Effects of radiant exposure and distance on resin-based composite polymerization.

PURPOSE: To evaluate the hardness profile of three resin-based restorative composites (RBC) (Filtek Z250XT, Filtek One Bulk Fill, Filtek Bulk Fill Flow) polymerized by a multi-wave curing light. METHODS: Specimens (n= 12) were prepared by inserting 2 mm RBC increments into a split-mold and polymerized from the top using either 20- or 40-second exposure times. Specimen curing was performed directly at a 1 mm distance (control-group) or through an ivorine-tooth slot preparation at a 5 mm distance (experimental-group). Specimens were stored (37 ± 1°C/24 hours), then subjected to Knoop indenter (25g/5 seconds). Specimens' KHN values were obtained from the upper and lower surfaces. Relative hardness (RH) (lower-to-upper ratio) was calculated for each specimen. Data were analyzed with three-way ANOVA and Tukey's HSD (α= 0.05). RESULTS: There was no significant RH difference among RBCs in the control group, regardless of the exposure time (P> 0.05). Average RH ratios for all RBCs tested in this group were greater than 0.80. However, the average RH values of the experimental RBC group were significantly lower. The RH for Z250 was 0.39 in the 20-second group, while RH was 0.63 in the 40-second group. BF had an RH ratio of 0.70 in the 20-second and 0.72 in the 40-second group, while One Bulk had a ratio of 0.65 in the 20-second and 0.71 in the 40-second groups. Doubled exposure time substantially increased RH of all tested materials at a 1 mm tip-to-material distance. Clinically relevant 5 mm light-tip to material-surface distance significantly reduced polymerization efficacy of RBC specimens, regardless of the exposure time. CLINICAL SIGNIFICANCE: Adequate light-polymerization of resin-based direct restoratives is necessary for long-term clinical success. Polymerizing Class 2 restorations is challenging due to a hard-to-reach location and an increased distance between the light source and the restorative material. Insufficient polymerization is often seen at the bottom of the proximal box of the Class 2 cavity, with a detrimental effect on restoration longevity.

Radiant-exposure attenuation through Class-2 proximal slots.

PURPOSE: To determine the extent of radiant exposure (RE) attenuation of three LED light-polymerization units (LPUs), and their beam-profile, at the bottom of the Class-2 slot, using MARC-PS. METHODS: 10 seconds RE was delivered to MARC-PS' anterior sensor by Bluephase-Style, Demi-Plus, and Deep-Cure-S. Two ivorine lower first-molars received Class-2 proximal box preparations: (3×2×4 mm and 4×4×4 mm) and were sectioned horizontally above the cementoenamel junction. Tofflemire matrix-retainer was placed around each tooth and secured with a low-fusing compound. Each LPU tested delivered 10 seconds RE to MARC-PS through proximal slots. Mean RE of three readings per group was obtained. Data were analyzed using Pearson correlation, mixed ANOVAs with a pre-set alpha of 0.05. RESULTS: RE attenuation ratio calculated from the baseline to 4× 4×4/3×2×4 Class-2 boxes were: 58.25/80.03 Bluephase-Style; 49.36/80.25 Demi-Plus; 32.8/77.43 Deep-Cure-S. A significant and strong correlation (r= 0.86, P< 0.001) between the reduction in aperture size and RE was found. The beam profile of LED-LPUs tested decreased RE values at the bottom of a proximal box. More than 80% RE value reduction from the baseline to the smallest Class-2 cavity 3×2×4 aperture was observed. CLINICAL SIGNIFICANCE: Polymerization of resin-composites at the bottom of the Class-2 box is challenging due to the small aperture size, depth, and hard-to-reach location. Inadequate polymerization at the bottom of the Class-2 proximal box is a causative factor for secondary caries and, ultimately, restoration failure.