In vitro temperature changes in the pulp chamber caused by laser and Quadwave LED-light curing units.

The study evaluated the pulp temperature (PT) increase in Class I and V preparations when exposed to the Monet Laser (for 1 and 3 s), the PinkWave (for 3 and 10 s), the Valo Grand (for 3 and 10 s), the PowerCure, (for 3 and 10 s) and the SmartLite Pro (for 10 s). Non-retentive Class I and Class V cavities were prepared in one molar fixed in an acrylic plate and positioned in a warm water bath. The PT baseline was kept at 32 °C to simulate physiological conditions. Two T-type thermocouples were inserted through the roots into the pulp chamber in two positions: close to the pulp horn and the buccal wall close to the Class V cavity. The water flow was adjusted to 0.026 mL/min, and real-time temperature data were collected every 0.5 s. PT measurements were made with the tip of the LCU 0 and 6 mm away from the tooth surface. The radiant exitance (mW/cm2) and radiant exposure (J/cm2) were calculated. One-way ANOVA compared the effect of the pulpal flow, and ΔT values were subjected to two-way ANOVA, followed by Scheffe's post hoc tests. The Monet Laser used for 3 s and the PinkWave used for 10 s produced the greatest PT rise in the Class I cavity. The simulated pulpal flow did not influence the PT rise. Overall, cavities exposed at the 0 mm distance had higher ΔT values than groups at 6 mm distance. The placement of a rubber dam for Class V restorations may prevent positioning LCUs directly over the cavity, which may affect the rise in PT.

Temperature changes and hardness of resin-based composites light-cured with laser diode or light-emitting diode curing lights.

The temperature and Vickers Hardness (VH) at the top and bottom surfaces of three resin-based composites (RBCs) were measured when light-cured using five light-curing units (LCUs). The spectrum, power, and energy delivered to the top of the RBCs and transmitted through the RBCs were measured. Starting at 32℃, the temperature rise produced by the Monet Laser (ML-1 s and 3 s), Valo Grand (VG-3 s and 10 s), DeepCure (DC-10 s), PowerCure, (PC-3 s and 10 s) and PinkWave (PW-10 s) were measured at the bottom of specimens 2 mm deep × 6 mm wide made of Filtek Universal A2, Tetric Evoceram A2 and an experimental RBC codenamed Transcend UB. The VH values measured at the top and bottom of these RBCs were analyzed using ANOVA and Scheffe's post hoc test (p < 0.05) to determine the effects of the LCUs on the RBCs. The transmitted power from the ML was reduced by 77.4% through 2 mm of Filtek Universal, whereas light from PW decreased by only 36.8% through Transcend. The highest temperature increases from the LCU combined with the exothermic reaction occurred for Transcend, and overall, no significant differences were detected between Filtek Universal and Tetric Evoceram (p = 0.9756). Transcend achieved the highest VH values at the top and bottom surfaces. The PinkWave used for 10 s produced the largest temperature increase (20.2℃) in Transcend. The Monet used for 1 s produced the smallest increase (7.8℃) and the lowest bottom:top VH ratios.

Irradiance from 12 LED light curing units measured using 5 brands of dental radiometers.

OBJECTIVE: To evaluate the accuracy of five brands of radiometers in reporting the irradiance (mW/cm2 ) from twelve brands of LCUs compared to a 'Gold Standard' (GS) reference obtained from a hand-held laboratory-grade radiometer. MATERIALS AND METHODS: The irradiance was measured from two examples of twelve brands of previously used LCUs on two examples of five brands of dental radiometers. The emission spectrum was also obtained. Irradiance data from each brand of LCU against each meter was analyzed using the Shapiro-Wilk test for normality. The irradiance values were subjected to a two-way ANOVA followed by Bonferroni tests for each LCU brand. Finally, a descriptive analysis was made using a 95% confidence interval around the mean irradiance. RESULTS: The power output from the LCUs ranged from 271 mW to 1005 mW. Among the tested radiometers, only the Bluephase Meter II could accurately report the irradiance from 11 out of the 12 brands of LCU evaluated in this study. When measured using the "GS" system, the mean irradiance values from the two examples of nine brands of previously used LCU were not always within ±10% of the irradiance values stated by the manufacturer. CONCLUSIONS: The mean irradiance values from 9 of the 12 brands of used LCUs were beyond ±10% of the irradiance values stated by the manufacturer. Only the Bluephase Meter II could accurately report the irradiance from 11 out of the 12 brands of LCU evaluated in this study. CLINICAL SIGNIFICANCE: There was a wide range in the power output from the LCUs tested. It was impossible to accurately measure the irradiance from all the LCUs using the dental radiometers examined. However, dental radiometers should still be used in dental offices to monitor the light output from LCUs and verify that they are working correctly before they are used on patients.

In-vitro pulpal temperature increases when photo-curing bulk-fill resin-based composites using laser or light-emitting diode light curing units.

OBJECTIVE: To evaluate the in vitro pulpal temperature rise (ΔT) within the pulp chamber when low- and high-viscosity bulk-fill resin composites are photo-cured using laser or contemporary light curing units (LCUs). MATERIALS AND METHODS: The light output from five LCUs was measured. Non-retentive Class I and V cavities were prepared in one upper molar. Two T-type thermocouples were inserted into the pulp chamber. After the PT values reached 32°C under simulated pulp flow (0.026 mL/min), both cavities were restored with: Filtek One Bulk Fill (3 M), Filtek Bulk Fill Flow (3 M), Tetric PowerFill (Ivoclar Vivadent), or Tetric PowerFlow (Ivoclar Vivadent). The tooth was exposed as follows: Monet Laser (1 and 3 s), PowerCure (3 and 20 s), PinkWave (3 and 20 s), Valo X (5 and 20 s) and SmartLite Pro (20 s). The ΔT data were subjected to one-way ANOVA followed by Scheffe's post hoc test. RESULTS: Monet 1 s (1.9 J) and PinkWave 20 s (30.1 J) delivered the least and the highest amount of energy, respectively. Valo X and PinkWave used for 20 s produced the highest ΔT values (3.4-4.1°C). Monet 1 s, PinkWave 3 s, PowerCure 3 s (except FB-Flow) and Monet 3 s for FB-One and TP-Fill produced the lowest ΔT values (0.9-1.7°C). No significant differences were found among composites. CONCLUSIONS: Short 1- to 3-s exposures produced acceptable temperature rises, regardless of the composite. CLINICAL SIGNIFICANCE: The energy delivered to the tooth by the LCUs affects the temperature rise inside the pulp. The short 1-3 s exposure times used in this study delivered the least amount of energy and produced a lower temperature rise. However, the RBC may not have received sufficient energy to be adequately photo-cured.

Effect of thickness of CAD/CAM materials on light transmission and resin cement polymerization using a blue light-emitting diode light-curing unit.

OBJECTIVE: Evaluate the effect of thickness of high-translucency (HT) CAD/CAM materials on irradiance and beam profile from a blue light-emitting diode light-curing unit (LCU) and on the degree of conversion (DC) and maximum polymerization rate (Rpmax ) of a light-cured resin cement (LCC). MATERIAL AND METHODS: The direct output from the LCU, the light transmission and irradiance ratio (IR) through one conventional composite and nine HT CAD/CAM materials (0.5, 1.0, 1.5, or 2.0-mm thick; n = 5) were measured with a integrating sphere coupled to a spectrometer. The light beam was assessed with a beam profiler camera. The DC at 600 s and the Rpmax of one LCC was determined using a Fourier transform infrared spectrometer (n = 5). Data were analyzed by ANOVA followed by Tukey's tests, and Dunnett's test was also used for irradiance data (α = 0.05). RESULTS: A significant decrease in irradiance through all materials occurred as thickness increased. Thin CAD/CAM materials improved light homogeneity, which decreased with the increase in thickness. The DC of the LCC directly exposed to light was the same as when exposed to 45%, 25%, 15%, or 5% IRs. Rpmax decreased with the decrease in IR. CONCLUSIONS: Although the HT CAD/CAM materials reduced the irradiance from the LCU, minor effects were observed in the LCC's DC. CLINICAL SIGNIFICANCE: Despite the light attenuation of blue light through different CAD/CAM materials that were up to 2-mm thick, the degree of conversion of one brand of light-cured resin cement was clinically acceptable when the LCU was used for 30 s.

Effect of zirconia decontamination protocols on bond strength and surface wettability.

OBJECTIVE: To evaluate the effects of human saliva decontamination protocols on bond strength of resin cement to zirconia (Y-PSZ), wettability, and microbial decontamination. MATERIALS AND METHODS: Zirconia plates were sandblasted and divided into (a) not contaminated, (b) contaminated with human saliva and: (c) not cleaned, (d) cleaned with air-water spray, (e) cleaned with 70% ethanol, (f) cleaned with Ivoclean, or (g) cleaned with nonthermal atmospheric plasma (NTAP). The wettability and microbial decontamination of the surfaces were determined after saliva contamination or cleaning. Monobond Plus (Ivoclar Vivadent) was applied after cleaning, followed by Variolink LC (Ivoclar Vivadent). The samples were stored 1 week before shear bond strength (SBS) testing, and data (SBS and wettability) were analyzed by one-way analysis of variance and Tukey test (α = .05). RESULTS: Saliva contamination reduced SBS to zirconia compared to not contaminated. Both Ivoclean and NTAP produced higher SBS compared to not cleaned and were not significantly different from the not contaminated. Ivoclean produced the highest contact angle, and NTAP the lowest. With the exception of using just water-spray, all cleaning protocols decontaminated the specimens. CONCLUSIONS: Both Ivoclean and NTAP overcame the effects of saliva contamination, producing an SBS to zirconia comparable to the positive control. CLINICAL SIGNIFICANCE: Dental ceramics should be cleaned prior to resin cementation to eliminate the effects of human saliva contamination, and Ivoclean and NTAP are considered suitable materials for this purpose.

Effect of tooth brushing on gloss retention and surface roughness of five bulk-fill resin composites.

OBJECTIVES: To determine the effects of tooth brushing on five bulk-fill resin based composites (RBCs). METHOD: Ten samples of Filtek Supreme Enamel (control), Filtek One Bulk Fill, Tetric EvoCeram Bulk Fill, SonicFill 2, SDR flow+, and Admira Fusion X-tra were light cured for 20 seconds using the Valo Grand curing light. After 24 hours storage in air at 37°C, specimens were brushed in a random order using Colgate OpticWhite dentifrice and a soft toothbrush. Surface gloss was measured prior to brushing, after 5,000, 10,000 and 15,000 back and forth brushing cycles. Surface roughness was measured after 15,000 brushing cycles using atomic force microscopy (AFM) and selected scanning electron microscope (SEM) images were taken. The data was examined using ANOVA and pair-wise comparisons using Scheffe's post-hoc multiple comparison tests (α = 0.05). RESULTS: Surface gloss decreased and the surface roughness increased after brushing. Two-way ANOVA showed that both the RBC and the number of brushing cycles had a significant negative effect on the gloss. One-way ANOVA showed that the RBC had a significant effect on the roughness after 15,000 brushing cycles. For both gloss and roughness, brushing had the least effect on the nano-filled control and nano-filled bulk-fill RBC, and the greatest negative effect on Admira Fusion X-tra. The SEM images provided visual agreement. There was an excellent linear correlation (R2 = 0.98) between the logarithm of the gloss and roughness. CONCLUSION: After brushing, the bulk-fill RBCs were all rougher than the control nano-filled RBC. The nano-filled bulk-fill RBC was the least affected by brushing. CLINICAL SIGNIFICANCE: Bulk-fill RBCs lose their gloss faster and become rougher than the nanofilled conventional RBC, Filtek Supreme Ultra. The nanofilled bulk-fill RBC was the least affected by tooth brushing.

Effect of four different mono and multi-wave light-curing units on the Knoop hardness of veneer resin composites.

OBJECTIVES: To evaluate the effect of mono and multi-wave light-curing units (LCUs) on the Knoop hardness of resin-based composites (RBC) that use different photoinitiators. METHODS: Central incisor-shaped specimens 12 mm long, 9 mm wide, and 1.5 mm thick were made from 2 RBCs that use different photoinitiators: Tetric N-Ceram (Ivoclar Vivadent) - and Vittra APS (FGM), both A2E shade. They were light-cured with 4 different LCUs: two claimed to be multi-wave - VALO Grand (Ultradent) and Emitter Now Duo (Schuster); and two were monowave - Radii Xpert (SDI) and Elipar DeepCure-L (3 M Oral Care) using 2 different light exposure protocols: one 40 s exposure centered over the specimen; and two 20 s light exposures that delivered light from two positions to better cover the entire tooth. 16 groups with 10 specimens in each group were made. The Knoop hardness (KH, kg/mm2) was measured at the top and bottom of the specimen in the center and at the cervical, incisal, mesial, and distal peripheral regions. The active tip diameters (mm) and spectral radiant powers (mW/nm) of the LCUs were measured with and without the interposition of the RBC, as well as the radiant exposure beam profiles (J/cm²) delivered to the top of the RBCs. The data was analyzed using Three-way ANOVA and Tukey's tests (α = 0.05). RESULTS: The VALO Grand (1029 mW) emitted twice the power of the Radii Xpert (500 mW). The KH values of VI and TN resin composite specimens were significantly affected by the LCU used (p < .001), the measurement location (p < .001), and the surface of the specimen (p < .001). LCUs with wider tip diameters produced greater Knoop hardness values at the peripheries of the 12 mm of long, 9 mm wide specimens. In general, the VALO Grand produced the highest KH values, followed by Elipar DeepCure-L, then by Radii Xpert. The Emitter Now Duo LCU produced the lowest values. Exposing the veneers from two locations reduced the differences between the LCUs and the effect of the measurement location. Only the VALO Grand could fully cover the composite veneer with light when the two locations were used. SIGNIFICANCE: The light tip must cover the entire restoration to photocure the RBC beneath the light tip.

Bioactivity of Dental Restorative Materials: FDI Policy Statement.

The term bioactivity is being increasingly used in medicine and dentistry. Due to its positive connotation, it is frequently utilised for advertising dental restorative materials. However, there is confusion about what the term means, and concerns have been raised about its potential overuse. Therefore, FDI decided to publish a Policy Statement about the bioactivity of dental restorative materials to clarify the term and provide some caveats for its use in advertising. Background information for this Policy Statement was taken from the current literature, mainly from the PubMed database and the internet. Bioactive restorative materials should have beneficial/desired effects. These effects should be local, intended, and nontoxic and should not interfere with a material's principal purpose, namely dental tissue replacement. Three mechanisms for the bioactivity of such materials have been identified: purely biological, mixed biological/chemical, or strictly chemical. Therefore, when the term bioactivity is used in an advertisement or in a description of a dental restorative material, scientific evidence (in vitro or in situ, and preferably in clinical studies) should be provided describing the mechanism of action, the duration of the effect (especially for materials releasing antibacterial substances), and the lack of significant adverse biological side effects (including the development and spread of antimicrobial resistance). Finally, it should be documented that the prime purpose, for instance, to be used to rebuild the form and function of lost tooth substance or lost teeth, is not impaired, as demonstrated by data from in vitro and clinical studies. The use of the term bioactive dental restorative material in material advertisement/information should be restricted to materials that fulfil all the requirements as described in the FDI Policy Statement.

Ability of short exposures from laser and quad-wave curing lights to photo-cure bulk-fill resin-based composites.

OBJECTIVE: This study investigated the ability of a laser, and a 'quad-wave' LCU, to photo-cure paste and flowable bulk-fill resin-based composites (RBCs). METHODS: Five LCUs and nine exposure conditions were used. The laser LCU (Monet) used for 1 s and 3 s, the quad-wave LCU (PinkWave) used for 3 s in the Boost and 20 s in the Standard modes, the the multi-peak LCU (Valo X) used for 5 s in the Xtra and 20 s in the Standard modes, were compared to the polywave PowerCure used in the 3 s mode and for 20 s in the Standard mode, and to the mono-peak SmartLite Pro used for 20 s. Two paste consistency bulk-fill RBCs: Filtek One Bulk Fill Shade A2 (3 M), Tetric PowerFill Shade IVA (Ivoclar Vivadent), and two flowable RBCs: Filtek Bulk Fill Flowable Shade A2 (3 M), Tetric PowerFlow Shade IVA (Ivoclar Vivadent) were photo-cured in 4-mm deep x 4-mm diameter metal molds. The light received by these specimens was measured using a spectrometer (Flame-T, Ocean Insight), and the radiant exposure delivered to the top surface of the RBCs was mapped. The immediate degree of conversion (DC) at the bottom, and the 24-hour Vickers Hardness (VH) at the top and bottom of the RBCs were measured and compared. RESULTS: The irradiance received by the 4-mm diameter specimens ranged from 1035 mW/cm2 (SmartLite Pro) to 5303 mW/cm2 (Monet). The radiant exposures between 350 and 500 nm delivered to the top surface of the RBCs ranged from 5.3 J/cm2 (Monet in 1 s) to 26.4 J/cm2 (Valo X), although the PinkWave delivered 32.1 J/cm2 in 20 s 350 to 900 nm. All four RBCs achieved their maximum DC and VH values at the bottom when photo-cured for 20 s. The Monet used for 1 s and the PinkWave used for 3 s on the Boost setting delivered the lowest radiant exposures between 420 and 500 nm (5.3 J/cm2 and 3.5 J/cm2 respectively), and they produced the lowest DC and VH values. CONCLUSIONS: Despite delivering a high irradiance, the short 1 or 3-s exposures delivered less energy to the RBC than 20-s exposures from LCUs that deliver> 1000 mW/cm2. There was an excellent linear correlation (r > 0.98) between the DC and the VH at the bottom. There was a logarithmic relationship between the DC and the radiant exposure (Pearson's r = 0.87-97) and between the VH and the radiant exposure (Pearson's r = 0.92-0.96) delivered in the 420-500 nm range.

Surface properties and Streptococcus mutans biofilm adhesion of ion-releasing resin-based composite materials.

OBJECTIVE: To evaluate the adhesion of Streptococcus mutans (S. mutans) and related surface properties of ion-releasing resin-based composite (RBC) restorative materials. METHODS: Two ion-releasing RBCs, Activa (ACT) and Cention-N (CN), were compared to a conventional RBC (Z350) and a resin-modified glass ionomer cement (Fuji-II-LC). Ten disk-shaped specimens were fabricated for each material (n = 40). After standardized surface polishing procedure, the surface properties of the specimens were evaluated using surface roughness measurements by a profilometer and hydrophobicity using water contact angle measurements. To assess bacterial adhesion, the number of S. mutans bacteria was calculated from colony-forming units (CFU). Confocal laser scanning microscope analysis was done for qualitative & quantitative assessment. The data were analyzed using One-way ANOVA followed by Tukey's post-hoc test to compare the mean values of surface roughness, water contact angle and CFU values. To compare the mean dead cell percentage Kruskal-Wallis rank test and Conover test were used. A p-value of ≤ 0.05 was used to report the statistical significance. RESULTS: Z350 and ACT had the smoothest surfaces, followed by CN, and the roughest surface was seen in FUJI-II-LC. The lowest water contact angles were seen in CN, and Z350, and the highest were in ACT. S. mutans counts were the highest in ACT and the lowest in Z350 and CN. CN and Fuji-II-LC registered the highest percentage of dead bacterial cells, while the lowest were in ACT. SIGNIFICANCE: Surface properties did not significantly influence bacterial adhesion. More S. mutans bacteria accumulated on ACT than on the nanofilled composite and on CN. CN had antibacterial effects against Streptococcus mutans biofilms.

Effect of thickness and shade of CAD/CAM composite on the light transmission from different light-curing units.

The thickness and shade of a restoration will affect the transmission of light from the light-curing unit (LCU). This study determined the power (mW), spectral radiant power (mW/nm), and beam profile of different LCUs through various thicknesses and shades of a CAD-CAM resin composite (BRAVA Block, FGM). Five thicknesses: 0.5; 0.75; 1.0; 1.5, and 2.0 mm, in three shades: Bleach; A2 and A3.5 of a CAD-CAM resin (n = 5). Two single-peak LCUs: EL, Elipar DeepCure-S (3M Oral Care); and OP, Optilight Max (Gnatus), and one multiple-peak LCU: VL, VALO Grand (Ultradent), were used. The LCUs were positioned touching the surface of the BRAVA Block. The power and emission spectrum were measured using a fiberoptic spectrometer attached to an integrating sphere, and the beam profiles using a laser beam profiler. The effect of the material thickness on the light attenuation coefficients was determined. VL and EL delivered more homogeneous beam profiles than OP. The type of the BRAVA Block had a significant effect on the transmitted power, and wavelengths of transmitted light (p < 0.001). There was an exponential reduction in the power and emission spectrum as the thickness of the BRAVA Block increased (p < 0.001). The light transmission through the A2 shade was least affected by the thickness (p < 0.001). The attenuation coefficient was higher for the violet light and higher for A3.5 than the A2 or Bleach shades. No violet light from the VL could be detected at the bottom of 2.0 mm of the BRAVA Block.

Effect of pre-heating methods and devices on the mechanical properties, post-gel shrinkage, and shrinkage stress of bulk-fill materials.

This study evaluated the effect of using two different pre-heating methods on the three resin-based composite (RBCs). Three paste viscosity bulk-fill RBCs (VisCalor Bulk [VC]; VOCO; x-tra fil Caps [XF], VOCO; Filtek One Bulk Fill [FO], 3 M) were pre-heated using either a VisCalor Dispenser (VOCO) to 65 °C, or the Caps Warmer (VOCO) to 37 °C, 54 °C, or 68 °C. The temperature inside the capsules and cavity was monitored before and after insertion into the matrix. Within 30 s of inserting the RBC, they were light-activated using a VALO (Ultradent) curing light for 20 s. The post-gel shrinkage (Shr - %), Flexural Strength (FS - MPa), Elastic Modulus (E - MPa), degree of conversion (DC - %), Knoop Hardness (KH - N/mm2), diametral tensile strength (DTS - MPa), and compressive strength (CS - MPa) of the RBCs were measured (10 specimens per group). The shrinkage stress was calculated using three-dimensional finite element analysis. Data were analyzed using one-way, two-way ANOVA and Tukey's test (α = 0.05). The temperature fell rapidly after the RBC was inserted into the cavity. Pre-heating the RBCs did not affect the mechanical properties. FO had the lowest E, DC, and KH values, VC had intermediate values, and XF achieved the highest values. The DTS and CS values were not affected by the various pre-heating methods, the temperature, or RBC. Pre-heating methods at 37 °C produced higher shrinkage for all RBCs. VC pre-heated to 65 °C produced the lowest stress when measured at 10 min after light activation.

Intra- and inter-brand accuracy of four dental radiometers.

This study measured the accuracy and precision of four commercial dental radiometers. The intra-brand accuracy was also determined. The light outputs from 14 different curing lights were measured three times using four brands of dental radiometers and the results were compared to two laboratory-grade power meters that were used as the "gold standard". To ensure proper representation, three examples of each brand of dental radiometer were used. Data collected was analyzed using ANOVA, with 95% confidence intervals, comparing the laboratory-grade meters to the dental radiometers. Bioequivalence was established where the confidence interval for the irradiance values was within ±20% of the "gold standard" reading. Forest plots were used to highlight bioequivalence values. The two laboratory-grade meters differed by less than 0.6%. Overall, all three examples of the Bluephase and SDI radiometers as well as two examples of the LEDRadiometer and one CureRite meter were bioequivalent to the gold standard. However, the type of curing light measured had a significant effect on the accuracy of the radiometer. There was significant variability of the irradiance readings between radiometer brands, and between irradiance values recorded by the three samples of each brand studied. This made it impossible to definitively rank the radiometer brands for accuracy. Within the ±20% bioequivalence limits of this study, there was a clinically significant difference in the irradiance readings between radiometer brands and the choice of curing light affected the results. There was also significant variation in irradiance readings reported by different examples of the same brand of radiometer. Whether in clinical practice or in research, dental radiometers should not be used when either the irradiance or energy delivered needs to be accurately known.

Depth of cure of 10 resin-based composites light-activated using a laser diode, multi-peak, and single-peak light-emitting diode curing lights.

OBJECTIVES: To evaluate the depth of cure (DOC) of ten contemporary resin-based composites (RBCs), light-cured using different LCUs and exposure times. METHODS: The power, radiant emittance, irradiance, radiant exposure (RE), and beam profiles from a laser (M, Monet), a multi-peak (V, Valo Grand), and single-peak (S, SmartLite Pro) LCU were measured. The DOC was measured using a 6-mm diameter metal mold and a solvent dissolution method to remove the uncured RBC. The length of the remaining RBC was divided by 2. The exposure times were: 1 s and 3 s for M, 10 s and 20 s for V, and 10 s and 20 s for S. Data were analyzed using: Bland-Altman distribution, Pearson's Correlation, and an artificial neural network (ANN) to establish the relative importance of the factors on the DOC (α=0.05; ß=0.2). RESULTS: Significant differences were found in the DOC achieved by the different LCUs and composites. The laser LCU emitted the highest power, radiant emittance is used above and in the tables and delivered the highest irradiance. However, this LCU used for 1 s delivered the lowest RE and produced the shortest DOC in all ten RBCs. The ANN demonstrated that the RE is the most critical factor for the DOC. Bland-Altman comparisons showed that the DOCs achieved with the laser LCU used for 1 s were between 17 and 34% shorter than the other conditions. CONCLUSIONS: Although the laser LCU cured all 10 RBCs when used for 1 s, it produced the shallowest DOC, and some RBCs did not achieve their minimum DOC threshold. The RE and not the irradiance was the most important factor in determining the DOC of these 10 RBCs. CLINICAL SIGNIFICANCE: Despite delivering high power and irradiance, the laser used for l s delivered a lower radiant exposure than the conventional LCUs used for 10 s. This resulted in a shorter DOC.

Influence of Adhesion Promoter Primers on Polymerization Kinetics and Long-term Bond Strength of Composite Cements to Zirconia.

PURPOSE: To investigate the influence of primers on polymerization kinetics of resin-based luting and its effect on the microhardness and bond strength to zirconia. Materials and Methods: Panavia V5 (PV; Kuraray Noritake) with Tooth Primer (TPprimer; Kuraray Noritake) or Clearfil Ceramic Primer (CPprimer; Kuraray Noritake), and RelyX Ultimate (RU; 3M Oral Care) with Scotchbond Universal (SUadhesive; 3M Oral Care) were evaluated. Polymerization kinetics of luting materials with or without primers (TPprimer or SUadhesive) were evaluated using Fourier transform near-infrared (FT-NIR) spectroscopy in self- and dual-curing modes (n = 5). Microhardness of luting materials was evaluated after 1, 12, and 24 h (n = 5). Shear bond strengths to zirconia ceramics (Katana Zirconia, Kuraray Noritake; and Lava Esthetic, 3M Oral Care) after 24 h and 1 year (n = 8) were assessed to determine the effect of the following surface treatments: no treatment, non-thermal atmospheric plasma, primer (CPprimer or SUadhesive), and the combination of plasma + primers. Statistical analyses were performed at a 5% significance level. RESULTS: PV achieved a significantly higher degree of conversion (DC) when TPprimer was used, while there was no increase in conversion for RU combined with SUadhesive. Light activation significantly improved polymerization, which also produced greater microhardness. CPprimer and SUadhesive significantly improved immediate bond strength to zirconia ceramics. However, after 1 year, only SUadhesive with RU was able to maintain the bond strength. Plasma surface treatment did not improve bonding to zirconia. CONCLUSION: The use of primers improved the DC for PV only. Light curing produced higher conversion and microhardness for both resin-based luting materials. Bond strength to zirconia was improved when primers were used. However, only RU demonstrated reliable long-term adhesion to zirconia.

Ion releasing direct restorative materials: Key mechanical properties and wear.

OBJECTIVES: To investigate the depth of cure (DoC), fracture toughness (KIC) and wear of ion releasing resin-based composite (RBC) restorative materials. METHODS: Two ion releasing RBCs, Activa (ACT) and Cention-N (CN) were compared to a conventional RBC (Z350) and a resin-modified glass ionomer cement (Fuji-II-LC). The DoC was measured in a 10-mm deep semi-circular metal mold with a 2-mm internal radius (n = 8). The molds were irradiated from one end for 20-s. The Knoop hardness (KH) was measured at 0.5-mm intervals from the surface after the specimens had been stored at 37 °C for 24-h. To measure the KIC, single-edge-notched specimens (n = 15/group) were prepared (25×5x2.5-mm) for a 3-point bending test and then stored for either 1 or 30-days in water at 37 °C. Disk-shaped specimens (n = 10) were subjected to 250,000-load cycles of 49-N using a chewing simulator against spherical steatite antagonists. DoC and wear data were analyzed by one-way ANOVA and Tukey post hoc tests (p ≤ 0.05). KIC data were analyzed by two-way ANOVA and one-way ANOVA, and the Tukey post hoc test (p ≤ 0.05). In addition, an independent t-test was used to determine if storage time had any effect (α = 0.05) on the KIC of each material. RESULTS: Maximum hardness value was the highest for Z350 and the lowest for ACT. The depth at which 80% of the maximum KH, was the highest for CN (9.2 mm) and the lowest for Z350 (2 mm). All tested materials met the manufacturers' claims for DoC. After 1-day, the highest KIC values were recorded for ACT and the lowest for Fuji-II-LC. Water storage (30-days) significantly reduced the KIC value for all materials except Fuji-II-LC. The highest wear rate values were recorded for CN followed by ACT. SIGNIFICANCE: All tested materials met their manufacturers' claims for DoC. Water storage for 30-days significantly reduced the fracture toughness for ACT and CN. Wear was significantly higher for ACT and CN.

Correlation of the mechanical and biological response in light-cured RBCs to receiving a range of radiant exposures: Effect of violet light.

OBJECTIVE: This study correlates the mechanical and biological response of commercially available resin-based composites (RBCs) to clinically relevant light-curing conditions. METHODS: Two RBCs (Venus and Venus Pearl; Kulzer) that use different monomer and photo-initiator systems, but have a similar filler volume and shade, were exposed to either just blue light, or violet and blue light from two different LCUs (Translux Wave and Translux 2Wave; Kulzer). Distance and exposure times were adjusted so that both LCUs delivered 5 similar levels of radiant exposures (RE) between 1.5 J/cm²-25 J/cm² in the blue wavelength range. Thus, the violet light was additional light. The top and bottom of 2-mm thick specimens were subjected to a depth-sensing indentation test (Martens hardness/HM, Vickers hardness/HV, indentation modulus/YHU, mechanical work/Wtotal, plastic deformation work/Wplas, creep/Cr). The viability of human gingival fibroblasts was assessed after three days of exposure to RBC eluates. One and multiple-way analysis of variance (ANOVA), the Tukey honestly significant difference (HSD) post-hoc tests (α = 0.05), t-test and a Spearman correlation analysis were used. RESULTS: As the RE increased, the mechanical properties increased at a greater rate at the top compared to the bottom of the RBCs. Values measured at the bottom of 2-mm increments approached the values measured at the top only when RE > 25 J/cm² of blue light was delivered. Toxicity decreased with RE and elution cycles and was lower for Venus Pearl. Within one RE level, addition of violet light resulted in significantly improved properties (in 131 out of 150 comparisons, p < 0.05). This effect was stronger for Venus Pearl. There was a good correlation between mechanical and biological parameters. This correlation decreased as the number of eluates increased. CLINICAL SIGNIFICANCE: The mechanical and biological response to variation in RE is interrelated. The addition of violet light has a positive effect, particularly at low RE.

Effect of Light-curing Unit Design and Mouth Opening on the Polymerization of Bulk-fill Resin-based Composite Restorations in Molars.

PURPOSE: This study evaluated the effect of the design of the light-curing unit (LCU) and mouth opening on the properties of bulk-fill resin-based composites (RBCs). MATERIALS AND METHODS: Eighty molars received a mesio-occlusal-distal preparation and were restored using two different bulk-fill RBCs, Opus Bulk Fill APS (FGM) and Filtek Bulk Fill One (3M Oral Care), using two different designs of LCU, straight (Valo Cordless [Ultradent]) and angled (Radii-Cal [SDI]). Two mouth openings of 25 and 45 mm at the incisors were used. Forty samples were sectioned mesiodistally. One half was immersed in tetrahydrofuran to examine the effect of the solvent on the RBCs (SE), and the other half to measure the degree of conversion (DC) in proximal and occlusal boxes using Fourier Transform Infrared spectroscopy. The other 40 samples were subjected to thermomechanical fatigue and immersed in silver nitrate to examine the gingival margin integrity (GMI) using SEM. The irradiance (mW/cm2) and emission spectrum (mW/cm2/nm) from the LCUs were measured using a MARC Resin Calibrator (BlueLight Analytics). DC data were analyzed by 3-way ANOVA and Tukey's test; SE and GMI were analyzed by an ANOVA on Ranks and Dunn test (α = 0.05). RESULTS: The DC values were similar in the occlusal and proximal boxes when using Valo Cordless, irrespective of RBC and the mouth opening used. Lower DC values were measured in proximal boxes when using Radii-Cal. The mouth opening had a greater effect on the irradiance delivered by Radii-Cal. Radii-Cal with 25-mm mouth opening had greater SE and GMI values, whereas the SE and GMI values obtained with Valo Cordless were unaffected by mouth opening. CONCLUSION: The choice of LCU did not influence the properties of tested bulk-fill RBCs when the 45-mm mouth opening was used. However, when using the 25-mm mouth opening, the choice of LCU did influence the properties of the RBCs.

Effect of time on the post-irradiation curing of six resin-based composites.

OBJECTIVES: To evaluate the effect of time on the Vickers microhardness (VH) at the top and bottom surfaces of six conventional resin-based composites (RBCs) up to twelve weeks after light curing. METHODS: Five specimens of Filtek Supreme Ultra, Herculite Ultra, Mosaic Ultra, Tetric EvoCeram, TPH Spectra HV, and Venus Pearl were packed into opaque molds that were 2.3mm in diameter and 2.5mm deep. The uncured RBC specimens were covered by a polyester strip and photo-cured with an Elipar DeepCure-S light-curing unit (LCU) according to the manufacturer's instructions. After irradiation, the polyester strip was removed, and the Vickers microhardness was measured immediately at top and bottom surfaces. The hardness measurements were repeated after 30min, 1h, 2h, 4h, 24h, 1 week, 4 weeks, and 12 weeks. In between, the specimens were stored in dry and dark conditions at 37°C. Two-way ANOVA (α=0.05) followed by Tukey-Kramer post hoc multiple comparison tests were used to determine where statistically significant differences existed. RESULTS: The micro-hardness values at the top surface always exceeded those at the bottom surface. A significant logarithmic increase of the micro-hardness due to post-irradiation curing took place between 30min and 24h (p<0.05). There was no significant increase in the VH after 24h. Depending on the RBC, compared to the immediate values the hardness 24h post-irradiation had increased by 11-27% at the top surface and by 21-58% at the bottom. SIGNIFICANCE: Even after 12 weeks, the bottom hardness values never reached the top microhardness values. The results of studies that wait 24h or longer before measuring the properties of RBC specimens will be significantly enhanced by the impact of post-irradiation curing. Especially within the first 4h, the time when specimens are measured is critical information and should be reported.