Effect of dual-peak LED unit on the polymerization of coinitiator-containing composite resins

Are polywave light-emitting diodes more effective than monowave ones in the photoactivation of resin-based materials containing alternative photoinitiators? A systematic review

OBJECTIVE

This systematic review aimed to analyze if using polywave light-emitting diodes (LED) to photoactivate resin-based materials (resin composites, adhesive systems, and resin cements) containing alternative photoinitiators provide better physicochemical properties than monowave ones.

MATERIAL AND METHODS

Inclusion criteria were in vitro studies that evaluated the degree of conversion, microhardness and flexural strength in resin-based materials containing alternative photoinitiators and light-activated with mono and polywave LEDs. Exclusion criteria were studies that evaluated the physicochemical properties of composites through any material interposed between the LED and the resin composite and studies that exclusively compared different modes and/or light activation times. Selection of studies, data extraction, and risk-of-bias analysis was performed. Data from selected studies were qualitatively analyzed. A systematic search was performed in June 2021 using PubMed/Medline, Embase, Scopus, and ISI Web of Science databases and grey literature without language restriction.

RESULTS

A total of 18 studies were included in the qualitative analysis. Nine studies used diphenyl (2,4,6-trimethylbenzoyl) phosphine oxide (TPO) as an alternative photoinitiator for resin composite. Polywave LED improved the degree of conversion of resin composite compared to monowave in 9 of the included studies. Polywave LED improved the microhardness of resin composite compared to monowave in 7 of the included studies. Polywave LED improved the degree of conversion for 11 studies and microhardness of resin composite compared to monowave for 7 included studies. No differences in the flexural strength medium between poly and monowave LEDs were observed. The evidence was graded as low quality due to the high risk of bias for 11 studies.

CONCLUSION

The existing studies, with their limitations, revealed that the polywave light-emitting diode maximizes activation, resulting in a higher degree of double-bond conversion and microhardness of resin composites containing alternative photoinitiators. However, the flexural strength of these materials is not influenced by the type of light activation device.

Toxicity of resin-matrix cements in contact with fibroblast or mesenchymal cells

The main aim of this study was to perform an integrative review on the toxic effects of resin-matrix cements and their products in contact with fibroblasts or mesenchymal cells. A bibliographic search was performed on PubMed using the following search terms: "cytotoxicity" AND "fibroblast" OR "epithelial" OR "mesenchymal" AND "polymerization" OR "degree of conversion" OR "methacrylate" OR "monomer" AND "resin cement" OR "resin-based cement". The initial search in the available database yielded a total of 277 articles of which 21 articles were included in this review. A decrease in the viability of mouse fibroblasts ranged between 13 and 15% that was recorded for different resin-matrix cements after light curing exposure for 20 s. The viability of human fibroblasts was recorded at 83.11% after light curing for 20 s that increased up to 90.9% after light curing exposure for 40 s. Most of the studies linked the highest toxicity levels when the cells were in contact with Bis-GMA followed by UDMA, TEGDMA and HEMA. Resin-matrix cements cause a cytotoxic reaction when in contact with fibroblasts or mesenchymal cells due to the release of monomers from the polymeric matrix. The amount of monomers released from the resin matrix and their cytotoxicity depends on the polymerization parameters.

Resin-based composite materials: elution and pollution

Pollution arises from all human activity and the provision of oral healthcare using resin-based composite restorative materials (RBCs) should be considered. This paper aims to provide a comprehensive review of the potential pollutant risk to the environment from the chemical compounds found in resin-based restorative materials, by including: 1) the principal pollutant compounds present in the resin matrix; 2) the degradation process of RBCs and its consequences; 3) the methods used for the detection and quantification of monomer elution and RBC microparticles; and 4) a review of the release mechanisms of eluates and RBC microparticles into the environment.

RBCs are pollutants by virtue of the compounds created during the degradation processes. These are in the form of the constituent eluted monomers and microparticles. Their impact on the environment and biodiversity is unknown. These materials are currently one of the main direct-placement restorative materials and their success is unquestionable when used and maintained correctly. Mitigation strategies for reducing the impact of pollution on the environment should be considered and implemented by all stakeholders and processes in the supply chain, from manufacturing, clinical use and waste management.

All the constituent components of resin-based composites have the potential to act as environmental pollutants as a consequence of their breakdown and subsequent elution.

Microparticles have a pollution potential as they are easily dispersed in solution and have an increased surface area that potentiates the elution of monomers.

Strategies to reduce their pollution impact should include: a) development of innovative direct-placement restorative materials; b) minimising waste; and c) providing good-quality preventive dentistry that minimises restoration failure and requirement for replacement.

Monowave and polywave light-curing of bulk-fill resin composites: degree of conversion and marginal adaptation following thermomechanical aging

Aim: This study aimed to evaluate the effect of polymerization with either a monowave (MW) or a polywave (PW) light-curing unit (LCU) on the degree of conversion (DC) and marginal adaptation following thermomechanical aging of an ormocer bulk-fill resin composite (RC) (Admira fusion X-tra Bulk Fill – AB), a methacrylate-based bulk-fill RC (Tetric N-Ceram Bulk Fill – TB) and a conventional RC (Tetric N-Ceram – TC).

Methods: DC was assessed in five samples of each RC using Fourier transform infrared spectroscopy. For determination of marginal adaptation, standard preparations were made in 60 bovine incisors, divided into three groups, according to the RC. The bulk-fill RC was inserted in a single increment of 4 mm. In contrast, the conventional RC was inserted in three increments. Marginal gap was evaluated after thermomechanical aging. Data were analyzed using a two-way analysis of variance (ANOVA) and Tukey’s tests for multiple comparisons (α = 0.05).

Results: The two-way ANOVA showed a significant effect (p<.05) of the RC factor but not of the LCU factor. The Tukey test showed that TB had the significantly lowest DC followed by TC, and with AB having the significantly highest DC. For the marginal adaptation, a significant effect was found for the LCU factor and the for the interaction RC × LCU (p<.05). Groups light-cured with PW showed significantly wider marginal gaps than MW. TC presented wider marginal gaps (17.36 µm) when cured with PW than when cured with MW (13.05 µm). The two bulk-fill RC resulted in similar marginal gap formation to each other.

Conclusion: The ormocer-based bulk-fill RC showed a higher DC than the methacrylate-based bulk-fill RC but similar marginal adaptation. The LCU, MW or PW, had no significant influence on the DC, and no relevance on the marginal adaptation.

Effect of a third-generation LED LCU on microhardness of tooth-colored restorative materials

OBJECTIVE

To assess the effects of different modes of a third-generation light-curing unit (LCU) (VALO) on the microhardness of restorative materials.

DESIGN

A microhybrid composite resin (Filtek(™) Z550), a giomer (Beautifil II), a compomer (Dyract eXtra) and a RMGIC (Photac(™) Fil) were used in the study. Three different modes of VALO were tested and a second-generation LCU (Elipar S10) was used as a control. The microhardness (VHN) was measured using a Vickers Hardness tester. Data were analyzed using two-way anova and post hoc Tukey's test (P < 0.05).

RESULTS

The Filtek Z550 group had the highest VHN values followed by Photac Fil, Beautifil II and the Dyract eXtra at both top and bottom surfaces, however the difference between Filtek Z550 and Photac Fil was not statistically significant for the bottom surfaces (P > 0.05). Of the different curing protocols tested, the VALO LCU in Mode 3 resulted in the lowest VHN values at both top and bottom surfaces (P < 0.05).

CONCLUSION

Based on the results of this study, it can be concluded that the high-power mode of the VALO LCU can be recommended for clinical applications especially in pediatric patients, as it can shorten the time required to adequately polymerize resin-based tooth-colored restorative materials.

405 nm diode laser, halogen lamp and LED device comparison in dental composites cure: an "in vitro" experimental trial

BACKGROUND AND AIMS

A 405 nm diode laser is indicated for composite materials polymerizing, thanks to the recent evolution in their compositions, absorbing in blue part of the spectrum. The purpose of this research was to evaluate its performance on two different kinds of composite resins.

MATERIALS AND METHODS

Two different composites were polymerized with a traditional halogen lamp, a LED device and a 405 nm diode laser. The depth of the cure, the volumetric shrinkage, and the degree of the conversion (DC%) of the double bond during the curing process were measured. One-way ANOVA test, Kruskal-Wallis tests, and Dunn comparison tests were used for statistic analysis.

RESULTS

Regarding the depth of polymerization, the laser had the worst performance on one composite while on the other, no significant difference with the other devices was observed. The volumetric shrinkage showed that laser produced the lowest change in both of the composites. The DC% measure confirmed these findings.

CONCLUSIONS

Based on the results of this preliminary study, it is not possible to recommend the 405 nm diode laser for the polymerization of dental composites.

Photopolymerization upon LEDs: new photoinitiating systems and strategies

The use of LEDs as novel and efficient light sources for the photopolymerization of various monomers (acylate, epoxy), interpenetrating polymer networks and thiols–ene, leads to the development of novel photoinitiating systems adapted for the LED emission.

Photoinitiators in dentistry: a review

Polymerization of Resin Based Composites (RBCs) initiated by a light curing unit activating photoinitiators. Different RBCs require different light energy levels for proper curing. Manufacturers are now producing RBCs with more than one initiator and not all of these will be properly polymerised with blue LED lights. An added problem is that manufacturers do not always indicate the type of photoinitiators in their materials. This review discusses the importance of matching the spectral output of LCUs to the absorption spectra of RBCs and the consequences of spectral mismatch. Resin based composites (RBCs) were first introduced in the 1960s and with development of effective and reliable dentine bonding systems2, have been used routinely as a filling material for both anterior and posterior teeth. The early RBCs were either chemically cured two component materials or photo-initiated materials that used UV initiators in the beginning and then transitioned to visible light initiators such as camphorquinine which was introduced in 1978.3 The first report of a light curing material was of an ultraviolet (UV) cured fissure sealant. However, due to the limited penetration depth of the UV light and the potential health hazards, this system was quickly abandoned. The advancement of science yielded light curing materials which contributed to a significant clinical progress over the UV and chemically cured RBCs. Additional advancements to direct RBC restoration materials included luting agents for ceramic restorations, pit and fissure sealants and resin modified glass ionomers. Polymerization in an RBC is initiated by a light curing unit (LCU); this technology is based on the use of photoreactive systems that absorb light irradiation from the LCUs at appropriate wavelength. Then the photoinitiators contained in the RBCs, absorb the incoming photons from the LCU and the monomers in the molecular structure become excited and in that active state, there is a change from monomers into a polymer network. The success of this technology hinges on matching the spectral emission of the LCU with the requirements of the photoinitiator system to convert the monomers into a polymer network. The amount of activated photo initiator depends on the concentration of photoinitiator in the material, the number of photons to which the material is exposed and the energy of the photons (wavelength), the latter depending on the curing light.The most common photoinitiator in dental materials today is camphorquinone, which has a peak activity around 470 nanometres. The factors affecting polymerization include filler type, size and loading, the thickness and shade of the restorative material, the effectiveness of light transmission (eg. light guide tips being free from debris and scratches), exposure time, distance of the light source from the restorative material and light intensity. It is important to note that the photoinitiator activation occurs at specific wavelengths, in other words, the optimum efficiency is obtained when the peak absorptivity of the photoinitiator corresponds with the spectral emission from the LCU. Commercially available curing units have different light intensities and light sources, with energy levels in QTH, LED and other LCUs ranging from 300 to more than 2000 mW/cm.