 0.001), while the choice of the curing intensity was not significant (p = 0.465). The effect of the binary or ternary combinations of the three parameters was significant for the combinations resin composite type coupled adhesive system (η_P² = 0.054, p < 0.001), only. The flowable resin composites showed predominantly mixed, while the universal and bulk-fill resin composite showed adhesive failure types. Cohesive failure types were not observed in any group. Multi-step adhesive systems are preferable to one-step adhesive systems due to their higher bond strength to dentin. Flowable resin composites showed the highest bond strength and should become more important as restoration material especially in cavity lining. The use of a soft start modus for polymerization of resin composites does not enhance the bond strength to dentin.

Controlling In Vivo, Human Pulp Temperature Rise Caused by LED Curing Light Exposure

Objective:

The objective of this study was to evaluate the in vivo effectiveness of air spray to reduce pulp temperature rise during exposure of intact premolars to light emitted by a high-power LED light-curing unit (LCU).

Methods and Materials:

After local Ethics Committee approval (#255945), intact, upper first premolars requiring extraction for orthodontic reasons from five volunteers received infiltrative and intraligamental anesthesia. The teeth (n=9) were isolated using rubber dam, and a minute pulp exposure was attained. The sterile probe from a wireless, NIST-traceable, temperature acquisition system was inserted directly into the coronal pulp chamber. Real-time pulp temperature (PT) (°C) was continuously monitored, while the buccal surface was exposed to a polywave LED LCU (Bluephase 20i, Ivoclar Vivadent) for 30 seconds with simultaneous application of a lingually directed air spray (30s-H/AIR) or without (30s-H), with a seven-minute span between each exposure. Peak PT values were subjected to one-way, repeated-measures analysis of variance, and PT change from baseline (ΔT) during exposure was subjected to paired Student's t-test (α=0.05).

Results:

Peak PT values of the 30s-H group were significantly higher than those of 30s-H/AIR group and those from baseline temperature (p&lt;0.001), whereas peak PT values in the 30s-H/AIR group were significantly lower than the baseline temperature (p=0.003). The 30s-H/AIR group showed significantly lower ΔT values than did the 30s-H group (p&lt;0.001).

Conclusion:

Applying air flow simultaneously with LED exposure prevents in vivo pulp temperature rise.

Effect of Simulated Pulpal Microcirculation on Temperature When Light Curing Bulk Fill Composites

Objectives:

To evaluate the effect of light curing bulk fill resin composite restorations on the increase in the temperature of the pulp chamber both with and without a simulated pulpal fluid flow.

Methods and Materials:

Forty extracted human molars received a flat occlusal cavity, leaving approximately 2 mm of dentin over the pulp. The teeth were restored using a self-etch adhesive system (Clearfil SE Bond, Kuraray) and two different bulk fill resin composites: a flowable (SDR, Dentsply) and a regular paste (AURA, SDI) bulk fill. The adhesive was light cured for 20 seconds, SDR was light cured for 20 seconds, and AURA was light cured for 40 seconds using the Bluephase G2 (Ivoclar Vivadent) or the VALO Cordless (Ultradent) in the standard output power mode. The degree of conversion (DC) at the top and bottom of the bulk fill resin composite was assessed using Fourier-Transform Infra Red spectroscopy. The temperature in the pulp chamber when light curing the adhesive system and resin composite was measured using a J-type thermocouple both with and without the presence of a simulated microcirculation of 1.0-1.4 mL/min. Data were analyzed using Student t-tests and two-way and three-way analyses of variance (α=0.05 significance level).

Results:

The irradiance delivered by the light-curing units (LCUs) was greatest close to the top sensor of the MARC resin calibrator (BlueLight Analytics) and lowest after passing through the 4.0 mm of resin composite plus 2.0 mm of dentin. In general, the Bluephase G2 delivered a higher irradiance than did the VALO Cordless. The resin composite, LCU, and region all influenced the degree of cure. The simulated pulpal microcirculation significantly reduced the temperature increase. The greatest temperature rise occurred when the adhesive system was light cured. The Bluephase G2 produced a rise of 6°C, and the VALO Cordless produced a lower temperature change (4°C) when light curing the adhesive system for 20 seconds without pulpal microcirculation. Light curing SDR produced the greatest exothermic reaction.

Conclusions:

Using simulated pulpal microcirculation resulted in lower temperature increases. The flowable composite (SDR) allowed more light transmission and had a higher degree of conversion than did the regular paste (AURA). The greatest temperature rise occurred when light curing the adhesive system alone.

Wavelength-dependent light transmittance in resin composites: practical implications for curing units with different emission spectra

OBJECTIVES

To evaluate light transmittance as a function of wavelength for eight composite materials and compare the transmittance for blue light produced from two curing units with different emission spectra.

MATERIALS AND METHODS

Light transmittance through 2- and 4-mm-thick composite specimens was recorded in real time during 30 s of curing using a broad-spectrum (peaks at 405 and 450 nm) and a narrow-spectrum (peak at 441 nm) LED-curing unit. The spectral resolution of 0.25 nm and temporal resolution of 0.05 s resulted in a large amount of light transmittance data, which was averaged over particular spectral ranges, for the whole measurement period. Statistical analysis was performed using Welch ANOVA with Games-Howell post hoc test, t test, and Pearson correlation analysis. The level of significance was 0.05 and n = 5 specimens per experimental group were prepared.

RESULTS

Light transmittance varied as a function of wavelength and time, revealing significantly different patterns among the tested materials. Light transmittance for different parts of curing unit spectra increased in the following order of emission peaks (nm): 405 < 441 < 450. Of particular interest was the difference in transmittance between 441 and 450 nm, as these peaks are relevant for the photoactivation of camphorquinone-containing composites. A high variability in light transmittance among materials was identified, ranging from statistically similar values for both peaks up to a fourfold higher transmittance for the peak at 450 nm.

CONCLUSION

Each material showed a unique pattern of wavelength-dependent light transmittance, leading to highly material-dependent differences in blue light transmittance between two curing units.

CLINICAL RELEVANCE

Minor differences in blue light emission of contemporary narrow-peak curing units may have a significant effect on the amount of light which reaches the composite layer bottom.

Influence of Class V preparation on in vivo temperature rise in anesthetized human pulp during exposure to a Polywave® LED light curing unit

OBJECTIVE

This in vivo study evaluated pulp temperature (PT) rise in human premolars having deep Class V preparations during exposure to a light curing unit (LCU) using selected exposure modes (EMs).

METHODS

After local Ethics Committee approval, intact first premolars (n=8) requiring extraction for orthodontic reasons, from 8 volunteers, received infiltrative and intraligamental anesthesia and were isolated using rubber dam. A minute pulp exposure was attained and sterile probe from a wireless, NIST-traceable, temperature acquisition system was inserted into the coronal pulp chamber to continuously monitor PT (°C). A deep buccal Class V preparation was prepared using a high speed diamond bur under air-water spray cooling. The surface was exposed to a Polywave^® LED LCU (Bluephase 20i, Ivoclar Vivadent) using selected EMs, allowing 7-min span between each exposure: 10-s in low (10-s/L), 10-s (10-s/H), 30-s (30-s/H), or 60-s (60-s/H) in high mode; and 5-s-Turbo (5-s/T). Peak PT values and PT increases over physiologic baseline levels (ΔT) were subjected to 1-way, repeated measures ANOVAs, and Bonferroni's post-hoc tests (α=0.05). Linear regression analysis was performed to establish the relationship between applied radiant exposure and ΔT.

RESULTS

All EMs produced higher peak PT than the baseline temperature (p<0.001). Only 60-s/H mode generated an average ΔT of 5.5°C (p<0.001). A significant, positive relationship was noted between applied radiant exposure and ΔT (r²=0.8962; p<0.001).

SIGNIFICANCE

In vivo exposure of deep Class V preparation to Polywave^® LED LCU increases PT to values considered safe for the pulp, for most EMs. Only the longest evaluated EM caused higher PT increase than the critical ΔT, thought to be associated with pulpal necrosis.

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.

Light-curing units used in dentistry: factors associated with heat development-potential risk for patients

Objectives

To investigate how heat development in the pulp chamber and coronal surface of natural teeth with and without cusps subjected to irradiance using light-emitting diode (LED)–light-curing units (LCUs) is associated with (i) irradiance, (ii) time, (iii) distance, and (iv) radiant exposure.

Materials and methods

Three different LED-LCUs were used. Their irradiance was measured with a calibrated spectrometer (BlueLight Analytics Inc., Halifax, Canada). An experimental rig was constructed to control the thermal environment of the teeth. The LED-LCU tip position was accurately controlled by a gantry system. Tooth surface temperature was measured by thermography (ThermaCAM S65 HS, FLIR Systems, Wilsonville, USA) and pulp chamber temperature with a thermocouple. LED-LCU tip distance and irradiation times tested were 0, 2, and 4 mm and 10, 20, and 30 s, respectively. Ethical permission was not required for the use of extracted teeth.

Results

Maximum surface and pulp chamber temperatures were recorded in tooth without cusps (58.1 °C  ± 0.9 °C and 43.1 °C ± 0.9 °C, respectively). Radiant exposure explained the largest amount of variance in temperature, being more affected by time than irradiance.

Conclusions

At all combinations of variables tested, repeated measurements produced consistent results indicating the reliability of the method used. Increased exposure time seems to be the factor most likely to cause tissue damage.

Clinical relevance

Risk of superficial tissue damage at irradiances >1200 mW/cm² is evident. There is a risk of pulp damage when only thin dentin is left at higher irradiances (>1200 mW/cm²). Clinicians should be aware of LED-LCU settings and possible high temperature generated.

Emission Characteristics and Effect of Battery Drain in “Budget” Curing Lights

Recently, “budget” dental light-emitting diode (LED)–based light-curing units (LCUs) have become available over the Internet. These LCUs claim equal features and performance compared to LCUs from major manufacturers, but at a lower cost. This study examined radiant power, spectral emission, beam irradiance profiles, effective emission ratios, and the ability of LCUs to provide sustained output values during the lifetime of a single, fully charged battery. Three examples of each budget LCU were purchased over the Internet (KY-L029A and KY-L036A, Foshan Keyuan Medical Equipment Co, and the Woodpecker LED.B, Guilin Woodpecker Medical Instrument Co). Major dental manufacturers provided three models: Elipar S10 and Paradigm (3M ESPE) and the Bluephase G2 (Ivoclar Vivadent). Radiant power emissions were measured using a laboratory-grade thermopile system, and the spectral emission was captured using a spectroradiometer system. Irradiance profiles at the tip end were measured using a modified laser beam profiler, and the proportion of optical tip area that delivered in excess of 400 mW/cm2 (termed the effective emission ratio) was displayed using calibrated beam profile images. Emitted power was monitored over sequential exposures from each LCU starting at a fully charged battery state. The results indicated that there was less than a 100-mW/cm2 difference between manufacturer-stated average tip end irradiance and the measured output. All the budget lights had smaller optical tip areas, and two demonstrated lower effective emission ratios than did the units from the major manufacturers. The budget lights showed discontinuous values of irradiance over their tip ends. One unit delivered extremely high output levels near the center of the light tip. Two of the budget lights were unable to maintain sustained and stable light output as the battery charge decreased with use, whereas those lights from the major manufacturers all provided a sustained light output for at least 100 exposures as well as visual and audible indications that the units required recharging.

Effect of a broad-spectrum LED curing light on the Knoop microhardness of four posterior resin based composites at 2, 4 and 6-mm depths

OBJECTIVE

To measure the Knoop microhardness at the bottom of four posterior resin-based composites (RBCs): Tetric EvoCeram Bulk Fill (Ivoclar Vivadent), SureFil SDR flow (DENTSPLY), SonicFill (Kerr), and x-tra fil (Voco).

METHODS

The RBCs were expressed into metal rings that were 2, 4, or 6-mm thick with a 4-mm internal diameter at 30°C. The uncured specimens were covered by a Mylar strip and a Bluephase 20i (Ivoclar Vivadent) polywave(®) LED light-curing unit was used in high power setting for 20s. The specimens were then removed and placed immediately on a Knoop microhardness-testing device and the microhardness was measured at 9 points across top and bottom surfaces of each specimen. Five specimens were made for each condition.

RESULTS

As expected, for each RBC there was no significant difference in the microhardness values at the top of the 2, 4 and 6-mm thick specimens. SureFil SDR Flow was the softest resin, but was the only resin that had no significant difference between the KHN values at the bottom of the 2 and 4-mm (Mixed Model ANOVA p<0.05). Although the KHN of SureFil SDR Flow was only marginally significantly different between the 2 and 6-mm thickness, the bottom at 6-mm was only 59% of the hardness measured at the top.

CLINICAL SIGNIFICANCE

This study highlights that clinicians need to consider how the depth of cure was evaluated when determining the depth of cure. SureFil SDR Flow was the softest material and, in accordance with manufacturer's instructions, this RBC should be overlaid with a conventional resin.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

SIGNIFICANCE

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

Effect of 457 nm diode-pumped solid state laser on the polymerization composite resins: microhardness, cross-link density, and polymerization shrinkage

OBJECTIVE

The purpose of the present study was to test the usefulness of 457 nm diode-pumped solid state (DPSS) laser as a light source to cure composite resins.

MATERIALS AND METHODS

Five different composite resins were light cured using three different light-curing units (LCUs): a DPSS 457 nm laser (LAS), a light-emitting diode (LED), and quartz-tungsten-halogen (QTH) units. The light intensity of LAS was 560 mW/cm(2), whereas LED and QTH LCUs was ∼900 mW/cm(2). The degree of polymerization was tested by evaluating microhardness, cross-link density, and polymerization shrinkage.

RESULTS

Before water immersion, the microhardness of laser-treated specimens ranged from 40.8 to 84.7 HV and from 31.7 to 79.0 HV on the top and bottom surfaces, respectively, and these values were 3.3-23.2% and 2.9-31.1% lower than the highest microhardness obtained using LED or QTH LCUs. Also, laser-treated specimens had lower top and bottom microhardnesses than the other LCUs treated specimens by 2.4-19.4% and 1.4-27.8%, respectively. After ethanol immersion for 24 h, the microhardness of laser-treated specimens ranged from 20.3 to 63.2 HV on top and bottom surfaces, but from 24.9 to 71.5 HV when specimens were cured using the other LCUs. Polymerization shrinkage was 9.8-14.7 μm for laser-treated specimens, and these were significantly similar or lower (10.2-16.0 μm) than those obtained using the other LCUs.

CONCLUSIONS

The results may suggest that the 457 nm DPSS laser can be used as a light source for light-curing dental resin composites.

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.