The power of light - From dental materials processing to diagnostics and therapeutics.

Harnessing the power of light and its photonic energy is a powerful tool in biomedical applications. Its use ranges from biomaterials processing and fabrication of polymers to diagnostics and therapeutics. Dental light curable materials have evolved over several decades and now offer very fast (≤ 10 s) and reliable polymerization through depth (4-6 mm thick). This has been achieved by developments on two fronts: (1) chemistries with more efficient light absorption characteristics (camphorquinone [CQ], ~30 L mol-1 cm1 [ʎmax 470 nm]; monoacylphosphine oxides [MAPO], ~800 L mol-1 cm-1 [ʎmax 385 nm]; bisacylphosphine oxide [BAPO], ~1,000 L mol-1 cm-1 [ʎmax 385 nm]) as well mechanistically efficient and prolonged radical generation processes during and after light irradiation, and; (2) introducing light curing technologies (light emitting diodes [LEDs] and less common lasers) with higher powers (≤ 2 W), better spectral range using multiple diodes (short: 390-405 nm; intermediate: 410-450 nm; and long: 450-480 nm), and better spatial power distribution (i.e. homogenous irradiance). However, adequate cure of materials falls short for several reasons, including improper selection of materials and lights, limitations in the chemistry of the materials, and limitations in delivering light through depth. Photonic energy has further applications in dentistry which include transillumination for diagnostics, and therapeutic applications that include photodynamic therapy, photobiomodulation, and photodisinfection. Light interactions with materials and biological tissues are complex and it is important to understand the advantages and limitations of these interactions for successful treatment outcomes. This article highlights the advent of photonic technologies in dentistry, its applications, the advantages and limitations, and possible future developments.

150 years of dental education and research - University of Birmingham School of Dentistry.

This paper discusses the historical development of dental education and research over the last 150 years from a Birmingham School of Dentistry perspective. The School opened its doors to students in 1858 and has seen many changes and developments in both education and research. Looking back throughout the history, one of our greatest abilities as dental professionals is to be adaptable and the future will bring plenty of opportunity for us to demonstrate this. We have seen how resilient dentistry has been over the COVID-19 pandemic, both in terms of education and research; the next 150 years will be a very exciting time to work in the field.

Photobiomodulation reduces hippocampal apoptotic cell death and produces a Raman spectroscopic "signature".

Apoptotic cell death within the brain represents a significant contributing factor to impaired post-traumatic tissue function and poor clinical outcome after traumatic brain injury. After irradiation with light in the wavelength range of 600-1200 nm (photobiomodulation), previous investigations have reported a reduction in apoptosis in various tissues. This study investigates the effect of 660 nm photobiomodulation on organotypic slice cultured hippocampal tissue of rats, examining the effect on apoptotic cell loss. Tissue optical Raman spectroscopic changes were evaluated. A significantly higher proportion of apoptotic cells 62.8±12.2% vs 48.6±13.7% (P<0.0001) per region were observed in the control group compared with the photobiomodulation group. After photobiomodulation, Raman spectroscopic observations demonstrated 1440/1660 cm-1 spectral shift. Photobiomodulation has the potential for therapeutic utility, reducing cell loss to apoptosis in injured neurological tissue, as demonstrated in this in vitro model. A clear Raman spectroscopic signal was observed after apparent optimal irradiation, potentially integrable into therapeutic light delivery apparatus for real-time dose metering.

Electrophoretic deposition of novel semi-permeable coatings on 3D-printed Ti-Nb alloy meshes for guided alveolar bone regeneration.

OBJECTIVE: Guided bone regeneration (GBR) techniques use barrier membranes to augment the alveolar ridge for the site-specific growth of bone defects. However, current approaches using cast metal substructures exhibit poor adaptation to the surgical site and increased risk of infection. This study aimed to fabricate multi-functional coatings with 3D-printed porous titanium-niobium (Ti-Nb) alloy meshes to maintain space, prevent the ingrowth of fibroblasts and inhibit the colonization of bacteria for GBR. METHODS: Ti-Nb alloy meshes were prepared by selective laser melting (SLM) and used as substrates for novel surface coatings. Porous chitosan (CS)/ gelatin (G)/ doxycycline (Dox) coatings were formed on the meshes using electrophoretic deposition (EPD) and freeze-drying. The process of EPD was characterized through Fourier transform infrared spectroscopy (FT-IR), zeta potential, and particle size analysis. The cytotoxicity of the coatings was evaluated through the culture of osteoblasts and immunostaining. The antibacterial activity of the coatings was tested using inhibition zone tests against Staphylococcus aureus (S. aureus) and scanning electron microscope (SEM). The inhibition of fibroblasts infiltration and nutrients transfer properties were analyzed using immunostaining and permeability tests. RESULTS: High yield strength (567.5 ± 3.5 MPa) and low elastic modulus (65.5 ± 0.2 GPa) were achieved in Ti-Nb alloy bulk samples. The data of zeta potential, FT-IR and SEM indicated that porous spongy coatings were chemically bonded following EPD. In vitro analysis of CSGDox1 (containing Dox at 1 mg·mL-1) coating revealed its antibacterial effect and biocompatibility. Moreover, the CSGDox1 coating was proved to be effective for preventing the ingrowth of fibroblasts, whilst allowing the infiltration of nutrients. SIGNIFICANCE: This study verified that the EPD of CSGDox coatings on the 3D-printed Ti-Nb meshes can maintain space, provide antibiotic release whilst maintaining a barrier against soft-tissue growth, which is essential for the success of GBR treatment.

On the inaccuracies of dental radiometers.

This study investigated the accuracy of sixteen models of commercial dental radiometers (DR) in measuring the output of thirty-eight LED light curing units (LCUs) compared with a 'gold standard' laboratory-grade spectrometer integrating-sphere (IS) assembly. Nineteen Type I (fiber-bundle light guide) and nineteen Type II (light source in head) LED LCUs were tested, some using different output modes and light guides, resulting in 61 test subsets per radiometer. Gold standard (GS) output measurements (n = 3) were taken using the IS and confirmed with two types of laboratory-grade power meter (PowerMax-Pro 150 HD and PM10-19C; Coherent). One DR (Bluephase Meter II, Ivoclar; BM II) allowed power (mW) as well as irradiance (mW/cm2) recordings. Irradiance readings (n = 3) for each DR/LCU were compared with the IS derived irradiance. Individual LCU irradiance values were normalized against IS data. The GS method yielded reproducible data with a 0.4% pooled coefficient of variation for the LCUs. Mean power values ranged from 0.19 W to 2.40 W. Overall power values for the laboratory-grade power meters were within 5% of GS values. Individual LCU/DR normalized irradiance values ranged from 7% to 535% of the GS; an order of magnitude greater than previous reports. BM II was the only radiometer to average within 20% of normalized pooled GS irradiance values, whereas other radiometers differed by up to 85%. Ten radiometers failed to provide any reading for 1 LCU. When tested with the PowerMax-Pro in high speed (20 kHz) mode, eight LCUs demonstrated pulsing outputs undetectable at the standard (10 Hz) data acquisition rate. Sufficient light exposure is critical for the successful curing of dental resin-based materials. Substantial discrepancies may occur between actual and estimated radiometric data using current DRs. More accurate DRs need to be developed. Manufacturers' accuracy claims for DRs should specify compatible LCUs and testing parameters.

Potential for direct application of blue light for photo-disinfection of dentine.

The direct application of light for photo-disinfection potentially provides a safe and novel modality to inhibit or eliminate cariogenic bacteria residing upon and within dentine. This study aimed to both; characterize the pattern of transmission of 405 nm light through molar dentine at different tooth locations, as well as, determine the irradiation parameters that are antibacterial for Streptococcus mutans under various growth conditions, including lawns, planktonic cultures, and biofilms. To determine the amount of light (405 nm) transmitted at different anatomical tooth locations; irradiance values were recorded after blue light (470-4054 mW/cm2) had traversed through occlusal, oblique, and buccal dentine sections; and three thicknesses - 1, 2 and 3 mm were investigated. To determine tubular density; scanning electron micrographs from 2 mm outer (dentine-enamel junction) and inner (pulp) dentine sections were analysed. For photo-disinfection studies; S. mutans was irradiated using the same 405 nm wavelength light at a range of doses (110-1254 J/cm2) in both biofilm and planktonic cultures. The inhibitory effect of the irradiation on bacterial lawns was compared by measuring zones of inhibition; and for planktonic cultures both spectrophotometric and colony forming unit (CFU) assays were performed. A live/dead staining assay was utilised to determine the effect of irradiation on bacterial viability in mature biofilms. Data indicated that increasing dentine thickness decreased light transmission significantly irrespective of its orientation. Occlusal and oblique samples exhibited higher transmission compared with buccal dentine. Oblique dentine 405 nm light transmission was comparable with that of occlusal dentine independent of section thickness. An increased tubule density directly positively correlated with light transmission. Irradiation at 405 nm inhibited S. mutans growth in both biofilm and planktonic cultures and a dose response relationship was observed. Irradiation at doses of 340 and 831 J/cm2 led to significant reductions in bacterial growth and viability; as determined by CFU counting and live/dead staining. Data suggests that phototherapy approaches utilising a 405 nm wavelength have therapeutic potential to limit cariogenic bacterial infections both at the surface and within dentine.

Chemistry of novel and contemporary resin-based dental adhesives.

The chemistry of resin-based dental adhesives is critical for its interaction with dental tissues and long-term bonding stability. Changes in dental adhesives composition influences the materials' key physical-chemical properties, such as rate and degree of conversion, water sorption, solubility, flexural strength and modulus, and cohesive strength and improves the biocompatibility to dental tissues. Maintaining a suitable reactivity between photoinitiators and monomers is important for optimal properties of adhesive systems, in order to enable adequate polymerisation and improved chemical, physical and biological properties. The aim of this article is to review the current state-of-the-art of dental adhesives, and their chemical composition and characteristics that influences the polymerisation reaction and subsequent materials properties and performance.

Bis(4-methyl phenyl)iodonium as an alternative component to diphenyliodonium in camphorquinone-based ternary initiating systems.

OBJECTIVE: To evaluate the influence of different co-initiators (diphenyliodonium hexafluorophosphate - DPI - and bis(4-methyl phenyl)iodonium hexafluorophosphate - BPI) on chemical and mechanical properties of resins. METHODS: Nine experimental resins (50% Bis-GMA and 50% TEGDMA, w/w) with 60 wt% filler particles were formulated. The initiating system used was camphorquinone (CQ-1 mol%) and ethyl dimethylaminobenzoate (EDAB-2 mol%). Experimental groups were established according to DPI and BPI quantities (0.25, 0.5, 0.75, and 1 mol%). The control group was a resin containing only CQ-EDAB. Light transmission through the resin during polymerisation was analysed with a UV-vis spectrophotometer. Real-time polymerisation of the systems was evaluated using an FTIR spectrometer. Real-time polymerisation shrinkage strain was evaluated, and the flexural strength and modulus of materials were obtained by 3-point bending. Experimental groups were statistically analysed by Analysis of Variance and Tukey's test (α = 0.05). Dunnett's test was applied to compare experimental groups with control. RESULTS: Light transmission rapidly increased initially for resins containing DPI or BPI. After 30 s cure, the irradiance on the lower surface of resin specimens was similar for all groups. After 10 s of light irradiation, groups containing DPI and BPI had higher conversion than the control. However, conversion after 120 s post-irradiation was similar for all groups. The rate of polymerisation, shrinkage strain, and the maximum strain rate were higher for groups containing DPI/BPI. The use of iodonium salts increased the flexural strength and flexural moduli of resins. SIGNIFICANCE: DPI and BPI increased resin reactivity similarly. Increased rate of polymerization influenced light transmission through the resin in the first seconds of polymerisation and increased resin shrinkage and rate of shrinkage, as well as flexural strength and moduli.

Photo-polymerisation variables influence the structure and subsequent thermal response of dental resin matrices.

OBJECTIVE: The structure of the polymer phase of dental resin-based-composites is highly sensitive to photo-polymerisation variables. The objective of this study was to understand how different polymer structures, generated with different photo-polymerisation protocols, respond to thermal perturbation. METHODS: Experimental resins were prepared from a series of Bis-GMA/TEGDMA blends (40/60, 50/50 and 60/40 wt.%), with either Camphorquinone/DMAEMA or Lucirin TPO as the photo-initiator system. Resins were photo-polymerised, in a disc geometry, at either relatively 'high' (3000 mW cm-2 for 6 s) or 'low' (300 mW cm-2 for 60 s) irradiances ensuring matched radiant exposures (18 J cm-2). Specimens were heated, from 20-160 °C at a rate of 5 °C min-1, whilst simultaneous synchrotron X-ray scattering measurements were taken at 5 °C increments to determine changes in polymer chain segment extension and medium-range order as a function of temperature. For each unique resin composition (n = 3), differential scanning calorimetry was used to measure glass transition temperatures using the same heating protocol. A paired t-test was used to determine significant differences in the glass transition temperature between irradiance protocols and photo-initiator chemistry at ɑ = 0.05. RESULTS: Resins pre-polymerised through the use of TPO and or high irradiances demonstrated a reduced rate of chain extension indicative of lower thermal expansion and a larger decrease in relative order when heated below the glass transition temperature. Above the transition temperature, differences in the rate of chain extension were negligible, but slower converted systems showed greater relative order. There was no significant difference in the glass transition temperature between different photo-initiator systems or irradiance protocols. SIGNIFICANCE: The evolution of chain extension and medium-range order during heating is dependent on the initial polymer structure which is influenced by photo-polymerisation variables. Less ordered systems, generated at faster rates of reactive group conversion displayed reduced chain extension below the glass transition temperature and maintained lower order throughout heating.

Increased rates of photopolymerisation by ternary type II photoinitiator systems in dental resins.

To evaluate the effects of Type I and Type II photoinitiator systems on curing efficiency, degree of conversion (DC) and chemico-physical properties of resin based materials. A comonomer base containing 50%wt 2.2-bis[4-(2-hydroxy-3-methacryloxypropoxy)phenyl]propane (bis-GMA) and 50%wt triethyleneglycol dimethacrylate (TEGDMA) was formulated with either 0.5 or 1mol% of Type II camphoroquinone (CQ), Type I monoacylphosphine oxide (MAPO) or bis-acylphosphine oxide (BAPO) photoinitiators. The Type II system was either a binary (1: 2 CQ:amine) or ternary system (1: 2 CQ:amine + 0.5 mol% DPI). Degree and rate of polymerization was measured by Fourier Transform Infrared Spectroscopy (FTIR). Knoop micro-hardness prior to and following ethanol immersion was assessed. Flexural strength and modulus was measured under three-point bend test. Water sorption and solubility was also evaluated. The photoinitiator absorption spectra and the total absorbed energy per unit volume (Eabs) for 0.5mol% photoinitiator in each material was calculated. Despite the reduced total absorbed energy per unit volume for CQ based systems, ternary Type II system significantly improved curing efficiency (P < 0.05) compared to both Type I photoinitiators and degree of conversion compared to MAPO only, whilst exhibiting comparable mechanical and physical properties compared to both Type I based materials at equivalent molar concentrations of photoinitiator (P > 0.05). Ternary Type II systems is an efficient alternative to improve the polymerization of resin materials, promoting similar or even better properties than Type I initiators. DPI can increase the reactivity of CQ systems and promote polymerization rates superior than Type I photoinitiators.

Under the spotlight: mechanisms of photobiomodulation concentrating on blue and green light.

Photobiomodulation (PBM) describes the application of light at wavelengths ranging from 400-1100 nm to promote tissue healing, reduce inflammation and promote analgesia. Traditionally, red and near-infra red (NIR) light have been used therapeutically, however recent studies indicate that other wavelengths within the visible spectrum could prove beneficial including blue and green light. This review aims to evaluate the literature surrounding the potential therapeutic effects of PBM with particular emphasis on the effects of blue and green light. In particular focus is on the possible primary and secondary molecular mechanisms of PBM and also evaluation of the potential effective parameters for application both in vitro and in vivo. Studies have reported that PBM affects an array of molecular targets, including chromophores such as signalling molecules containing flavins and porphyrins as well as components of the electron transport chain. However, secondary mechanisms tend to converge on pathways induced by increases in reactive oxygen species (ROS) production. Systematic evaluation of the literature indicated 72% of publications reported beneficial effects of blue light and 75% reported therapeutic effects of green light. However, of the publications evaluating the effects of green light, reporting of treatment parameters was uneven with 41% failing to report irradiance (mW cm-2) and 44% failing to report radiant exposure (J cm-2). This review highlights the potential of PBM to exert broad effects on a range of different chromophores within the body, dependent upon the wavelength of light applied. Emphasis still remains on the need to report exposure and treatment parameters, as this will enable direct comparison between different studies and hence enable the determination of the full potential of PBM.

Shining a light on high volume photocurable materials.

Spatial and temporal control is a key advantage for placement and rapid setting of light-activated resin composites. Conventionally, placement of multiple thin layers (<2mm) reduces the effect of light attenuation through highly filled and pigmented materials to increase polymerisation at the base of the restoration. However, and although light curing greater than 2mm thick layers is not an entirely new phenomenon, the desire amongst dental practitioners for even more rapid processing in deep cavities has led to the growing acceptance of so-called "bulk fill" (4-6mm thick) resin composites that are irradiated for 10-20s in daily clinical practice. The change in light transmission and attenuation during photopolymerisation are complex and related to path length, absorption properties of the photoinitiator and pigment, optical properties of the resin and filler and filler morphology. Understanding how light is transmitted through depth is therefore critical for ensuring optimal material properties at the base of thick increments. This article will briefly highlight the advent of current commercial materials that rationalise bulk filling techniques in dentistry, the relationship between light transmission and polymerisation and how optimal curing depths might be achieved.

A randomised controlled trial of a nanofilled composite at three years: Did selective enamel etching have an effect?

General dental practice is increasingly being recognised as the ideal situation for the conduct of clinical trials into the longevity of restorations. The aim of this study was to investigate the survival of 75 nanofilled resin composite restorations placed in an assortment of cavities using a self-etch dentine bonding agent, in five UK dental practices by members of the UK-based practice-based research group, the PREP Panel, with half of the restorations receiving a selective enamel etch and the other half being placed using a self-etching approach. The results indicated good performance of the restorations examined, with no failures being identified and excellent surface characteristics, in terms of colour stability, minimal surface roughness and optimal anatomic form. Selective enamel etching tended to produce less marginal discolouration, although these results were not statistically significant.

Five Year Clinical Evaluation of Restorations Placed in a Low Shrinkage Stress Composite in UK General Dental Practices.

This paper evaluates the five year clinical evaluation of restorations formed in a low shrinkage stress resin composite material (3M ESPE Filtek Silorane, Seefeld, Germany) and placed in the general dental practices of five members of the PREP Panel, a group of UK practice-based researchers. Results indicated satisfactory performance of the material under evaluation, other than for marginal staining, which affected 60% of the restorations evaluated after five years, albeit with less than 10% of the circumference of the restorations being affected. CLINICAL RELEVANCE: The low shrinkage stress material, Filtek Silorane™, demonstrated good clinical performance in the majority of parameters which were assessed at five years.

Development and application of LED arrays for use in phototherapy research.

Lasers/LEDs demonstrate therapeutic effects for a range of biomedical applications. However, a consensus on effective light irradiation parameters and efficient and reliable measurement techniques remain limited. The objective here is to develop, characterise and demonstrate the application of LED arrays in order to progress and improve the effectiveness and accuracy of in vitro photobiomodulation studies. 96-well plate format LED arrays (400-850 nm) were developed and characterised to accurately assess irradiance delivery to cell cultures. Human dental pulp cells (DPCs) were irradiated (3.5-142 mW/cm2 : 15-120 s) and the biological responses were assessed using MTT assays. Array calibration was confirmed using a range of optical and analytical techniques. Multivariate analysis of variance revealed biological responses were dependent on wavelength, exposure time and the post-exposure assay time (P < 0.05). Increased MTT asbsorbance was measured 24 h post-irradiation for 30 s exposures of 3.5 mW/cm2 at 470, 527, 631, 655, 680, 777, 798 and 826 nm with distinct peaks at 631 nm and 798 nm (P < 0.05). Similar wavelengths were also effective at higher irradiances (48-142 mW/cm2 ). LED arrays and high throughput assays provide a robust and reliable platform to rapidly identify irradiation parameters which is both time- and cost-effective. These arrrays are applicable in photobiomodulation, photodynamic therapy and other photobiomedical research.

Filler characteristics of modern dental resin composites and their influence on physico-mechanical properties.

OBJECTIVE: The mechanical properties of dental resin-based composites (RBCs) are highly dependent on filler characteristics (size, content, geometry, composition). Most current commercial materials are marketed as "nanohybrids" (i.e. filler size <1µm). In the present study, filler characteristics of a selection of RBCs were described, aiming at identifying correlations with physico-mechanical properties and testing the relevance of the current classification. METHODS: Micron/sub-micron particles (> or <500nm) were isolated from 17 commercial RBCs and analyzed by laser diffractrometry and/or electron microscopy. Filler and silane content were evaluated by thermogravimetric analysis and a sedimentation technique. The flexural modulus (Eflex) and strength (σflex) and micro-hardness were determined by three-point bending or with a Vickers indenter, respectively. Sorption was also determined. All experiments were carried out after one week of incubation in water or 75/25 ethanol/water. RESULTS: Average size for micron-sized fillers was almost always higher than 1µm. Ranges for mechanical properties were: 3.775wt%) were associated with the highest mechanical properties (Eflex and σflex>12GPa and 130MPa, respectively) and lowest solvent sorption (∼0.3%). SIGNIFICANCE: Mechanical properties and filler characteristics significantly vary among modern RBCs and the current classification does not accurately illustrate either. Further, the chemical stability of RBCs differed, highlighting differences in resin and silane composition. Since Eflex and sorption were well correlated to the filler content, a simple and unambiguous classification based on such characteristic is suggested, with three levels (ultra-low fill, low-fill and compact resin composites).

The dark art of light measurement: accurate radiometry for low-level light therapy.

Lasers and light-emitting diodes are used for a range of biomedical applications with many studies reporting their beneficial effects. However, three main concerns exist regarding much of the low-level light therapy (LLLT) or photobiomodulation literature; (1) incomplete, inaccurate and unverified irradiation parameters, (2) miscalculation of 'dose,' and (3) the misuse of appropriate light property terminology. The aim of this systematic review was to assess where, and to what extent, these inadequacies exist and to provide an overview of 'best practice' in light measurement methods and importance of correct light measurement. A review of recent relevant literature was performed in PubMed using the terms LLLT and photobiomodulation (March 2014-March 2015) to investigate the contemporary information available in LLLT and photobiomodulation literature in terms of reporting light properties and irradiation parameters. A total of 74 articles formed the basis of this systematic review. Although most articles reported beneficial effects following LLLT, the majority contained no information in terms of how light was measured (73%) and relied on manufacturer-stated values. For all papers reviewed, missing information for specific light parameters included wavelength (3%), light source type (8%), power (41%), pulse frequency (52%), beam area (40%), irradiance (43%), exposure time (16%), radiant energy (74%) and fluence (16%). Frequent use of incorrect terminology was also observed within the reviewed literature. A poor understanding of photophysics is evident as a significant number of papers neglected to report or misreported important radiometric data. These errors affect repeatability and reliability of studies shared between scientists, manufacturers and clinicians and could degrade efficacy of patient treatments. Researchers need a physicist or appropriately skilled engineer on the team, and manuscript reviewers should reject papers that do not report beam measurement methods and all ten key parameters: wavelength, power, irradiation time, beam area (at the skin or culture surface; this is not necessarily the same size as the aperture), radiant energy, radiant exposure, pulse parameters, number of treatments, interval between treatments and anatomical location. Inclusion of these parameters will improve the information available to compare and contrast study outcomes and improve repeatability, reliability of studies.

Photopolymerization of highly filled dimethacrylate-based composites using Type I or Type II photoinitiators and varying co-monomer ratios.

OBJECTIVES: The use of a Type I photoinitiator (monoacylphosphine oxide, MAPO) was described as advantageous in a model formulation, as compared to the conventional Type II photoinitiator (Camphorquinone, CQ). The aim of the present work was to study the kinetics of polymerization of various composite mixtures (20-40-60-80 mol%) of bisphenol A glycidyl dimethacrylate/triethylene glycol dimethacrylate (BisGMA/TegDMA) containing either CQ or MAPO, based on real-time measurements and on the characterization of various post-cure characteristics. METHODS: Polymerization kinetics were monitored by Fourier-transform near-infrared spectroscopy (FT-NIRS) and dielectric analysis (DEA). A range of postcure properties was also investigated. RESULTS: FT-NIRS and DEA proved complementary to follow the fast kinetics observed with both systems. Autodecceleration occurred after ≈1 s irradiation for MAPO-composites and ≈5-10 s for CQ-composites. Conversion decreased with increasing initial viscosity for both photoinitiating systems. However despite shorter light exposure (3s for MAPO vs 20s for CQ-composites), MAPO-composites yielded higher conversions for all co-monomer mixtures, except at 20 mol% BisGMA, the less viscous material. MAPO systems were associated with increased amounts of trapped free radicals, improved flexural strength and modulus, and reduced free monomer release for all co-monomer ratios, except at 20 mol% BisGMA. SIGNIFICANCE: This work confirms the major influence of the initiation system both on the conversion and network cross-linking of highly-filled composites, and further highlights the advantages of using MAPO photoinitiating systems in highly-filled dimethacrylate-based composites provided that sufficient BisGMA content (>40 mol%) and adapted light spectrum are used.

The effect of ultra-fast photopolymerisation of experimental composites on shrinkage stress, network formation and pulpal temperature rise.

OBJECTIVES: to complement our previous work by testing the null hypotheses that with short curing times and high DC, TPO-based resin composites would exhibit (1) higher polymerization stresses and consequently display (2) higher temperature rise and (3) higher flexural modulus, flexural strength and hardness, compared to a conventional CQ-based experimental composite. METHODS: Two experimental resin composites using either Lucirin-TPO or camphorquinone/DMAEMA as photoinitiators were prepared. Light curing was carried out using spectral outputs adapted to the absorption properties of each initiator. Different irradiation protocols were selected (0.5, 1, 3, 9 s at 500, 1000 and 2000 mW/cm(2) for Lucirin-TPO based composites and 20 or 40 s at 1000 mW/cm2 for Lucirin-TPO and camphorquinone-based composites). Degree of conversion (DC) was measured in real time by means of FT-NIR spectroscopy. Pulpal temperature rise (ΔT) was studied in a tooth model. Polymerization stress was monitored using the Bioman instrument. For cured specimens, flexural modulus and flexural strength were determined using a three point bending platform and Vickers hardness was determined with a microhardness indentor on samples prior to and after 24 h incubation in 75/25 ethanol/H2O. Premolars were restored with both materials and microleakage at the teeth/composite interfaces following restoration was assessed. RESULTS: Lucirin-TPO-based composites irradiated at radiant exposures of 3 J/cm(2) and more exhibited significantly higher DCs, associated with increased flexural moduli and hardness compared to CQ-based composites. For an ultra-short irradiation time of 1 s at 1000 mW/cm(2), TPO-composites displayed similar polymerization stresses compared to CQ-controls with yet a 25% increase for flexural modulus and 40% increase for hardness measured after EtOH/H2O sorption. Higher stress rates were however observed in all curing protocols compared to CQ-composites. Microleakage was similar between TPO and CQ-composites irradiated at 1000 mW/cm(2) for 3 and 20 s respectively, while a significant increase was observed for TPO-composites irradiated for 1 s. ΔT measured through a 0.6 mm thick dentin layer were all below 5.5°C; TPO-composites exhibited similar or lower values compared to controls. SIGNIFICANCE: The use of Lucirin-TPO in resin composites along with appropriate curing conditions may allow for a major reduction of irradiation time while improving mechanical properties. The amount of stress observed during polymerization in TPO-based composites can be similar to those using CQ and the cohesion at the restoration-tooth interface was not affected by short curing times. Contrary to other studies, we found that the temperatures increases measured during polymerization were all well below the 5.5°C threshold for the pulp.