Clinical Evaluation of the Soft-Start (Pulse-delay) Polymerization Technique in Class I and II Composite Restorations

Effect of Fast High-Irradiance Photo-Polymerization of Resin Composites on the Dentin Bond Strength

This study investigated the influence of conventional (10 s at 1160 mW/cm²) and fast high-irradiance (3 s at 2850 mW/cm²) light curing on the micro-tensile bond strength (μTBS) of bulk-fill resin composites bonded to human dentin. Sixty-four extracted human molars were ground to dentin and randomly assigned into eight groups (n = 8 per group). After application of a three-step adhesive system (Optibond FL), four different bulk-fill composites (two sculptable and two flowable composites) were placed. Of these, one sculptable (Tetric PowerFill) and one flowable (Tetric PowerFlow) composite were specifically developed for fast high-irradiance light curing. Each composite was polymerized with the conventional or the fast high-irradiance light-curing protocol. The specimens were cut into dentin-composite sticks, μTBS was determined and failure modes were analyzed. Statistical analysis was performed using t-test for independent observations and one-way ANOVA. A statistical difference between the curing protocols was only found for Tetric PowerFlow, where the conventional protocol (23.8 ± 4.2 MPa) led to significantly higher values than the fast high-irradiance light-curing protocol (18.7 ± 3.7 MPa). All other composite materials showed statistically similar values for both polymerization protocols. In conclusion, the use of fast high-irradiation light curing has no negative influence on the μTBS of the investigated high-viscosity bulk-fill composites. However, it may reduce the dentin bond strength of flowable bulk-fill composite.

Thermal shrinkage reveals the feasibility of pulse-delay photocuring technique

OBJECTIVES

To resolve the feasibility of the pulse-delay photocuring technique as a clinical strategy for reducing the detrimental polymerization stress induced in dental composites during the photocuring process.

METHODS

Model dental composites with high and low-filler contents were cured with the pulse-delay photocuring technique using different combinations of photocuring variables (irradiance, exposure time, and delay time). Irradiance used ranged from 0.1W/cm² to 4W/cm². The exposure time of the first pulse varied from 0.2s to 27.2s and the delay times ranged from 10s to 120s. The radiant exposure was varied from 4J/cm² to 20J/cm². A cantilever-beam based instrument (NIST Standards Reference Instrument 6005) was used to implement the photocuring technique for the measurement of the polymerization properties (the degree of monomer conversion, polymerization stress induced due to shrinkage, and temperature change due to the reaction exotherm and curing light absorbance) simultaneously in real-time. These properties were compared with those obtained using the conventional photocuring technique (i.e., using a constant irradiance for a fixed exposure time, a uniform exposure).

RESULTS

There exists a minimum radiant exposure, such that a reduction in the polymerization stress can be achieved without sacrificing the degree of monomer conversion by using the pulse-delay over the conventional photocuring technique. More specifically, stress reductions of up to 19% and 32% was observed with the pulse-delay when compared with the conventional photocuring technique at an irradiance of 0.5W/cm² and 4W/cm², respectively. The reduction occurred when the exposure time of the first pulse was greater than, but closer to, the gelation time (i.e., lower than the vitrification time) of the composite, regardless of the delay time used. Lower thermal shrinkage (contraction) during the post-curing time, rather than the stress relaxation during the delay time or lower degree of monomer conversion as claimed in the literature, is the cause of the reduction in the polymerization stress.

SIGNIFICANCE

The study clarifies a long-standing confusion and controversy on the applicability of the pulse-delay photocuring technique for reducing the polymerization stress and promotes its potential clinical success for dental restorative composites.

Compliance of randomized controlled trials in posterior restorations with the CONSORT statement: a systematic review of methodology

OBJECTIVES

This study aims to investigate the compliance of randomized controlled trials (RCTs) in posterior restorations with the Consolidated Standards of Reporting Trials Statement (CONSORT) statement and to analyze the risk of bias (RoB) of these studies.

METHODS

A systematic search was performed in PubMed, Scopus, Web of Science, LILACS/BBO, and Cochrane Library. Only RCTs published in peer-reviewed journals were included. The compliance with the CONSORT was evaluated in a 0-2 scale where 0 = no description, 1 = poor description and 2 = adequate description. Descriptive analyses of the CONSORT mean score by journal, country, and RoB were performed. The RoB in RCTs was evaluated by using the Cochrane Collaboration's tool version 1.0.

RESULTS

A total of 15,476 studies were identified after duplicates removal. O only 202 meet the eligibility criteria, among which 31 were follow-up studies. Concerning the overall RoB, only 29 out of 171 were classified as low risk of bias. The overall mean CONSORT score was 19 ± 5.4 points, which means compliance of approximately 59%. Significant differences among countries, publication period, and RoB were observed (p < 0.001). The journal's impact factor was not correlated with the overall CONSORT score (p = 0.36).

CONCLUSIONS

The adherence of RCTs conducted in posterior restorations to the CONSORT Statement is still low. In addition, most studies were classified as at unclear risk of bias. These results call up an urgent need for improvement.

CLINICAL RELEVANCE

Most RCTs conducted in posterior teeth have poor reporting and are mainly classified as having an unclear risk of bias.

Effect of modulated photoactivation of bulkfill composite on microleakage in fluorosed and nonfluorosed teeth: A confocal laser scanning microscopy study

Aim:

The aim of this study is to compare the microleakage of bulkfill composite activated by modulated photoactivation between fluorosed and nonfluorosed teeth using the confocal laser scanning microscope.

Methodology:

One hundred and twenty intact human premolar teeth with Thylstrup and Fejerskov index fluorosis index 0–4 were stored in 0.5% thymol at the room temperature until further use. Standardized Class V preparations of 2 mm depth, 3 mm width, and 2 mm height were prepared on the buccal surface. The cavities were etched with 37% phosphoric acid, rinsed and primed with Tetric N bond, cured for 20 s with Quartz Tungsten Halogen (QTH) variable intensity light-curing unit spectrum-800 operating at 450 mW/cm². Later, bulk fill composite was placed in the cavity and cured. Depending on the curing mode used, all the fluorosed and nonfluorosed teeth were divided into three subgroups each (n = 20) – Conventional light curing, stepped curing, and pulse delayed curing. All samples were stored in distilled water at the room temperature for 24 h and subjected to 500 thermocycles. The prepared teeth were placed in 0.6% rhodamine solution for 48 h; sectioned longitudinally using a hard-tissue microtome and scanned under a confocal laser scanning electron microscope. Data were analyzed using the one-way ANNOVA, Wilcoxson signed-rank test, and Kruskal–Wallis test.

Results:

Significant differences were observed between fluorosed and nonfluorosed groups. Intragroup comparisons showed significant differences between fluorosed step and conventional subgroups.

Conclusion:

Fluorosed teeth had higher microleakage values than nonfluorosed teeth. Pulse-delayed subgroup had the least microleakage to that of conventional and stepped curing subgroups, in both fluorosed and nonfluorosed groups.

Characterizing the output settings of dental curing lights

OBJECTIVES

For improved inter-study reproducibility and ultimately improved patient care, researchers and dentists need to know what electromagnetic radiation (light) is emitted from the light-curing unit (LCU) they are using and what is received by the resin. This information cannot be obtained from a dental radiometer, even though many studies have used a dental radiometer.

METHODS

The light outputs from six LCUs (two QTH and four broad-spectrum LED units) were collected in real-time using an integrating sphere connected to a fiberoptic spectrometer during different light exposures.

RESULTS

It was found that the spectral emissions were unique to each LCU, and there was no standardization in what was emitted on the various ramp (soft-start) settings. Relative to the normal use setting, using the ramp setting reduced the radiant energy (J) delivered from each LCU. For one of the four broad-spectrum LED LCUs, the spectral emissions in the violet range did not increase when the overall radiant power output was increased. In addition, this broad-spectrum LED LCU emitted no light from the violet LED chip for the first 5s and only emitted violet light when the ramp phase finished.

CONCLUSIONS

A single irradiance value derived from a dental radiometer or from a laboratory grade power meter cannot adequately describe the output from the LCU. Manufacturers should provide more information about the light output from their LCUs. Ideally, future assessments and research publications that include resin photopolymerization should report the spectral radiant power delivered from the LCU throughout the entire exposure cycle.

A 7-year randomized prospective study of a one-step self-etching adhesive in non-carious cervical lesions. The effect of curing modes and restorative material

OBJECTIVE

The aim of this study was to evaluate the clinical retention of a one-step self-etching adhesive system (Xeno III) in Class V non-carious cervical lesions and the effect of restorative material and curing techniques on longevity of the restorations.

MATERIALS AND METHODS

A total of 139 Class V restorations were placed with the self-etching primer Xeno III and a resin composite (Tetric Ceram) or a poly-acid modified resin composite (Dyract AP) in non-carious cervical lesions without intentional enamel involvement. The materials were cured with a conventional continuous light, a soft-start or a pulse-delay curing mode. The restorations were evaluated at baseline, 6, 12, 18 and 24 months and then yearly during a 7 year follow-up with modified USPHS criteria. Dentine bonding efficiency was determined by the percentage of lost restorations.

RESULTS

During the 7 years, 135 restorations could be evaluated. No post-operative sensitivity was reported by the participants. Overall relative cumulative loss rate frequencies for the adhesive system at 6 and 18 months and 7 years, independent of curing technique and restorative material, were 0.8%, 6.9% and 23.0%, respectively. The self-etching adhesive fulfilled at 18 months the full acceptance ADA criteria. Tetric Ceram showed at 7 years a 20.9% loss of retention and Dyract AP a 25.0% loss rate (Log rank p = 0.48). The loss rates for the 3 curing techniques: continuous, soft start and pulse delay were 17%, 27.9% and 24.4%, respectively (Log rank p = 0.52). No secondary caries was observed.

SIGNIFICANCE

The single-step self-etching adhesive showed acceptable clinical long-time retention rates to dentine surfaces independent of restorative material and curing technique used.

Postoperative sensitivity in Class V composite restorations: Comparing soft start vs. constant curing modes of LED

Background:

One of the major disadvantages associated with using composites is polymerization shrinkage; stresses are generated at the margins, and if these stresses exceed the bond strength, microleakage occurs at the tooth restoration interface which causes ingress of cariogenic bacteria, post-operative sensitivity, and secondary caries. LED offers several curing modes: constant cure, ramped cure, and soft start cure. It is claimed that soft start polymerization mode produces less polymerization shrinkage and consequently less postoperative sensitivity.

Objective:

To compare the postoperative sensitivity in Class V composite restorations using soft start and constant LED curing modes.

Materials and Methods:

Using the appropriate burrs cavity was prepared and filled with composite Z 100(3M-ESPE) using a incremental technique. Each increment of 2 mm was cured either with soft start or constant cure. All patients were evaluated at day 2 for postoperative sensitivity.

Results and Discussion:

Out of 124 restorations that were placed, only three restorations presented with postoperative sensitivity, each one being in mild, moderate, and severe categories, respectively. No relationship was seen between the sensitivity and tooth type. There was no statistically significant difference in postoperative sensitivity in either of the treatment modalities (constant or soft start).

Conclusion:

We conclude that restorations placed with the soft start curing technique did not show significant changes in postoperative sensitivity when compared to the constant curing technique.

Effect of filler content of flowable composites on resin-cavity interface

The purpose of this in vitro study was to evaluate marginal integrity and wall adaptation in 1- and 2-mm-deep cavities restored with a high filler-loaded flowable composite in comparison to a flowable composite with lower filler content and a conventional hybrid composite. 1-mm-deep dentin and 2-mm-deep enamel-dentin Class I cavities were prepared and restored with a self-etch adhesive and with one of the composites. Samples were crosscut and evaluated for marginal integrity and gap formation using a digital microscope. Selected samples were also observed using a scanning electron microscope. For 1-mm-deep cavities, no differences in marginal integrity and wall adaptation were observed among the three composites. For 2-mm-deep cavities, those restored with the bulk technique and with the higher filler-loaded flowable composite demonstrated a similar outcome as that of the conventional hybrid composite. On the effect of restorative techniques, cohesive enamel defects were observed in bulk-filled 2-mm-deep cavities. However, when the incremental technique was used in conjunction with the higher filler-loaded flowable composite and the conventional hybrid composite for 2-mm-deep cavities, superior results were obtained.

Influence of Photoactivation Protocol and Light Guide Distance on Conversion and Microleakage of Composite Restorations

In this study, soft-start photoactivation methods were demonstrated to be able to reduce microleakage with only a discrete reduction in the degree of conversion. This was achieved when this protocol was associated with a 7 mm distance from the light guide, which is common in deep preparations in clinical practice.