Effect of a 3-second Off-label Exposure on the Depth of Cure of Eight Resin-based Composites.

OBJECTIVES: This study evaluated the depth of cure (DoC) of eight resin-based composites (RBCs) photocured using one multipeak light-curing unit (LCU) on the standard output setting for the manufacturer's RBC recommended exposure time and at a higher irradiance for 3 seconds. METHODS: Three conventional RBCs: Tetric EvoCeram (Evo), Tetric N-Ceram (Cer), Tetric Prime (Pri); and five bulk-fill: Tetric N-Ceram Bulk Fill (CerBF), Opus Bulk Fill APS (OpusBF), Opus Bulk Fill Flow APS (OpusF), Tetric PowerFill (PFill) and Tetric PowerFlow (PFlow) were examined. Only PFill and PFlow are formulated to be photocured in 3 seconds. The RBCs were packed into a metal mold and photocured using a Bluephase PowerCure LCU for the RBC manufacturer's recommended exposure time on the standard mode and using the 3-second high irradiance mode. After photocuring, the specimens were immersed in a solvent for 1 hour. The length of the remaining RBC was measured and divided by 2. Data were analyzed using two-way analysis of variance (ANOVA) followed by the Tukey post hoc multiple comparison test (α=0.05). RESULTS: There was no significant difference in the DoC values for PFill and PFlow when photocured using the 3-second high irradiance protocol compared to the lower irradiance standard mode protocol. All other RBCs had significantly lower DoC values (p<0.001) when photocured off-label using the 3-second high irradiance mode. CONCLUSION: Of the eight RBCs tested, only PFill and PFlow achieved the same DoC when the high irradiance 3-second curing method was used compared to when their longer lower irradiance protocol was used.

Application of near-infrared-to-blue upconversion luminescence for the polymerization of resin cements through zirconia discs.

OBJECTIVES: To investigate a near-infrared-to-blue luminescence upconversion curing method for polymerizing resin cements under zirconia discs. METHODS: Lava zirconia discs of different thicknesses (0.5-2.0 mm) were manufactured. First, the transmittances of the NIR and two blue lights (BLs) (LED and halogen lights) through these discs were measured. Second, NaYF4:Yb3+/Tm3+ upconversion phosphor (UP) powder was milled into 0.5-µm particle sizes. A light-curable resin cement VariolinkII base was chosen as the control (UP0), and an experimental cement (UP5) was prepared by adding 5 % UPs. These two cements were examined using multiphoton excitation microscopy for particle distribution. UP5 and UP0 were polymerized with or without zirconia shielding then subjected to a microhardness test. A multifold analysis was performed to examine the effects of zirconia thickness, curing protocols (pure BL or combined BL and NIR curing), and cement type. RESULTS: The transmittance of NIR was superior to that of BL through zirconia discs of all thicknesses. UP particles were homogeneously distributed in UP5 and emitted blue luminescence under 980-nm NIR excitation. UP5 showed higher microhardness values than UP0 under any curing protocol or zirconia shielding condition. The combination of 20-s BL and 40-s NIR curing yielded the highest microhardness in uncovered UP5. However, combining 40-s BL and 20-s NIR curing surpassed the other groups when the zirconia discs were thicker than 0.5 mm. SIGNIFICANCE: NIR exhibits higher transmission through zirconia than BL. UP particles work as strengthen fillers and photosensitizers in cements. NIR upconversion curing could be a new strategy for polymerizing resin cements under thick zirconia restorations.

Characterization of dental light-curing resin composites incorporating multiple modified low-shrink monomers.

OBJECTIVE: Polymerization shrinkage poses a significant challenge in dental resin composites. The objective of this study is to introduce spiroorthocarbonate monomer 3,9-dimethylene-1,3,5,7-tetraoxa-spiro[5,5]undecane (BMSOC) and epoxy resin monomer 3,4-epoxycyclohexylmethyl-3,4-epoxycyclohexane carboxylate (ECHM-ECHC) into bisphenol-S-bis(3-methacrylato-2-hydroxy propyl)ether (BisS-GMA) based resin composites to develop composites with reduced shrinkage properties. METHODS: BMSOC and BisS-GMA were synthesized and thoroughly mixed with ECHM-ECHC, followed by inorganic fillers and photoinitiators. Based on the composition of the resin matrix, five groups of experimental composites were prepared, with traditional bisphenol A-dimethacrylate glycidyl ester (Bis-GMA)/triethylene glycol dimethacrylate (TEGDMA) based composite serving as the control. The polymerization properties, including degree of conversion (DC) and polymerization shrinkage (PS), as well as marginal microleakage, wettability, flexural strength (FS), flexural modulus (FM), and biocompatibility were evaluated. RESULTS: The results demonstrated that compared with the control group, the PS of BisS-GMA based composites containing BMSOC and ECHM-ECHC were significantly reduced (P < 0.05), and the lowest PS (0.96 ± 0.08 %) was observed when the ratio of BisS-GMA: (Epoxy + BMSOC) was 4:6. Additionally, the experimental composites also exhibited improved DC, minimal microleakage, low hydrophilicity, enhanced mechanical properties, qualified in vivo biocompatibility, and slight/moderate in vitro biocompatibility. SIGNIFICANCE: The resin composites incorporating multiple modified low-shrink monomers are promising for dental applications to prevent various clinical problems caused by PS and extend restoration longevity.

Effect of curing mode of resin composite cements on water sorption, color stability, and biaxial flexural strength.

OBJECTIVES: To determine whether water sorption and solubility of a recently introduced self-adhesive cement is comparable to two clinically tested resin composite cements after thermal aging, and if this is affected by the curing mode. Whether water sorption is correlated with color difference and biaxial flexural strength was also investigated. METHODS: Water sorption and solubility of three resin composite cements {RelyX Universal (RUV), (Panavia V5 (PV5), Panavia SA plus (PSA)} were measured after thermal aging. Disk-shaped specimens were either light-cured or autopolymerized (n = 15 per group). Color difference ΔE00 and biaxial flexural strength were also obtained. RESULTS: Sorption was highest for RUV (auto: 54.9 ± 9.0 µg/mm3, light: 49.7 ± 4.9 µg/mm3), followed by PSA (auto: 37.7 ± 1.4 µg/mm3, light: 34.5 ± 1.1 µg/mm3) and PV5 (auto: 21.7 ± 0.7 µg/mm3, light: 22.1 ± 0.4 µg/mm3). Light-curing reduced solubility values, particularly for RUV (from 60.7 ± 20.8 µg/mm3 to 6.4 ± 0.8 µg/mm3). Color differences of ΔE00 > 1.8 (considered clinically not acceptable) were noted after aging for RUV and PSA. Sorption and ΔE00 values after aging were correlated linearly (R2 = 0.970). Biaxial flexural strength values were highest for PV5 (light: 153.4 ± 15.9 MPa; auto: 133.2 ± 18.0 MPa) and lowest for RUV (light: 99.3 ± 12.8 MPa; auto: 35.1 ± 8.3 MPa). SIGNIFICANCE: Light-curing has beneficial effects on sorption, color stability, and biaxial flexural strength of resin composite cements. Cements containing 2-hydroxymethacrylate such as RUV and PSA are more prone to water sorption and color changes.

Effect of polymerisation protocols on water sorption, solubility and hygroscopic expansion of fast-cure bulk-fill composite.

OBJECTIVE: This study examines the effect of two light-curing protocols from a LED polywave light curing unit (LCU) on water sorption, solubility, and hygroscopic expansion of fast and conventional bulk-fill resin-based composites (RBCs) aged in distilled water for 120 d. METHODS: Three bulk-fill RBCs materials were studied: Tetric PowerFill® (fast photo-polymerised composite) (TPF), Tetric EvoCeram bulk-fill (EVO), and GrandioSo x-tra bulk-fill (GSO) (conventional photo-polymerised composites). Specimens were prepared within a 3D-printed resin mold (8-mm diameter x 4-mm height) and light-cured from one side only with 2 modes of polywave LCU (Bluephase® PowerCure): 3 s mode and for 20 s in "Standard" mode. Water sorption and solubility were measured at fixed time intervals for 120 d of distilled water storage, then reconditioned to dry to measure desorption for 75 d, all at 37 ± 1 °C. Hygroscopic (volumetric) expansion was recorded at the same time intervals up to 120 d. Data were analysed through SPSS using Two-way ANOVA, One-way ANOVA, independent t-tests, and Tukey's post-hoc correction tests (p < 0.05). RESULTS: TPF, when irradiated for 3 s demonstrated minimal water sorption (0.83%), solubility (1.01 µg/mm3), and least volumetric expansion (1.64%) compared to EVO and GSO. While EVO showed the highest water sorption (1.03%) and solubility (1.95 µg/mm3) at 3 s. GSO had the lowest sorption (0.67%) and (0.56%) in 3 s and 20 s protocols, respectively. Nevertheless, all the sorption and solubility data were within the ISO 4049 limits. SIGNIFICANCE: For TPF, fast (3 s) polymerisation did not increase either water sorption or solubility, compared with 20 s irradiation. However, with the two comparative bulk-fill composites, fast cure increased water sorption by 15-25% and more than doubled solubility. These findings were consistent with the lesser volumetric expansions observed for Tetric PowerFill at both the fast and standard protocols, indicating its relative stability across polymerisation protocols.

Effect of light-, chemical-, and dual-cured universal adhesives on the internal adaptation of resin composites to pulpal and gingival internal walls.

PURPOSE: To compare the internal adaptation of restorative systems bonded to mid-coronal and gingival dentin using light-cured, chemical-cured, and dual-cured adhesives, both immediately and after aging. METHODS: 60 molars were selected and received occluso-mesial preparations with dentin gingival margins. Restorations were performed using different restorative systems with light-cured, chemical-cured, and dual-cured adhesives. Internal adaptation was assessed by examining the percentage of continuous margin (%CM) at the pulpal and gingival dentin under a scanning electron microscope at x200 magnification. Half of the teeth were stored in sterile water for 24 hours, while the other half underwent 10,000 thermal cycles. Micro-morphological analysis was conducted on representative samples at x1,000 magnification. RESULTS: The restorative system with light-cured adhesive exhibited significantly lower %CM values at the gingival dentin, particularly after aging. Aging had a negative impact on the %CM values of the pulpal and gingival dentin in restorative systems with light-cured and dual-cured adhesives. Regional dentin variations influenced the %CM values, especially after aging, regardless of the restorative system used. The tested restorative system with chemical-cured adhesive is preferable for achieving improved internal adaptation when bonding to both mid-coronal and gingival dentin, compared to the other tested systems. CLINICAL SIGNIFICANCE: The study highlights the variations in adhesive performance between different regional dentin areas using the tested restorative systems.

Effect of dentin surface conditions and curing mode of resin cement on the dentin bond strength.

This study investigates the effects of dentin's drying time, roughness, and curing modes of resin cement on bond strength. Forty human teeth were divided into eight groups based on three experimental factors: dentin's roughness by 240-or 600-grit SiC paper (coarse or fine), dentin wetness with air-drying time (5-s or 10-s), and Single Bond Universal adhesive's curing mode by co-curing with RelyX Ultimate cement or light-curing separately (co-curing or light-curing). The micro-tensile bond strength of fifteen resin-dentin stikcs per groups was measured. Failure mode and adhesive layers were observed using stereoscopic and confocal laser scanning microscopy, respectively. The curing mode of the adhesive layer affected the bond strength of the dentin-resin cement (p<0.05). In particular, the light-curing mode exhibited a significantly higher bond strength than the co-curing one (p<0.05). The bond strength between the resin cement and dentin was improved in the 5-s drying groups than in the 10-s drying groups.

Toxicity and cytokine release from human dental pulp stem cells after exposure to universal dental adhesives cured by single peak and polywave LEDs.

OBJECTIVES: to assess the impact of universal adhesives, cured with single-peak and polywave LEDs, on the metabolic activity and cytokine release of human dental pulp stem cells (hDPSCs). In addition, analyze the degree of conversion (DC) of the adhesives cured with the different LEDs. METHODS: Discs (5 mm diameter, 1 mm thick) were prepared using three universal adhesives: Single Bond Universal (SBU, 3 M ESPE), Optibond Universal (OBU, Kerr), and Zipbond Universal (ZBU, SDI). These discs were cured for 40 s using a single-peak (DeepCure, 3 M ESPE) or a polywave light-emmiting diode (LED) curing unit (Valo Grand, Ultradent). After 24 h, the specimens were placed in 24-well culture plates, each containing 1 mL of culture medium for 24 h. hDPSCs (1.8 ×104) were seeded in 96-well plates and allowed to grow for 24 h. Subsequently, the cells were exposed to the extracts (culture medium containing eluates from the adhesive discs) for an additional 24 h. Cells not exposed to the extracts were used as a control group. The mitochondrial metabolism was assessed using the MTT assay and the cytokine release evaluated through MAGPIX. The degree of conversion of the adhesives was analyzed using FTIR (n = 5). The results were analyzed by ANOVA two-way and Tukey's test. RESULTS: OBU and ZBU eluates caused a statistically significant reduction in mitochondrial metabolism, regardless of the LED used, indicating their cytotoxicity. In contrast, SBU did not significantly affect the MTT results, resembling the control group. A higher release of cytokines IL-1, IL-6, IL-10, and TNF-α were found in association to ZBU. SBU, on the other hand, increased the release of IL-8. OBU did not influenced the cytokine release. SBU presented the higher DC, while OBU and ZBU had similar DC, lower than SBU. SIGNIFICANCE: In conclusion, universal adhesives exhibit toxicity towards hDPSCs, but the extent of toxicity varies depending on the adhesive material. ZBU was associated with increased cytokine release, particularly pro-inflammatory mediators, from hDPSCs. The different LEDs did not influenced the cytotoxicity of the evaluated adhesives.

Impact of optical fiber-based photo-activation on dental composite polymerization.

OBJECTIVES: The study aimed to introduce a novel two-step optical fiber-based photo-activation of dental resin-based composites (RBCs) for reducing polymerization shrinkage stress (PSS). METHODS: Proposed protocol design - in the first step, two flexible plastic optical fibers connected to a dental light curing unit (LCU), were used as light guides inserted into the filling to initiate low-irradiance polymerization from within; in the second step, fibers were extracted and remaining voids were filled with RBC, followed by conventional high-irradiance curing to finalize polymerization. Three bulk-fill RBCs were tested (Beautifil-Bulk Restorative, Filtek Bulk-fill Posterior, Tetric PowerFill) using tooth cavity models. Three non-invasive examination techniques were employed: Digital Holographic Interferometry, Infrared Thermography, and Raman spectroscopy for monitoring model deformation, RBC temperature change, and degree of conversion (DC), respectively. A control group (for each examined RBC) underwent conventional photo-activation. RESULTS: The experimental protocol significantly reduced model deformation by 15 - 35 %, accompanied by an 18 - 54 % reduction in RBC temperature change, emphasizing the impact of thermal shrinkage on PSS. Real-time measurements of deformation and temperature provided indirect insights into reaction dynamics and illuminated potential mechanisms underlying PSS reduction. After a 24-hour dark-storage period, DC outcomes comparable to conventional curing were observed, affirming the clinical applicability of the method. CONCLUSIONS: Protocol involving the use of two 1.5 mm fibers in the first step (300 mW/cm2 x 10 s), followed by a second conventional curing step (1000 mW/cm2 x 10 s), is recommended to achieve the desired PSS reduction, while maintaining adequate DC and ensuring efficient clinical application. CLINICAL SIGNIFICANCE: Obtained PSS reduction offers promise in potentially improving the performance of composite restorations. Additionally, leveraging the flexibility of optical fibers improves light guide approach for restorations on posterior teeth. Meanwhile, implementation in clinical practice is easily achievable by coupling the fibers with commercial dental LCUs using the provided plastic adapter.

Thermography and conversion of fast-cure composite photocured with quad-wave and laser curing lights compared to a conventional curing light.

OBJECTIVES: This study investigated effects of the different emittance-mode protocols from three light curing units (LCUs): (i) a Laser (Monet); (ii) a quad-wave (PinkWave); (iii) a conventional LED (Elipar S10) on the temperature rise (ΔT) and degree of conversion (DC) when photo-curing fast or conventional bulk-fill resin-based composites (RBC). The aim was to correlate ΔT and DC, and the radiant exposure delivered to RBC specimens. METHODS: A 3D-printed resin mold of 4 mm depth was filled with two bulk-fill RBCs: Tetric PowerFill® (fast photo-polymerised composite) (TPF) or Tetric EvoCeram® Bulk-Fill (EVO). Three LCUs were used: (i) Monet laser for 1 s and 3 s (MONET-1 s, MONET-3 s); (ii) PinkWave quad-wave used for 3 s in Boost mode (PW-3 s) and for 20 s in standard mode (PW-20 s); (iii) Elipar S10 for 5 s (S10-5 s) and for 20 s in standard mode (S10-20 s). 2-dimensional temperature maps were obtained before, during and for 60 s after the LCU had turned off using a thermal imaging camera. Thermal changes were analysed at five depths: (0, 1, 2, 3, and 4 mm from the top surface of the RBC). The maximum temperature rise (Tmax) and the mean temperature rise (ΔT) were determined. Cylindrical-shaped specimens were prepared from each material using a stainless-steel split mold (4 × 4 mm) and light-cured with the same protocols. The DC was measured for 120 s and at 1 h after LCU had turned off using Fourier Transform Infrared Spectroscopy (FTIR). Data were analysed using Three-way ANOVA, One-way ANOVA, independent t-tests, and Tukey post-hoc tests (p < 0.05). RESULTS: Radiant exposures delivered by the various irradiation protocols were between 4.5-30.3 J/cm2. Short exposure times from MONET-1 s and PW-3 s delivered the lowest radiant exposures (4.5 and 5.2 J/cm2, respectively) and produced the lowest ΔT and DC. The longer exposure times in the standard modes of PW-20 s, S10-20 s, and MONET-3 s produced the highest Tmax, ΔT, and DC for both composites. The ΔT range among composites at different depths varied significantly (31.7-49.9 °C). DC of TPF ranged between 30-65% and in EVO between 15.3-56%. TPF had higher Tmax, ΔT for all depths and DC compared to EVO, across the LCU protocols (p < 0.05), except for PW-20 s and MONET-3 s. The coronal part of the restorations (1-2 mm) had the highest ΔT. There was a positive correlation between ΔT and DC at 4-mm depth after 120 s SIGNIFICANCE: Longer, or standard, exposure times of the LCUs delivered greater radiant exposures and had higher DC and ΔT compared to shorter or high-irradiance protocols. The fast photo-polymerised RBC had comparatively superior thermal and conversion outcomes when it received a high irradiance for a short time (1-5 s) compared to the conventional Bulk-Fill RBC.

Polymerization efficiency of different bulk-fill resin composites cured by monowave and polywave light-curing units: a comparative study.

OBJECTIVES: The objective was to evaluate the polymerization efficiency of different bulk-fill resin-based composites cured by monowave and polywave light-curing units, by assessment of the degree of conversion and Vickers microhardness at different depths. METHOD AND MATERIALS: Two commercially available bulk-fill resin-based composites were used: Filtek One Bulk Fill Restorative (3M ESPE) and Tetric N-Ceram Bulk Fill (Ivoclar Vivadent). The light-curing units utilized were two LED light-curing units: a monowave LED light-curing unit (BlueLEX LD-105, Monitex) and a polywave LED light-curing unit (Twin Wave GT-2000, Monitex). For each test, 20 cylindrical specimens (4 mm diameter, 4 mm thickness) were prepared from each bulk-fill resin-based composite using a split Teflon mold. Ten specimens were light-cured by the monowave light-curing unit and the other ten were light-cured by the polywave light-curing unit according to the manufacturer's recommendations. Attenuated total reflectance-Fourier transform infrared spectroscopy (ATR-FTIR) was used to assess the degree of conversion, and a Vickers microhardness tester was used to assess Vickers microhardness. Statistical analysis was performed using three-way ANOVA and Tukey post-hoc tests (P < .05). RESULTS: The degree of conversion and Vickers microhardness in bulk-fill resin-based composites containing only camphorquinone as photoinitiator were similar when cured with either monowave or polywave light-curing units. However, bulk-fill resin-based composites containing a combination of photoinitiators exhibited significantly higher degree of conversion and Vickers microhardness when cured with a polywave light-curing unit. Although all groups showed statistically significant differences between the top and bottom surfaces regarding degree of conversion and Vickers microhardness, all of them showed bottom/top ratios > 80% regarding degree of conversion and Vickers microhardness. CONCLUSION: The polywave light-curing unit enhanced the polymerization efficiency of bulk-fill resin-based composites especially when the latter contained a combination of photoinitiators, but does not prevent the use of a monowave light-curing unit.

Pulpal Temperature Variances During Step-by-step Adhesive Restorative Procedure Using Three Different High-irradiance Light-curing Units.

The rise in temperature in pulp tissues is related not only to heat transfer by high-irradiance light-curing units (LCUs), but also to restorative procedures. This research aimed to compare the rise in pulp temperature (PT) induced by three LCUs at each restorative step while considering the influence of resin composite shade and thickness. To accomplish this, the investigators used a proposed experimental model replicating pulp fluid circulation with a controlled, simulated intraoral temperature in bovine incisors. The recorded external and internal PT ranged from 36.7°C to 37.1°C and 32.7°C to 33.0°C, respectively. A significant decrease of internal temperature was recorded during class V preparation, followed by a progressive and representative rise of temperature in the subsequent restorative steps. The temperature was significantly higher during light curing of the adhesive system using Valo compared to light curing using Elipar and Radii Cal. However, none of the analyzed devices produced a temperature that exceeded the pulp tolerance limit (a temperature increase over 5.5°C). The paired test showed no significant difference in pulp temperature associated with the thickness of the increment of resin composite. However, shade was found to have more influence on the amount of energy absorbed by pulp tissue-A1 samples showed significantly higher temperature variation compared to samples using the A4 shade of resin composite. To conclude, the microcirculation and the performance of procedures under constant air-water flux dissipate the heat absorbed by the pulp. Additionally, the data suggest that all three LCUs analyzed can be safely used in clinical procedures, and that the resin composite shade may influence the amount of irradiance delivered to the tooth surface and represents a significant factor in pulp temperature variance.

Light transmittance through resin-matrix composite onlays adhered to resin-matrix cements or flowable composites.

OBJECTIVE: The aim of this study was to evaluate the influence of the thickness of resin-matrix composite blocks manufactured by CAD-CAM on the light transmittance towards different resin-matrix cements or flowable composites. METHODS: Sixty specimens of resin-matrix composite CAD-CAM blocks reinforced with 89 wt% inorganic fillers were cross-sectioned with 2 or 3 mm thicknesses. The specimens were conditioned with adhesive system and divided in groups according to the luting material, namely: two dual-cured resin-matrix cements, two traditional flowable resin-matrix composites, and one thermal-induced flowable resin-matrix composite. Specimens were light-cured at 900 mW/cm2 for 40s. Light transmittance assays were preformed using a spectrophotometer with an integrated monochromator before and after light-curing. Microstructural analysis was performed by optical and scanning electron microscopy (SEM). Nanoindentation tests were performed to evaluate mechanical properties for indirect evaluation of degree of monomers conversion. RESULTS: Optical and SEM images revealed low thickness values for the cementation interfaces for the traditional flowable resin-matrix composite. The cement thickness increased with the size and content of inorganic fillers. The highest light transmittance was recorded for the onlay blocks cemented with the traditional flowable resin-matrix composites while a group cemented with the dual-cured resin-matrix cement revealed the lowest light transmittance. The elastic modulus and hardness increased for specimens with high content of inorganic fillers as well as it increased in function of the light transmittance. CONCLUSIONS: The light transmittance of flowable resin-matrix composites was higher than that for resin-matrix cement after cementation to resin-matrix composites blocks. The type, size, and content of inorganic fillers of the luting material affected the thickness of the cement layer and light transmittance through the materials. CLINICAL RELEVANCE: On chair-side light curing, the transmission of visible light can be interfered by the chemical composition and viscosity of the luting materials. The increase in size and content of inorganic fillers of resin-matrix composites and luting materials can decrease the light transmittance leading to inefficient polymerization.

Comparison of Adhesion Performance of a Self-curing and a Light-curing Universal Adhesive to Various Dental Substrates and CAD/CAM Materials.

PURPOSE: To compare the adhesion of a self-curing (Tokuyama Universal Bond, TUB) and a light-curing (Scotchbond Universal, SBU) universal adhesive to CAD/CAM materials, enamel, and dentin. This study also assessed differences in enamel adhesion between self-etch vs selective etching modes, as well as immediate and long-term adhesion to dentin for both adhesives. MATERIALS AND METHODS: Shear bond strength (SBS) testing was used to assess adhesion to enamel, dentin, Lava Ultimate (LU), Vita Enamic (VE), IPS e.max CAD (LD), IPS e.max ZirCAD (3Y-Zir), and Lava Esthetic (5Y-Zir) (n = 10). Moreover, bonding to enamel in self-etch and selective etching modes (n = 10) as well as immediate and aged resin-dentin bond strength (24 h after bonding, after 100,000 thermal cycles [TC] and long-term storage) was evaluated using the microtensile bond-strength test (n = 30). Failure mode was also determined for the bonding to dentin. Statistical analyses consisted of one-way and two-way ANOVA with appropriate post-hoc Tukey-Kramer or two-sample t-tests, as well as the chi-squared or Fisher's exact test (α = 0.05). RESULTS: TUB and SBU universal adhesives presented similar bonding to LU, VE, 3Y-Zir, and 5Y-Zir. However, SBS for TUB was superior to SBU when bonding to lithium-disilicate glass-ceramic (IPS e.max CAD). SBU showed better adhesion to dentin and enamel when used in the self-etch mode, while TUB promoted strong bond strength to enamel in the selective etching mode. TUB after TC was the only aging condition that yielded a significant reduction in resin-dentin bond strength. CONCLUSION: In-vitro adhesion performance of the self-curing and light-curing universal adhesives varies depending on the dental substrate or CAD/CAM restorative material used for bonding.

Shedding light on the problem: Proficiency and maintenance practices of light-curing units among dental assistants.

BACKGROUND: Proper light curing is crucial for the success of restorative dentistry and to bond brackets to teeth, yet the responsibility is often delegated to dental assistants (DAs). This study assessed the proficiency and maintenance protocols of DAs when using light-curing units (LCUs) in Saudi Arabia. METHODS: Self-administered questionnaires were distributed to practicing DAs. The questionnaire contained sections on knowledge, adherence to best practices, and how to maintain the LCU. Demographic data were collected as well. Descriptive statistics and linear regressions at a significance level of (p = 0.05) were conducted to identify any relationships that influenced the DAs' LCU knowledge, practice, and maintenance protocols. RESULTS: Among the surveyed DAs, 66% were responsible for using the LCU during treatment, 16% used their fingers for support when light curing, 50% held the LCU tip 1-2 mm from the restoration during curing, and 51% did not have a specific maintenance protocol at their workplace. 70% did not know the output from the LCU, and their educational background correlated with knowledge (b = -14.42, p < 0.001). The type of institution type correlated with adherence to best practices (b = -13.65, p = 0.011), and level of knowledge and adherence to maintenance protocols showed a direct correlation (b = 0.002, p = 0.041). CONCLUSIONS: The findings revealed that a significant percentage of the DAs who replied had insufficient knowledge and did not follow the best practices and maintenance protocols for the LCUs they were using. Their educational background and workplace factors influenced this knowledge gap, while the absence of a maintenance protocol and suboptimal practices were associated with the type of institution. CLINICAL SIGNIFICANCE: To maintain the best practice, clinicians and institutions should improve the education and training of DAs. Otherwise, inadequate light curing by the DAs may jeopardize the long-term success of many dental procedures.

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.

Evaluation of microhardness of short fiber-reinforced composites inside the root canal after different light curing methods - An in vitro study.

OBJECTIVES: Short fiber-reinforced composite (SFRC) materials make it possible to reinforce root canal treated teeth with individualized, directly layered intraradicular posts (the Bioblock technique). The question arises, however, as to whether the photopolymerization of the material is sufficient deep within the root canal space and if it can be improved through different light-conducting options. Our study aimed to investigate the hardness of intraradicular SFRC material applied using the Bioblock technique and cured with various illumination methods, as measured through nanoindentation. MATERIALS AND METHODS: For this investigation, thirty plastic artificial teeth that had undergone root canal treatment were selected. These teeth were randomly divided into six study groups (Group 1-6; each group consisting of 5 teeth). The restoration procedures involved the use of SFRC or conventional composite materials, placed 6 mm apically from the root canal orifice. In Group 1 and 2, a conventional composite was used, whereas in Group 3-6, SFRC was employed for interradicular reinforcement (with a layered technique in Group 3 and 4 and a bulk-fill technique in Group 5 and 6). A modified light source was utilized for photopolymerization in Group 2, 4, and 6, whereas in Group 3 and 5, the polymerization light was directed through a prefabricated glass fiber posts. The control group (Group 1) utilized conventional composite material with a standard light-curing method. Following embedding and sectioning, the hardness of the composite materials was measured at 2 mm intervals within the root canal (1st, 2nd, 3rd measurements, in the coronal to apical direction). RESULTS: During the 1st measurement, light curing conducted through the glass fiber posts (Group 3 and 5) led to markedly higher hardness levels compared to the groups restored with conventional composite (control group with p = 0.002, p = 0.001, and Group 2 with p = 0.043, p = 0.034, respectively). In the 2nd measurement, only Group 5 demonstrated significantly greater hardness in comparison to the control group (p = 0.003) and Group 2 (p = 0.015). However, in the 3rd measurement, no statistically significant differences were observed among the groups. CONCLUSION: light curing through the glass fiber post provides outstanding hardness for the SFRC material in the apical layer in the root canal.

Evaluation of the effect of high-intensity light-curing device on micro-leakage of pits and fissure sealants.

Reducing treatment time is one of the most important trends in modern dentistry. This study aimed to compare the micro-leakage around the resin sealants when using both high and conventional intensity light-curing systems. The study sample consisted of 30 extracted human maxillary premolar teeth that were divided into two equal groups according to the light-curing system used: Group 1, High-Intensity Light-Curing System and Group 2, Conventional Light-Curing System. Light-curing by Woodpecker I-LED device with two intensities (high and conventional) has been used. All teeth were subjected to 500 cycles of thermocycling. Then, a methylene blue dye microleakage test was performed, and the teeth were sectioned longitudinally and studied under a stereo microscope. The mean of micro-leakage in the high-intensity group (1.33 ± 1.29) was less than in the conventional intensity group (1.63 ± 1.29) without any statistically significant differences (p = 0.320). The high-intensity light-curing system mode may be a good and acceptable alternative to conventional intensity light-curing system mode in polymerization of pits and fissure sealants.

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.

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.