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.

[Consensus recommendations from Chinese experts on the standard operation procedure of curing light in direct composite resin adhesive restorations].

The curing light in direct composite resin adhesive restorations is a common technique and treatment method in oral clinic. It has many advantages, such as matching the color of the teeth, less removing the hard tissues of the teeth, resistance to abrasion, good masticatory performance and so on. It has almost replaced the traditional amalgam filling in the clinical dentistry repair. However, in clinical practice, improper use of the technique can also lead to increased loss of restorations and postoperative sensitivity. The reason is related not only to the physical and chemical properties of the material itself, but also the operator's lack of understanding and mastering the properties of the light cured material, especially the use rules of the light curing lamp. To this end, in September 2017, the vice chairman of Society of Cariology and Endodontology, Chinese Stomatological Association, professor Liang Jingping, organized a part of professional experts in this field, and invited the chief expert in 3M company, Dr. Joe Oxman, held a meeting about the use principle, operation mode and specification symposium of light curing lamp. Experts at the meeting had a very heated discussion, forming the following consensus.

Light curing procedures - performance, knowledge level and safety awareness among dentists.

OBJECTIVES: This study aimed to investigate dentists' exposure to curing light and to obtain information about the dentists' knowledge on practical use and technical features of their curing lights as well as their safety awareness. METHODS: A pre-coded questionnaire was sent electronically to all dentists (n=1313) in the Public Dental Service (PDS) in Norway in 2015. RESULTS: The Response rate was 55.8%. The dentists spent on average 57.5% of their working days placing restorations, ranging from 1 to 30 (mean 7.7, SD 3.6) restorations per day. The average length of light curing one normal layer of composite was 27s. The longest individual mean curing time per day was about 100 times higher than that of the lowest. The mean curing time for lamps of the lower reported irradiances was similar to the time representing exceedance of international guidelines for limit values for blue light to the eyes. Almost one-third of the dentists used inadequate eye protection against blue light. The odds of using adequate eye protection were significantly higher among young dentists (p<0.01). The majority of the respondents (78.3%) were unaware of the irradiance value of their curing lights, thus rendering the curing time uncertain. More dentists in this group did not perform regular maintenance of their curing lights compared with all respondents (17.1% vs. 3.3%, p<0.01). CONCLUSIONS: This study revealed considerable variations among Norwegian dentists in the Public Dental Service with respect to performance of light curing of restorations, safety awareness and technical knowledge of the curing light. CLINICAL SIGNIFICANCE: The questionnaire study identifies specific knowledge gaps among Norwegian dentists with regard to curing lights and use of personal protection. Today's dependence on technology in dentistry necessitates that the operator possesses knowledge of essential technical specifications and safe use of devices and instruments routinely used in dental treatment.

A PREP Panel, Practice-Based, Evaluation of the Handling of the Kerr Demi-Ultra Light Curing Unit.

This paper describes the handling evaluation (by a group of practice-based researchers, the PREP Panel) of a recently introduced Light Curing Unit (LCU), the Kerr Demi-Ultra, which possesses a number of novel features such as its ultracapacitor power source, and the Light Emitting Diodes (LEDs) which provide the light output being placed close to the tip of the light guide. CPD/CLINICAL RELEVANCE: Testing of new devices and materials with respect to their handling is of importance, given that an easy to handle device should produce better clinical results than one which is difficult to use.

Effect of emitted wavelength and light guide type on irradiance discrepancies in hand-held dental curing radiometers.

The purpose of this study was to determine any discrepancies in the outputs of five commercial dental radiometers and also to evaluate the accuracy of these devices using a laboratory-grade spectroradiometer. The power densities of 12 different curing light sources were repeatedly measured for a total of five times using each radiometer in a random order. The emission spectra of all of the curing light sources were also measured using the spectroradiometer, and the integral value of each spectrum was calculated to determine the genuine power densities, which were then compared to the displayed power densities measured by the dental radiometers. The displayed values of power density were various and were dependent on the brand of radiometer, and this may be because each radiometer has a different wavelength sensitivity. These results cast doubt upon the accuracy of commercially available dental radiometers.

Assessing the irradiance delivered from light-curing units in private dental offices in Jordan.

BACKGROUND: The authors conducted a study to examine the irradiance from light-curing units (LCUs) used in dental offices in Jordan. METHODS: Two of the authors visited 295 private dental offices (15 percent) in Jordan and collected the following information about the LCUs: age, type (quartz-tungsten-halogen or light-emitting diode), date of last maintenance, type of maintenance, last date of use, number of times used during the day, availability of a radiometer, exposure time for each resin-based composite increment, size of light-curing tips and presence of resin-based composite on the tips. The authors used a radiometer to measure the irradiance from the LCUs. They used linear regression with stepwise correlation for the statistical analysis. The authors set the minimum acceptable irradiance at 300 milliwatts/square centimeter. RESULTS: The mean irradiance of the 295 LCUs examined was 361 mW/cm(2), and 136 LCUs (46.1 percent) delivered an irradiance of less than 300 mW/cm(2). The unit's age, type and presence of resin-based composite on the light-curing tips had a significant effect on the irradiance (P ≤ .001). CONCLUSIONS: Only 37 of the 141 quartz-tungsten-halogen units (26.2 percent) and 122 of the 154 light-emitting diode units (79.2 percent) delivered at least 300 mW/cm(2). Resin contamination on the light-curing tips had a significant effect on the irradiance delivered. The irradiance from the LCUs decreased with use. Practical Implications. The irradiance from many of the units in this study was less than 300 mW/cm(2), which may affect the quality of resin-based composite restorations. Dentists should monitor the performance of the LCUs in their offices weekly.

Light curing in orthodontics; should we be concerned?

OBJECTIVES: Light cured materials are increasingly used in orthodontic clinical practice and concurrent with developments in materials have been developments in light curing unit technology. In recent years the irradiances of these units have increased. The aim of this study was to determine the safe exposure times to both direct and reflected light. METHODS: The weighted irradiance and safe exposure times of 11 dental curing lights (1 plasma arc, 2 halogen and 8 LED lights) were determined at 6 distances (2-60 cm) from the light guide tip using a spectroradiometer. In addition, using the single most powerful light, the same two parameters were determined for reflected light. This was done at a distance of 10 cm from the reflected light, but during simulated bonding of 8 different orthodontic brackets of three material types, namely stainless steel, ceramic and composite. RESULTS: The results indicate that the LED Fusion lamp had the highest weighted irradiance and the shortest safe exposure time. With this light the maximum safe exposure time without additional eye protection for the patient (at 10 cm), the operator (at 30 cm) and the assistant (at 60 cm) ranged from 2.5 min, 22.1 min and 88.8 min respectively. This indicates a relatively low short term risk during normal operation of dental curing lights. For reflected light at a distance of 10 cm the risk was even lower, but was affected by the material and shape of the orthodontic bracket under test. SIGNIFICANCE: The short term risks associated with the use of dental curing lights, halogen, LED or plasma, appear to be low, particularly if as is the case adequate safety precautions are employed. The same is true for reflected light from orthodontic brackets during bonding. What is still unclear is the potential long term ocular effects of prolonged exposure to the blue light generated from dental curing lights.

Effect of light-emitting diode and halogen light curing on the micro-hardness of dental composite and resin-modified glass ionomer cement: an in vitro study.

AIMS: This in vitro study was conducted to evaluate and compare the micro-hardness of composite resin and resin-modified glass ionomer cement using light-emitting diode (LED) and halogen curing and also to inter-compare the effect of LED and halogen curing. MATERIALS AND METHODS: The study sample comprised of 4 stainless steel plates with a thickness of 2 mm. For these stainless steel plates, holes were made to a diameter of 3 mm. The samples were divided into 4 groups of 8 each and labeled as group I, group II, group III, group IV, thus making provision for the two different modes of light exposure. In each group, the hole was restored with its respective restorative material and cured with light-curing unit according to manufacturer instructions. The results were statistically analyzed using Mann-Whitney test. RESULTS AND CONCLUSION: It was concluded that the curing efficacy of the LED lamp was comparable to that of conventional halogen lamp, even with a 50% reduction in cure time, and resin composite (Filtek Z-250) presented the highest hardness values, whereas complete hardening of resin-modified glass ionomer cement (RMGIC) (Vitremer) was observed because of its self-curing system even after the removal of light source.

Curing efficiency of modern LED units.

Recent reports claim that modern light-emitting diode (LED) curing units improve curing efficiency by increasing the units' irradiance. In this context also, short polymerisation times up to 5 s are proposed. The aim of this study was to examine whether there are differences in the curing efficiency of modern LED curing units by assessing their effect on two different composite materials and by varying the irradiation time. A nano- and a micro-hybrid resin-based composite (RBC) were polymerised for 5, 10 and 20 s with three commercial and a Prototype LED unit (Elipar™ S10). Cylindrical specimens (6 mm in depth, 4 mm in diameter) were prepared in three increments, each 2-mm thick, and were consecutively cured. Degree of cure was measured for 20 min in real time at the bottom of the samples, starting with the photoinitiation. The micro-mechanical properties (modulus of elasticity, E and Vickers hardness, HV) were measured as a function of depth, in 100-µm steps, on the above described samples stored in distilled water for 24 h at 37°C. Data were analysed with multivariate ANOVA followed by Tukey's test, t test and partial eta-squared statistics. In descending order of the strength of their effect, the type of RBC, depth, polymerisation time and curing unit were significant factors affecting the micro-mechanical parameters (p < 0.05). The degree of cure at 6-mm depth was less but significantly influenced by the curing unit and curing time and was independent from the type of RBC. A 5-s irradiation time is not recommended for these units. Whereas a 5-s irradiation is acceptable at the sample's surface, a minimum of 20 s of irradiation is necessary for an adequate polymerisation 2 mm beyond the surface.

Effect of distance on irradiance and beam homogeneity from 4 light-emitting diode curing units.

PURPOSE: To quantify the effect of distance on the irradiance and beam homogeneity from 4 curing lights. METHODS: Four light-emitting diode curing lights were evaluated: Fusion, Bluephase 16i, Demi and FlashLite Magna. The irradiance at the centre of the light beam (ICB) was measured at 1.0 to 9.0 mm from the emitting tip using a 3.9-mm diameter probe connected to a spectrometer. The uniformity of the beam from each curing light was characterized by means of the "top hat factor" at 2.0, 4.0, 6.0 and 8.0 mm from the emitting tip. The useful beam diameter, within which irradiance values were greater than 400 mW/cm2, was calculated. The ICB, top hat factor and useful beam diameter were compared by analysis of variance and Fisher's protected least significant difference test at α = 0.01. RESULTS: At all distances, the ICB was lowest for the FlashLite Magna and highest for the Fusion. Only the Fusion maintained an ICB above 1000 mW/cm2 at the 8.0 mm distance. For distances between 2.0 and 8.0 mm, the top hat factors were similar for the Fusion and the Demi, lower for the Bluephase 16i and lowest for the FlashLite Magna. CONCLUSIONS: Beam homogeneity, top hat factors and ICB varied significantly among the curing lights. These results indicate that deep restorations may not be adequately cured if the curing time is based on data obtained when the curing light is positioned close to the radiometer or resin. In addition, a single irradiance value cannot be used to describe the light output from a curing light.

A method for improving the light intensity distribution in dental light-curing units.

A method for improving the uniformity of the radiation light from dental light-curing units (LCUs), and the effect on the polymerization of light-activated composite resin are investigated. Quartz-tungsten halogen, plasma-arc, and light-emitting diode LCUs were used, and additional optical elements such as a mixing tube and diffusing screen were employed to reduce the inhomogeneity of the radiation light. The distribution of the light intensity from the light guide tip was measured across the guide tip, as well as the distribution of the surface hardness of the light-activated resin emitted with the LCUs. Although the additional optical elements caused 13.2-25.9% attenuation of the light intensity, the uniformity of the light intensity of the LCUs was significantly improved in the modified LCUs, and the uniformity of the surface hardness of the resin was also improved. Our results indicate that the addition of optical elements to the LCU may be a simple and effective method for reducing inhomogeneity in radiation light from the LCUs.

Factors affecting the energy delivered to simulated class I and class v preparations.

PURPOSE: To determine the effect of operator, curing light and preparation location, as well as any correlations among these variables, on the amount of light energy delivered to simulated cavity preparations. MATERIALS AND METHODS: Each of 10 dentists and 10 fourth-year dental students light-cured a Class I preparation in tooth 26 and a Class V preparation in tooth 37 in a dental mannequin head. The operators exposed each preparation for 10 seconds with each of 3 LED-based curing lights (Bluephase G2 on high power, Demi and VALO on standard power). Each operator also used the VALO unit in the plasma mode for 2 sequential 3-second curing cycles. For each combination of operator, curing light and preparation, the irradiance (mW/cm(2)) received at the base of the preparation was measured with a laboratory-grade spectroradiometer, and software was used to calculate the energy density delivered in real time. The statistical analysis included 3-way analysis of variance (ANOVA) and the Fisher protected least significant difference (PLSD) test for post hoc pairwise comparisons. RESULTS: There was a large qualitative and quantitative variation in the irradiance delivered to the preparations by each operator. Three-way ANOVA showed no statistically significant differences between dentists and dental students in terms of the amount of energy delivered (p = 0.90). However, there were statistically significant differences in energy delivered by the various curing lights (p < 0.001) and between the 2 preparation locations (p < 0.001). According to the Fisher PLSD test for post hoc pairwise comparison of means, the VALO unit used in the plasma mode for two 3-second curing cycles delivered the most energy (16.4 +/- 3.1 J/cm(2)) to the Class I preparation, and the same light used for 10 seconds in the standard mode delivered the least amount of energy (9.9 +/- 2.4 J/cm(2)) (p < 0.001). For the Class V preparation, the VALO unit used in the plasma mode for two 3-second curing cycles delivered the most energy (12.5 +/- 4.0 J/cm(2)), and the Demi unit, used for 10 seconds, delivered the least energy (7.4 +/- 2.5 J/cm(2)). CONCLUSIONS: The energy delivered by a curing light to a preparation in a simulated clinical environment was affected by the operator's light-delivery technique, the choice of curing light and the location of the preparation.

Curing efficiency of high-intensity light-emitting diode (LED) devices.

We evaluated the curing efficiency of 4 high-intensity light-emitting diode (LED) devices by assessing percentage of residual C=C (%RDB), surface microhardness (SM), depth of cure (DC), percentage of linear shrinkage-strain (%LS), and percentage of wall-to-wall contraction (%WWC). The light-curing units tested were a QTH light, the Elipar TriLight (3M/ESPE), and 4 LED devices - the Allegro (Denmat), the Bluephase (Ivoclar/Vivadent), the FreeLight2 (3M/ESPE), and The Cure TC-01 (Spring Health Products). The %RDB was measured by microFTIR spectroscopy. Microhardness measurements (Vickers) were performed at the surface (H0) and at depths of 3 mm (H3) and 5 mm (H5) of cylindrical specimens. Depth of cure was expressed as the ratio of microhardness at each depth, relative to the corresponding surface value (H3/H0 and H5/H0). The bonded disc method was used to evaluate %LS. For the %WWC evaluation, cylindrical resin restorations were imaged by high resolution micro-CT and the %WWC was calculated at depths of 0 mm and 2 mm. There were no statistical differences among the LEDs in %RDB or %LS. The Bluephase and Allegro had the highest SM values. As compared with the other LEDs, the Bluephase and The Cure TC-01 had lower values for depth of cure at depths of 3 mm and 5 mm. There were no significant differences in %WWC among the LEDs at either depth, and the QTH had the lowest %WWC at both depths.