Effect of Beam Profiles From Different Light Emission Tip Types of Multiwave Light-emitting Diodes on the Curing Profile of Resin-based Composites.

Light activation is an important clinical step for achieving success in restorative procedures. This study evaluated the influence of beam profile from different light emission tip types of multiwave light-emitting diodes (LEDs) on the curing profile of resin-based composites. Experimental composites were produced containing either camphorquinone (CQ) or diphenyl(2,4,6-trimethylbenzoyl)phosphine oxide (TPO) as a photoinitiator. Multiwave LEDs with either a bundle light guide tip (Bluephase G2, Ivoclar Vivadent) or a microlens tip (VALO Cordless, Ultradent) were characterized using a beam profiler. Block-shaped samples (5×5×3 mm depth) of the two composites were cured in a custom-designed mold with the multiwave LEDs positioned to compare the regions exposed to the 420-495 nm (blue) and 380-420 nm (violet) emittances. To map the curing profile, the degree of conversion (DC) of longitudinal thin cross sections from each block was evaluated using transmission FT-NIR. Radiant exposure transmitted through the composites during curing was evaluated at different thicknesses. Data were analyzed using analysis of variance and Tukey test (α=0.05; ß=0.2). The results indicated that there were differences in the beam profile and the overall radiant exposures transmitted through the composites using each multiwave LED (p<0.01, df=1 F=73.18). However, there were no differences in the curing profiles provided by the two multiwave LEDs (p=0.89, df=12 F=0.52), and similar effects were found according to the different LED emittance regions (p=0.09, df=5, F=2.11). When considering up to 1 mm in depth, no differences in the DC were found between the composites containing either photoinitiators. Starting at 2 mm in depth, the composite containing TPO showed a decrease in DC in the 420-495 nm emittance region, while the composite containing CQ showed a similar decrease in cure efficiency only at 3-mm depth under both 380-420 nm and 420-495 nm emittance regions. Thus, despite the fact that the nonuniform light beam emitted from the two multiwave LEDs was visually distinctly different when delivering 24 J/cm2, this difference did not seem to affect the curing profile of the composites. However, light transmission within 380-420 nm seems to be reduced with depth, directly affecting the curing profile of composites containing a photoinitiator with absorbance falling within this emission range.

The Combination of CQ-amine and TPO Increases the Polymerization Shrinkage Stress and Does Not Improve the Depth of Cure of Bulk-fill Composites.

OBJECTIVES: To evaluate the effect of combining camphorquinone (CQ) and diphenyl(2,4,6-trimethylbenzoyl)phosphine oxide (TPO) on the depth of cure and polymerization shrinkage stress of bulk-fill composites. METHODS AND MATERIALS: Experimental bulk-fill composites were produced containing equal molar concentrations of either CQ-amine or CQ-amine/TPO. The degree of in-depth conversion through each millimeter of a 4-mm-thick bulk-fill increment was evaluated by Fourier transform near-infrared microspectroscopy using a central longitudinal cross section of the increment of each bulk-fill composite (n=3). Light-transmittance of the multi-wave light-emitting diode (LED) emittance used for photoactivation (Bluephase G2, Ivoclar Vivadent) was recorded through every millimeter of each bulk-fill composite using spectrophotometry. The volumetric shrinkage and polymerization shrinkage stress were assessed using a mercury dilatometer and the Bioman, respectively. The flexural modulus was also assessed by a three-point bend test as a complementary test. Data were analyzed according to the different experimental designs (α=0.05 and ß=0.2). RESULTS: Up to 1 mm in depth, adding TPO to CQ-based bulk-fill composites increased the degree of conversion, but beyond 1 mm no differences were found. The light-transmittance of either wavelengths emitted from the multi-wave LED (blue or violet) through the bulk-fill composites were only different up to 1 mm in depth, regardless of the photoinitiator system. Adding TPO to CQ-based bulk-fill composites did not affect volumetric shrinkage but did increase the flexural modulus and polymerization shrinkage stress. CONCLUSION: Adding TPO to CQ-based bulk-fill composites did not increase the depth of cure. However, it did increase the degree of conversion on the top of the restoration, increasing the polymerization shrinkage stress.

Effect of Hydrofluoric Acid Concentration and Etching Time on Bond Strength to Lithium Disilicate Glass Ceramic.

The aim of this study was to evaluate the influence of different concentrations of hydrofluoric acid (HF) associated with varied etching times on the microshear bond strength (µSBS) of a resin cement to a lithium disilicate glass ceramic. Two hundred seventy-five ceramic blocks (IPS e.max Press [EMX], Ivoclar Vivadent), measuring 8 mm × 3 mm thickness, were randomly distributed into five groups according to the HF concentrations (n=50): 1%, 2.5%, 5%, 7.5%, and 10%. Further random distribution into subgroups was performed according to the following etching times (n=10): 20, 40, 60, 120, and 20 + 20 seconds. After etching, all blocks were treated with a silane coupling agent followed by a thin layer of an unfilled resin. Three resin cement cylinders (∅=1 mm) were made on each EMX surface, which was then stored in deionized water at 37°C for 24 hours before testing. The µSBS was in a universal testing machine at a crosshead speed of 1 mm/min until failure. Data were submitted to two-way analysis of variance, and multiple comparisons were performed using the Tukey post hoc test (α=0.05). One representative EMX sample was etched according to the description of each subgroup and evaluated using scanning electron microscopy for surface characterization. The HF concentrations of 5%, 7.5%, and 10% provided significantly higher µSBS values than 1% and 2.5% (p<0.05), regardless of the etching times. For 1% and 2.5% HF, the etching times from 40 to 120 seconds increased the µSBS values compared with 20 seconds (p<0.05), but etching periods did not differ within the 5%, 7.5%, and 10% HF groups (p>0.05). The effect of re-etching was more evident for 1% and 2.5% HF (p<0.05). Different HF concentrations/etching times directly influenced the bond strength and surface morphology of EMX.

Light-emitting Diode Beam Profile and Spectral Output Influence on the Degree of Conversion of Bulk Fill Composites.

OBJECTIVES: To evaluate the beam profile and the spectral output of monowave and polywave light-emitting diodes (LEDs) and their influence on the degree of conversion (DC) of bulk fill composites. METHODS: A monowave LED (Smartlite Focus, Dentsply) and a polywave LED (Valo Cordless, Ultradent) were characterized using a resin calibrator and a laser beam profile analyzer. Two bulk fill composites, Sonic Fill 2 (SF) containing camphorquinone (CQ) and Tetric EvoCeram Bulk Fill (TEB) containing CQ associated with alternative photoinitiators, were placed in custom-designed molds (n=3) and photoactivated by the monowave or polywave LED with 20 J/cm2. To map the DC, longitudinal cross sections (0.5 mm thick) from the center of the restoration were evaluated using FT-NIR microscopy. SF and TEB light transmittances (n=3) through 4-mm-thick specimens were evaluated during curing. Data were analyzed using a split-plot analysis of variance and Tukey test (α=0.05; ß=0.2). RESULTS: The monowave LED had a radiant emittance of 20 ± 0.5 J/cm2 over 420-495 nm, and the polywave LED had an emittance of 15.5 ± 0.4 J/cm2 over 420-495 nm and of 4.5 ± 0.2 J/cm2 over 380-420 nm. The total radiant exposure at the bottom of TEB was 2.2 ± 0.2 J/cm2 with the monowave LED and 1.6 ± 0.3 J/cm2 with the polywave LED, and for SF it was 0.4 ± 0.1 J/cm2 for both LEDs. There were no differences in the curing profiles produced either by the monowave or the polywave LED (p=0.9), according to the regions under influence of blue and/or violet emission at the same depth. There was no statistical difference in the DC for SF using the monowave or polywave LED at any depth (p=0.29). TEB had a higher DC at up to 2 mm in depth when the polywave LED was used (p<0.004), but no differences were found when starting at 2.5 mm. CONCLUSIONS: Monowave and polywave LEDs emitted nonhomogeneous light beams, but this did not affect the DC homogeneity of bulk fill composites. For composites containing CQ associated with alternative photoinitiators, polywave LEDs had a higher DC, but only at the top part of the restoration; lower wavelength absorption photoinitiators were ineffective in deeper areas.

The Effect of Hydrofluoric Acid Concentration on the Bond Strength and Morphology of the Surface and Interface of Glass Ceramics to a Resin Cement.

The purpose of this study was to evaluate the influence of various concentrations of hydrofluoric acid (HF) on the surface/interface morphology and µ-shear bond strength (µSBS) between IPS Empress Esthetic (EST) (Ivoclar Vivadent) and IPS e.max Press (EMX) (Ivoclar Vivadent) ceramics and resin cement. Ceramic blocks were divided into 12 groups for each kind of ceramic. Six different HF concentrations were evaluated: 1%, 2.5%, 5%, 7.5%, 10%, and 15%. All groups were silanated after etching, and half of the specimens within each group received a thin layer of unfilled resin (UR). Three resin cement cylinders were prepared on each ceramic block for µSBS testing. The specimens were stored in distilled water at 37°C for 24 hours. The µSBS test was carried out in a universal testing machine at a crosshead speed of 0.5 mm/min until fracture. The data were submitted to three-way analysis of variance and multiple comparisons were performed using the Tukey post hoc test (p<0.05). The etched surfaces and bonded interfaces were evaluated using scanning electron microscopy. µSBS means (MPa) for 1%, 2.5%, 5%, 7.5%, 10%, and 15% HF concentrations were, respectively, 25.2, 27.2, 30.1, 31.4, 33.3, and 31.8. µSBS means with or without UR application measured 32.24 and 27.4, respectively; EST and EMX measured 29.8 and 29.9, respectively. For the HF concentrations, 10% and 15% showed higher µSBS means than did 1% and 2.5% (p<0.05); 7.5% was higher than 1% (p<0.05); and no statistical differences were found among the other concentrations (p>0.05). When evaluating UR, µSBS mean was significantly higher and better infiltration was observed on the etched surfaces. No statistical difference was found between the ceramics. The HF concentration and UR influenced the bond strength and surface/interface morphology.

Can the hydrophilicity of functional monomers affect chemical interaction?

The number of carbon atoms and/or ester/polyether groups in spacer chains may influence the interaction of functional monomers with calcium and dentin. The present study assessed the chemical interaction and bond strength of 5 standard-synthesized phosphoric-acid ester functional monomers with different spacer chain characteristics, by atomic absorption spectroscopy (AAS), ATR-FTIR, thin-film x-ray diffraction (TF-XRD), scanning electron microscopy (SEM), and microtensile bond strength (µTBS). The tested functional monomers were 2-MEP (two-carbon spacer chain), 10-MDP (10-carbon), 12-MDDP (12-carbon), MTEP (more hydrophilic polyether spacer chain), and CAP-P (intermediate hydrophilicity ester spacer). The intensity of monomer-calcium salt formation measured by AAS differed in the order of 12-MDDP=10-MDP>CAP-P>MTEP>2-MEP. FTIR and SEM analyses of monomer-treated dentin surfaces showed resistance to rinsing for all monomer-dentin bonds, except with 2-MEP. TF-XRD confirmed the weaker interaction of 2-MEP. Highest µTBS was observed for 12-MDDP and 10-MDP. A shorter spacer chain (2-MEP) of phosphate functional monomers induced formation of unstable monomer-calcium salts, and lower chemical interaction and dentin bond strength. The presence of ester or ether groups within longer spacer carbon chains (CAP-P and MTEP) may affect the hydrophilicity, µTBS, and also the formation of monomer-calcium salts.

Two methods to simulate intrapulpal pressure: effects upon bonding performance of self-etch adhesives.

AIM: To evaluate the effects of two methods to simulate physiological pulpal pressure on the dentine bonding performance of two all-in-one adhesives and a two-step self-etch silorane-based adhesive by means of microtensile bond strength (µTBS) and nanoleakage surveys. METHODOLOGY: The self-etch adhesives [G-Bond Plus (GB), Adper Easy Bond (EB) and silorane adhesive (SIL)] were applied to flat deep dentine surfaces from extracted human molars. The restorations were constructed using resin composites Filtek Silorane or Filtek Z350 (3M ESPE). After 24 h using the two methods of simulated pulpal pressure or no pulpal pressure (control groups), the bonded teeth were cut into specimens and submitted to µTBS and silver uptake examination. Results were analysed with two-way anova and Tukey's test (P < 0.05). RESULTS: Both methods of simulated pulpal pressure led statistically similar µTBS for all adhesives. No difference between control and pulpal pressure groups was found for SIL and GB. EB led significant drop (P = 0.002) in bond strength under pulpal pressure. Silver impregnation was increased after both methods of simulated pulpal pressure for all adhesives, and it was similar between the simulated pulpal pressure methods. CONCLUSIONS: The innovative method to simulate pulpal pressure behaved similarly to the classic one and could be used as an alternative. The HEMA-free one-step and the two-step self-etch adhesives had acceptable resistance against pulpal pressure, unlike the HEMA-rich adhesive.

Effects of surface treatments, thermocycling, and cyclic loading on the bond strength of a resin cement bonded to a lithium disilicate glass ceramic.

SUMMARY Objectives : The aim of this present study was to investigate the effect of two surface treatments, fatigue and thermocycling, on the microtensile bond strength of a newly introduced lithium disilicate glass ceramic (IPS e.max Press, Ivoclar Vivadent) and a dual-cured resin cement. Methods : A total of 18 ceramic blocks (10 mm long × 7 mm wide × 3.0 mm thick) were fabricated and divided into six groups (n=3): groups 1, 2, and 3-air particle abraded for five seconds with 50-µm aluminum oxide particles; groups 4, 5, and 6-acid etched with 10% hydrofluoric acid for 20 seconds. A silane coupling agent was applied onto all specimens and allowed to dry for five seconds, and the ceramic blocks were bonded to a block of composite Tetric N-Ceram (Ivoclar Vivadent) with RelyX ARC (3M ESPE) resin cement and placed under a 500-g static load for two minutes. The cement excess was removed with a disposable microbrush, and four periods of light activation for 40 seconds each were performed at right angles using an LED curing unit (UltraLume LED 5, Ultradent) with a final 40 second light exposure from the top surface. All of the specimens were stored in distilled water at 37°C for 24 hours. Groups 2 and 5 were submitted to 3,000 thermal cycles between 5°C and 55°C, and groups 3 and 6 were submitted to a fatigue test of 100,000 cycles at 2 Hz. Specimens were sectioned perpendicular to the bonding area to obtain beams with a cross-sectional area of 1 mm(2) (30 beams per group) and submitted to a microtensile bond strength test in a testing machine (EZ Test) at a crosshead speed of 0.5 mm/min. Data were submitted to analysis of variance and Tukey post hoc test (p≤0.05). Results : The microtensile bond strength values (MPa) were 26.9 ± 6.9, 22.2 ± 7.8, and 21.2 ± 9.1 for groups 1-3 and 35.0 ± 9.6, 24.3 ± 8.9, and 23.9 ± 6.3 for groups 4-6. For the control group, fatigue testing and thermocycling produced a predominance of adhesive failures. Fatigue and thermocycling significantly decreased the microtensile bond strength for both ceramic surface treatments when compared with the control groups. Etching with 10% hydrofluoric acid significantly increased the microtensile bond strength for the control group.

Prolonged curing time reduces the effects of simulated pulpal pressure on the bond strength of one-step self-etch adhesives.

The aim of this study was to evaluate the effects of extended light-curing procedures on the microtensile bond strength (µTBS) of one-step self-etch adhesives (1-SEAs) submitted to simulated pulpal pressure. Coronal deep-dentin specimens were bonded using Clearfil S3 Bond (S3), Adper Easy Bond (EB), or G-Bond Plus (GB) following the manufacturers' recommendations and light-cured for 10 seconds or 40 seconds. The dentin-bonded specimens were stored in distilled water for 24 hours without pulpal pressure (control) or submitted to 20 cm H2O simulated pulpal pressure for 24 hours. The specimens were cut into matchsticks and subjected to µTBS testing. The data were statistically analyzed using the three-way analysis of variance and Tukey's tests (p<0.05). Debonded sticks were investigated through scanning electron microscopy. EB obtained higher bond strengths than GB and S3. However, prolonged light activation (40 seconds) provided higher µTBS for all adhesives when submitted to pulpal pressure. Conversely, pulpal pressure caused a drop in µTBS in EB and S3 when light-cured for 10 seconds. A mixed failure mode was mainly attained for the control groups, whereas the specimens submitted to pulpal pressure failed in the adhesive mode. The µTBS of GB was not affected by pulpal pressure when light-cured for 10 seconds. Adhesive was the most prevalent failure mode, except when light-cured for 40 seconds, which showed predominantly cohesive failure. Extended curing times improved the resistance of 1-SEAs to simulated pulpal pressure.

Influence of the volume of composite and photoactivation method on push-out bond strength and Knoop hardness of a resin composite.

AIM: The aim of this paper was to evaluate the influence of modulated photoactivation methods and volume of composite on Knoop hardness (KHN) and push-out bond strength (PBS) of Filtek Z350 to root dentin. METHODS: Three volumes (small, medium and large) of composite were bulk inserted in cavities prepared in 90 premolars. The specimens were photoactivated with continuous light, pulse-delay, or soft-start methods and submitted to PBS and KHN tests. The failure pattern was evaluated in stereomicroscope after the bond strength test. The data were submitted to two-way ANOVA and Tukey's test (P<0.05). RESULTS: Modulated photoactivation methods showed a higher PBS than continuous method (P<0.05). Medium volume of composite showed higher PBS than small and large volumes when photoactivated with continuous method (P<0.05). Pulse-delay significantly increased KHN for medium and large volumes in comparison to continuous method (P<0.05). Medium volume of composite showed KHN significantly higher than small and large volumes (P<0.05). CONCLUSION: The volume of composite influenced the PBS and KHN of resin composites. Pulse-delay showed the highest bond strength to dentin, as well KHN similar to the conventional method. The analysis of the failure pattern showed predominance of adhesive failure.

Variations in caries diagnoses and treatment recommendations and their impacts on the costs of oral health care.

OBJECTIVE: To evaluate the reproducibility of caries detection and treatment planning among public health dentists and estimate the possible impact of their decisions on financial costs. RESEARCH DESIGN AND SETTINGS: Thirty nine dentists working in the public health service of Piracicaba, São Paulo, Brazil made a combined visual-radiographic caries examination of 40 occlusal surfaces of extracted permanent teeth mounted on two dental mannequins and proposed treatment plans for each tooth. Histological validation then evaluated the diagnoses validity and the suitability of the treatment plans. OUTCOME MEASURES: Inter-examiner agreement was calculated by Cohen's Kappa statistics. The sensitivity and specificity of caries detection and treatment decision were calculated. The costs of dental treatment plans for public health system were calculated from a Brazilian public health service fee scale. RESULTS: Inter-examiner agreement for caries detection was moderate (kappa = 0.42) while for treatment decisions it was fair (kappa = 0.29). The sensitivity and specificity were 0.69 and 0.65 for caries detection and 0.56 and 0.65 for treatment decision respectively. Dentists overestimated the presence and depth of carious lesions and there was a tendency to treat enamel lesions using invasive therapeutic procedures. Mean treatment cost across the two cases was 32US$ (range 9-65) while the histologically validated cost was 23US$. CONCLUSION: The variability in caries detection and treatment decision negatively affected the cost of the dental treatment.

Radiopacity of root filling materials using digital radiography.

AIM: To evaluate radiopacity of root filling materials using digital radiography. METHODOLOGY: The sealers tested were AH Plus, Endofill, EndoREZ and Epiphany. Gutta-percha (Dentsply Maillefer) and Resilon cones were also tested. Acrylic plates, containing six wells, measuring 1 mm in depth and 5 mm in diameter, were prepared for the test, and filled with the materials. The test samples were radiographed together with an aluminium stepwedge calibrated in millimetres, according to ANSI/ADA Specification 57. For the radiographic exposures, digital imaging plates and an X-ray machine at 70 kVp and 8 mA were used. The object-to-focus distance was 30 cm, and the exposure time, 0.2 s. After the laser optic reading process, the software determined the radiopacity of the standardized areas, using grey-scale values, calculating the average radiographic density for each material. RESULTS: The decreasing values of radiopacity of the studied materials, expressed in millimetres of aluminium equivalent, were: Resilon (13.0), AH Plus(TM) (11.2), gutta-percha (9.8), Epiphany (8.0), Endofill (6.9) and EndoREZ (6.6). CONCLUSION: All materials had radiopacity values above 3 mm of aluminium recommended by ANSI/ADA Specification 57.

Halogen and LED light curing of composite: temperature increase and Knoop hardness.

This study assessed the Knoop hardness and temperature increase provided by three light curing units when using (1) the manufacturers' recommended times of photo-activation and (2) standardizing total energy density. One halogen--XL2500 (3M/ESPE)--and two light-emitting diode (LED) curing units--Freelight (3M/ESPE) and Ultrablue IS (DMC)--were used. A type-K thermocouple registered the temperature change produced by the composite photo-activation in a mold. Twenty-four hours after the photo-activation procedures, the composite specimens were submitted to a hardness test. Both temperature increase and hardness data were submitted to ANOVA and Tukey's test (5% significance). Using the first set of photo-activation conditions, the halogen unit produced a statistically higher temperature increase than did both LED units, and the Freelight LED resulted in a lower hardness than did the other curing units. When applying the second set of photo-activation conditions, the two LED units produced statistically greater temperature increase than did the halogen unit, whereas there were no statistical differences in hardness among the curing units.

Efeito das técnicas de inserção de compósitos odontológicos sobre a infiltração marginal / Effect of techniques of composit resin on microleakage

O objetivo deste estudo foi avaliar o efeito de duas técnicas de inserção do compósito sobre o nível de infiltração marginal na interface dente/compósito restaurador. Foram preparadas 40 cavidades circulares medindo 4 mm de diamêtro por 3 mm de profundidade em dentes bovinos, que foram divididos em 4 grupos (n=10): Grupo 1 - Único encremento + P60; Grupo 2 - Único encremento + Definite; Grupo 3 - Três incrementos + P60 ; e Grupo 4 - Três incrementos + Definite. Todas as amostras foram armazenadas em água destilada a 37°C, por 24 horas e submetidas a 500 ciclos térmicos (5° e 55°) por 30 segundos em cada banho. Em seguida, os dentes foram imersos em solução de azul de metileno a 2 por cento, por 4 horas, e a microinfiltração avaliada. Os resultados submetidos ao teste estatístico de Kruskal-Wallis mostraram que a técnica de inserção em 3 incrementos para o Definite com 1 incremento; o P60 com 3 incrementos apresentou níveis de infiltração marginal estatisticamente menores em relação ao P60 e Definite, ambos com 1 incremento