The Effect of a Targeted Educational Intervention on Light-Curing Confidence and Skills in Multidisciplinary Dental Training

PURPOSE

Light-curing plays a vital role in various dental procedures across specialties; however, previous studies have revealed significant gaps in knowledge and practice, highlighting the necessity for focused educational interventions to enhance skills and confidence in this area.

AIM

To evaluate the confidence, knowledge, clinical practice skills, and performance of dental residents from different specialties before and after an educational intervention on light-curing.

METHODS

Forty-nine residents from restorative, pediatric, and orthodontic departments were invited to partake in this light-curing training, conducted over three sessions. (i) Pre-assessment surveys regarding satisfaction, confidence, knowledge, and clinical practice were collected, along with pre-assessment light-curing measurements of the irradiance and radiant exposure values delivered to simulated restorations using a patient simulator (MARC-PS, Bluelight). (ii) An interactive lecture. (iii) Post-assessment light-curing followed by post-surveys. Statistical analysis utilized the Wilcoxon signed-rank test (p < 0.05).

RESULTS

The response rate was 83% (n = 34). The median irradiance and radiant exposure values were recorded as 1234-1263 mW/cm2, 12.5-12.8 J/cm2, and 1258-1441 mW/cm2, 12.7-14.5 J/cm2 before and after the educational intervention, respectively. Significant improvements in knowledge were observed among restorative and pediatric residents (p < 0.05). The clinical practice skills of residents from all three disciplines showed improvement following the intervention (p < 0.05). Restorative residents generally outperformed the others. Significant correlations were identified between satisfaction with past learning, self-confidence in learning, and light-curing performance (p < 0.05).

CONCLUSION

Incorporating comprehensive light-curing training into graduate dental curricula across specialties is recommended for enhancing resident performance and confidence through targeted educational strategies.

The dark art of light curing in dentistry

OBJECTIVE

This study was designed to show that the commonly reported irradiance values that are quoted in most publications inadequately describe the light output from light curing units (LCUs).

METHODS

The total spectral radiant power (mW) output from 12 contemporary LCUs was measured with a fiberoptic spectroradiometer and a calibrated integrating sphere. Five recordings were taken for each LCU and exposure mode. In addition, the irradiances (mW/cm²) delivered at 0-mm, 5-mm and 10-mm distances were recorded through a 6-mm diameter aperture and the radiant exposures (J/cm²) from the LCUs were calculated. Light beam profiles from the LCUs were recorded using a beam profiler, and the images were overlaid on a molar tooth to simulate a clinical setting. Data were analyzed using ANOVA followed by Tukey post-hoc test (α = 0.05).

RESULTS

The mean power outputs from the LCUs ranged from 380 to 2472 mW (p < 0.0001). The highest irradiance was recorded from the Cicada CV 215-G7 (3091 mW/cm² in its highest mode) and the lowest from the Radii Cal CX (731 mW/cm²). The emission spectra differed, even among the multi-peak and single-peak LCUs. Radiant exposures from the entire light tip ranged from 18.3 J/cm², Radii Cal CX, in its standard 25 s exposure mode to 3.9 J/cm² from the Monet Laser in a 3 s exposure setting. Half (50 %) of the measured irradiance values from the LCUs differed from the manufacturers' value by more than 10 %. There were significant differences in the impact of distance from the tip. The beam profiles visually highlighted the varying effects of distance from the LCU tip among different units.

CONCLUSION

There were significant differences in the emission spectra, power outputs, tip diameters, irradiances, radiant exposures, and the effect distance from the light tips. These differences underline the importance of manufacturers and researchers correctly measuring and reporting the output from the LCU to ensure that research is reproducible and that patients receive acceptable dental restorations.

CLINICAL SIGNIFICANCE

This article alerts clinicians, researchers and journal editors that providing only the tip irradiance (radiant exitance) value from the LCU is no longer sufficient. Manufacturers and researchers should include information on the spectral radiant power, emission spectrum, tip diameters, and also the effect of distance on the irradiance and radiant exposure, beam profiles and tooth access information when describing an LCU.

Impact of Battery Levels of a Cordless LED Curing Unit on Resin Cement under Varied Lithium Disilicate Thicknesses and Translucencies

OBJECTIVES

This study aimed to evaluate the impact of battery levels on the emission of a multi-peak cordless LED light-curing unit (LCU) and the effect on the degree of conversion (DC) and Knoop hardness (KH) of a light-cure resin luting agent activated through varying lithium disilicate (LiS2) ceramic thicknesses and translucencies.

METHODS

High and low translucency LiS2 discs (IPS e.max Press HT and LT, respectively; shade A1) with thickness of 0.5, 1.0, 1.5, and 2.0 mm were fabricated. Resin luting agent specimens (Variolink Esthetic LC) were prepared and cured using a Bluephase G2 LCU at different battery levels (100%, 50%, and 10%) through the LiS2 ceramics. The transmitted irradiance was evaluated using USB4000 MARC, while FTIR and a microhardness tester assessed DC and KH, respectively. After ensuring homoscedasticity, the data wee analyzed using analysis of variance and Tukey HSD test (α=0.05).

RESULTS

The study found strong positive correlations between battery levels and irradiance, particularly with no ceramic interposition and through HT ceramics (R2=0.9471), although this correlation diminished with thicker HT (R2=0.7907) and LT ceramics (R2<0.2980). Both battery levels and ceramic thickness significantly influenced transmitted irradiance (p<0.0001), resulting in lower values with decreased battery levels and increased ceramic thicknesses (p<0.0001). LT ceramics showed lower transmittance than HT. DC was significantly affected by both battery levels and ceramic thicknesses, with generally lower DC values except for LT ceramics at a 10% battery level (p<0.0001). No significant differences in DC were observed between HT and LT translucencies (p=0.548). KH was higher in HT than LT ceramics at 100% and 50% battery levels, with thicker ceramics showing lower KH values at 10% battery level (p<0.0001). Conclusion: Reduced battery levels in cordless LED curing units significantly affect the irradiance, degree of conversion, and hardness of light-curable resin luting agents. Maintaining battery levels above 50% is recommended for optimal performance. Thicker and more opaque ceramics significantly impacted incident irradiance. However, preserving radiant energy could potentially mitigate these limitations.

Effect of Battery Level During Successive Charging Cycles on the Performance of Certified and Low-cost Uncertified Light-curing Units Available on E-commerce

OBJECTIVE

To evaluate the influence of battery level on power (mW), emission spectrum (mW/cm2/ nm), and light distribution on the active tip (mW/ cm2) of certified (FDA/ANVISA) and low-cost uncertified light-curing units (LCUs) purchased through e-commerce.

METHODS

Seven LCUs, three certified: VALO Grand (Ultradent); Radii Xpert (SDI); and LED.B (Woodpecker); and four uncertified: 1 Sec; BS 300; LED curing light; and VAFU (VRN, AZDENT), were used. The LCUs were evaluated by calculating the power (mW) after each sequential five exposure cycles of 20 seconds and the emission spectrum (mW/cm2/nm) in the initial and final cycles, using an integrating sphere during three battery charging cycles. Beam profiling was used to check the light distribution on the LCU tip after every 50 exposure cycles until the battery fully discharged. Data were analyzed by linear regression between power and the number of exposure times (R2).

RESULTS

The certified LCUs VALO Grand (R2=0.005), LED.B (R2=0.02), and Radii Xpert (R2=0.09) and the uncertified LCU VAFU (R2=0.002) had no significant power reduction during the three battery charging cycles. The uncertified LCUs BS 300 (R2=0.87), 1 Sec (R2=0.60), and LED curing light (R2=0.83) showed significant power reduction, decreasing the emission spectrum (mW/cm2/nm) at the end of the battery charging cycle. The light distribution on the active tip across the level battery was modified significantly with successive exposure times.

CONCLUSIONS

The certified LCUs (VALO Grand, Radii Xpert, and LED.B) and uncertified LCU (VAFU), maintained power, emission spectrum, and light distributions during the tested battery life cycles. Low-cost certified LCU LED.B exhibited inhomogeneous light concentrated at the center of the tip. Low-cost uncertified LCUs-BS 300, 1 Sec, and LED curing light-had significant power reductions during the battery cycles and increased inhomogeneous light distribution along the successive exposure times.

Influence of Battery Levels in Cordless LED Light-curing Units on Properties of Resin Cement and Glass Fiber Post Retention

PURPOSE

This study aimed to assess the impact of battery levels in single-peak and multi-peak light-curing units (LCUs) on irradiance, and their effects on glass fiber post push-out bond strength to root dentin and the degree of conversion of dual-cure universal resin cement.

METHODS AND MATERIALS

Sixty bovine roots underwent endodontic treatment and were randomly distributed into 6 groups (n=10), formed by combining two LCUs (single-peak and multipeak) and three battery levels (100%, 50%, and 10%). A spectrophotometer measured irradiance (mW/ cm2) and spectral irradiance (mW/cm2/nm). Push-out bond strength (PBS) tests occurred at three root regions (cervical, middle, and apical), with optical and scanning electron microscopy for failure mode analysis. Degree of conversion (DC) was evaluated across the root regions. Data were analyzed using two-way repeated measures ANOVA and the Tukey HSD test. The Fisher exact test verified failure modes (α=0.05).

RESULTS

As multipeak LCU battery levels decreased, emitted irradiance also diminished, with notable PBS reductions in the apical thirds. Failure modes were influenced by different conditions, primarily exhibiting mixed modes. Battery levels significantly impacted DC in the multipeak LCU, particularly in the cervical region, while the single-peak LCU exhibited DC reduction at the 10% battery level in the cervical region.

CONCLUSIONS

Emitted irradiance, resin cement DC, and glass fiber post bond strength to root dentin may be influenced by varying cordless LCUs and battery levels.

Reduction of microorganisms in carious dentin by photodynamic therapy mediated by potassium iodide added to methylene blue and red laser

OBJECTIVE

To evaluate the effect of the association of potassium iodide to antimicrobial photodynamic therapy on human carious dentin produced with a microcosm biofilm model.

METHODS

A microcosm biofilm model was used to generate a caries lesion on human dentin. Pooled human saliva diluted with glycerol was used as an inoculum on specimens immersed on McBain artificial saliva enriched with 1 % sucrose (24 h at 37 °C in 5 % CO2). After refreshing culture media for 7 days, the dentin specimens were divided in 5 groups (3 specimens per group, in triplicate; n = 9): C (NaCl 0.9 %), CX (2 % chlorhexidine), PKI (0.01 % methylene blue photosensitizer+50 mM KI), L (laser at 15 J, 180 s, 22.7 J/cm2), and PKIL (methylene blue + KI + Laser). After the treatments, dentin was collected, and a 10-fold serial dilution was performed. The number of total microorganisms, total lactobacilli, total streptococci, and Streptococcus mutans was analyzed by microbial counts (CFU/mL). After normality and homoscedasticity analysis, the Welch's ANOVA and Dunnett's tests were used for CFU. All tests used a 5 % significance level.

RESULTS

CX and PKIL groups showed significant bacterial decontamination of dentin, compared to group C (p < 0.05) reaching reductions up to 3.8 log10 for CX for all microorganisms' groups and PKIL showed 0.93, 1.30, 1.45, and 1.22 log10 for total microorganisms, total lactobacilli, total streptococci, and S. mutans, respectively.

CONCLUSION

aPDT mediated by the association of KI and methylene blue with red laser reduced the viability of microorganisms from carious dentin and could be a promising option for cavity decontamination.

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.

Power output from 12 brands of contemporary LED light-curing units measured using 2 brands of radiometers

Background

Given the increasing use of photo-activated resins in dentistry, dentists and researchers need a user-friendly dental radiometer to measure the power output from dental light-curing units (LCUs).

Objective

Our goal was to measure the accuracy of two brands of dental radiometers in reporting the power (mW) from twelve brands of contemporary LCUs compared to a ‘gold standard’ (GS) reference value obtained from an integrating sphere attached to a fiberoptic spectroradiometer.

Methods

The power output was measured from two units of 12 brands of LCUs, five times on the ‘‘GS” system, five times on two Bluephase Meter II dental radiometers, and five times on two Mini Gig hand-held spectroradiometers. The emission spectrum was also recorded using the ‘GS’ integrating sphere. The power values reported by each meter were subjected to t-tests to compare the two examples of each LCU, and 3-way ANOVA followed by Bonferroni’s post-hoc tests. Regression analyses were also performed to determine the relationship between the data from the hand-held radiometers and the ‘GS’ integrating sphere.

Results

There was a large difference in the power values (mW) and the emission spectra from the 12 brands of LCUs on their standard-settings (p<0.001). Except for one LCU (Dental Spark @ 15.1%), the differences between the two LCUs of the same brand were less than 5.3% when measured using the ‘GS’ integrating sphere. Regression analyses showed a highly significant agreement between the power values reported from the two brands of radiometers and the ‘GS’ integrating sphere (R² > 98%).

Conclusion

We concluded that the power values reported from both brands of dental radiometers we tested were accurate, provided that the light source did not emit wavelengths of light that were beyond the radiometer’s detection limit.

Pre-Heating Effect on Monomer Elution and Degree of Conversion of Contemporary and Thermoviscous Bulk-Fill Resin-Based Dental Composites

Detection of unreacted monomers from pre-heated resin-based dental composites (RBC) is not a well-investigated topic so far. The objectives were to determine the temperature changes during the application and polymerization, the degree of conversion (DC) and unreacted monomer elution of room temperature (RT), and pre-heated thermoviscous [VisCalor Bulk(VCB)] and high-viscosity full-body contemporary [Filtek One Bulk(FOB)] bulk-fill RBCs. The RBCs' temperatures during the sample preparation were recorded with a K-type thermocouple. The DC at the top and bottom was measured with micro-Raman spectroscopy and the amounts of eluted BisGMA, UDMA, DDMA, and TEGDMA were assessed with High-Performance Liquid Chromatography. The temperatures of the pre-heated RBCs decreased rapidly during the manipulation phase. The temperature rise during photopolymerization reflects the bottom DCs. The differences in DC% between the top and the bottom were significant. RT VCB had a lower DC% compared to FOB. Pre-heating did not influence the DC, except on the bottom surface of FOB where a significant decrease was measured. Pre-heating significantly decreased the elution of BisGMA, UDMA, DDMA in the case of FOB, meanwhile, it had no effect on monomer release from VCB, except TEGDMA, which elution was decreased. In comparison, RBC composition had a stronger influence on DC and monomer elution, than pre-cure temperature.

Utilizing Light Cure Units: A Concise Narrative Review

The use of photo-curable resin composite restorations is an essential treatment modality in modern dental practice. The success and longevity of these restorations depend on achieving predictable and effective polymerization. Understanding the dynamics of the polymerization and the effect of light cure units (LCUs) on this process is paramount. The goal of this concise narrative review is to provide a simplified presentation of basic principles of composite chemistry, polymerization reactions, and photo-curing with relevant terminologies. Clinical guidelines for choosing and maintaining LCUs, as well as safety precautions and factors under the control of the clinician are listed. Finally, clinical recommendations of LCUs’ usage and monitoring are included to aid practitioners in achieving predictable polymerization during the placement of direct resin composite restorations.

Relationship Between the Cost of 12 Light-curing Units and Their Radiant Power, Emission Spectrum, Radiant Exitance, and Beam Profile

OBJECTIVES

To correlate the radiant power (mW), radiant exitance (or tip irradiance in mW/cm2), emission spectrum (mW/cm2/nm), and beam irradiance profile of 12 light-curing units (LCUs) available in the Brazilian market with their market cost.

METHODS AND MATERIALS

Six LCUs that cost more than US$900 (Bluephase G4,VALO Grand, VALO Cordless, Radii Xpert, Elipar DeepCure-S, and Radii plus) and six low-cost LCUs costing less than US$500 (Radii Cal, Optilight Max, High Power LED 3M, Emitter D, Emitter C, and LED B) were examined. Radiant power (mW) and emission spectrum (mW/nm) were measured using an integrating sphere connected to a fiber-optic spectroradiometer. The internal tip diameter (mm) of each LCU was measured using a digital caliper and was used to calculate the average radiant exitance (mW/cm2). Irradiance profiles at the light tip were measured using a commercial laser beam profiler. The cost of each LCU in Brazil was correlated with internal tip diameter, radiant power, and tip irradiance.

RESULTS

None of the low-cost LCUs were broad spectrum multiple peak LCUs. There was no correlation between the cost of the LCUs and their averaged tip irradiance; however, there was a high positive correlation between the cost of the LCUs and the radiant power and tip diameter. The VALO Grand, Elipar DeepCure-S, VALO Cordless, and Bluephase G4 all emitted a higher radiant power. They also had a significantly greater tip diameter than other LCUs. For the LCUs with a nonuniform output, some areas of the light tip delivered less than 400 mW/cm2, while other areas delivered more than 2500 mW/cm2.

CONCLUSIONS

In general, LCUs that had a higher cost (US$971-US$1800) delivered more power (mW) and had a greater tip diameter (mm), which covered more of a tooth. In general, the low-cost LCUs (US$224-US$470) emitted a lower radiant power and had a smaller tip diameter.

Degree of conversion and in vitro temperature rise of pulp chamber during polymerization of flowable and sculptable conventional, bulk-fill and short-fibre reinforced resin composites

OBJECTIVE

Determine the degree of conversion (DC) and in vitro pulpal temperature (PT) rise of low-viscosity (LV) and high-viscosity (HV) conventional resin-based composites (RBC), bulk-fill and short-fibre reinforced composites (SFRC).

METHODS

The occlusal surface of a mandibular molar was removed to obtain dentine thickness of 2 mm above the roof of the pulp chamber. LV and HV conventional (2 mm), bulk-fill RBCs (2-4 mm) and SFRCs (2-4 mm) were applied in a mold (6 mm inner diameter) placed on the occlusal surface. PT changes during the photo-polymerization were recorded with a thermocouple positioned in the pulp chamber. The DC at the top and bottom of the samples was measured with micro-Raman spectroscopy. ANOVA and Tukey's post-hoc test, multivariate analysis and partial eta-squared statistics were used to analyze the data (p < 0.05).

RESULTS

The PT changes ranged between 5.5-11.2 °C. All LV and 4 mm RBCs exhibited higher temperature changes. Higher DC were measured at the top (63-76%) of the samples as compared to the bottom (52-72.6%) in the 2 mm HV conventional and bulk-fill RBCs and in each 4 mm LV and HV materials. The SFRCs showed higher temperature changes and DC% as compared to the other investigated RBCs. The temperature and DC were influenced by the composition of the material followed by the thickness.

SIGNIFICANCE

Exothermic temperature rise and DC are mainly material dependent. Higher DC values are associated with a significant increase in PT. LV RBCs, 4 mm bulk-fills and SFRCs exhibited higher PTs. Bulk-fills and SFRCs applied in 4 mm showed lower DCs at the bottom.

The light-curing unit: An essential piece of dental equipment

INTRODUCTION

This article describes the features that should be considered when describing, purchasing and using a light-curing unit (LCU).

METHODS

The International System of Units (S.I.) terms of radiant power or radiant flux (mW), spectral radiant power (mW/nm), radiant exitance or tip irradiance (mW/cm² ), and the irradiance received at the surface (also in mW/cm² ) are used to describe the output from LCU. The concept of using an irradiance beam profile to map the radiant exposure (J/cm² ) from the LCU is introduced.

RESULTS

Even small changes in the active tip diameter of the LCU will have a large effect on the radiant exitance. The emission spectra and the effects of distance on the irradiance delivered are not the same from all LCUs. The beam profile images show that using a single averaged irradiance value to describe the LCU can be very misleading. Some LCUs have 'hot spots' of high radiant exitance that far exceed the current ISO 10650 standard. Such inhomogeneity may cure the resin unevenly and may also be dangerous to soft tissues. Recommendations are made that will help the dentist when purchasing and then safely using the LCU.

CONCLUSIONS

Dental manufacturers should report the radiant power from their LCU, the spectral radiant power, information about the compatibility of the emission spectrum from the LCU with the photoinitiators used, the active optical tip diameter, the radiant exitance, the effect of distance from the tip on the irradiance delivered, and the irradiance beam profile from the LCU.

Irradiance of Different Curing Modes of Common Light Cure Devices: An In Vitro Study

Aim:

The aim of this study was to test the irradiance values of different curing modes of commonly available light cure devices (LCDs).

Materials and Methods:

An in vitro investigation was carried out to compare the irradiance output of 10 brands of LCDs available in Saudi Arabia measured using a digital radiometer. Values were recorded for three time points when applicable (0, 10, and 20s). This technique was repeated five times for each LCD. Normal, high-intensity, and soft-start modes were evaluated for all brands with the features available. Irradiance values between brands were analyzed using one-way analysis of variance followed by Bonferroni method. Changes in irradiance between different time points were analyzed using one sample t test for normal and high-intensity modes and using paired t test for soft-start mode. All comparisons were carried out at 0.05 significance level.

Results:

The highest values were reported for Ortholux Luminous, Elipar DeepCure-S, Elipar DeepCure, and KaVo mini-LED with values above 1000 mW/cm². All LCDs showed values above 600 mW/cm². Three LCDs had high-intensity mode and only one device had soft-start mode. Changes over the different time points were not statistically significant exept for soft-start mode.

Conclusion:

All tested LCDs had irradiance values sufficient for adequate polymerization of resin composite. Only four of these are capable of curing bulk-fill composites.

Three-dimensional beam profiling used to characterize dental light-curing units

Two-dimensional (2D) beam profiling is an emerging technique used to characterize the beam homogeneity in dental light-curing units (LCUs). This project developed a method to combine multiple 2D beam profiles that had been measured along the beam path to create a 3D profile of the beam. This allowed a quantitative investigation of beam divergence and homogeneity at different distances from the source. To illustrate the use of this technique, four representative dental LCUs were measured. In addition, the selected dental LCUs demonstrated the effects of LCU design, particularly that of fiber optic light guides, on beam quality. The results show the value of a program that can recombine multiple beam profile images made at different distances from the source to create a 3D beam profile of a light beam.

Influence of Different Cordless Light-emitting-diode Units and Battery Levels on Chemical, Mechanical, and Physical Properties of Composite Resin

Clinical Relevance

Irradiance may decrease as the light-emitting diode (LED) is discharged. Therefore, the LED must be charged carefully to prevent the possibility of influencing the chemical, mechanical, and physical properties of composite resin.

SUMMARY

The aim of this study was to evaluate the influence of different light-emitting diode (LED) curing units and battery levels on the chemical, mechanical, and physical properties of composite resins. The irradiance for each cycle from full to completely discharged battery level was evaluated, for five different new cordless LED units: Optilight Color (Gnatus), Bluephase (Ivoclar), Valo (Ultradent), Radii Plus (SDI), and Radii Xpert (SDI). After the irradiance evaluation, composite resin specimens were prepared and light cured, while varying the battery level for each LED unit: high level (HL, 100%), medium level (ML, 50%), and low level (LL, 10%). The degree of conversion, diametral tensile strength, sorption, and solubility were also evaluated. Data were checked for homoscedasticity and submitted to two-way and three-way analysis of variance, depending on the test performed, followed by the Tukey test with a significance level of 95%. A negative correlation was found between irradiance and cycles of light curing, which was checked by the Pearson correlation test. Valo and Radii Xpert were not influenced by the battery level in any test performed. However, different battery levels for some LED units can influence the degree of conversion, diametral tensile strength, sorption, and solubility of composite resins.

Accuracy of Irradiance and Power of Light-Curing Units Measured With Handheld or Laboratory Grade Radiometers

Abstract This study measured and compared exitance irradiance and power of 4 commercial dental light-curing units (LCU) (Elipar S10, Elipar DeepCure-S, Corded VALO and Bluephase Style) using different types of radiometers. The devices used to analyze the LCU were classified as either handheld analog (Henry Schein, Spring, Demetron 100A, Demetron 100B and Demetron 200), handheld digital (Bluephase 1, Bluephase II, Coltolux, CureRite and Hilux), or laboratory instruments (Thermopile and Integrating Sphere). The laboratory instruments and the Bluephase II radiometer were also used to measure the LCU’s power (mW). The LCU’s were activated for 20 s (n=5). Data were analyzed using Kruskal-Wallis and Student-Newman-Keuls multiple comparison test (a=0.05). Among the LCU, the laboratory instruments presented different irradiance values, except for Corded VALO. The Coltolux and Hilux radiometers measured greater irradiance values compared to the laboratory instruments for the four LCUs tested. Within a given LCU, handheld analog units measured lower irradiance values, compared to handheld digital and laboratory instruments, except using the Spring radiometer for the Elipar S10 LCU. None of the handheld radiometers were able to measure similar irradiance values compared to laboratory instruments, except for Elipar S10 when comparing Bluephase 1 and Thermopile. Regarding power measurement, Bluephase II always presented the lowest values compared to the laboratory instruments. These findings suggest that the handheld radiometers utilized by practitioners (analog or digital) exhibit a wide range of irradiance values and may show lower outcomes compared to laboratory based instruments.

Effect of Contamination, Damage and Barriers on the Light Output of Light-Curing Units

Background:

Light-curing is a crucial step during the application of composite resin restorations. The clinical success of composite depends on the Light-Curing Units (LCU) to deliver adequate light energy to polymerize the resin. However, light-curing usually does not receive the proper awareness it deserves.

Objective:

This study aims to evaluate the effect of contamination and debris of the LCU’s tip on its light output. Determine the effect of damage to the LCU’s tip such as chipping, dents and scratches. Additionally, it evaluates the effect of plastic barrier sleeves.

Methods:

Sixty LED LCUs were tested using MARC™ Resin Calibrator (BlueLight Analytic Inc., Halifax, Canada) to measure their irradiance and energy before and after cleaning their tips. They were also tested with and without a clear plastic barrier. Additionally, four damaged LCUs received new tips and were tested again. Kruskal-Wallis H and One-Way ANOVA tests were used for statistical analysis.

Results:

Cleaning the LCUs’ tips showed significant improvement, an average increase of 8.2%. However, some units increased by up to 47% in irradiance and energy values. Replacing the damaged tip with a new one significantly improved the output of the LCUs, increasing light energy by up to 73%. The barrier used in this study caused 7% reduction in the energy delivered by the LCUs. The statistical analysis showed that cleaning the LCUs and replacing their damaged tips resulted in a significant increase in energy (p<0.05).

Conclusion:

Unclean or damaged LCUs’ tips can drastically reduce the light output of the LCUs, reducing the quality of the composite restorations. Clinicians are strongly recommended to regularly monitor, clean and maintain their curing lights.

Stability of the Light Output, Oral Cavity Tip Accessibility in Posterior Region and Emission Spectrum of Light-Curing Units

Objectives: 

This study evaluated the light output from six light-emitting diode dental curing lights after 25 consecutive light exposures without recharging the battery, tip accessibility in the posterior region, and light beam spread from light-curing units.

Methods: 

Irradiance, spectral peak, and radiant exposure were measured with the battery fully charged (Bluephase Style, ESPE Cordless, Elipar S10, Demi Ultra, Valo Cordless, and Radii-Cal) and monitored for 25 light exposures (each lasting 10 seconds). The tip diameter was measured to identify the beam size and the ability of the six light-curing units to irradiate all areas of the lower second molar in the standard output setting.

Results: 

Four curing lights delivered a single peak wavelength from 454 to 462 nm, and two (Bluephase Style and Valo Cordless) delivered multiple emission peaks (at 410 and 458 nm and 400, 450, and 460 nm, respectively). The irradiance and radiant exposure always decreased after 25 exposures by 2% to 8%, depending on the light unit; however, only ESPE Cordless, Valo Cordless, and Radii-Cal presented a statistical difference between the first and the last exposure. The tip diameter ranged from 6.77 mm to 9.40 mm. The Radii-Cal delivered the lowest radiant exposure and irradiance. This light was also unable to access all the teeth with the tip parallel to the occlusal surface of the tooth.

Conclusion: 

Not all of the blue-emitting lights deliver the same emission spectra, and some curing lights delivered a lower irradiance (as much as 8% lower) after the 25th exposure.

Light Curing in Dentistry

The ability to light cure resins 'on demand' in the mouth has revolutionized dentistry. However, there is a widespread lack of understanding of what is required for successful light curing in the mouth. Most instructions simply tell the user to 'light cure for xx seconds' without describing any of the nuances of how to successfully light cure a resin. This article provides a brief description of light curing. At the end, some recommendations are made to help when purchasing a curing light and how to improve the use of the curing light.

Light curing in dentistry and clinical implications: a literature review

Contemporary dentistry literally cannot be performed without use of resin-based restorative materials. With the success of bonding resin materials to tooth structures, an even wider scope of clinical applications has arisen for these lines of products. Understanding of the basic events occurring in any dental polymerization mechanism, regardless of the mode of activating the process, will allow clinicians to both better appreciate the tremendous improvements that have been made over the years, and will also provide valuable information on differences among strategies manufacturers use to optimize product performance, as well as factors under the control of the clinician, whereby they can influence the long-term outcome of their restorative procedures.

Influence of Emission Spectrum and Irradiance on Light Curing of Resin-Based Composites

PURPOSE

This study examined the influence of different emission spectra (single-peak and broad-spectrum) light-curing units (LCUs) delivering the same radiant exposures at irradiance values of 1200 or 3600 mW/cm² on the polymerization and light transmission of four resin-based composites (RBCs).

METHODS AND MATERIALS

Two prototype LCUs that used the same light tip, but were either a single-peak blue or a broad-spectrum LED, were used to deliver the same radiant exposures to the top surfaces of the RBCs using either standard (1200 mW/cm²) or high irradiance (3600 mW/cm²) settings. The emission spectrum and radiant power from the LCUs were measured with a laboratory-grade integrating sphere coupled to a spectrometer, and the light beam was assessed with a beam profiler camera. Four RBCs (Filtek Supreme Ultra A2, Tetric EvoCeram A2, Tetric EvoCeram T, and TPH Spectra High Viscosity A2) were photoactivated using four different light conditions: single-peak blue/standard irradiance, single-peak blue/high irradiance, broad-spectrum/standard irradiance, and broad-spectrum/high irradiance. The degree of conversion (N=5) and microhardness at the top and bottom of 2.3-mm-diameter by 2.5-mm-thick specimens (N=5) were analyzed with analysis of variance and Tukey tests. The real-time light transmission through the RBCs was also measured.

RESULTS

For all light conditions, the 2.3-mm-diameter specimens received a homogeneous irradiance and spectral distribution. Although similar radiant exposures were delivered to the top surfaces of the RBCs, the amount of light energy emitted from the bottom surfaces was different among the four RBCs, and was also greater for the single-peak lights. Very little violet light (wavelengths below 420 nm) reached the bottom of the 2.5-mm-thick specimens. The degree of conversion and microhardness results varied according to the RBC (p<0.05). The RBCs that included alternative photoinitiators had greater microhardness values at the top when cured with broad-spectrum lights, while at the bottom, where little violet light was observed, the results were equal or higher when they were photoactivated with single-peak blue lights. With the exception of the microhardness at the top of TPH, equivalent or higher microhardness and degree-of-conversion values were achieved at the bottom surface when the standard (1200 mW/cm²) irradiance levels were used compared to when high irradiance levels were used.

CONCLUSIONS

Considering the different behaviors of the tested RBCs, the emission spectrum and irradiance level influenced the polymerization of some RBCs. The RBCs that included alternative photoinitiators produced greater values at the top when cured with broad-spectrum lights, while at the bottom, results were equal or higher for the RBCs photoactivated with single-peak blue lights.

Light-curing units used in dentistry: factors associated with heat development-potential risk for patients

Objectives

To investigate how heat development in the pulp chamber and coronal surface of natural teeth with and without cusps subjected to irradiance using light-emitting diode (LED)–light-curing units (LCUs) is associated with (i) irradiance, (ii) time, (iii) distance, and (iv) radiant exposure.

Materials and methods

Three different LED-LCUs were used. Their irradiance was measured with a calibrated spectrometer (BlueLight Analytics Inc., Halifax, Canada). An experimental rig was constructed to control the thermal environment of the teeth. The LED-LCU tip position was accurately controlled by a gantry system. Tooth surface temperature was measured by thermography (ThermaCAM S65 HS, FLIR Systems, Wilsonville, USA) and pulp chamber temperature with a thermocouple. LED-LCU tip distance and irradiation times tested were 0, 2, and 4 mm and 10, 20, and 30 s, respectively. Ethical permission was not required for the use of extracted teeth.

Results

Maximum surface and pulp chamber temperatures were recorded in tooth without cusps (58.1 °C  ± 0.9 °C and 43.1 °C ± 0.9 °C, respectively). Radiant exposure explained the largest amount of variance in temperature, being more affected by time than irradiance.

Conclusions

At all combinations of variables tested, repeated measurements produced consistent results indicating the reliability of the method used. Increased exposure time seems to be the factor most likely to cause tissue damage.

Clinical relevance

Risk of superficial tissue damage at irradiances >1200 mW/cm² is evident. There is a risk of pulp damage when only thin dentin is left at higher irradiances (>1200 mW/cm²). Clinicians should be aware of LED-LCU settings and possible high temperature generated.

Ability of four dental radiometers to measure the light output from nine curing lights

OBJECTIVES

To evaluate the accuracy of four dental radiometers when measuring the output from nine light curing units (LCUs).

METHODS

The light output from nine light-emitting diode LCUs was measured with a laboratory-grade power meter (PowerMax-Pro 150 HD) and four dental radiometers (Bluephase Meter II, SDI LED Radiometer, Kerr LED Radiometer, and LEDEX CM4000). Ten measurements were made of each LCU with each radiometer. Analysis of variance (ANOVA) followed by Tukey tests (α=0.05) were used to determine if there was a difference between the calculated irradiance values from the power meter and those from the radiometers. Where applicable, the LCUs were ranked according to their power and irradiance values. The emission spectra from the LCUs was measured using an integrating sphere attached to a fiber-optic spectrometer (N=10). The beam profile of the LCUs was measured with a beam profiler camera.

RESULTS

Of the dental radiometers, only the Bluephase Meter II could measure power. ANOVA showed no significant difference between power values measured with the laboratory-grade meter and the Bluephase Meter II (p=0.527). The difference between the mean irradiance reported by the various radiometers for the same LCU was up to 479mW/cm². The ranking of the power values obtained using the laboratory-grade meter was the same for the Bluephase Meter II.

CONCLUSION

When compared to the calculated irradiance values from the laboratory-grade power meter, the Bluephase Meter II provided the most accurate data.

CLINICAL SIGNIFICANCE

Considering the great variation between the irradiance values provided by radiometers and their overall inaccuracy when compared to a laboratory-grade meter, dentists should not place too much faith in the absolute irradiance value. However, hand-held radiometers can be used to monitor changes in the light output of LCUs over time.