UK dental care for children - a specialist workforce analysis.

Introduction The main specialties involved with the treatment of children in the UK are paediatric dentistry and orthodontics. In December 2019, these accounted for approximately 38% of all specialists listed by the General Dental Council (GDC). Recent evidence of difficulties filling specialist NHS job posts and the absence of specialists in some UK postal areas suggests a demographic analysis of these specialties is timely.Aims To gather data and help contribute towards assessing the need for future specialist training places by mapping GDC-listed specialists registered in UK postal areas and plotting specialists' first GDC registration dates.Method The data were obtained from the GDC.Results In ten years' time, approximately 40% (n = 92) of currently registered specialists in paediatric dentistry and 37% (n = 487) of specialists in orthodontics will be aged 60 years or over. Forty-four percent (n = 54) of 124 UK postal areas had no specialist in paediatric dentistry while 2% (n = 3) had no specialist in orthodontics.Conclusion Demographic profiling can be compiled from data available to the public. This is likely to be of interest for those responsible for specialist workforce planning and funding NHS specialist dental care for children.

A brief history of LED photopolymerization.

OBJECTIVES: The majority of modern resin-based oral restorative biomaterials are cured via photopolymerization processes. A variety of light sources are available for this light curing of dental materials, such as composites or fissure sealants. Quartz-tungsten-halogen (QTH) light curing units (LCUs) have dominated light curing of dental materials for decades and are now almost entirely replaced by modern light emitting diode light curing units (LED LCUs). Exactly 50 years ago, visible LEDs were invented. Nevertheless, it was not before the 1990s that LEDs were seriously considered by scientists or manufactures of commercial LCUs as light sources to photopolymerize dental composites and other dental materials. The objective of this review paper is to give an overview of the scientific development and state-of-the-art of LED photopolymerization of oral biomaterials. METHODS: The materials science of LED LCU devices and dental materials photopolymerized with LED LCU, as well as advantages and limits of LED photopolymerization of oral biomaterials, are discussed. This is mainly based on a review of the most frequently cited scientific papers in international peer reviewed journals. The developments of commercial LED LCUs as well as aspects of their clinical use are considered in this review. RESULTS: The development of LED LCUs has progressed in steps and was made possible by (i) the invention of visible light emitting diodes 50 years ago; (ii) the introduction of high brightness blue light emitting GaN LEDs in 1994; and (iii) the creation of the first blue LED LCUs for the photopolymerization of oral biomaterials. The proof of concept of LED LCUs had to be demonstrated by the satisfactory performance of resin based restorative dental materials photopolymerized by these devices, before LED photopolymerization was generally accepted. Hallmarks of LED LCUs include a unique light emission spectrum, high curing efficiency, long life, low energy consumption and compact device form factor. SIGNIFICANCE: By understanding the physical principles of LEDs, the development of LED LCUs, their strengths and limitations and the specific benefits of LED photopolymerization will be better appreciated.

Time dependence of composite shrinkage using halogen and LED light curing.

OBJECTIVES: The polymerization shrinkage of light cured dental composites presents the major drawback for these aesthetically adaptable restorative materials. LED based light curing technology has recently become commercially available. Therefore, the aim of the present study was to investigate if there was a statistically significant difference in linear and volumetric composite shrinkage strain if a LED LCU is used for the light curing process rather than a conventional halogen LCU. METHODS: The volumetric shrinkage strain was determined using the Archimedes buoyancy principle after 5, 10, 20, 40 s of light curing and after 120 s following the 40 s light curing time period. The linear shrinkage strain was determined with a dynamic mechanical analyzer for the composites Z100, Spectrum, Solitaire2 and Definite polymerized with the LCUs Trilight (halogen), Freelight I (LED) and LED63 (LED LCU prototype). The changes in irradiance and spectra of the LCUs were measured after 0, 312 and 360 min of duty time. RESULTS: In general there was no considerable difference in shrinkage of the composites Z100, Spectrum or Solitaire2 when the LED63 was used instead of the Trilight. There was, however, a statistically significant difference in shrinkage strain when the composite Definite was polymerized with the LED63 instead of the Trilight. The spectrum of the Trilight changed during the experiment considerably whereas the LED63 showed an almost constant light output. The Freelight I dropped considerably in irradiance and had to be withdrawn from the study because of technical problems. SIGNIFICANCE: The composites containing only the photoinitiator camphorquinone showed similar shrinkage strain behaviour when a LED or halogen LCU is used for the polymerization. The irradiance of some LED LCUs can also decrease over time and should therefore be checked on a regular basis.

The influence of storage and indenter load on the Knoop hardness of dental composites polymerized with LED and halogen technologies.

OBJECTIVES: The mechanical properties of light cured dental composites are greatly influenced by the light curing unit (LCU) used for the polymerization. Previous studies have shown that for some composites lower mechanical properties were obtained if light emitting diode (LED) LCUs were used for the polymerization instead of halogen LCUs. Previous studies have also shown that light cured composites improve their mechanical properties through a post-curing process after the initial illumination with the LCUs. Therefore, this study investigated the post-curing process, to ascertain if it can compensate for the lower mechanical properties of composites polymerized with LED LCUs. METHODS: The Knoop hardness was measured for four dental composites (Z100, Spectrum, Definite, Solitaire2) polymerized with an LED LCU (LED63 prototype) or a halogen LCU (Trilight), directly after the curing process and after 5 days of storage. In addition, the load on the indenter was varied from 200 to 400 gf to investigate the influence of the load on the measured hardness on the top and bottom of the 2 mm thick samples. RESULTS: In general the Knoop hardness at the bottom of the stored samples, cured with the LED LCU, was the same or statistically significantly greater than for the samples cured with the halogen LCU. A statistically significantly lower (p<0.0001) Knoop hardness was obtained on the top of the samples if the composite Definite was polymerized with the LED LCU instead of the halogen LCU. The load of 200 or 400 gf on the indenter had a statistically significant influence (p<0.0001) on the measured Knoop hardness for the composite Z100. The Knoop hardness measured with an indenter load of 400 gf increased statistically significantly (p<0.0001) for all composites after the 5 days' storage, whether cured with the LED LCU or halogen LCU. SIGNIFICANCE: The post-curing effect cannot compensate for the lower hardness of composites containing co-initiators if polymerized with an LED LCU instead of a halogen LCU. The indenter load had a statistically significant influence on the measured Knoop hardness of composites and has the potential to falsify results if not selected carefully.

Photoinitiator dependent composite depth of cure and Knoop hardness with halogen and LED light curing units.

Light curing units (LCUs) are used for the polymerization of dental composites. Recent trends in light curing technology include replacing the halogen LCUs with LCUs using light emitting diodes (LEDs) reducing curing times and varying the LCUs light output within a curing cycle. This study investigated the time dependence of the Knoop hardness and depth of cure of dental composites polymerized with a halogen LCU (Trilight) and two LED LCUs (the commercial Freelight and custom-made LED LCU prototype). The halogen LCU was used in the soft-start (exponential increase of output power) and standard mode. Four dental composites (Z100, Spectrum, Definite, Solitaire2) were selected, two of them (Definite, Solitaire2) contain co-initiators in addition to the standard photoinitiator camphorquinone. The depth of cure obtained with the Trilight in the standard mode was statistically significantly greater (p < 0.05) than that obtained with the LED LCUs for all materials and curing times. The custom made LED LCU prototype (LED63) achieved a statistically significantly greater depth of cure than the commercial LED LCU Freelight for all materials and curing times. There was no statistical difference in Knoop hardness at the 95% confidence level at the surface of the 2 mm thick sample between the LED63 or Trilight (standard mode) for the composite Z100 for all times, and for Spectrum for 20s and 40s curing time. The composites containing co-initiators showed statistically significantly smaller hardness values at the top and bottom of the samples if LED LCUs were used instead of halogen LCUs. The experiment revealed that the depth of cure test does not and the Knoop hardness test does discriminate between LCUs, used for the polymerization of composites containing photoinitiators in addition to camphorquinone.

Polymerization and light-induced heat of dental composites cured with LED and halogen technology.

Most commercial light curing units (LCUs) for dental applications use conventional halogen bulbs. Commercial LCUs using light emitting diodes (LEDs) have recently become established on the market, even though some aspects of their performance have not been fully investigated. Temperature rise of dental composites during the light-induced polymerization is considered to be a potential hazard for the pulp of the tooth. This study, therefore, investigated the temperature rise in three different composites (Z100, Durafill, Solitaire2) in two shades (A2, A4) polymerized for 40s with two LED LCUs (Freelight, custom-made LED LCU prototype) and two halogen LCUs (Trilight, Translux). The Trilight was used in the standard and soft-start mode. The temperature rise within the composites were recorded for 60s with a thermocouple and also observed with a high-resolution infrared (HRIR) camera. The factors LCU (p < 0.0001), composite (p < 0.0001) and shade (p = 0.0014) had statistically significant influences on the temperature rise. All composites cured with the halogen LCUs reached at a depth of 2 mm, a statistically significant higher temperature (p < 0.0001) than those cured with the LED LCUs. Only one composite showed a statistically significant lower temperature rise for the halogen LCUs at the 95% confidence level, when the soft-start mode was used instead of the standard mode. In general, the composites with the lighter shade (A2) reached higher temperatures than the darker shade (A4), if the LED LCUs were used. When the halogen LCUs were used, the situation was reversed, the composites with the darker shade (A4) reaching higher temperatures than the lighter shade (A2). This study showed that a HRIR camera represents a powerful tool for the observation of temperature propagation on small samples. This study also showed that LED LCUs represent a viable alternative to halogen LCUs for the light polymerization of dental composites because of a generally lower temperature increase within the composite.

Knoop hardness depth profiles and compressive strength of selected dental composites polymerized with halogen and LED light curing technologies.

After the first light-emitting diode (LED) light curing units (LCUs) became available commercially, a comparison of mechanical properties between materials polymerized with conventional halogen lamps and this new technology was required. This study, therefore, investigated the curing performance of two conventional commercial halogen LCUs (Translux CL, Spectrum800), a custom-made LED LCU prototype, and one of the first commercially available LED LCUs (LUXoMAX). The Spectrum800 was adjusted to a similar irradiance to the custom-made LED LCU prototype. Both technologies were compared by measuring compressive strength and Knoop hardness depth profiles for selected dental composites polymerized for 20 or 40 s. Four dental composites (Z100, Spectrum TPH, Solitaire2, and Definite) were used. Two of these composites (Solitaire2 and Definite) contain co-initiators in addition to the standard photoinitiator camphorquinone. In general, the material hardness obtained with the LUXoMAX was statistically significantly (p < 0.05) lower at the depths of 0.1, 1.0, 1.9, and 3.1 mm, for all composites and curing times, than for the other three LCUs. The LED LCU prototype achieved, with one exception, up to a depth of 1.9 mm a material hardness for the composites Z100, Spectrum TPH and Solitaire2 that was not statistically significant different (p < 0.05) from the hardness obtained with the halogen LCUs. At a greater depth (3.1 mm), however, the LED LCU prototype showed statistically significantly lower hardness values than the halogen units. The compressive strength test showed at a 95% confidence level that similar compressive strengths were achieved with the LCUs LUXoMAX and Spectrum800, and the Translux and LED LCU prototype.

High power light emitting diode (LED) arrays versus halogen light polymerization of oral biomaterials: Barcol hardness, compressive strength and radiometric properties.

The clinical performance of light polymerized dental composites is greatly influenced by the quality of the light curing unit (LCU) used. Commonly used halogen LCUs have some specific drawbacks such as decreasing light output with time. This may result in a low degree of monomer conversion of the composites with negative clinical implications. Previous studies have shown that blue light emitting diode (LED) LCUs have the potential to polymerize dental composites without having the drawbacks of halogen LCUs. Since these studies were carried out LED technology has advanced significantly and commercial LED LCUs are now becoming available. This study investigates the Barcol hardness as a function of depth, and the compressive strength of dental composites that had been polymerized for 40 or 20s with two high power LED LCU prototypes, a commercial LED LCU, and a commercial halogen LCU. In addition the radiometric properties of the LCUs were characterized. The two high power prototype LED LCUs and the halogen LCU showed a satisfactory and similar hardness-depth performance whereas the hardness of the materials polymerized with the commercial LED LCU rapidly decreased with sample depth and reduced polymerization time (20 s). There were statistically significant differences in the overall compressive strengths of composites polymerized with different LCUs at the 95% significance level (p = 0.0016) with the two high power LED LCU prototypes and the halogen LCU forming a statistically homogenous group. In conclusion, LED LCU polymerization technology can reach the performance level of halogen LCUs. One of the first commercial LED LCUs however lacked the power reserves of the high power LED LCU prototypes.