William M. Palin

Refractive Index Mismatch and Monomer Reactivity Influence Composite Curing Depth

Limited cure depth is a drawback of light-activated composites. We hypothesize that curing light transmission and cure depth are influenced by monomer reactivity and filler/resin refractive index mismatch. Light transmission throughout cure was recorded for composites based on strontium (refractive index 1.51) or barium (refractive index 1.53) glass fillers. Fillers were mixed (70 wt%) with 4 bisphenol-A diglycidyl-ether-dimethacrylate (bis-GMA):triethylene glycol dimethacrylate (TEGDMA) formulations with refractive indices ranging from 1.4703 to 1.5370. Following polymerization, cure depth and pre- and post-cure translucency parameters were determined. Transmission changes and cure depths related to monomer reactivity and filler/resin refractive index mismatch with significant interaction. Composites became more opaque or translucent on curing. Optimizing filler/resin refractive index mismatch provides increased curing depth and assists shade-matching.

Photoinitiator type and applicability of exposure reciprocity law in filled and unfilled photoactive resins.

OBJECTIVES To test the influence of photoinitiator type and filler particle inclusion on the validity of exposure reciprocity law. MATERIALS AND METHODS 50/50 wt% Bis-GMA/TEGDMA resins were prepared with equimolar concentrations of camphorquinone/DMAEMA (0.20/0.80 mass%) (CQ) or Lucirin-TPO (0.42 mass%), and were used either unfilled or filled to 75 mass%. Specimens were cured with a halogen Swiss Master Light (EMS, Switzerland) using four different curing protocols: 400 mW/cm² for 45 s as reference protocol (18 J/cm²), 1500 mW/cm² for 12 s (18 J/cm²), 3000 mW/cm² for 6 s (18 J/cm²) and 3 s (9 J/cm²). Degree of conversion (DC) was measured in real time for 70 s by FT-NIRS and temperature rise using a thermocouple. Depth of cure was determined with a penetrometer technique. RESULTS With respect to DC and depth of cure, exposure reciprocity law did not hold for any tested material, except for the depth of cure of filled CQ-based materials. At similar radiant exposure, DC was significantly higher (p<0.05) for all unfilled and filled TPO-based materials compared with CQ-based materials. As exposure time was reduced and irradiance increased, TPO-based materials exhibited higher DC whilst an opposite trend was observed for CQ-based materials (p<0.05). For similar curing regimes, depth of cure of CQ-based materials remained significantly greater than that of TPO-based materials. Adding fillers generally reduced DC, except at higher irradiance for CQ-based materials where a positive effect was observed (p<0.05). SIGNIFICANCE The validity of exposure reciprocity law was dependent on several factors, among which photoinitiator type and filler content were important. Lucirin-TPO is a highly reactive and efficient photoinitiator, which may allow the potential for a reduction in curing time of TPO-based photoactive materials in thin sections.

Monomer conversion versus flexure strength of a novel dental composite

OBJECTIVES To quantify the monomer conversion and flexural strength of an experimental oxirane-based composite material (EXL596) compared with two, commercially available, dimethacrylate based restoratives (Z250 and Z100). METHODS Fourier-transform infra-red spectroscopy (FTIR) was utilised to evaluate the degree of conversion (DC) (n=5) and biaxial flexure strength (BFS) testing (n=20) was used to analyse flexural strength and associated Weibull moduli (m) of each material following 0.1, 0.5, 1, 4, 24 and 48 h immersion in a lightproof waterbath maintained at 37+/-1 degrees C. RESULTS The DC of Z250 and Z100 following 0.1, 0.5 and 1 h post-irradiation was significantly greater than the DC of EXL596 for the same immersion periods. This was manifested as a significant decrease in BFS and associated m of EXL596 compared with Z250 and Z100 for the 0.1, 0.5 and 1 h post-irradiation periods. The DC and BFS of EXL596 were significantly greater than Z250 and Z100 following 24 h immersion. CONCLUSIONS Assessment of FTIR spectra, BFS and associated m has provided a useful method in the quantitative analysis of resin-based composite conversion. Identification of the decreased DC of EXL596 compared with Z250 and Z100 was achieved using FTIR. However, decreased conversion rates within the first hour following irradiation of EXL596 may compromise flexural strength properties (associated with a decrease in BFS and m) which may be inadequate under masticatory loading.

The influence of irradiation potential on the degree of conversion and mechanical properties of two bulk-fill flowable RBC base materials

OBJECTIVE To assess the depth of cure claims of two bulk-fill flowable RBC bases (SDR and x-tra base) using Fourier transform infrared (FTIR) spectroscopy, biaxial flexure strength (BFS), and Vickers hardness number (VHN) for specimen depths of 8mm (in 1mm increments). METHODS The degree of conversion (DC) was measured by monitoring the peak height (6164cm(-1)) of specimens (11.0±0.1mm diameter, 1.0±0.1mm thickness) during light irradiation for 20s using a quartz tungsten halogen light curing unit at 650±26mW/cm(2). DC was measured up to 120s post irradiation and repeated (n=3) for irradiation depths up to 8mm (in 1mm increments). Further series (n=20) of eight discs were prepared, stacked, light irradiated and numbered from one to eight (distance from the LCU). The specimens were stored at 37±1°C for 24h and BFS tested with the fracture fragments used to determine the VHN for each specimen. RESULTS X-tra base can be irradiated to 8mm without a change in DC, something the SDR material cannot claim. However, the DC results confirm both bulk-fill flowable RBC bases have a depth of cure in excess of 4mm. One-way ANOVAs of BFS and VHN data showed significant differences between irradiation depths for x-tra base and SDR with increasing irradiation depth (4mm) resulting in significant reductions in mean BFS and VHN. SIGNIFICANCE The claims that the bulk-fill flowable RBC bases have a depth of cure in excess of 4mm can be confirmed but the differing chemistry of the resin formulations and filler characteristics contribute to significant differences in DC, BFS and VHN data between the two materials tested.

Developments in low level light therapy (LLLT) for dentistry

OBJECTIVES Low level light/laser therapy (LLLT) is the direct application of light to stimulate cell responses (photobiomodulation) in order to promote tissue healing, reduce inflammation and induce analgesia. There have been significant studies demonstrating its application and efficacy at many sites within the body and for treatment of a range of musculoskeletal injuries, degenerative diseases and dysfunction, however, its use on oral tissues has, to date, been limited. The purpose of this review is to consider the potential for LLLT in dental and oral applications by providing background information on its mechanism of action and delivery parameters and by drawing parallels with its treatment use in analogous cells and tissues from other sites of the body. METHODS A literature search on Medline was performed on laser and light treatments in a range of dental/orofacial applications from 2010 to March 2013. The search results were filtered for LLLT relevance. The clinical papers were then arranged to eight broad dental/orofacial categories and reviewed. RESULTS The initial search returned 2778 results, when filtered this was reduced to 153. 41 were review papers or editorials, 65 clinical and 47 laboratory studies. Of all the publications, 130 reported a positive effect in terms of pain relief, fast healing or other improvement in symptoms or appearance and 23 reported inconclusive or negative outcomes. Direct application of light as a therapeutic intervention within the oral cavity (rather than photodynamic therapies, which utilize photosensitizing solutions) has thus far received minimal attention. Data from the limited studies that have been performed which relate to the oral cavity indicate that LLLT may be a reliable, safe and novel approach to treating a range of oral and dental disorders and in particular for those which there is an unmet clinical need. SIGNIFICANCE The potential benefits of LLLT that have been demonstrated in many healthcare fields and include improved healing, reduced inflammation and pain control, which suggest considerable potential for its use in oral tissues.

The reliability in flexural strength testing of a novel dental composite

OBJECTIVES To investigate the reliability of bi-axial flexure and three-point flexure testing of an experimental, low-shrink oxirane-based dental composite, EXL596 compared with two conventional methacrylate based restoratives, Z250 and Z100. METHODS Specimens (n=20) of a novel oxirane-based composite and two commercially available methacrylate based composites were fabricated for flexural testing to evaluate mean bi-axial flexure strengths, three-point flexure strengths and the associated Weibull moduli (m) following 24 h immersion in a lightproof waterbath maintained at 37+/-1 degrees C. RESULTS Mean bi-axial flexure strengths and the associated m of EXL596, Z250 and Z100 were 168+/-11 MPa (m=16.2+/-4), 140+/-12 MPa (m=11.9+/-3) and 126+/-13 MPa (m=10.2+/-2), respectively. Three-point flexure strengths and the associated m of EXL596, Z250 and Z100 were 113+/-15 MPa (m=9.2+/-2), 92+/-10 MPa (m=8.5+/-2) and 79+/-16 MPa (m=6.3+/-1), respectively. CONCLUSIONS The present investigation suggests that bi-axial flexure strength testing of dental resin-based composites provides a more reliable testing method than three-point flexure. The increased reliability was considered in terms of the associated Weibull moduli following bi-axial flexure testing as a result of the elimination of the additional induced variability introduced during the curing regime of three-point flexure specimens.

Effects of Red Light-emitting Diode Irradiation on Dental Pulp Cells:

Light irradiation activates a range of cellular processes in a variety of cell types, including stem cells, and can promote tissue repair. This study investigated the effects of light-emitting diode (LED) exposure on dental pulp cells (DPCs). Dose response analysis at 20-second intervals up to 120 seconds demonstrated that a LED array emitting 653-nm red light stimulated significantly increased cell growth at 3 and 7 days post-irradiation with 40 (149 mJ/cm2) and 60 (224 mJ/cm2) seconds of radiant exposure. Double-dosing cells at days 1 and 4 of a 7-day culture period with 60-second (224 mJ/cm2) LED exposure significantly increased cell growth compared with a single dosing regime. BrdU analysis demonstrated significantly increased proliferation rates associated with significantly increased ATP, nitric oxide (NO), and mitochondrial metabolic activity. LED-stimulated NO levels were not reduced by inhibition of NO-synthase activity. Light exposure also rescued the inhibition of mitochondrial dysfunction and increased levels of in vitro mineralization compared with control. Media exchange experiments indicated that autocrine signaling was not likely responsible for red-light-induced DPC activity. In conclusion, data analysis indicated that 653-nm LED irradiation promoted DPC responses relevant to tissue repair, and this is likely mediated by increased mitochondrial activity.

Irradiation Modes' Impact on Radical Entrapment in Photoactive Resins.

Different irradiation protocols are proposed to polymerize dental resins, and discordances remain concerning their impact on the material. To improve this knowledge, we studied entrapment of free radicals in unfilled Bis-GMA/TEGDMA (50:50 wt%) resin after light cure. The tested hypothesis was that various irradiation parameters (curing time, irradiance, and radiant exposure) and different irradiation modes (continuous and pulse-delay) led to different amounts of trapped free radicals. The analysis of cured samples (n = 3) by electron paramagnetic resonance (EPR) revealed that the concentrations of trapped free radicals significantly differed according to the curing protocol. When continuous modes with similar radiant exposure were compared, higher concentrations of trapped free radicals were measured for longer times with lower irradiance. Concerning pulse modes, the delay had no influence on trapped radical concentration. These results give new insights into the understanding of the photopolymerization process and highlight the relevance of using EPR when studying polymerization of dimethacrylate-based materials.

Ultra-fast light-curing resin composite with increased conversion and reduced monomer elution

OBJECTIVES To test the null hypotheses that photoactive resin composites containing a Type I photoinitiator would exhibit reduced DC or increased monomer elution at substantially short curing times compared with materials based on a Type 2 ketone/amine system. METHODS Two experimental resin composites were prepared, using either Lucirin-TPO or camphorquinone/DMAEMA. Specimens were light-cured using appropriate spectral emission that coincided with the absorption properties of each initiator using different irradiation protocols (0.5, 1, 3, 9s at 500, 1000 and 2000mW/cm(2) for Lucirin-TPO based composites and 20 or 40s at 1000mW/cm(2) for Lucirin-TPO and camphorquinone-based composites). Degree of conversion (DC) was measured by Raman spectroscopy, propagating radical concentrations were collected by means of electron paramagnetic resonance (EPR) and monomer leaching was characterized using high-performance liquid chromatography (HPLC). RESULTS The null hypotheses were rejected, except for a single irradiation protocol (0.5s @ 500mW/cm(2)). Lucirin-TPO-based composites could cure 20 times faster and release at least 4 times less monomers in comparison to camphorquinone-based composites. At 1000mW/cm(2), and 1s irradiation time for curing times of 1s, Lucirin-TPO based composites displayed 10% higher DC. The difference in polymerization efficiency of Lucirin-TPO compared with camphorquinone-based resin composites were explained using EPR; the former showing a significantly greater yield of radicals which varied logarithmically with radiant exposure. SIGNIFICANCE Lucirin-TPO is substantially more efficient at absorbing and converting photon energy when using a curing-light with an appropriate spectral emission and otherwise a limitation noted in several previous publications. At concentrations of 0.0134mol/L, Lucirin-TPO-based composites require a minimum light intensity of 1000mW/cm(2) and an exposure time of 1s to provide significantly improved DC and minimal elution compared with a conventional photoinitiator system. The use of a wide range of curing protocols in the current experiment has realized the significant potential of Lucirin-TPO and its impact for clinical applications, in replacement to materials using camphorquinone.

Initial fracture resistance and curing temperature rise of ten contemporary resin-based composites with increasing radiant exposure.

OBJECTIVES The principal objective of this study was to determine whether the bulk fracture resistance of ten light activated composites varied over a clinically realistic range of radiant exposures between 5 and 40 J/cm(2). METHODS Ten operators were tested for clinically simulated radiant exposure delivery from a Bluephase(®) (Ivoclar Vivadent, Schaan, Liechtenstein) LED light to an occlusal cavity floor in tooth 27 in a mannequin head using a MARC(®)-Patient Simulator (Bluelight Analytics Inc., Halifax, NS) device. Notch disc test samples were prepared to determine the torque resistance to fracture (T) of the composites. Samples were irradiated with the same monowave Bluephase(®) light for 10s, 20s or 40s at distances of 0mm or 7 mm. After 24h, storage samples were fractured in a universal testing machine and torque to failure was derived. RESULTS Radiant exposure delivered in the clinical simulation ranged from 14.3% to 69.4% of maximum mean radiant exposure deliverable at 0mm in a MARC(®)-Resin Calibrator (Bluelight Analytics Inc., Halifax, NS) test device. Mean torque to failure increased significantly (P<0.05) with radiant exposure for 8 out of 10 products. The micro-fine hybrid composite Gradia Direct anterior (GC) had the lowest mean (S.D.) T between 10.3 (1.8)N/mm and 13.7 (2.2)N/mm over the tested radiant exposure range. Three heavily filled materials Majesty Posterior, Clearfil APX and Clearfil Photo-Posterior (Kuraray) had mean T values in excess of 25 N/mm following 40 J/cm(2) radiant exposure. Mean T for Z100 (3MESPE) and Esthet-X (Dentsply) increased by 10% and 91% respectively over the tested range of radiant exposures. CONCLUSIONS Individual products require different levels of radiant exposure to optimize their fracture resistance. Light activated composites vary in the rate at which they attain optimal fracture resistance. CLINICAL SIGNIFICANCE Unless the clinician accurately controls all the variables associated with energy delivery, there is no way of predicting that acceptable fracture resistance will be achieved intra-orally.