Minimally invasive management of vital teeth requiring root canal therapy.

The present study aimed to investigate the possible use of a non-instrumentation technique including blue light irradiation for root canal cleaning. Extracted human single rooted teeth were selected. Nine different groups included distilled water, NaOCl, intra-canal heated NaOCl, and NaOCl + EDTA irrigation after either instrumentation or non-instrumentation, and a laser application group following non-instrumentation technique. The chemical assessment of the root canal dentine was evaluated using energy dispersive spectroscopy (EDS) and Fourier transform infrared (FT-IR) spectroscopy. Surface microstructural analyses were performed by using scanning electron microscopy (SEM). The antimicrobial efficacy of different preparation techniques was evaluated using microbial tests. Light application didn't change the calcium/phosphorus, carbonate/phosphate and amide I/phosphate ratios of the root canal dentin. The root canal dentin preserved its original chemistry and microstructure after light application. The instrumentation decreased the carbonate/phosphate and amide I/phosphate ratios of the root canal dentin regardless of the irrigation solution or technique (p < 0.05). The application of light could not provide antibacterial efficacy to match the NaOCl irrigation. The NaOCl irrigation both in the non-instrumentation and instrumentation groups significantly reduced the number of bacteria (p < 0.05). The use of minimally invasive root canal preparation techniques where the root canal is not instrumented and is disinfected by light followed by obturation with a hydraulic cement sealer reduced the microbial load and preserved the dentin thus may be an attractive treatment option for management of vital teeth needing root canal therapy.

Alternative co-initiators for photocurable dental resins: Polymerisation, quantum yield of conversion and cytotoxicity.

OBJECTIVE: Cyclic acetals such as are naturally occurring compounds capable of acting as co-initiators during free-radical polymerisation, and potentially serve to offer non-allergic and biologically less toxic alternatives to conventional (tertiary) amines. The current study aimed to evaluate the polymerisation efficiency and potential toxicity of cyclic acetals compared with conventional photoinitiator systems in photocurable dental resins. METHODS: Both, 1,3 benzodioxole (BZD) and piperonyl alcohol (PA) were used in 0.5, 1.0, 1.5, 2.0, 3.0, 4.0 and 6.0 mol% concentrations. Whereas, N-phenyl glycine (NPG) was utilised in 0.5, 1.0, 1.5, 2.0, 3.0, 4.0 mol% concentrations for photopolymerisation of an unfilled model resin system, BisGMA and TEGDMA (1:1 mass %), involving three separate camphorquinone (CQ) concentrations of 0.5 (Low), 1.0 (Intermediate) and 1.5 (High) mol%. Conventional tertiary amines; ethyl-4-dimethyamino benzoate (EDMAB) and dimethylaminoethyl methacrylate (DMAEMA) were utilised for comparison. Real-time degree of conversion (DC, %) was evaluated using Fourier transform near-infra-red spectroscopy and quantum yield of conversion of CQ was calculated using UV-Vis spectroscopy. Cytotoxicity of NPG and cyclic acetals were assessed using MTT to determine metabolic activity of human dental pulp cells (HDPCs). RESULTS: The cyclic acetals were capable of facilitating free radical polymerisation as co-initiators at all three CQ concentrations. Furthermore, the use of NPG as a co-initiator resulted in post-irradiation DC (%) that were comparable to both EDMAB and DMAEMA for all CQ concentrations. Alternative compounds facilitated the hydrogen abstraction process, which provided high conversion of CQ molecules. Quantum yield increased from 0.009 ± 0.0001 (0.5 mol%) to 0.03 ± 0.006 (6.0 mol%), and 0.01 ± 0.0003 (0.5 mol%) to 0.04 ± 0.001 (6.0 mol%), for respective BZD and PA formulations involving 1.0 mol% CQ. The use of NPG led to relatively higher quantum yield values (Up to 0.09 ± 0.007 at 4.0 mol%), though it exhibited competitive effects in absorbing blue light, which might be attributed to the photolytic degradation of NPG and the formation of N-methylaniline. MTT assay indicated alternative co-initiators to be comparatively less cytotoxic than EDMAB and CQ. Relative metablic activity of HDPCs treated with BZD, PA, and NPG eluates were 58.3 ± 15.7, 57.5 ± 17.4 and 64.6 ± 12.2 %, when compared with untreated HDPCs group (Control), respectively. Exposure to DMAEMA-based eluate led to relative metabolic activity (60.0 ± 0.5 %) that was comparable to that of cyclic acetals. Treatment with neat model resin eluate displayed the highest relative reduction in metabolic activity (28.9 ± 22.4) (P < 0.05), suggesting bisGMA and TEGDMA monomers played significant role in the overall cytotoxicity of photocurable systems involving HDPCs. SIGNIFICANCE: Cyclic acetals were capable of facilitating photo-induced free radical polymerisation reactions with relatively less cytotoxicity compared with their amine counterparts, which might realise reduced cytotoxicity of photocurable materials used for dentistry and biomaterial applications.

An Evaluation of the Efficacy of LED Light Curing Units in Primary and Secondary Dental Settings in the United Kingdom.

OBJECTIVE: This study aimed to evaluate the irradiance and the quality of LED light curing units (LCUs) in primary and secondary clinics in the UK and to assess the effect of damage, contamination, use of protective sleeves, and distance of light tips to target on the irradiance and performance of LCUs. METHODS: The irradiance levels (mW/cm2) of 26 LED LCUs from general dental practices and 207 LED LCUs from two dental hospitals were measured using a digital radiometer (Blue Phase II, Ivoclar, Vivadent, Amherst, NY). Ten LED light guide tips (Satelec Mini, Acteon, Merignac, France) were selected to evaluate the effect of chipping, contamination (tip debris), and use of protective sleeves and tips to sensor distance on irradiance (mW/cm2) using a MARC Resin Calibrator (Blue Light Analytics, Halifax, Canada). Homogeneity of the light output was evaluated using a laser beam profiler (SP620; Ophir-Spiricon, North Longan, UT, USA). Statistical analysis was conducted using a one-way analysis of variance (ANOVA) with post hoc Tukey test (α=0.05) and linear regression with stepwise correlation tests. RESULTS: Thirty-three percent of the LCUs delivered irradiance output less than 500 mW/cm2. The condition of the light curing tips was poor, with 16% contaminated with resin debris, 26% damaged, and 10% both contaminated and damaged. The irradiance output was significantly reduced in contaminated (62%) and chipped (50%) light curing tips and when using protective sleeves (24%) (p<0.05). Irradiance was also reduced when increasing the distance with 25% and 34% reduction at 7 mm and 10 mm, respectively (p<0.05). CONCLUSION: There remains a lack of awareness of the need for regular monitoring and maintenance of dental LCUs. Damaged and contaminated light curing tips, use of protective sleeves, and increasing the distance from the restoration significantly reduced the irradiance output and the performance of the LCUs.

Photobiomodulation of oral fibroblasts stimulated with periodontal pathogens.

Photobiomodulation (PBM) utilises light energy to treat oral disease, periodontitis. However, there remains inconsistency in the reporting of treatment parameters and a lack of knowledge as to how PBM elicits its molecular effects in vitro. Therefore, this study aimed to establish the potential immunomodulatory effects of blue and near infra-red light irradiation on gingival fibroblasts (GFs), a key cell involved in the pathogenesis of periodontitis. GFs were seeded in 96-well plates in media + / - Escherichia coli lipopolysaccharide (LPS 1 µg/ml), or heat-killed Fusobacterium nucleatum (F. nucleatum, 100:1MOI) or Porphyromonas gingivalis (P. gingivalis, 500:1MOI). Cultures were incubated overnight and subsequently irradiated using a bespoke radiometrically calibrated LED array (400-830 nm, irradiance: 24 mW/cm2 dose: 5.76 J/cm2). Effects of PBM on mitochondrial activity (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and adenosine triphosphate (ATP) assays, total reactive oxygen species production (ROS assay) and pro-inflammatory/cytokine response (interleukin-8 (IL-8) and tumour growth factor-ß1 (TGFß1)) were assessed 24 h post-irradiation. Data were analysed using one-way ANOVA followed by the Tukey test. Irradiation of untreated (no inflammatory stimulus) cultures at 400 nm induced 15%, 27% and 13% increases in MTT, ROS and IL-8 levels, respectively (p < 0.05). Exposure with 450 nm light following application of P. gingivalis, F. nucleatum or LPS induced significant decreases in TGFß1 secretion relative to their bacterially stimulated controls (p < 0.001). Following stimulation with P. gingivalis, 400 nm irradiation induced 14% increases in MTT, respectively, relative to bacteria-stimulated controls (p < 0.05). These findings could identify important irradiation parameters to enable management of the hyper-inflammatory response characteristic of periodontitis.

Violet-Blue Light Arrays at 405 Nanometers Exert Enhanced Antimicrobial Activity for Photodisinfection of Monomicrobial Nosocomial Biofilms.

Light-emitting diodes (LEDs) demonstrate therapeutic effects for a range of biomedical applications, including photodisinfection. Bands of specific wavelengths (centered at 405 nm) are reported to be the most antimicrobial; however, there remains no consensus on the most effective irradiation parameters for optimal photodisinfection. The aim of this study was to assess decontamination efficiency by direct photodisinfection of monomicrobial biofilms using a violet-blue light (VBL) single-wavelength array (SWA) and multiwavelength array (MWA). Mature biofilms of nosocomial bacteria (Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus) were grown on 96-well polypropylene PCR plates. The biofilms were then exposed to VBL for 2,700 s (SWA) and 1,170 s (MWA) to deliver 0 to 670 J/cm2, and the antibacterial activity of VBL was assessed by comparing the seeding of the irradiated and the nonirradiated biofilms. Nonirradiated groups were used as controls. The VBL arrays were characterized optically (spectral irradiance and beam profile) and thermally. The SWA delivered 401-nm VBL and the MWA delivered between 379-nm and 452-nm VBL, albeit at different irradiances and with different beam profiles. In both arrays, the irradiated groups were exposed to increased temperatures compared to the nonirradiated controls. All bacterial isolates were susceptible to VBL and demonstrated reductions in the seeding of exposed biofilms compared with the nonirradiated controls. VBL at 405 nm exerted the most antimicrobial activity, exhibiting reductions in seeding of up to 94%. Decontamination efficiency is dependent on the irradiation parameters, bacterial species and strain, and experimental conditions. Controlled experiments that ameliorate the heating effects and improve the optical properties are required to optimize the dosing parameters to advance the successful clinical translation of this technology.IMPORTANCE This study reports the efficacy of VBL and blue light (BL) and their antimicrobial activity against mature biofilms of a range of important nosocomial pathogens. While this study investigated the antibacterial activity of a range of wavelengths of between 375 and 450 nm and identified a specific wavelength region (∼405 nm) with increased antibacterial activity, decontamination was dependent on the bacterial species, strain, irradiation parameters, and experimental conditions. Further research with controlled experiments that ameliorate the heating effects and improve the optical properties are required to optimize the dosing parameters to advance the successful clinical translation of this technology.

Investigating the limits of resin-based luting composite photopolymerization through various thicknesses of indirect restorative materials.

OBJECTIVE: To determine the limitations of using light-curable resin-based luting composites (RBLCs) to bond indirect ceramic/resin-composite restorations by measuring light transmittance through indirect restorative materials and the resulting degree of conversion (DC) of the luting-composites placed underneath. METHODS: Various thicknesses (0-4mm) and shades of LAVA Zirconia and LAVA Ultimate were prepared and used as light curing filters. A commercial, light curable RBLC, RelyX Veneer (control) was compared with four experimental RBLCs of the following composition: TEGDMA/BisGMA (50/50 or 30/70wt%, respectively); camphorquinone/amine (0.2/0.8wt%) or Lucirin-TPO (0.42wt%); microfillers (55wt%) and nanofillers (10wt%). RBLCs covered with the LAVA filter were light-cured for 40s, either with the dual-peak BluephaseG2 or an experimental device emitting either in the blue or violet visible band. The samples were analyzed by Raman spectroscopy to determine DC. Light transmittance through the filters was measured using a common spectroscopy technique. RESULTS: All the factors studied significantly influenced DC (p<0.05). RBLCs with increased TEGDMA content exhibited higher DC. Only small differences were observed comparing DC without filters and filters ≤1mm (p>0.05). For thicknesses ≥2mm, significant reductions in DC were observed (p<0.05). Transmittance values revealed higher filter absorption at 400nm than 470nm. A minimal threshold of irradiance measured through the filters that maintained optimal DC following 40s irradiation was identified for each RBLC formulation, and ranged between 250-500mW/cm2. SIGNIFICANCE: This work confirmed that optimal photopolymerization of RBLCs through indirect restorative materials (≤4mm) and irradiation time of 40s is possible, but only in some specific conditions. The determination of such conditions is likely to be key to clinical success, and all the factors need to be optimized accordingly.

Penetration of sub-micron particles into dentinal tubules using ultrasonic cavitation.

OBJECTIVES: Functionalised silica sub-micron particles are being investigated as a method of delivering antimicrobials and remineralisation agents into dentinal tubules. However, their methods of application are not optimised, resulting in shallow penetration and aggregation. The aim of this study is to investigate the impact of cavitation occurring around ultrasonic scalers for enhancing particle penetration into dentinal tubules. METHODS: Dentine slices were prepared from premolar teeth. Silica sub-micron particles were prepared in water or acetone. Cavitation from an ultrasonic scaler (Satelec P5 Newtron, Acteon, France) was applied to dentine slices immersed inside the sub-micron particle solutions. Samples were imaged with scanning electron microscopy (SEM) to assess tubule occlusion and particle penetration. RESULTS: Qualitative observations of SEM images showed some tubule occlusion. The particles could penetrate inside the tubules up to 60µm when there was no cavitation and up to ∼180µm when there was cavitation. CONCLUSIONS: The cavitation bubbles produced from an ultrasonic scaler may be used to deliver sub-micron particles into dentine. This method has the potential to deliver such particles deeper into the dentinal tubules. CLINICAL SIGNIFICANCE: Cavitation from a clinical ultrasonic scaler may enhance penetration of sub-micron particles into dentinal tubules. This can aid in the development of novel methods for delivering therapeutic clinical materials for hypersensitivity relief and treatment of dentinal caries.

The impact of endodontic access on the biaxial flexure strength of dentine-bonded crown substrates - an in vitro study.

AIM: To investigate how preparation of a simulated access cavity into ceramic materials suitable for the manufacture of dentine-bonded crowns (DBCs) impacted on biaxial flexural strength (BFS) determined as a monolithic structure and in a more clinically representative resin-cemented form. METHODOLOGY: One hundred and twenty feldspathic and 120 leucite-reinforced ceramic disc-shaped specimens were divided into eight groups (n = 30). All groups received 'fit' surface treatments representative of pre-cementation modifications and of cementation prior to preparation of a representative endodontic access cavity through the sample. BFS was determined for both 'intact' and the 'annular' disc-shaped specimens which had received simulated endodontic access. Newly reported analytical solutions were used to calculate BFS of the 'annular' specimens. Statistical analysis included two-way anovas (α = 0.05) and Weibull analysis. Fractographic examination provided insight into the fracture mechanisms. RESULTS: A two-way anova identified a significant impact of material (P < 0.01) and of resin coating (P < 0.01) on the mean BFS of intact specimens. For the annular ceramic specimens, the substrate material significantly impacted on mean BFS (P < 0.01), but the effect of resin coating was dependent on the substrate type (P < 0.01). CONCLUSIONS: Endodontic access cavity preparation modified the critical defect population of the all-ceramic restorative materials investigated. The strength of a predominantly glassy ceramic following endodontic access can be maintained if adhesive cementation was used; however, the beneficial effects of adhesive cementation on ceramic reinforcement were lost on leucite-reinforced ceramics following access cavity preparation. Replacement restoration for these materials would be recommended clinically following endodontic access as opposed to repair of the access cavity using a direct restorative material.

Biaxial flexure strength determination of endodontically accessed ceramic restorations.

OBJECTIVES: To report analytic solutions capable of identifying failure stresses from the biaxial flexure testing of geometries representative of endodontic access cavities prepared through dental restorative materials. METHODS: The ring-on-ring biaxial flexure strength of annular discs with a central circular hole supported peripherally by a knife-edge support and loaded evenly at the upper edge of the central hole were solved using general expressions of deformations, moments and shears for flat plates of a constant thickness. To validate the solutions, finite element analyses were performed. A three-dimensional one-quarter model of the test was generated using a linear P-code FEA software and the boundary conditions represented the experimental test configuration whereby symmetry planes defined the full model. To enable comparison of the maximum principal stresses with experimental derived data, three groups of nominally identical feldspathic ceramic disks (n=30) were fabricated. Specimens from Group A received a 4mm diameter representative endodontic access cavity and were tested in ring-on-ring. Group B and C specimens remained intact and were tested in ring-on-ring and ball-on-ring, respectively, to give insight into strength scaling effects. Fractography was used to confirm failure origins, and statistical analysis of fracture strength data was performed using one-way ANOVAs (P<0.05) and a Weibull approach. RESULTS: The developed analytical solutions were demonstrated to deviate <1% from the finite element prediction in the configuration studied. Fractography confirmed the failure origin of tested samples to coincide with the predicted stress maxima and the area where fracture is observed to originate clinically. Specimens from the three experimental groups A-C exhibited different strengths which correlated with the volume scaling effects on measured strength. SIGNIFICANCE: The solutions provided will enable geometric and materials variables to be systematically studied and remove the need for load-to-failure 'crunch the crown' testing.

An audit of cavity and crown preparations and two direct restorations carried out by foundation dentists in the Oxford and Wessex Deaneries.

It is likely that many foundation dentists (FDs) will have completed only minimal amounts of restorative dentistry for a number of months immediately prior to commencing work as FDs. Thus this audit aimed to assess the performance of the FDs when they carried out a number of simulated clinical exercises: amalgam cavities and restoration; Class IV resin composite restorations; and full crown preparations for metal-ceramic restorations. A total of 67 FDs completed the assessments and some results did indicate a high level of concern and need for further evaluation of restorative practice.

Reduced polymerization stress of MAPO-containing resin composites with increased curing speed, degree of conversion and mechanical properties.

OBJECTIVES: The degree and rate of photopolymerization in resin-based dental composites will significantly affect polymer network formation and resultant material properties that may determine their clinical success. This study investigates the mechanical properties, the generation of stress from polymerization, tooth cusp deflection and marginal integrity of experimental resin composites that contain different photoinitiators. METHODS: Experimental light-activated resin composites (60vol% particulate filled in 50/50mass% bis-GMA/TEGDMA) were formulated using a monoacylphosphine oxide (MAPO) photoinitiator and compared with a conventional camphoroquinone (CQ)-based system. Similar radiant exposure was used (18Jcm(-2)) for polymerization of each material although the curing protocol was varied (400mWcm(-2) for 45s, 1500mWcm(-2) for 12s and 3000mWcm(-2) for 6s). Degree and rate of polymerization was calculated in real-time by near infrared spectroscopy and the generation of stress throughout polymerization measured using a cantilever beam method. Flexural strength and modulus were acquired by three-point bend tests. Standardized cavities in extract pre-molar teeth were restored with each material, the total cuspal deflection measured and post-placement marginal integrity between the tooth and restoration recorded. RESULTS: Generally, MAPO- exhibited a significantly higher degree of conversion (72±0.8 to 82±0.5%) compared with CQ-based materials (39±0.7 to 65±1.6%) regardless of curing protocol (p<0.05) and MAPO-based materials exhibited less difference in conversion between curing protocols. CQ-based materials exhibited between ∼85 and 95% of the maximum rate of polymerization at <15% conversion, whereas MAPO-based RBCs did not approach the maximum rate until >50% conversion. Higher irradiance polymerization had a significant deleterious effect on the mechanical properties of CQ-based materials (p<0.05) whereas MAPO-based materials exhibited increased strength and modulus and were less affected by the curing method. Total cuspal deflection in restored extracted teeth was higher for CQ- compared with MAPO-based materials cured at the lowest irradiance curing protocol (12.9±4.0 and 8.3±1.5µm) and similar at 3000mWcm(-1) for 6s (10.1±3.5 and 9.0±1.5µm). A significant decrease in marginal integrity was observed for CQ-based RBCs cured at high irradiance for short exposure time compared with that of the MAPO-based RBC cured using a similar protocol (p=0.037). SIGNIFICANCE: Polymer network formation dictates the final properties of the set composite and the use MAPO photoinitiators may provide an effective restorative material that exhibits higher curing speeds, increased degree of conversion, strength and modulus without compromise in terms of polymerization stress and marginal integrity between tooth and restoration.

Contemporary issues in light curing.

This review article will help clinicians understand the important role of the light curing unit (LCU) in their offices. The importance of irradiance uniformity, spectral emission, monitoring the LCU, infection control methods, recommended light exposure times, and learning the correct light curing technique are reviewed. Additionally, the consequences of delivering too little or too much light energy, the concern over leachates from undercured resins, and the ocular hazards are discussed. Practical recommendations are provided to help clinicians improve their use of the LCU so that their patients can receive safe and potentially longer lasting resin restorations.

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.

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/cm(2)) and 60 (224 mJ/cm(2)) seconds of radiant exposure. Double-dosing cells at days 1 and 4 of a 7-day culture period with 60-second (224 mJ/cm(2)) 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.

High irradiance curing and anomalies of exposure reciprocity law in resin-based materials.

OBJECTIVES: The aim of this work was to investigate the effect of high irradiance curing on resultant degree of conversion of 'flowable' resin composites and their counterpart higher viscosity paste materials. METHODS: Five commercial flowable materials (Venus; Heraeus Kulzer, Synergy D6; Coltene, Premise; Kerr, Grandio; Voco and Gradia; GC Corp) and their counterpart higher viscosity restorative versions were tested. Specimens were cured with a halogen Swiss Master Light (EMS, Switzerland) using five different curing protocols with similar radiant exposure (18J/cm(2)): 400mW/cm(2) for 45s, 900mW/cm(2) for 20s, 1500mW/cm(2) for 12s, 2000mW/cm(2) for 9s and 3000mW/cm(2) for 6s. Degree of conversion (DC) was measured in real time by Fourier transform near infrared spectroscopy (FT-NIRS). RESULTS: Three- and subsequent two way ANOVA testing revealed significant differences (p≤0.02) with respect to "composite type" and "cure protocol" for DC for all 5 product comparisons. Supplementary one-way ANOVA also revealed significant differences between curing protocols (p<0.05). The majority of higher viscosity resin composite paste materials exhibited similar DC regardless of curing protocol. However, a significant decrease in DC for specimens cured at 3000mW/cm(2) for 6s compared with 400mW/cm(2) for 45s was observed for the flowable materials, Grandio (41±0.36 and 62±1.15%, respectively) and Venus (44±0.44 and 67±0.44%, respectively). Conversely, other flowable materials exhibited little or no significant differences between curing modes. Generally, a higher degree of conversion was observed for flowables compared with their more viscous counterpart, except at high irradiance for those materials where a reciprocal relationship with exposure time was not observed. CONCLUSIONS: The validity of exposure reciprocity law and final degree of conversion depends on several factors, amongst which resin viscosity and filler content were important. Practitioners should be aware of the importance of resin composite constituents and irradiation protocols. Information on material composition and appropriate radiation sources by manufacturers may assist practitioners with the selection of appropriate curing protocols for specific material/light curing unit combinations with the aim of reducing the incidence of under-cured restorations and the clinical impact thereof.

Two year clinical evaluation of a low-shrink resin composite material in UK general dental practices.

OBJECTIVE: A novel resin composite system, Filtek Silorane (3M ESPE) with reduced polymerization shrinkage has recently been introduced. The resin contains an oxygen-containing ring molecule ('oxirane') and cures via a cationic ring-opening reaction rather than a linear chain reaction associated with conventional methacrylates and results in a volumetric shrinkage of ∼1%. The purpose of this study was to review the literature on a recently introduced resin composite material, Filtek Silorane, and evaluate the clinical outcome of restorations formed in this material. METHODS: Filtek Silorane restorations were placed where indicated in loadbearing situations in the posterior teeth of patients attending five UK dental practices. These were evaluated, after two years, using modified USPHS criteria. RESULTS: A total of 100 restorations, of mean age 25.7 months, in 64 patients, were examined, comprised of 30 Class I and 70 Class II. All restorations were found to be present and intact, there was no secondary caries. Ninety-seven per cent of the restorations were rated optimal for anatomic form, 84% were rated optimal for marginal integrity, 77% were rated optimal for marginal discoloration, 99% were rated optimal for color match, and 93%% of the restorations were rated optimal for surface quality. No restoration was awarded a "fail" grade. No staining of the restoration surfaces was recorded and no patients complained of post-operative sensitivity. SIGNIFICANCE: It is concluded that, within the limitations of the study, the two year assessment of 100 restorations placed in Filtek Silorane has indicated satisfactory clinical performance.

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.

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.

Dynamic monitoring of refractive index change through photoactive resins.

OBJECTIVES: The change in optical characteristics through the bulk of curing photopolymers is not fully understood. Photopolymerization processes are accompanied by photoinitiator absorption, density changes and volumetric shrinkage, which alter optical properties and affects curing efficiency through depth. METHODS: This investigation demonstrates the use of a novel low coherence interferometry technique for simultaneous measurement of optical (refractive index) and physical (shrinkage) properties throughout curing of photoactive monomers containing various concentrations of bisphenol-A-diglycidyl ether dimethacrylate and triethylene glycol dimethacrylate. RESULTS: Reliability of the interferometry technique was compared with an Abbé refractometer and showed a significant linear regression relationship (p<0.001; adjusted R(2)>0.99) for both uncured and cured resins. The extent and rate of refractive index change and magnitude of shrinkage strain was dependent upon monomer formulation. SIGNIFICANCE: The development of this interferometry technique provides a powerful non-invasive tool that will be useful for improving light transmission through photoactive resins and filled resin composites by precise control of optical properties through material bulk.

Investigating filler morphology and mechanical properties of new low-shrinkage resin composite types.

Three types of low-shrinkage composites are today commercially available: Ormocers, cationic ring-opening curing systems and highly filled methacrylate-based materials, which cure via free-radical polymerization mechanisms. The aim of this study was to characterize the inorganic fraction of materials belonging to each type and to compare their mechanical properties. Two Ormocers (Admira and an experimental Ormocer V35694), one ring-opening composite (Filtek Silorane) and five methacrylate-based composites [Filtek Supreme XT, Tetric EvoCeram, Grandio, Synergy D6 (Coltène-Whaledent, Langenau, Germany) and an experimental material, V34930] were tested. Inorganic fillers were quantified by thermogravimetric analysis and morphologically characterized by scanning electron microscopy. Dynamic modulus was determined by an impulse excitation technique, static elastic moduli and flexural strength by a three-point bending method. The results were analyzed using ANOVA tests (P < 0.05) and linear correlations. Grandio, V34930 and V35694 exhibited significantly higher filler mass fractions. Both dynamic and static moduli of Grandio and V34930 were significantly higher than the other materials (P < 0.05), although no significant difference in flexural strength was observed between material type (P > 0.05). From the present findings, it was suggested that V35694 and Filtek Silorane exhibit comparable properties to conventional methacrylate-based composites, although clinically the cavity type and location must guide material choice. Under high occlusal load, the use of Grandio and V34930 might be favoured. For small cavities, alternative technologies could be preferred as the need for mechanical resistance is lower and the potential for stress generation is greater.