Optical power outputs, spectra and dental composite depths of cure, obtained with blue light emitting diode (LED) and halogen light curing units (LCUs).

OBJECTIVE: To test the hypothesis that a prototype LED light curing unit, (LCU), a commercial LED LCU and a halogen LCU achieve similar cure depths, using two shades of a camphorquinone photoinitiated dental composite. To measure the LCUs' outputs and the frequency of the LED LCU's pulsed light, using a blue LED array as a photodetector. DESIGN: Cure depth and light output characterisation to compare the LCUs. SETTING: An in vitro laboratory study conducted in the UK. MATERIALS AND METHODS: The LCUs cured A2 and A4 composite shades. A penetrometer measured the depth of cure. Analysis was by one-way ANOVA, two-way univariate ANOVA and Fisher's LSD test with a 95% confidence interval. A power meter and spectrograph characterised the LCUs' emissions. A blue LED array measured the pulsed light frequency from an LED LCU. RESULTS: Statistically significant different LCU irradiances (119 mW/cm2 to 851 mW/cm2) and cure depths (3.90 mm SD +/- 0.08 to 6.68 mm SD +/- 0.07) were achieved. Composite shade affected cure depth. A blue LED array detected pulsed light at 12 Hz from the commercial LED LCU. CONCLUSIONS: The prototype LED LCU achieved a greater or equal depth of cure when compared with the commercial LCUs. LEDs may have a potential in dentistry for light detection as well as emission.

Light-emitting diode (LED) polymerisation of dental composites: flexural properties and polymerisation potential.

The clinical performance of light polymerised dental composites is greatly influenced by the quality of the light-curing unit (LCU) used. Commonly used halogen LCUs have some specific drawbacks such as decreasing of the light output with time. This may result in low degree of monomer conversion of the composites with negative clinical implications. Previous studies have shown that blue-light-emitting diode (LED) LCUs have the potential to polymerise dental composites without having the drawbacks of halogen LCUs. Despite the relatively low irradiance of current LED LCUs, their efficiency is close to that of conventional halogen LCUs with more than twice the irradiance. This phenomenon has not been explained fully yet. Hence, more tests of the LED LCU's effectiveness and of the mechanical properties of oral biomaterials processed with LED LCUs need to be carried out. This study investigates the flexural properties of three different composites with three different shades, which were polymerised with either a commercial halogen LCU or an LED LCU, respectively. In most cases no significant differences in flexural strength and modulus between composites polymerised with a halogen LCU or an LED LCU, respectively, were found. A simple model for the curing effectiveness based on the convolution absorption spectrum of the camphorquinone photoinitiator present in composites and the emission spectra of the LCUs is presented.

Depth of cure and compressive strength of dental composites cured with blue light emitting diodes (LEDs).

OBJECTIVE: The primary objective of this pilot study was to test the hypotheses that (i) depth of cure and (ii) compressive strength of dental composites cured with either a light emitting diode (LED) based light curing unit (LCU) or a conventional halogen LCU do not differ significantly. The second objective of this study was to characterise irradiance and the emitted light spectra for both LCUs to allow comparisons between the units. METHODS: Dental composite (Spectrum TPH, shades A2 and A4) was cured for 40 s with either a commercial halogen LCU or a LED LCU, respectively. The LED LCU uses 27 blue LEDs as the light source. The composites' depth of cure was measured for 10 samples of 4 mm diameter and 8 mm depth for each shade with a penetrometer. The results were compared using a Student's t-test. Compressive strengths were determined after 6 and 72 h, for six samples of 4 mm diameter and 6 mm depth for each shade after being polymerised for 40 s from each end of the mould. Groups were compared using a three way ANOVA. RESULTS: The conventional halogen LCU cured composites significantly (p < 0.05) deeper (6.40 mm A2, 5.19 mm A4) than did the LED LCU (5.33 mm A2, 4.27 mm A4). Both units cured the composite deeper than required by both ISO 4049 and the manufacturer. A three way ANOVA showed that there were no significant differences in the compressive strengths of samples produced with either the LED LCU or the halogen LCU (p = 0.460). Significant differences in compressive strength of samples stored for 6 and 72 h (p = 0.0006) and of samples of different shades (p = 0.035) were found as confirmed by the three way ANOVA. The light spectra of both units differed strongly. While the halogen LCU showed a broad distribution of wavelengths with a power peak at 497 nm, the LED LCU emitted most of the generated light at 465 nm. The LED LCU produced a total irradiance of 350 mW cm-2 whereas the halogen LCU produced a total irradiance of 755 mW cm-2. SIGNIFICANCE: The results showed that both units provided sufficient output to exceed minimum requirements in terms of composites' depth of cure according to ISO 4049 and the depth of cure and the composites' compressive strength stated by the manufacturer. Compressive strengths of dental composites cured under laboratory conditions with a LED LCU were statistically equivalent to those cured with a conventional halogen LCU. With its inherent advantages, such as a constant power output over the lifetime of the diodes, LED LCUs have great potential to achieve a clinically consistent quality of composite cure.

Dental composite depth of cure with halogen and blue light emitting diode technology.

OBJECTIVES: To test the hypothesis that a blue light emitting diode (LED) light curing unit (LCU) can produce an equal dental composite depth of cure to a halogen LCU adjusted to give an irradiance of 300 mWcm-2 and to characterise the LCU's light outputs. MATERIALS AND METHODS: Depth of cure for three popular composites was determined using a penetrometer. The Student's t test was used to analyse the depth of cure results. A power meter and a spectrometer measured the light output. RESULTS: The spectral distribution of the LCUs differed strongly. The irradiance for the LED and halogen LCUs were 290 mWcm-2 and 455 mWcm-2, when calculated from the scientific power meter measurements. The LED LCU cured all three dental composites to a significantly greater (P < 0.05) depth than the halogen LCU. CONCLUSIONS: An LED LCU with an irradiance 64% of a halogen LCU achieved a significantly greater depth of cure. The LCU's spectral distribution of emitted light should be considered in addition to irradiance as a performance indicator. LED LCUs may have a potential for use in dental practice because their performance does not significantly reduce with time as do conventional halogen LCUs.

A clinical trial to evaluate the retention of a silver cermet-ionomer cement used as a fissure sealant.

A randomized clinical trial was under-taken to compare the retention of a silver cermet-ionomer cement, Ketac Silver, with a conventional, autopolymerizing BIS-GMA resin sealant, Delton, using matched pairs of fissure sites within each subject's mouth. One hundred twenty matched contralateral pairs of fissure sites in first and second permanent molars of 53 school children were sealed with the two materials. The choice of site and material was selected at random. The ages of the children ranged from five to 16 years; first permanent molars were sealed in the five- to 10-year age group, and second permanent molars in the 11- to 16-year age group. Sealants were assessed as present, partly present, or absent at 6, 12, and 24 months. The number of pairs of sites available for reassessment declined from 102 at six months to 59 at 24 months as patients were lost to the study. Retention rates were higher for the Ketac Silver sealants at all three inspection intervals (P < 0.01): 93% compared with 74% at six months, 81% compared with 65% at 12 months, and 83% compared with 58% at 24 months. When analyzed according to age range, the difference between the retention rates was statistically significant in the five- to 10-year-olds but not significant in the 11- to 16-year-olds. The conclusion reached in this study was that cermet cement was better retained than conventional resin sealants in younger children.

Gastrointestinal bleeding in a 15 month old male. A presentation of Munchausen's syndrome by proxy.

Munchausen's syndrome by Proxy is a well-described entity that may not always be immediately considered in a complicated case. We describe this syndrome being portrayed through the guise of gastrointestinal bleeding in a 15 month old male and discuss not only the difficulty involved in solidifying this diagnosis but also the consequences that may occur should this diagnosis not be entertained. Failure to diagnose Munchausen's syndrome by proxy often results from failure to consider the diagnosis. These cases frequently have specific characteristics that allow seasoned clinicians to suspect the diagnosis. Once the diagnosis is considered, it is crucial to take steps to protect not only the index patient but also siblings who not infrequently are also recipients of this life threatening form of child abuse.