Official Publication of the American Academy of Esthetic Dentistry, Scandinavian Academy of Esthetic Dentistry, Japan Academy of Esthetic Dentistry

, International Federation of Esthetic Dentistry, American Academy of Cosmetic and Adhesive Dentistry, Australian Society of Aesthetic Dentistry and the Belgian Academy of Esthetic Dentistry

2000

• a

Volume 12

a

Number 6

Journal of Esthetic Dentistry
ADMINISTRATIVE BOARD EDITOR-IN-CHIEF

Harald O. Heymann, DDS, MEd
ASSOCIATE EDITOR

Edward J. Swift Jr., DMD, MS
EDITORIAL ASSISTANT

Betty T. Cates
SECTION EDITORS

Edward P. Allen, DDS, PhD Stephen C. Bayne, MS, PhD Terence Donovan, DDS, MS Vincent G. Kokich, DDS, MSD Jorge Perdigão, DMD, MS, PhD Louis F. Rose, DDS, MD Edwin S. Rosenberg, BDS, H.Dip.Dent, DMD Henri Rotsaert, RDT Richard E. Walton, DDS, MS
EDITORIAL ADVISORY BOARD

Leonard Abrams (USA) Steve Acquilino (USA) Pinhas Adar (USA) Ken Anusavice (USA) Donald Arens (USA) Luiz Narciso Baratieri (Brazil)

William Becker (USA) Urs Belser (Switzerland) Gunnar Bergenholtz (Sweden) Robert Berger (USA) Joe Camp (USA) Gerard J. Chiche (USA) Noah Chivian (USA) Gordon J. Christensen (USA) E. Steven Duke (USA) Jim Dunn (USA) Jack Ferracane (USA) Mauro Fradeani (Italy) Mark J. Friedman (USA) David A. Garber (USA) Jaime A. Gil (Spain) Ronald E. Goldstein (USA) Ueli Grunder (Switzerland) Van B. Haywood (USA) Abraham Ingber (USA) John Kanca (USA) Ivo Krejci (Switzerland) Masahiro Kuwata (Japan) Paul Lambrechts (Belgium) Karl F. Leinfelder (USA) William Liebenberg (Canada) Felix Lutz (Switzerland) Pascal Magne (Switzerland) Ronald I. Maitland (USA)

Lloyd Miller (USA) Preston D. Miller (USA) Ivar A. Mjör (Norway/USA) Dan Nathanson (USA) Linda C. Niessen (USA) Patrick Palacci (France) Nicola Pietrobon (Switzerland) William R. Proffit (USA) François Roulet (Germany) Cliff Ruddle (USA) Frederick A. Rueggeberg (USA) Fortunato Santos (Brazil) Peter Schärer (Switzerland) Cherilyn G. Sheets (USA) Richard Simonsen (USA) Dan Sneed (USA) Frank Spear (USA) Howard F. Strassler (USA) Jörg Strub (Germany) Daniel Sullivan (USA) Asami Tanaka (USA) Dennis P. Tarnow (USA) Martin Trope (USA) Arnold S. Weisgold (USA) John West (USA) Ray Williams (USA) David C. Winkler (Denmark) Robert Winter (USA)

OFFICIAL PUBLICATION OF THE AMERICAN ACADEMY OF ESTHETIC DENTISTRY JAPAN ACADEMY OF ESTHETIC DENTISTRY SCANDINAVIAN ACADEMY OF ESTHETIC DENTISTRY INTERNATIONAL FEDERATION OF ESTHETIC DENTISTRY AMERICAN ACADEMY OF COSMETIC AND ADHESIVE DENTISTRY AUSTRALIAN SOCIETY OF AESTHETIC DENTISTRY BELGIAN ACADEMY OF ESTHETIC DENTISTRY

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Title???
Fred Rueggeberg, Murray Bouschlicher CLINICAL ARTICLES ?? RESEARCH ARTICLES ??

291

Developments in Shrinkage Control of Adhesive Restoratives
Bibi S. Dauvillier, MSc, Maxim P. Aarnts, PhD, Albert J. Feilzer, DDS, PhD

300

Curing Dental Resins and Composites by Photopolymerization
Jeffrey W. Stansbury, PhD

309

Polymerization Contraction Stress of Resin Composite Restorations in a Model Class I Cavity Configuration Using Photoelastic Analysis
Yoshifumi Kinomoto, DDS, PhD, Mitsuo Torii, DDS, PhD, Fumio Takeshige, DDS, PhD, Shigeyuki Ebisu, DDS, PhD

320

Effect of Distance on the Power Density from Two Light Guides
Richard B. Price, DDS, MS, FDS RCS (Edin), Tore Dérand, DDS, PhD, Mary Sedarous, BSc, Pantelis Andreou, PhD, Robert W. Loney, DMD, MS

328

Effect of Ramped Light Intensity on Polymerization Force and Conversion in a Photoactivated Composite
Murray R. Bouschlicher, DDS, MS, Frederick A. Rueggeberg, DDS, MS

340

Polymerization Depth of Contemporary Light-Curing Units Using Microhardness
Frederick A. Rueggeberg, DDS, MS, Janet W. Ergle, Donald J. Mettenburg

350

INDEX

Journal of Esthetic Dentistry

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the revolution apparently is not over yet. However. experience has come full circle. Gone are the days of hurried placement and crude. direct. ramped output. distorted matrix band. freeze it in place. rushed shaping within a confined. routine practice. quartz tungsten halogen (QTH) sources. Light-activation has improved esthetics (less restoration yellowing) and decreased porosity compared that which was inevitable from mixing of paste–paste formulations. However. plasma arc units (PAC lights). and contour the restoration and then. Work performed years ago on the possible clinical implications of the rates at which resins cure and the potential for stress development were read but not truly appreciated for their insight and implication. with prolonged placement time to sculpt. Thus. and enables immediate. highintensity QTH. we now know that these internal porosities actually aided to decrease stress development. it has been a revolution many contemporary clinicians have lived through. To assess proponent claims of the various methods of composite photopolymerization. argon ion lasers. light-curing of dental restorations has become a predictable. the clinician is faced with the dilemma of jumping on the bandwagon to minimize precious chairside time. One needs only to scan product advertisement periodicals to comprehend the scope of curing units available and methods being advocated for polymerization: conventional cure. Younger practitioners. Available now are materials offering setting-on-command. Claims are made from marketing aspects. and minimal chairside-contact time. and highly esthetic results to be obtained with minimal loss of patient time from work or school.Perspectives TITLE? Light-activation of dental restorative materials has become a “way of life” for the average clinician. almost instantly. with assumed or unfounded clinical data to support them. The breadth of choice for a light-curing unit is now bewildering. and the new light emitting diodes (LEDs). With the advent of high speed curing and soft-start polymerization. This understanding must be coupled with laboratory and clinical evidence supporting principals established from basic science. while attempting to provide restorations of high quality and long clinical durability. and brought to “light” aspects of the polymerization process here-to-fore either ignored or not realized. NUMBER 6. relieving stress development at the tooth–restoration interface. pulse-delay methods. and the slower rate of curing permitted the partially cured restoration to flow from the unbonded surfaces. adapt. This special issue on photocuring is not meant to provide the final answer to these questions but instead is meant to be a framework upon which readers can start to VOLUME 12. Recent developments in curing light technology have shaken the complacence of many practitioners. stepped output. In short. may not fully appreciate the journey from chemical-cured composites to the light-cured generation. however. It provides the bread and butter of many practices. With proven clinical longevity to support its use. the fundamentals underlying polymerization need to be understood. 2000 287 .

this issue is not THE answer. However. the methods used for placement and light-curing are directly under the clinicians control. The influence of water sorption on stress relaxation of composites is also addressed. and the effects of variation in light intensity (the soft-start techniques and the new high output intensity models) still have not been proved. final conversion value to provide clinically adequate properties to the restoration are addressed. This article stresses the importance of knowing the relation of these manipulative factors to the development of stresses from polymerization. Harald Heymann for the encouragement. and the various factors that influence them.” The articles contained in this issue represent a compilation of historic perspectives. each author was specifically asked to present his or her work with the clinician in mind and. and clinical realities of only a small sampling of the totality of issues related to this topic. Building up a composite in increments helps to reduce the configuration factor (C-factor) and minimizes stress development. The true benefits and mechanisms of stress alteration from placing low modulus resin liners is still not definitive. and motivation to provide this accumulation of works for the reader’s consideration. knowledgeable decisions can be made with respect to use of photocuring in an individual’s practice.g. and factors affecting the efficiency of the 288 JOURNAL OF ESTHETIC DENTISTRY . Thus. As co-editors. the clinician must become aware of issues. it is only through understanding that change can arise. The problems of balancing a low polymerization reaction rate with obtaining a high. the mechanisms underlying the reaction. This issue has been developed with the clinician in mind. We are indebted to Dr. because it represents the input of many talented and dedicated individuals who are experts in their own right. Allowing a composite to flow prior to reaching high moduli values (the gel point) permits a relief of these stresses instead of allowing them to build up within the material and at the material–tooth interface. To enhance the profession. Fred Rueggeberg and Murray Bouschlicher Guest Editors A RT I C L E S I N T H I S I S S U E Dauvillier. and Feilzer review the underlying causes of contraction of polymeric restorative materials. but is designed to take a few steps toward educating the practitioner so that well-informed. and it will cure. Aarnts. Awareness itself does not lead to change. composite monomeric and filler formulation). however. Clinicians may take the mechanisms underlying photocuring of light-activated dental restorations for granted.. whenever possible. and knowledge of the components. Some factors affecting stress development are out of the clinician’s control (e. to emphasize the clinical relevance of the findings. we take pride in the assemblage of this work. support. this process is complex. Again.PERSPECTIVES comprehend the complexities underlying what can so easily be taken for granted: “shine the light. basic science.

RUEGGEBERG AND BOUSCHLICHER

potential for cure all have clinical significance. The fundamentals of this reaction as well as many other aspects of this topic are addressed by Stansbury in his work entitled “Curing Dental Resins and Composites by Photopolymerization.” The reasons underlying the mechanisms of oxygen inhibition, the difficulty in adequately curing some composite systems containing the new alternative photoinitiator systems, the influence of fillers in composites, the level of heat generated during composite cure, and the rationale underlying post-cure heating of composites are clearly addressed. Using a simulated Class I situation, Kinomoto and colleagues have developed a sophisticated but visual method of comprehending the magnitude and direction of stresses developed in a light-cured composite material, as well as in the material to which it is bonded. Interestingly, when the light-cured material was exposed in preparations made in extracted bovine teeth, gap formation was present. When this gap formed, low stresses showed in the cured composite, because the composite was not bonded to an interface. The distribution of stress patterns in model composite preparations was similar for both the self-cured and light-cured composites. However, the light-cured material demonstrated significantly higher stress values. Stresses also develop in the substrate that is being restored, as is clearly demonstrated in this work. This article demonstrates the location and variation of stress development along the lateral restoration walls as well as across the pulpal floor of a restoration. Clinicians can easily understand how and where stresses develop in resinbased restorations, and can then refine their techniques to minimize the deleterious effects of these forces. The influence of light-curing tip design on the power density delivered to the restorative material surface affects the overall potential for curing of the restoration, and its clinical durability. Thus, Price and colleagues, evaluated the effect of tip distance and power density between a standard 8-mm diameter curved light guide and an intensifying tip (the Turbo tip) in “Effect of Distance on the Power Density from Two Light Guides.” Even though the absolute intensity delivered when using the Turbo tip is greater than with the conventional tip at the distal tip end, the rate at which the power density declines as the tip distance increases occurred at a significantly higher rate with the Turbo tip than the conventional guide. Interestingly, at tip-to-target distances greater than 5 mm, the conventional light guide provided significantly greater power density than did the Turbo tip. Thus, clinicians need to be familiar with any “focusing” effect of light guides to use them to their greatest clinical potential. The rate at which composite polymerizes to bonded substrates may significantly affect the development of stresses between these materials, and thus affect the potential for successful bonding. Bouschlicher and Rueggeberg address these issues in their article “Effect of Ramped Light Intensity on Polymerization Force and Conversion in a Photoactivated Composite.” Using bonded surfaces attached to a force measuring device, the real-time force development between a commercially available composite and the bonded substrates was determined when using a light-curing unit in a variety of exposure modes: standard,

VOLUME 12, NUMBER 6, 2000

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PERSPECTIVES

continuous output; an exponential increase in light intensity; a two-step method; and at half intensity of the continuous exposure. The results indicate that use of the exponential ramp significantly reduces stress development during curing and also results in equivalent total cure values to those achieved when the composite was exposed using standard techniques. Thus, laboratory data indicate that use of this type of soft-start cure method does verify theoretic concepts of stress reduction when a low rate of light intensity is used during the initial phases of exposure. The potential for a wide variety of commercially available light-curing units and techniques to polymerize a photoactivated composite was evaluated by Rueggeberg, Ergle, and Mettenburg in “Polymerization Depths of Contemporary Light-Curing Units Using Microhardness.” The same shade and lot of composite was exposed to conventional quartz tungsten halogen units, high-intensity QTH lights, soft-start techniques (step and pulse-delay modes), plasma arc (PAC) lights, and various exposure durations of an argon ion laser. The claims of curing light manufacturers and advocates of certain curing methods were evaluated on their ability to provide hardness of composite similar to that obtained with the standard technique: a 40-second exposure from a conventional QTH light source. Clinical usefulness of the results focuses on evaluating the ability of newer light-curing units to shorten exposure duration or to provide enhanced depth of cure compared with the conventional curing methods. In most instances, cure depths, using manufacturer’s recommended exposure durations, did not exceed the 2-mm depth traditionally accepted. Some high-intensity units (high-intensity QTH, the PAC light, and the laser) did provide for lowered exposure duration while presenting similar hardness values. However, extremely short exposure durations advocated by some manufacturers did not provide hardness values equivalent to those achieved with conventional treatment.

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JOURNAL OF ESTHETIC DENTISTRY

Developments in Shrinkage Control of Adhesive Restoratives
BIBI S. DAUVILLIER, MSc* MAXIM P. AARNTS, PhD* ALBERT J. FEILZER, DDS, PhD*

ABSTRACT

Purpose: This article reviews material properties and application techniques important in minimizing effects of polymerization shrinkage during the curing reaction of resin composite restorative materials used in adhesive dentistry. Materials and Methods: Relevant scientific publications were critically reviewed. Results: Since it was recognized that shrinkage, which takes place during the curing reaction of resin composite restorative materials, may cause severe problems in adhesive dentistry, considerable effort has been put into reducing the negative effects. The most important problem is the debonding of the restoration–tooth interface, resulting in increased microleakage and, ultimately, in secondary caries. Despite all efforts, there is still no material or general application method that guarantees a leak-proof and durable restoration.
CLINICAL SIGNIFICANCE

It is of the utmost importance that dental practitioners know how to deal with the problems related to resin composite shrinkage, so that they can choose the material and procedure most likely to produce a leak-proof and durable restoration, maximizing the potential for clinical success. (J Esthet Dent 12:291–299, 2000)

R

esin composite restorative materials have gained a permanent position on the dental market. Their superior esthetics and consecutive preparation requirements (less destructive than amalgam) have been instrumental in this commercial success. The ideal restoration has a tight seal with remaining tooth structure, since otherwise, bacteria and toxins

produced by bacteria can invade and grow in the gap formed, resulting in pulp irritation and even secondary caries (Figure 1).1,2 This perfect adaptation must be obtained during curing and then maintained during thermal and mechanical cycling for the lifetime of the restoration or of the patient. Currently no commercially available resin composite guarantees an intact seal. Because the resin has no

anti-microbiologic activity, it is important that a restoration be placed in such a way that the best possible marginal seal is obtained. There are, however, many side effects that frustrate the goal of a perfectly sealed restoration. Most of these effects are related to polymerization shrinkage of the restoration during the curing process. Commercially available composites

*Department of Dental Materials Science, Academic Centre for Dentistry, Amsterdam, The Netherlands
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To prevent shrinkage.9. At high filler loading.8 So. the lower the polymerization shrinkage for a given volume of monomer. composite with high 292 JOURNAL OF ESTHETIC DENTISTRY . this value ranges from 2% to 5%.3–6 Therefore. Do dental composites always shrink toward the light? J Dent Res 1998.4–6.3 However. owing to increased viscosity. with most values near 3. within the composite. with permission. 77:1435–1445. an increase in the percentage of filler loading is also accompanied by a significant drawback. including prepolymerized resin powder. unfilled resins containing mainly bis-GMA and TEGDMA undergo a volumetric shrinkage of approximately 9 to 10%. the proportion of diluents (small monomers) in the resin system must increase to ensure acceptable handling properties. Tantbirojn D. (Reprinted from Versluis A. whereas the density of the material increases. The present generation of chemically or light-activated resin composites undergo a free volumetric shrinkage of 4 to 9% for flowable composites. this addition may negate the effect of the high filler loading on cure shrinkage.DEVELOPMENTS IN SHRINKAGE CONTROL OF ADHESIVE RESTORATIVES Figure 1.8. the presence of filler particles considerably reduces that shrinkage. One variable is the size of the monomer molecule undergoing polymerization. Douglas WH.10 At the same time.5% of volume. Effects of shrinkage stresses in restoration.7 Volume reduction during curing results from closer packing of monomer molecules in the polymerized resin matrix. The larger the molecule before polymerization. High filler loading results in lower polymerization shrinkage. Upon polymerization. SHRINKAGE The matrix of most contemporary composite materials consists of methacrylate-based monomers. a major portion of this article is devoted to what the practitioner can do to minimize the negative effects of polymerization shrinkage.9 This relation holds true until the point where a relatively high level of filler results in a clay-like paste.9 Several variables are known to influence polymerization shrinkage. For non-flowable or condensable composites. it is important to minimize the density difference between the cured and the uncured material. However.11–13 Another influential variable is the volume fraction of the inorganic filler.) still undergo a volumetric shrinkage of 2 to 9%. Moreover. dimensional stability of the restoration is poor in the early stages of cure.

Germany) at distance of 4 mm. provided that good adhesion between the restoration and the tooth is achieved. However. volumetric shrinkage is constrained. A large portion of shrinkage occurs in the early stages of the curing reaction: after about 15 minutes for chemically activated materials. This constraint. VOLUME 12. as the process of gaining acceptance by the Food and Drug Administration (FDA) is time-consuming and expensive. to prevent gap formation.5) was mixed 1:1 w/w and the light-activated composite (C = 1. must be controlled and directed toward the preparation walls. Danbury. ESPE. bonding systems. model 100. standard mode.15 Commercial development of these resins may be many years away. Thus. 2000 293 . a shrinking material pulls away from the weakest bond. which ultimately causes high shrinkage stress. occasionally even before the patient has left the dentist’s chair. they will largely eliminate the clinical consequences of polymerization shrinkage and will allow simple bulk placement of the material. 3M Dental Products. Voids or microcracks in the restoration or in enamel are formed during polymerization. NUMBER 6.DAUVILLIER ET AL filler loading results in a high degree of stiffness. Demetron Research Corp.14. if such resins ultimately are developed. the nature of the resin undergoing polymerization plays an important role in shrinkage. However. the most likely moment is when the magnitude of shrinkage stress exceeds the strength of the developing restoration– tooth bond. as a result of adhesion to preparation walls. Figure 2. when local stress exceeds polymer network strength. In dental practice. Minnesota) and an analogous light-activated resin composite (Silux Plus. The chemically activated composite (C = 0. inevitably leads to development of stress. unbonded surface of the restoration.. 3M Dental Products) during curing at room temperature for 1 hour. and other means.16 Although of crucial importance. Several research groups are currently attempting to develop new resins that undergo less polymerization shrinkage.0) was exposed for 40 seconds with a light unit (Elipar Highlight. The light intensity at the light exit tip was 600 mW/cm2 (radiometer. as well as the poor interfa- It should now be clear that shrinkage of resin composites. St. the subject of bonding systems is beyond the scope of this review. conditioners. Finally. and after about 60 seconds for light-activated materials (Figure 2). Paul. These voids and microcracks. Seefeld. Note temperature effect after light exposure and difference in onset shrinkage strain. Although loss of adhesion from the tooth structure can occur at any time. Relation between axial shrinkage stress (y-axis) and axial shrinkage strain (x-axis) of a chemically activated resin composite (Silar. Adhesion to dentin is usually enhanced by the use of etching techniques. problems associated with adhesion loss often start during this early stage of cure. and in the remainder of the article an optimal adhesion between the tooth and restoration is assumed. in combination with an increasing modulus of elasticity. STRESS In principle. the weakest bond is generally the free. Connecticut). which up to now has been regarded as inevitable.

Resin composites can be chemically modified to reduce the polymerization rate in various ways. unreacted monomer remaining in the cured composite. but unfortunately there is no nonshrinking material on the market that can compete on all levels with conventional composite materials. Although materials differ in monomer composition. In all probability. the volume change attributable to shrinkage is compensated by material flow from the unbonded.15. on the one hand.26. resulting in more residual. A slow polymerization rate may be expected to increase the ability of the material to flow without damaging its internal structure. The development of nonshrinking materials (shrinkage lower than 0. resin composites can be divided into two general groups on the basis of polymerization rate: light-activated and chemically activated composites.25 Reducing the amount of initiator system components requires no other chemicals than those already used in current systems. water sorption after curing might frustrate the high expectations of a nonshrinking material). or type of restoration can also have an impact on the ultimate quality of the restoration. Addition of retardative agents requires a careful choice of biocompatible chemicals. together with a sufficiently high conversion.g. This statement implies that practitioners must have considerable material expertise if they are to make a well-informed decision in favor of a particular material or application method.27 However. under the same conditions. size. The properties of materials are largely determined by the manufacturer. For example.. One possible solution would be a reduction in the amount of polymerization shrinkage. The choice of a specific material. and adequate conversion of the monomers. In a restorative material with increased flow capacity. on the other hand. the dentist has to deal with a wide variety of commercial products. Flow or Viscoelastic Behavior The solutions to stress reduction previously mentioned are mainly of interest to researchers and manufacturers of composites.17 STRESS RELIEF Two factors have a major impact on the ultimate stress level of the restoration: the chemical and physical properties of a material and the way a material is handled during its application. However. light-activated composites generate higher polymerization shrinkage stress and more exothermic heat than 294 JOURNAL OF ESTHETIC DENTISTRY . is by developing new initiator systems. this manipulation will also influence the final material properties. application method.21–23 Moreover.4% of volume) might be a solution. the solution of one problem might very well create a new one (e. coating. Use of less reactive resins is one possibility. it has been demonstrated that.18–20 Obviously. ultimately resulting in lower stress. Light-activated resin composites are popular among dentists because they can be cured on command. a balance must be found between a low reaction rate. However. Chemical and Physical Properties For minimal impact on the integrity of a restored tooth. although a practitioner can influence those properties to some extent. Another approach to reduce shrinkage stress is to modify the resin composition so that the polymerization rate is lowered without influencing the degree of conversion.DEVELOPMENTS IN SHRINKAGE CONTROL OF ADHESIVE RESTORATIVES cial adhesion between filler and matrix. can encourage cohesive restoration fractures. outer surface. stress development must be minimized. loading. the best way to obtain a lower polymerization rate in light-activated resin composites.24 but this method may have a negative effect on degree of conversion. Changing the chemical and physical properties of compos- ite materials in such a way that shrinkage stress is no longer a problem is primarily the concern of those developing new resin composite materials. concentration of initiating system and filler type. a dentist can alter the ratio of a twopaste system or use special curing lights and light-curing procedures that affect polymerization rate and degree of conversion.

The practitioner is in full control of preparation design. often display marginal defects. to reduce internal stresses in the restored tooth. the shape of the preparation is often described by means of the configuration factor (C-factor) (Figure 3). usually denoted as the post-gel phase.28. in severe cases. 1st Ed.30 During the early stages of polymerization. Any further composite shrinkage will generate mechanical stress in the restoration. After a certain degree of conversion has been attained. voids can be generated in the viscoelastic material. the predominant reaction is the cross-linking of the polymeric chains.DAUVILLIER ET AL the analogous chemically activated composites. and standard Class II. St.e. microcracks or. This polymer chain movement is referred to as viscous flow behavior. 2000 295 . London: Elsevier Science. When adhesion survives the stress. resulting in a strong polymeric network. Minnesota) during curing at room temperature for various C-factor values. with permission.32 In this context. rectangular restorations. In: Fouassier JP. rigid viscoelastic material. monomers are mainly converted into polymeric chains. there is no longer the ability of individual polymer chains to slide. The C-factor denotes the ratio between the bonded and the free (unbonded) area of the restoration. the polymeric chains can still slide along one another to relieve stress. in which the restoration is bordered by preparation walls (i.31 Although during the chain-growing period material viscosity rapidly increases. it involves the design of the preparation and the methods used to apply a restoration. the corresponding configuration (C) factor values. Radiation curing in polymer science and technology. Paul. This factor explains why the adhesive Class IV restoration has proven so successful. however. NUMBER 6. Reprinted from Rabek JF. 1993. A.29 The dental literature has given considerable attention to a variety of methods designed specifically for light-activated resin composites. Experimental and analytical methods for the investigation of radiation curing. since composite flow is largely restricted to the small. free area of the material. The relation between different schematic. Configuration Reduction of the negative effects of shrinkage stress can be controlled by practitioners. and V restorations. In general. Time-axial shrinkage stress relation of a chemically activated resin composite (Silar. eds. At this stage. It should be noted that the term “bonded area” means bonded to a rigid surface. 3M Dental Products. The relation between the shape of a preparation and shrinkage stress development in composites has been demonstrated by Feilzer et al. B.. IV. there are many other factors that influence the actual shape of the preparation. When the cross-linking reaction becomes predominant. more bonded area leads to higher shrinkage stress. Rabek JF. VOLUME 12. a high C-factor). including some A B Figure 3. the polymeric chains reach sufficient modulus of elasticity to develop a strong. whereas other classes.

36.37 This concept is feasible only when the liner extends to the cavosurface margin.44.35 It is thought that. Layers. and (2) small increment light-activated composites can be more thoroughly cured. lower shrinkage stress.40 However. This material could dissipate the shear peak stress and generate no high polymerization shrinkage stress on the adhesive layer. high) C-factor are covered with a relatively thick layer of a low elastic modulus material.54.18. layering and low modulus liners are now generally accepted as a means of reducing polymerization shrinkage stress..34. since light intensity diminishes with the fourth power of light penetration.g.41–43 For this reason. etc. many studies report significantly lower exposure durations involving new light units.55 As curing efficiency and a lower polymerization rate may be 296 JOURNAL OF ESTHETIC DENTISTRY . the bulk shrinkage of the main restoration acquires some freedom of movement from the adhesive liner. water sorption. thus.. a valid comparison between light units requires that the spot diameter.DEVELOPMENTS IN SHRINKAGE CONTROL OF ADHESIVE RESTORATIVES with an undesirably high C-factor.51–53 However.19. Liners. Failure to specify these parameters makes comparison among light units impossible. and Porosities Three methods described to reduce the effects of shrinkage stress are all based upon a reduction of the effective C-factor. wear.e.” in which glass ionomer cements are used as liner. is given time to cure before the high-bulk shrinkage stresses of the overlying.20. owing to oxygen inhibition. wavelength distribution. exposure duration. There are several methods by which practitioners can reduce the impact of shrinkage stress on the quality of a restoration with a high C-factor. Both methods have the disadvantage of additional time-consuming steps during restoration. Young’s modulus. and they lead to a lower effective C-factor and. the dentist can apply a restorative material in several layers or increments. the main disadvantage of this method is that it is a timeconsuming procedure.44.).28. which further declines when the quality of the light source in the curing unit deteriorates with age. The advantage of this technique is twofold: (1) the C-factor for a small increment is lower than for bulk filling. which is often not properly cured.33 Of course. higher filler-loaded composite begin to act on it. These porosities can be considered as unbonded areas.38 The real effect of a low modulus lining material is probably its contribution to a more equal distribution of tensile and shear stresses over the adhesive interface.39 Deliberately admixing small air bubbles into a composite prior to use results in porosities in the cured composite. which may provide a site for bacteria growth. Although the mechanisms are not clear. Thus the adhesive. Additionally. when the walls of a preparation with an unfavorable (i. resulting in surface pitting. intensity. the practice of deliberately inducing porosities in a composite should be discouraged.50 Although present-day conventional light-activated composites were developed for traditional procedures with a conventional halogen light source (40–60 s exposure with light intensity 600 mW/cm2).46–49 A predictive model for depth-of-cure devised by Rueggeberg et al suggests that the duration of curing compensates for the lower intensity. either by reducing the output of the curing light or by increasing the distance between the light exit tip and the composite.45 A significant problem presented by the use of low light intensities is a reduced curing depth. The literature provides no clarity with respect to the “sandwich technique. Light Sources A recent method designed to reduce the polymerization rate of lightactivated resin-based materials involves varying light intensity on the restoration. For preparations with a large C-factor (Classes I and V). the elastic liner between the tooth and composite is often less wear-resistant at the restoration surface. and distance between light exit tip and composite must be specified. it should be kept in mind that porosities can have a negative effect on other composite properties (e. The physical and mechanical properties of composites are greatly influenced by the extent to which the resin has been cured.

general solution to these problems. substantially relieve shrinkage stress. Kalachandra S. Wall-to-wall polymerization contraction of composite resins versus filler content. Kim KH. Robinson SJ. The information presented is intended to help the clinician obtain maximum benefit from the selection and application of resin composites. 43:83–89. Because there is as yet no easy. 14. after fractures have already formed. a proper understanding of the mechanisms causing the problems. 8. Miyazaki M. Stansbury JW. Response of the dental pulp to invasion of bacteria around three filling materials. Venhoven BA. Photocuring of mono. Current concepts on adhesion to dentin. Watts DC. in which shrinkage stress is not as great a problem. Jorgensen KD. Relationship between composite matrix molecular structure and properties. 7:281–287. Polymers in dentistry. Davidson CL. Pandain MS. which is exposed to the oral cavity. 2. Asmussen E. Scand J Dent Res 1975.g. 15. 16. Hansen EK. 8:306–335. 10. Feilzer AJ. Determination of polymerization shrinkage kinetics in visible light-cured materials: methods development. 19:2007–2014. Liu DW. De Gee AJ. Munksgaard EC. VOLUME 12. Polymerization shrinkage and elasticity of flowable composites and filled adhesives. 15:128–137. 13. Van Meerbeek B. on the other. Culbertson BM. Brannstrom M. Nie J. De Gee AJ. there are few quantitative data available to assess its true impact. This gain produces a gradient from the outer surface to the bulk of the restoration. 19:301–303.. J Dent Res 1995. Imai Y. the surface of the restoration. is of crucial importance. Tong YH. on the one hand.64 Unfortunately. will initially gain in volume. Curing contraction of composites and glass ionomer cements. Shimokobe H. Moore BK. Ekstrand J. In the case of high C-factor restorations. a balance must be found between low shrinkage stress.57–63 Hygroscopic expansion (swelling) because of water sorption from saliva may. Davidson CL. nonshrinking composite materials may encounter major problems related to expansion stress in some types of restorations (e. Park JH. Microfracture mechanisms of dental resin composites containing spherically-shaped filler particles. Eick JD. 6. 35:1491–1500. 74:1110–1115. owing to the slow process of water sorption from saliva. 59:297–300. Onose H. However. mesioocclusodistal restorations). Effect of filler content of light-cured composites on bond strength to bovine dentine. swelling is much more marked for restorations with a low C-factor. Although water sorption is generally recognized as a stress-relieving mechanism. Wan QC. 73:499–504. Polymerization contraction and conversion of light-curing BisGMA-based methacrylate resins. A34:2405–2421. Influence of light intensity on polymerization shrinkage and integrity of restoration-cavity interface. Dooren LH. thus adding additional stress. Proc Inst Mech Eng [H] 1998. J Prosthet Dent 1988. 24:632–640. 12. After a prolonged period of swelling. Biomaterials 1998. Vanherle G. Enamel damages caused by contracting restorative resins. CONCLUSION In the past 10 years. Eick JD. 7. Kishi T. can influence ultimate shrinkage stress. NUMBER 6. Eur J Oral Sci 1995.56 Hygroscopic Expansion The hygroscopic properties of a composite. REFERENCES 1. and an adequate monomer conversion level. Vojinovic O. Gwinnett AJ. 2000 297 . The authors thank Mrs. Braden M. Fasting for her comments on the English text. Linden LA. Kato H. 3. Byerley TJ. Hinoura K. J Dent 1991.and di-functional (meth)acrylates with tris [2-(acryloyloxy) ethyl]isocyanurate. Deb S. Crit Rev Oral Biol Med 1997. a great deal of effort has been made toward the development of nonshrinking and even expanding composite materials for dental applications. J Dent Res 1994. Dent Mater 1991. Preparation and characterization of cyclopolymerizable resin formulations. B. J Macromol Sci Pure Appl Chem 1997. 4. Davidson CL. Robinson SJ. Feilzer AJ. after curing. Preparation and evaluation of visible lightcured multi-methacrylates for dental composites. 95:526–531. 14:871–875. 11. 212:453–464. at present. 9. Rabek JF. Labella R. Finally.DAUVILLIER ET AL diametrically opposed to each other. and the methods that can be used to reduce their impact on the quality of a restoration. Eur Polymer J 1999. Chappelow CC. Quintessence Int 1993. Adhesives and nonshrinking dental resins of the future. Biomaterials 1993. 83:120–122. 103:322–326. DISCLOSURE AND ACKNOWLEDGMENT 5. 17. Scand J Dent Res 1987. Lambrechts P. the dental practitioner still has to deal with shrinking resin composites and the accompanying problems. Dent Mater 1999. ASDC J Dent Child 1976. Pashley DH. de Gee AJ. although difficult to determine. stress relief may come too late. Cash AJ. Dickens B. Davy KW.

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Marginal integrity related to bond strength and strain capacity of composite resin restorative systems.DEVELOPMENTS IN SHRINKAGE CONTROL OF ADHESIVE RESTORATIVES 18. J Dent 1999. Unterbrink GL. Byerley TJ. Rabek JF. Pract Periodont Aesthet Dent 1999. 46. J Dent 1995. Am J Dent 1993. Int J Prosthodont 1994. Light intensity effects on resin-composite degree of conversion and shrinkage strain. Kemp-Scholte CM. Sahafi A. Elution of TEGDMA and BisGMA from a resin and a resin composite cured with halogen or plasma light. Uno S. London: Elsevier Science. Alster D. Cardash HS. 21:31–38. Factors affecting cure at depths within light-activated resin composites. Hattori T.. 33. Rueggeberg FA. Chappelow CC. Polymer 1992. Silikas N. 16:292–296. 71:1619–1622. 29:283–330. 27:383–389. Kemp-Scholte CM. 25. Osman YI. Dent Mater 1993. Davidson CL. DeCaprio AP. Synthesis and polymerization of new expanding dental monomers. New York: CBS College Publishing. Jorgensen KD. 19. Van Meerbeek B. Lambrechts P. De Gee AJ. Asmussen E. 40:359–376. Barkmeier WW. Bouschlicher MR. 47. Caughman WF. Dent Mater 1987. 91:396–405. Kalliyana Krishnan V. Scand J Dent Res 1991. Characterization of resin composites polymerized with plasma arc curing units. 9:2–5. McCabe JF. Feilzer AJ. 26. J Dent Res 1992. 25:747–751. 106:816–824. Eick JD. Comparison of polymerization contraction stresses between self. Stansbury JW. 23. Peutzfeldt A. 54:357–362. Ogden AR. 50. 53. J Dent 1993. 29. Monomethacrylate co-monomers for dental resins. 10:88–96. Oelgiesser D. J Oral Rehabil 1997. J Dent Res 1992. The influence of light exposure on polymerization of dual-cure resin cements. Takeshige F. 64:658–664. Quintessence Int 1986. Mol A. 8:345–350. J Dent 1999. 27.and light-curing composites. The relationship between porosity. 42. Oper Dent 1993. 44. Photopolymerization kinetics of dimethacrylates using the camphorquinone amine initiator system. 39. 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Department of Dental Material Science. Davidson CL. Do dental composites always shrink toward the light? J Dent Res 1998. 69:36–39. 77:1435–1445. Alternative interpretations of water sorption values of composite resins. Hardening shrinkage and hygroscopic expansion of composite resins. Leung RL. Asmussen E. J Dent Res 1982. Hirabayashi S.DAUVILLIER ET AL 55. The influence of water sorption on the development of setting shrinkage stress in traditional and resin-modified glass ionomer cements. J Biomed Mater Res 1986. Edahl A. de Gee AJ. Davidson CL. Visible light-cured composite resins: polymerization contraction. Versluis A. 20:121–131. 57. Tantbirojn D. Dent Mater 1995. (Comments) Reprint address: Albert J. Fan PL. 18:271–279. Aizawa M. The Netherlands. Greener EH. Ferracane JL. Hansen EK. 90:329–335. Feilzer AJ. J Dent 1979. de Gee AJ. Scand J Dent Res 1982. 60. Soderholm KJ. Dickson G. 62. Louwesweg 1. 58.nl ©2000 BC Decker Inc VOLUME 12. 90:490–496. Relaxation of polymerization contraction shear stress by hygroscopic expansion. 59. 62:28–31. Scand J Dent Res 1982. Long-term water sorption and solubility of composite filling materials. J Dent Res 1983. Hirano S. Pearson GJ. Feilzer. 65. Initial dimensional change of composites in dry and wet conditions. 64. Rapson JE. e-mail: a. 7:64–68. 61:654–658. J Dent Res 1990. J Biomed Mater Res 1984. Feilzer AJ. 64:78–80. Factors affecting the quantity of remaining double bonds in restorative resin polymers. J Dent Res 1985. Harashima I.feilzer@acta. Academic Centre for Dentistry Amsterdam. 56. Bowen RL. NL-1066 EA Amsterdam. 61. Stanford JW. The effect of resin formulation on the degree of conversion and mechanical properties of dental restorative resins. 2000 299 . Water sorption in a bis(GMA)/TEGDMA resin. Douglas WH. contraction pattern and hygroscopic expansion. NUMBER 6. 63. Hirasawa T. 11:186–190. Kakaboura AI.

2000) T he introduction of photopolymerization to dentistry began nearly coincident with the commercialization of this technology in the late 1960s. dentures. A variety of photocurable dental products.2 Since that time. mainly the use of multiple (incremental) layers to place large restorations. since the photopolymerization of early generation composites had serious limitations with respect to depth of cure.Curing Dental Resins and Composites by Photopolymerization JEFFREY W. represent a significant. such as sealants. the primary application of this technique is seen in composite restoratives. ultraviolet (UV)-cured pit and fissure sealants were put into clinical practice. PHD* ABSTRACT The development and continued evolution of photopolymerizable dental materials. School of Dentistry. The basic mechanisms by which the photoinitiators efficiently convert monomers into polymers are discussed along with the variety of factors that influence the photopolymerization process. It did not take long for dental practitioners to accept the modification to chemically cured composites that were based on a two-paste benzoyl peroxide-amine initiator system. adhesives. The highly successful integration of the light-activated curing process for dental applications is described in this review. adhesive and restorative applications of lightcured materials followed. A better appreciation of the photopolymerization process as well as its potential and limitations may aid the dentist in the delivery of both esthetic and restorative dental care.3 Also related to curing efficiency. This new technology offered significant advantages: (1) a single-paste system requiring no mixing and (2) complete operator control over working time with a rapid cure commencing on command. Aurora. Colorado 300 JOURNAL OF ESTHETIC DENTISTRY . practical advance for dentistry.1 and soon thereafter. The conventional camphorquinone-amine visible light photoinitiator system used in most dental restorative materials is illustrated in addition to some alternative initiator systems that have been studied for dental materials applications. STANSBURY. Along with these benefits came the need to develop new restorative placement techniques. York. Nuva Fil (Dentsply. However. particularly dental composite restoratives. the shade of composite material being placed as well as the day-to-day variation in output intensity of the curing lamp were other clinically relevant concerns raised with the *University of Colorado Health Sciences Center. Pennsylvania) was introduced in 1972. photoactivated dental materials have stayed current with and contributed to state-of-the-art advancements in photopolymerization technology. have been developed. CLINICAL SIGNIFICANCE Photopolymerization has become an integral component of the practice of dentistry. Initially. ( J Esthet Dent 12:300–308. and impression materials.

as a result. 2000 301 . The uniform change to visible light initiation within the dental materials industry avoided problems of UV-promoted tissue damage. the result of exposure to light is intramolecular α-cleavage (carbon– carbon bond fragmentation at the carbonyl group) to yield two free radicals. a photosensitizer is also included to absorb light at one wavelength and transfer the energy from its excited state to a photoinitiator that absorbs in a different wavelength range. The absorption spectrum of CQ has a broad maxi- Figure 2. based on benzoin methyl ether or other UV active photoinitiators. VOLUME 12. were reformulated to incorporate new visible light wavelength initiators. a tertiary amine photoreductant is used as the coinitiator to provide the reactive radicals that begin polymerization. In current dental resins. UV-induced alpha-cleavage of benzoin methyl ether (BME). either directly or indirectly. Exam- ples of this energy transfer are found in the visible light polymerizations conducted with cationic initiators that typically absorb in the UV region but can be sensitized to function at longer wavelengths by the inclusion of trace amounts of dyes or other active compounds including CQ. In some initiator systems. generate a reactive species that can then initiate polymerization.5 PHOTOINITIATION Figure 1. For high absorptivity to be achieved there obviously must be a relatively good match between the absorption spectrum of the photoinitiator and the emission spectrum of the light source. both of which have the potential to initiate polymerization. camphorquinone (CQ) is typically used as a visible light-activated free radical photoinitiator (Figure 2).7–9 The efficiency of any given photoinitiator is governed by a number of factors. Structure of camphorquinone (CQ) and visible light-activated free radical generation pathway.4.6 Initiators generally have a carbonyl group with nonbonding electrons that can be promoted to a π* antibonding orbital (lower energy bonding and higher energy antibonding molecular orbitals are created by the respective positive and negative overlap of atomic orbitals) by absorption of light at the appropriate wavelength. With initiators like benzoin methyl ether (Figure 1). NUMBER 6. In the case of a dental composite restorative containing CQ. as well as concerns of ophthalmologic damage to practitioners. A co-initiator is a separate compound that does not absorb light but interacts with an activated photoinitiator to produce a reactive species. A photoinitiator is a molecule that can absorb light and.STANSBURY advent of photopolymerization in dental practice. the original UV-curable materials. Cam- phorquinone is an example of a photoinitiator that requires a coinitiator for an efficient polymerization process to occur. By the 1980s.

Beyond this consideration. an exciplex (excited state complex) can form (see Figure 2). If. directly determine conversion. whereas the CQ-based counter radical may actually retard polymerization through termination reactions with growing polymer chains.CURING DENTAL RESINS AND COMPOSITES BY PHOTOPOLYMERIZATION mum at 468 nm in the blue region of the visible spectrum.17 Calorimetric methods that allow conversion to be calculated based on the heat released by the polymerization reaction have also been used. These polymerization-based measurement techniques. which includes individual monomer structures and comonomer ratios. or UV radiation that can cause biologic damage. along with choice of the photoinitiator concentration. and electron paramagnetic resonance (EPR) techniques. the amine can donate to CQ first an electron to form the radical ion pair and then a proton to generate the free radical species. as well as comparative photopolymerization 302 JOURNAL OF ESTHETIC DENTISTRY . Within this exciplex. such as initiator quenching by monomer or oxygen. rather than the resulting polymerization process. such as flexural strength or microhardness. γmax = 468 nm). more indirect approaches involve analysis of some physical or mechanical property of the resulting polymer. Thorough studies of the CQ-amine visible light photoinitiation process and its influence on polymerization kinetics have been described. The chain reaction process that defines free radical addition polymerization means that the absorption of a single photon of light by the initiator can result in the incorporation of hundreds of monomer units into the polymeric network. and exposure duration of the incident light define the irradiation energy.14.05 ms for the CQ triplet).10 control the number of active radical species produced per photon of light absorbed. predominantly with infrared spectroscopy. These factors. Dental curing units are generally halogen sources with bandpass filters that transmit in the 400.18–20 Other.11–13 CAMPHORQUINONE-AMINE PHOTOINITIATION SYSTEMS Traditionally. intensity. Studies of the CQ-amine photoinitiation process have generally involved either evaluation of polymerization kinetics during photopolymerization or measurement of the degree of conversion obtained following polymerization. also exerts considerable influence on the polymerization as network formation proceeds. prior to its decay or deactivation. it encounters an amine molecule through diffusion or a preexisting association. excited energy state (half-life of approximately 0. CQ-tertiary amine initiators have been the standard in dental composite restoratives. as well as competitive deactivation pathways. This filtering minimizes the harmful potential of either infrared radiation. permit a high degree of external control over the photopolymerization process. nuclear magnetic resonance spectroscopy. A useful photoinitiator must also have a high molar extinction coefficient (high absorptivity at low concentration). radiation in this range promotes an electron in one of the two carbonyl groups of CQ to a short-lived.21 It has been amply demonstrated that properties of the restorative materials tend to improve as the level of conversion attained during photopolymerization is increased. The wavelength. a number of studies have been undertaken to determine the mechanism of initiation and the parameters that affect photopolymerization. steady-state UVvisible light spectroscopy. It is the aminoalkyl radical that initiates monomer polymerization.15 With a relatively broad absorption spectrum in the visible region (400–550 nm. the resin composition. These factors.22 Direct observation of the photoinitiation step.16. has been accomplished with time-resolved laser spectroscopy. The compound should also undergo high yield intersystem crossing in the excited state (a change from the initially formed unreactive electron-promoted singlet state to the reactive triplet state) that can lead to productive chemical processes.to 540-nm visible region. which can give rise to a significant amount of heat.6 These direct observation approaches. and as such.

whereas higher CQ concentrations gave no additional improvements and yielded discolored polymer specimens.5% and 1. The effect of delaying VOLUME 12. A wide variety of aromatic and aliphatic amines have been compared for their initiating potential with CQ.29 An exponential increase in irradiation time was necessary to ensure maximal conversion as composite thickness increased. however. predominantly the copolymerizable N. resin-based materials for indirect restorative applications are typically photocured at elevated temperatures or are given a postirradiation heat treatment to achieve maximum conversion and physical properties.32 Another consequence of radicals trapped within polymers is the protracted post-cure. which in sufficient concentrations can alter bulk properties of the polymer. significant increases in both conversion and.22 Thus. tertiary aliphatic amines. Diffusion of oxygen through the polymer can result in conversion of the highly reactive carbon-based radicals to relatively stable hydroperoxides. which bear active hydrogens. particularly. The majority of potential conversion that can be attained with a given resin composition is achieved during the first few minutes after irradiation. air-inhibited surface layer.15 Work with chemically cured initiator systems (benzoyl peroxide-amine) demonstrated that aromatic amines were clearly more effective than aliphatic amines.25 A separate study showed that CQ levels at mole fractions between approximately 0. 2000 303 .12 Diffusion of oxygen into the exposed resin or composite surface as polymerization proceeds results in quenching of both initiator and polymer-based radical species and is responsible for the poorly polymerized. In one such investigation. demonstrated the long-term persistence of radicals that become trapped in the glassy polymeric matrix. show that the structure of the amine photoreductant used with CQ has a dramatic effect on the efficacy of the initiating system. it was found that conversion increased monotonically to approximately a 1:2 or 1:3 molar ratio of CQ to amine and then plateaued with additional amine. The fillers used in composite restoratives appear to significantly enhance the decay of trapped radicals.0% provided full conversion. which increases mobility within the polymeric network and allows free monomer and pendant chains to encounter remaining radical sites and react further. radical concentration increases rapidly and reaches an essentially steady-state condition where new radical production is balanced by radical termination processes. Using a standard dental curing unit.31 Lifetimes of these trapped radicals are directly related to the stiffness of the polymeric network and can vary from hours to months. Other EPR-based studies.28 During the initial stages.23 Aromatic tertiary amines were found to be somewhat more reactive co-initiators than the aliphatic counterparts. function as inhibitors of the photopolymerization process. Conversely.27 PHOTOPOLYMERIZATION IN DENTISTRY The use of EPR techniques to study photopolymerization is particularly appropriate since they provide methods to directly monitor free radical population throughout the polymerization process. the irradiation time necessary to achieve maximum radical formation was determined as a function of specimen thickness.30.24 However.N-dimethylaminoethyl methacrylate.26. are widely used in the photoinitiator systems of commercial dental restorative materials. The effect of the CQ:amine ratio on initiator efficiency has been examined by the measurement of conversion in unfilled resins.STANSBURY studies. which also concluded that typically used exposure durations are not sufficient to achieve maximum radical production. a 2-mm-thick composite specimen required approximately 100 seconds to reach a maximum radical concentration. At a fixed CQ concentration. or additional conversion. the evolution of polymer properties are observed up to and beyond 24 hours. NUMBER 6.21 This post-cure process can be greatly facilitated by the application of heat.14. that continues after irradiation is ended. primary amines.

The photopolymerization process in dental composites is complicated by the presence of inorganic fillers of various particle sizes.38 A reasonably close refractive index match between the resin matrix and the filler is an important factor to achieve efficient light throughput as well as yielding esthetically pleasing translucent polymerized composites. Inclusion of substantial amounts of inert filler in composites essentially mitigates the potential exothermic response by diluting the reactive group density of the resin and serving as a heat sink. the temperature differential generated during photopolymerization can become a clinical concern. Microfilled resins allow less light penetration than hybrid and small particle-filled products.41 Light interacts with filler particles. which can range in from approximately 0.46 ALTERNATIVE PHOTOINITIATOR SYSTEMS Variations in visible light photoinitiator formulations for use in dental materials have been introduced in 304 JOURNAL OF ESTHETIC DENTISTRY . owing simply to the absorbed photon energy. based on the methacrylate functional groups.04 µm to 10 µm depending on the material. affect the temperature rise that can be expected. resulting in absorption and scattering that significantly attenuates the irradiation intensity reaching deeper portions of the composite.43 Over the range of intensities associated with conventional dental curing lamps.39. even with extended irradiation intervals.19 Compounding this effect.33.44 Other studies have focused on the depth of cure of composites or on the significant differences in physical properties noted as a function of depth. and exposure duration as well as restoration composition and geometry. measured at the upper and lower surfaces of typical laboratory specimens. In addition. such as microhardness.34 It has also been shown that resins with higher concentrations of low viscosity diluent monomers.45 In nearly every instance. intensity.40 Since refractive index of the resin shifts to a significantly higher value as the polymerization occurs.42 The effects of variation in irradiation wavelength and exposure duration on the polymerization efficiency of CQ-amine-activated resin composites have been investigated. a discrepancy is observed between properties.CURING DENTAL RESINS AND COMPOSITES BY PHOTOPOLYMERIZATION the time between the irradiation step and the post-cure heating has been studied as a demonstration of the effect of trapped radicals on the continuation of the curing process. a spectral output that overlaps a significant portion of the CQ absorption range was found to be more efficient than a narrow irradiation band focused at the wavelength of the CQ absorption maximum. light transmission is affected. Therefore.37 It appeared that a majority of the temperature elevation observed was attributable to direct energy input from the light sources used and not from the exothermic heat of the polymerization reaction. such as triethylene glycol dimethacrylate (TEGDMA). A recent study involving conventional dental curing lights has demonstrated temperature deviations at the cavity floor between 3°C and 7°C during photocuring of 2-mm thick commercial composite specimens.36 For direct filling materials. Comparisons of photopolymerization conversion achieved with equal light flux but varied intensities (short-duration exposure at high intensity compared with longduration exposure at low intensity) demonstrated that modest to moderate increases in conversion were associated with higher light intensities. absorption of light of the effective wavelength by the initiator in the upper region of the composite acts as a filter for the light being transmitted to the lower boundary of the material. delays of greater than 40 seconds have been observed between the onset of irradiation and the transmission of light of the active wavelength from a 2-mm-thick composite specimen.35. certain curing lights can impart a significant thermal rise. Factors. reach higher immediate degrees of conversion. including the wavelength. The vinyl addition polymerization reaction is exothermic by approximately 55 kJ/mol. but have less additional conversion during the post-cure interval than do resins that contain less diluent co-monomer.

49 Thus. ingredients in photoinitiated dental resins. 2000 305 . the shoulder of these maxima extends well into the visible light wavelength and allows the ini- tiators to be used with conventional visible light dental curing units. or photobleaching. substantial proportions of propionaldehyde (PA) and 2.2-propanedione (PPD) has been examined (Figure 3). More complex three-component initiator systems are also currently being developed for improved polymerization efficiency and decreased sensitivity toward oxygen inhibition. Similar initiators. TPO = triacylphosphine oxide.50 The various initiator structures examined all have absorption maxima in the UV region from 320 nm to 390 nm. the photoinitiator composition has been varied to Figure 4. An example of this type of system is the investigation of a series of bisacylphosphine oxide (BAP) initiators (Figure 4). A rapid. A decrease in initiator-related discoloration after photocuring is clinically important in obtaining and maintaining an acceptable match of a restoration with adjacent tooth structure. addition of more stable hydroperoxide components in the experimental photoinitiator system decreased polymerization rates. VOLUME 12. however. The initiation mechanism is a direct intramolecular cleavage that requires no amine co-initiator. that occurs during photopolymerization with initiators of this type allows thick polymer samples to be cured with an esthetic appearance. As another modification to the conventional CQ-amine initiator system. The observed benefits may be attributable to the generation of free radicals from two distinctly different initiation mechanisms: proton abstraction with CQ-amine and direct intramolecular cleavage with PPD. the polymers produced were less yellow than those prepared with only CQ as the initiator. New initiators may potentially provide higher degrees of conversion or faster cure rates with minimal light exposure and reduced initiator concentration. Structures of phosphine oxide-based photoinitiators. BD = butanedione. Other studies evaluated the potential of photoinitiator systems that do not rely on camphorquinone as their basis. Extensive studies were conducted on the use of aldehydes or diketones as reactive Figure 3. PPD = l-phenyl-1.2-propanedione. BAP = bisacylphosphine oxide.48 Because the absorption maximum of PPD occurs at 410 nm. NUMBER 6. A simple alteration that can be made is addition of peroxide co-initiators to the CQ photoinitiator. triacylphosphine oxides (TPO) are also being examined as a co-initiator with CQ (see Figure 4). addition of 1-phenyl-1.3-butanedione (BD) additives enhanced conversion and improved mechanical properties with respect to the baseline materials with a chaintransfer mechanism proposed to account for the results (see Figure 3). The synergistic combination of PPD with CQ allows higher degrees of conversion to be achieved compared with only the CQ-amine initiator. PA = propionaldehyde.47 In contrast to the increased cure rates noted with additives such as di-t-butyl peroxide. light-induced disappearance of initiator-imparted color.STANSBURY efforts to enhance photopolymerization efficiency.51 In other cases. Structures of aldehyde and diketone additives to the photoinitiator systems.

The author has no financial interest in any of the companies or products mentioned in his article.N-diethyl dithiocarbamate) (XDT) was used in the UV-initiated photopolymerization to yield model cross-linked acrylic polymeric networks (see Figure 5). In dentin bonding. which relies on infiltration and polymerization of monomers within demineralized dentin. CQ has been added to serve as a visible wavelength sensitizer. The iodonium photocationic initiators are active in the UV region. the polymer formed does not undergo bimolecular radical termination reactions or have trapped radicals in the network. This is evidenced by the proliferation of light-curing units on the market. other curing units now provide low intensity initial irradiation followed by a ramping up to a higher intensity level. QTX used in the aqueous primer solution applied to dentin replaces CQ in the role of providing the critical interfacial polymerization of the subsequent bonding resin and overlying composite layers.9. dental materials researchers and manufacturers will undoubtedly continue to improve both the photoinitiator systems and the resins used in restorative materials.52.56 p-Xylene bis(N. 2-hydroxy-3-(3. Other devices offer the delivery of extremely intense doses of irradiation designed for rapid cure.54 The development of new resin systems for dental restorative applications can also necessitate the introduction of new photoinitiators. CONCLUSION The use of photopolymerization offers the dental practitioner a remarkable degree of control over the polymerization process. The benefits of more efficient resin polymerization may be expressed as further enhancements in restorative performance and durability and improved biocompatibility and color stability. Along with the availability of these and other photocuring technologies. a water soluble photoinitiator. QTX = 2-hydroxy-3-(3. 306 JOURNAL OF ESTHETIC DENTISTRY . Recent work directed toward a novel resin system based on epoxy rather than methacrylate curing chemistry has required use of cationic photoinitiators.55 These initiators typically contain an aliphatic side-chain on one of the aromatic rings. Whereas the conventional curing lights have tended toward higher power density outputs. Structures of application-specific photoinitiators.Ntrimethyl-1-propanaminium chloride. and thus.N-trimethyl-1-propanaminium chloride (QTX) has demonstrated potential to improve bond strengths (Figure 5). A novel approach to the study of the dental resin photopolymerization process involves the use of an iniferter.N.4 dimethyl-9-oxo-9H-thioxanthen-2-yloxy)-N.N.4-dimethyl-9oxo-9H-thioxanthen-2-yloxy)N. This allows characterization of the resulting polymers by thermal analysis techniques without causing an additional post-curing reaction that invariably alters polymer properties under observation.53 With an absorption maxium at 402 nm. Photocleavage of XDT occurs to yield a carbon-based initiating radical and a sulfur-based dithiocarbamate radical that remains associated with the terminus of the growing polymer chain. DISCLOSURE Figure 5.CURING DENTAL RESINS AND COMPOSITES BY PHOTOPOLYMERIZATION accommodate the demands imposed by specific dental materials applications. or living free radical initiator. DIH = diaryl iodonium hexafluoroantimonate. designed to improve solubility in the resin. such as diaryl iodonium hexafluoroantimonates (DIH) (see Figure 5). Although the polymerization is relatively slow.

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the photoelastic analysis was performed to examine stresses in and around the preparations. The purpose of this article is to familiarize the clinician with the characteristics of contraction stress by visualizing the stresses associated with this invisible and complex phenomenon. Kagoshima. posterior composite resin. PHD* SHIGEYUKI EBISU. PHD* ABSTRACT Purpose: An important factor that contributes to deterioration of resin composite restorations is contraction stress that occurs during polymerization. Clinicians must understand the concept of polymerization contraction stress and realize that the quality of composite resin restorations depends on successful management of these stresses. Then. Japan † Department of Operative Dentistry and Endodontology. and a light-cured transparent composite) were used as the restorative materials.0 mm. and the others are commercial products. Butt-joint preparations simulating Class I restorations (2. 2000 309 . a self-cured transparent composite. Materials and Methods: Internal residual stresses generated during polymerization of resin composite restorations were determined using micro-photoelastic analysis. DDS. DDS. significant stress was generated in the preparation models simulating tooth structure. When preparations in the transparent composite models were filled with posterior composite and lightcured transparent composite material. the stress distribution in the two composites was similar. (J Esthet Dent 12:309–319. the preparations were bulk filled with composite. After treatment of the preparation walls with a bonding system. but the magnitude of the stress was greater in the light-cured material. 2. Fringe patterns for directions and magnitudes of stresses were obtained using transmitted and reflected polarized light with polarizing microscopes. resulting in very low stress within the restoration. Kagoshima University Dental School.0 mm in depth) were prepared in three types of substrates (bovine teeth. Osaka University Graduate School of Dentistry. DDS. Specimens for photoelastic analysis were prepared by cutting sections perpendicular to the long axis of the preparation. a gap was formed between the dentinal wall and the composite restorative material. DDS. NUMBER 6. and transparent composite resin) and were used to examine contraction stress in and around the preparations. Japan VOLUME 12. The self-cured composite is an experimental material. Results: When cavity preparations in bovine teeth were filled with light-cured composite. Three types of composite materials (a posterior composite.0 mm × 5. When cavity preparations in the posterior composite models were filled with either self-cured or light-cured composite. owing to the contraction of both restorative materials. 2000) *Department of Restorative Dentistry and Endodontology. PHD† FUMIO TAKESHIGE.Polymerization Contraction Stress of Resin Composite Restorations in a Model Class I Cavity Configuration Using Photoelastic Analysis YOSHIFUMI KINOMOTO. Osaka. CLINICAL SIGNIFICANCE Polymerization contraction stress is an undesirable and inevitable characteristic of adhesive restorations encountered in clinical dentistry that may compromise restoration success. PHD* MITSUO TORII.

Palfique clear becomes almost transparent after polymerization.14–16 tensiometer. Moreover.6 Poor marginal adaptation of a composite restoration results in microleakage and its possible sequelae: thermal sensitivity.13 finite elemental analysis (FEA).7–12 However. 600-grit SiC paper.86%. This experimental self-cured composite was mixed using the bubbleless mixing technique. and its bending elastic modulus was 3. to visualize contraction stress within resin composite restorations. After tooth thawing.19. measured using a dilatometer with a mercury-filled capillary. Two different types of transparent resin composite materials were used in this study: Palfique clear (Tokuyama Co. The inorganic filler is 0.POLYMERIZATION CONTRACTION STRESS OF RESIN COMPOSITE RESTORATIONS IN A MODEL CLASS I CAVITY CONFIGURATION USING PHOTOELASTIC ANALYSIS R esin composite restoratives solidify by means of the chemical process termed polymerization. because the refraction indices of monomer and filler are adjusted to be equivalent. The volumetric polymerization shrinkage of Palfique clear. because the methods for determining contraction stress are complex. pulpal irritation. contraction stress occurs as a result of competition between strength of the bond with tooth structure and the contraction forces.6 GPa. and abutments have been examined using photoelastic analysis. contraction stress is one of the problems encountered with adhesive restorations and an important factor in the quality of marginal adaptation in resin composite restorations. flat enamel surfaces were prepared by grinding the teeth with wet No.. The monomer consists of a mixture of 40% Bis-GMA and 60% by weight of triethylene glycol dimethacrylate (TEGDMA). which is used for splinting of teeth and glazing of composite restorations. Shrinkage is not a problem when the resin composite shrinks on flat dentin surfaces.28 The bending elastic modulus was 3.1 Contraction shrinkage occurs when the distance between monomer molecules associated with van der Waals forces is decreased as a result of the formation of covalent bonds during monomer conversion.20 The goal of this article is to familiarize the clinician with the characteristics of contraction stress associated with polymerization shrinkage by visualizing the stresses associated with this invisible and complex phenomenon. Thus.27 The experimental paste-paste self-cured resin composite was prepared using the same filler and monomer as light-cured Palfique clear. posts. MATERIALS AND METHODS Extracted bovine incisors were stored in sterile water and frozen at –20°C for less than 1 month after removal of the pulpal soft tissue. if the shrinkage occurs when the resin composite is confined within a tooth cavity preparation. Studies examining contraction stress have been carried out using strain gauge.1 ± 0. Palfique clear is a commercial visible light-activated composite material. the distance change between molecules in fluid state and solid state induces contraction shrinkage.20 Photoelastic analysis is a technique for transforming internal stresses produced in materials into visible light patterns that indicate the locations and magnitudes of stresses. Polymerization is a repetitive intermolecular reaction whereby resin monomer molecules are converted into a network by covalent bonding to each other along polymer chains.19.8-µm spherical silicon dioxide that constitutes 60% of the weight of the composite. stresses generated within inlays. shrinkage occurs during polymerization of resin composite restorations as a function of the chemistry of the synthetic resins.21. Japan) and an experimental pastepaste self-cured resin composite.23–26 Modifications of traditional photoelastic methods using transparent resin composites and microscopes have been made.18 and photoelastic methods. and secondary caries.17. The bending moduli of each curing type (n = 6) were determined 30 minutes after the composite materials were packed 310 JOURNAL OF ESTHETIC DENTISTRY . relatively few studies have examined polymerization contraction stress of resin composite restoration directly. crowns.4 GPa.22 In the dental literature.3 ± 0. Tokuyama. However. was 5. There have been many studies evaluating the quality of marginal adaptation and associated microleakage.2–5 In clinical dentistry.

Calibration of the stress optical coefficient. Osaka. An impression of an acrylic model (5 mm × 2 mm × 2 mm) was made using silicon impression material. using methods described above.44 × 10–11 m2/N for Palfique clear and 2.0 mm and 2.0 mm in depth (Figure 1). Osaka. No marginal defects were observed between the preparation walls and the restoration when these model preparations were filled with the resin composite test materials. Experimental Design Because analysis of internal stresses can be performed only in transparent materials. and dried with air. The final composite model preparation was constructed by filling the impression with the appropriate composite material and light-cured for 240 seconds with a light-curing unit (Quick Light. Japan) was the commercial light-cured posterior composite material used in this study. Fabrication of Test Specimens Cavity preparations in bovine teeth were treated with 40% phosphoric acid solution (K-etchant.KINOMOTO ET AL into a brass mold (30 × 5 × 2. transparent resin composite restorations were placed in simulated cavity preparations in bovine teeth or resin composite models (Table 1).88%.30 Cavity preparations in the resin composite models were constructed from an Figure 1. Schematic illustrations of the prepared cavity in the resin composite model and the sectioned specimen for photoelastic analysis. the difference between self-cured (II-S) and light-cured (II-L) transparent composite restorations was evaluated in preparations in posterior composite models.19 was determined to be 1.20 The difference in elastic moduli between self-cured and light-cured composite materials was not statistically significant (Student’s t-test). standardized preparations were made with a diamond point under water cooling using a cavity preparation device. spray-washed.29 In bovine teeth. In preparations to be filled with light-cured composite material. Clearfil PhotoPosterior (Kuraray. In group I.5 GPa. 2000 311 . a dual-cured dentin bonding agent (Clearfil Photobond. The dimensions of each cavity preparation were 5.0 mm × 2. and its bending elastic modulus was 6. The volumetric polymerization shrinkage of this material was 1. Cavity Preparations in Models Butt-joint cavities simulating Class I preparations (box-shaped cavity preparations) were prepared in bovine teeth or models constructed from the resin composite materials described above. Japan). Stress distribution around cavity preparations prepared in light-cured transparent composite models and restored with posterior composite (III-P) or light-cured transparent composite material (III-L) was demonstrated in group III. lightcured transparent composite restorations were evaluated in extracted bovine teeth to simulate clinical conditions closely.1 ± 0. This preparation has a configuration factor (C-factor) of 3.5 mm) using a three-point bending test (span length 20 mm).8 as defined by Feilzer et al. applied to the preparation. performed as previously reported. In group II. Morita. Kuraray) for 30 seconds. Kuraray) was mixed according to manufacturer’s instructions. acrylic model. and exposed for 20 seconds with a light-curing unit VOLUME 12. NUMBER 6.07 × 10–11 m2/N for the experimental self-cured composite.

and light-cured composites in preparation models 7 7 7 To compare stresses around the preparations between posterior and transparent composites 5 5 *Commercial resin composite for restorative use. Buehler). SUMMARY OF EXPERIMENTAL DESIGN.3-µm alumina polishing agent (Alpha Micropolish Alumina No. †only self-cured transparent composite is an experimental material. Japan). Lake Bluff. Number Group Preparation Models Restorative Materials Rationale Underlying the Groups of Trial I II-S II-L III-P III-T Bovine tooth Light-cured posterior composite* Light-cured posterior composite Light-cured transparent composite‡ Light-cured transparent composite Light-cured transparent composite Self-cured transparent composite† Light-cured transparent composite Light-cured posterior composite Light-cured transparent composite To simulate clinical conditions closely To examine stresses in self. After 30 minutes. The free. Buehler. Kuraray) was applied. a patched image was prepared from two images set at 45 degrees relative to each other. Tokyo. because of the use of a plane polarized light source. Illinois. and lines of equal principal stress difference were constructed from the color prints of isochromatics. Japan) and a microscope cover slide glass. After these surface treatments. a self-cured dentin bonding agent (Clearfil New Bond. This process was necessary because isoclinics emerged as dark lines in the isochromatics. ‡commercial resin composite for splinting and glazing. For self-cured composite. using geometric construction.POLYMERIZATION CONTRACTION STRESS OF RESIN COMPOSITE RESTORATIONS IN A MODEL CLASS I CAVITY CONFIGURATION USING PHOTOELASTIC ANALYSIS TABLE 1. Each section was polished on linen with 0. Stress trajectories indicate the directions of the 312 JOURNAL OF ESTHETIC DENTISTRY . unbonded surface of each restoration was covered with a celluloid strip (GC. These images were immediately recorded on black-and-white and color negative films.0-mmthick sections perpendicular to the long axis of the restoration (see Figure 1). For light-cured composites. slight pressure was applied to extrude excess material. 2. Photoelastic Stress Analysis The internal residual stresses generated during polymerization of the restoration were determined using micro-photoelastic analysis. Colored isochromatic fringe patterns (isochromatics) were obtained using a reflective polarizing microscope (OPTIPHOT. (Quick Light). specimens were prepared for photoelastic analysis using a water-cooled diamond saw (Isomet. the restorations were stored in air at 37°C immediately after covering with a celluloid strip and cover slide. USA) to cut 2. Tokyo. using the stress-optic law. Isoclinic fringe lines (isoclinics) were obtained using a transmitted polarizing microscope (PHO. Stress trajectories were drawn from isoclinics.21. In preparations to be filled with self-cured transparent composite. the preparations were bulk-filled with the appropriate composite material. analysis of the fringe patterns inside the materials by the following method determined the principal stresses in the specimens.22 Isoclinics were sketched as the locus of points along which the principal stresses were parallel. placing a metal mirror under the specimens. Nikon). Although the crowded color fringe patterns indicated a high stress level at a free boundary condition. followed by immediate light exposure for 80 seconds and subsequent water storage at 37°C. Nikon. To obtain isochromatics without isoclinics.

KINOMOTO ET AL principal stresses at each point. stress change at a deeper part of the preparation. Two isotropic points on either side of the preparation walls are apparent near the enamel–dentin junctions. The isoclinics of groups II-S and II-L were similar and are presented in Figure 4. Torii M. RESULTS Figure 2. Nikon) at 10 times magnification. Stress trajectories constructed from isoclinics appeared to have similar patterns for both types of composite cure. Isochromatics and equal principal stress differences are shown in Figure 5.5% basic fuchsin) for 1 minute and examined for staining under a stereomicroscope (SMZ-10. J Dent 1998. The procedure of photoelastic analysis. internal stresses generated in the restorations were compared between self-cured (II-S) and light-cured (II-L) composite. Photoelastic analysis of polymerization contraction stresses in resin composite restorations. Principal stresses along stress trajectories at any given point in the restoration were determined using a graphic integration method. Isochromatics show the locus of points of constant difference between the maximum and minimum principal stresses. E = enamel. 2000 313 . (Reprinted from Kinomoto Y. Presence of the dye along the interface after immersion indicated gap formation and failure of the two materials to bond.1 mm from the wall (Figure 2). representative samples are presented in the results. Isoclinics (A) and stress trajectories of equivalent magnitude (B) in the bovine tooth preparation (group I). Data analysis was accomplished using linear regression. the internal stresses generated in this group were not large enough to examine in the present method. No dye was present between enamel and the composite. Fuchsin staining was observed between the dentinal wall and transparent composite restoration in every specimen prepared in this group. D = dentin. Test of Bond Integrity of Restorations To evaluate the integrity of the bond between transparent composite restoration and the preparation wall. Normal and shear stresses between the composite and the preparation wall were calculated using the direction and the magnitude of principal stresses in the resin composite restoration approximately 0. In group II. Isoclinics and stress trajectories for group I (bovine teeth) are shown in Figure 3. Because characteristic colored stress patterns were not apparent by reflective polarized light observation. Principal stress differences generated in light-cured composite were greater A B Because isoclinics and isochromatics obtained from every specimen were similar in each experimental group. with permission from Elsevier Science.) VOLUME 12. Two isotropic points indicated Figure 3. NUMBER 6. specimen cross-sections were placed in a dye solution (0.

isoclinics in light-cured composited. B. Torii M. Higher numbers represent greater stress difference values. Isoclinics and stress trajectories of equivalent magnitude in self-cured (group II-S) and light-cured (group II-L) composites.POLYMERIZATION CONTRACTION STRESS OF RESIN COMPOSITE RESTORATIONS IN A MODEL CLASS I CAVITY CONFIGURATION USING PHOTOELASTIC ANALYSIS A B C D Figure 4. Ebisu S. stress trajectories in self-cured composite. 27:383–389. were found near the internal line angle of the cavity preparation in both types A B C D Figure 5. 27:383–389. C. (Reprinted from Kinomoto Y. and D. J Dent 1999. normal stresses on the preparation floor were a function of distance from the center of the preparation floor defined by curves constructed using second-order polynomial regression.and light-cured composites. Simple regression indicated that normal and shear stresses at the lateral wall were a linear function of the distance from the cavosurface margin. Takeshige F. and D. Takeshige F. isoclinics in self-cured composite. Comparison of polymerization contraction stresses between self. isochromatics in light-cured composite. stress trajectories in light-cured composite. Ebisu S. A. By contrast. C.and light-cured composites. Normal and shear stresses generated at the interface between the composite restoration and the preparation walls are shown in Figure 6. J Dent 1999. which are normal stresses.) 314 JOURNAL OF ESTHETIC DENTISTRY . lines of equal principal stress difference in self-cured composite. B. a patched image was prepared from two images set at 45 degrees relative to each other. Torii M. Comparison of polymerization contraction stresses between self. All data obtained were plotted. To obtain isochromatics without isoclinics. even though they were cured using two different methods. A. The largest stresses. Stress patterns generated along the preparation walls were similar for both types of composites. with permission from Elsevier Science. Isochromatics and lines of equal principal stress difference in self-cured (group II-S) and light-cured (group II-L) composites. with permission from Elsevier Science. Solid lines are maximum principal stresses and dotted lines are minimum principal stresses along lines of equivalent stress trajectories.) than in self-cured material. lines of equal principal stress difference in light-cured composite. Isochromatics in self-cured composite. (Reprinted from Kinomoto Y.

KINOMOTO ET AL of composite.906). the distributions and magnitudes of internal stresses generated in and around resin composite restorations resulting from polymerization shrinkage were examined using micro-photoelastic analysis. it is unlikely that the distribution of the internal stresses was affected.227x2 + 0. Ebisu S. The isochromatic pictures indicate more fringes in the model preparations in group III-T than in group III-P.782 (r = –0. Comparison of polymerization contraction stresses between self. neither light attenuation through the material nor the distribution of the degree of cure was considered in the analysis. Interfacial normal (solid symbols) and shear (hollow symbols) stresses generated between the transparent composite and the preparation wall. In group I.762 (r2 = 0. comparison of the internal stresses resulting from polymerization shrinkage in the different cavity preparation conditions may be considered a reflection of the stresses generated under clinical conditions.944).984). 27:383–389. In this group.25 mm from the internal line angle to avoid an edge effect.866).766x + 10. with permission from Elsevier Science. model preparations were made in bovine teeth to simulate clinical conditions more closely. In selfcured composite (group II-S): lateral wall (AB)—normal stresses (stresses perpendicular to the wall. Torii M. top surface) y = –3. In group III. DISCUSSION In this investigation. toward the unbonded. 2000 315 . pulling restoration toward the restoration center) y = 5. preparation floor (BC)—normal stresses (stresses pulling restoration up. preparation floor (BC)—normal stresses y = 17. top surface) y = 7. Therefore. It is assumed that the maximum contraction stress occurs between the longitudinal walls of the prepared cavity.740x + 2. because the test composite was transparent after polymerization.107 (r2= 0. The elastic modulus of the posterior composite falls between those of human enamel and dentin.796 (r = –0. the transparent composites have lower viscosity than restorative composites and may have higher flow capacity in the gel stage. stresses generated around the preparations were compared between posterior composite (III-P) and light-cured transparent composite (III-T). the bond between the VOLUME 12. NUMBER 6.456x2 – 0. In light-cured composite (group II-L): lateral wall (AB)—normal stresses y = 8. pulling restoration upward.34 Although these factors may have some influence on the interpretation of the stress analysis. Isoclinics and stress trajectories in the preparation models were similar in these two materials (Figure 7). The stress profile obtained from analysis of this preparation type should closely approximate that generated between the opposing walls of a Class I restoration. shear stresses (stresses parallel to the wall.216x + 7. Many assumptions and simplifications underlie this type of stress analysis. away from the preparation floor toward the unbonded. These stresses were defined at a point 0. A model preparation sys- Figure 6.919). J Dent 1999.918).556x + 6.31–33 Finally. For simplicity.165 (r = 0.298x + 12. (Reprinted from Kinomoto Y. Furthermore.and light-cured composites. particularly interactions of the resin material with enamel and dentin. reaching 23 MPa in light-cured composite and 12 MPa in self-cured composite.074x + 6. a rectangular parallelepiped and an axisymmetric preparation were used to analyze internal stress development.) tem consisting of posterior composite material was employed to obtain sufficient bonding between the restoration and the preparation walls. Takeshige F. Square symbols are data in self-cured composite and circle symbols are data in light-cured composite.124 (r = 0. shear stresses y = –4.

Higher numbers represent greater stress difference values. and lines of equal principal stress difference with the posterior composite (group III-P) and the transparent composite (group III-T) in the transparent preparation models. stress trajectories in group III-T. E. isochromatics in group III-T. 316 JOURNAL OF ESTHETIC DENTISTRY . but the bond between enamel and composite was maintained. lines of equal principal stress difference in group IIIT.and light-cured composites were similar. This gap played an important role in stress relief and increased the flow capacity of the composite during polymerization. A. and F. with the light-cured group demonstrating higher stress values. To obtain isochromatics without isoclinics. but the stress magnitudes were different. A B C D E F Figure 7. Solid lines connect equivalent maximum principal stresses and dotted lines connect equivalent minimum principal stresses in stress trajectories. B. a patched image was prepared from two images set at 45 degrees relative to each other. C. Because internal stress was reduced in the tooth preparation as a result of gap formation. An isochromatic color fringe.POLYMERIZATION CONTRACTION STRESS OF RESIN COMPOSITE RESTORATIONS IN A MODEL CLASS I CAVITY CONFIGURATION USING PHOTOELASTIC ANALYSIS dentinal wall and the transparent composite failed. the composite model preparation system was used for group II to explore the contraction stress generated when composite polymerized under confined conditions. The rationale underlying this combination was to compare stresses around the preparations between the posterior composite and the transparent composite. was not clearly observed in these specimens. lines of equal principal stress difference in group III-P. Stress trajectories in group III-P. indicating the difference of principal stresses. D. probably because the internal stress was reduced. Comparison between groups II-S and II-L indicated that the stress distributions in the self. Stress trajectories. since the free surface of the restoration was presented not only at the outer surface but also at the gap along the dentinal wall. owing to the development of the gap between the dentinal wall and resin composite. isochromatics in group III-P. isochromatics.

The polymerization rate for these two types of composites is obviously different. Considering the low elastic modulus of the transparent composite.3. It has not been sufficiently demonstrated that the reduction of polymerization rate achieved by these low-intensity methods contributes significantly to stress reduction. indicating greater stress development. the stress generated in the clinical condition may be larger than that determined in the present study. Studies focusing on polymerization rate indicate a reduction in the width and extension of the marginal gaps in light-cured composite restorations at reduced rate. In group II-L. intact bond. reaching values as high as 23 MPa. the larger normal stress occurred around the internal line angle.42 Compared to a curing duration of several minutes for a self-cured composite. although the data analyzed internal stresses rather than shrinkage vectors.16 shrinkage vectors were oriented toward the deeper.and lightcured composites. They may also be related to the fact that different analytic methods were used to determine stress.39 The light exposure method termed “stepped light intensity” or “soft- start polymerization” has been advocated for composite cure. there is not enough time for the resin to flow. whereas selfcured composite takes several minutes. it takes only 40 seconds for a 2-mm-thick layer of light-cured composite to cure.16 Results of the present study are consistent with this report. Consistent with reports by Versluis et al. The magnitude of stress difference between self.36 These conflicting results may be attributed to the several assumptions and simplifications implicit in the model system for stress analysis used in this study. However. reported little difference in shrinkage vector patterns between self. the light-cured composite. NUMBER 6. as well as the larger volumetric polymerization shrinkage contributing to reduce internal stresses. whereas shrinkage occurs toward the center of the composite within self-cured composites. Further research regarding the light-exposure method should be performed to clarify the benefit of this method. but the magnitude of stress. Versluis et al.KINOMOTO ET AL It was generally agreed that lightcured composites shrink toward the direction of the light source. 2000 317 . In a clinical situation. This difference is likely the VOLUME 12. not toward the light source in the light-cured composite. the first low-intensity step is usually 10 or 20 seconds in duration. resulting in stress concentration at the internal line angles. Stresses generated along the preparation lateral wall were not uniformly distributed. the color fringe patterns. Analysis of stress distribution differences between the transparent and posterior composite in group III indicated that both groups were similar. restricted margin.40.and light-cured composites has been observed previously. The fringe of the transparent restoration (group III-T) is slightly greater than that of the posterior composite restoration (group III-P). and gap formation) and not by the different modes of curing. The opposite lateral walls resist forces generated by the contraction of the restoration. The results of the present study suggest that it may be reasonable to adjust the polymerization rate so that it is slower during the initial step and faster for the remainder of the process. was different. this time seems to be of short duration. Because lightcured composite exists in a gel stage only for a moment.41 This method uses an initial lowoutput light intensity followed by a greater intensity. The magnitude of normal tensile stress obtained in this study was lower than that reported by Rees and Jacobsen and Mahler14. using finite element analysis. It is concluded that stress distribution is predominantly controlled by boundary conditions (such as free surface.37 The main reason for this magnitude difference is that the polymerization rate of light-cured composite is greater than that of self-cured material.35 and larger than that estimated by Bowen and colleagues and Davidson and De Gee. with the greatest stresses occurring within deeper locations.38.

1941:144–349. J Am Dent Assoc 1983. and Dr. Experimental stress analysis of dental restorations. Kinomoto Y. Rees JS. Variability in microleakage observed in a total-etch wet-bonding technique under different handling conditions. 23. Yuasa. Carvalho RM. J Dent Res 1995. S. Ebisu S. Katona TR. Davidson CL. 63:146–148. Davidson CL. 15. Dent Mater J 1994. 63:1396–1399. LePeak PJ. for providing the experimen- 318 JOURNAL OF ESTHETIC DENTISTRY .and light-curing composites.L. Pang KM. 10. Stress generated by luting resins during cementation of composite and ceramic inlays.. clinicians must understand concepts underlying polymerization contraction stress and realize that the quality of composite resin restorations depends on the successful management of this stress. Also. Frocht MM. Effect of cavity depth and application technique on marginal adaptation of resins in dentin cavities. Composite restorative resins. 8. Simpson M. Adhesion bonding of various materials to hard tooth tissues: forces developing in composite materials during hardening. 2. Adhesion and microleakage tests of a new dentin bonding system. J Dent Res 1986. Asmussen E. 69:1240–1243. Winkler MM. Relaxation of polymerization contraction stresses by flow in dental composites. CONCLUSION tal transparent resin composite material. 21. Craig RG. Kuske A. Photoelasticity. London: John Wiley & Sons. De Gee AJ. Kawakami M. 22. J Prosthet Dent 1967. Feilzer A. 19:312–316. Oper Dent 1996. J Oral Rehabil 1992. 17:277–291. 1974:105–389. Although there have been attempts designed to reduce this stress in composite restorations. 10th Ed. Dent Mater 1992. 20. few methods have been shown to be effective. Nemoto K. Tay ER. 7. Sakaguchi RL. J Dent Res 1994. Japan. 106:475–477. Contraction stress and marginal adaptation of composite restorations in dentinal cavity. de Gee AJ. Bunczak MA. Photoelastic stress analysis. The effect of adhesive thickness on polymerization contraction stress of composite. Peyton FA. Pereira JC. D. 5. 35:191–195. Shimokobe H. 9. Philadelphia: WB Saunders. Stress analysis of a bulk-filling Class V light-cured composite restoration. Composition versus wall-to-wall polymerization contraction. Sasik CT. et al. Anusavice KJ. 8:37–41. El-Ebrashi K. Contraction stresses of composite resin filling materials. J Dent Res 1984. Acta Odontol Scand 1975. Kinomoto Y. 12. 16. 18. Davidson CL. 17. Greater deformation of the preparation model generated the larger fringe patterns. Hansen EK. Tokuyama. Relationship between bond strength and microleakage measured in the same Class I restorations. J Dent Res 2000. J Dent Res 1990. Rapson JE. 3. the results show that contraction stress results from competition between bond strength of the composite to the preparation walls (tooth structure) and the contraction forces associated with polymerization of the restoration itself. Torii M. 13:19–24. et al. Uno S. 1. 19:115–122. Strain gauge method for measuring polymerization contraction of composite resins. 33:337–344. Bowen RL. Contraction stress is an undesirable and inevitable characteristic of adhesive restorations encountered in clinical dentistry that may compromise the success of restorations. 79:812–817. Versluis A. J Dent 1991. DISCLOSURE AND ACKNOWLEDGMENTS The authors wish to thank Mr. Gjerdet NR. 14. Acta Odontol Scand 1977. J Dent 1998. A review of polymerization contraction: the influence of stress development versus stress relief. Yoshiyama M. 77:1435–1445. Condon JR. REFERENCES 11. 27:383–389. 21:17–24. The competition between the composite–dentin bond strength and the polymerization contraction stress. Takeshige F. Comparison of polymerization contraction stresses between self. Prati C. Carnes. Staninec M. Tao L. Tantbirojn D. Torii M. Hegdahl T. University of Texas Health Science Center at San Antonio. Two-dimensional photoelastic stress analysis of inlays. Pashley DH. Complete marginal seal of Class V resin composite restorations effected by increased flexibility. Part 1. 9:204–208. 4. 1996:211–235. London: John Wiley & Sons. 19. Jacobsen PH. Robertson G. Phillips’ science of dental materials. 13. Choi KK. Tokuyama Co. 65:1319–1321.POLYMERIZATION CONTRACTION STRESS OF RESIN COMPOSITE RESTORATIONS IN A MODEL CLASS I CAVITY CONFIGURATION USING PHOTOELASTIC ANALYSIS result of the larger polymerization shrinkage of the transparent composite compared to that of the posterior material. J Dent 1999. Do dental composites always shrink toward the light? J Dent Res 1998. 6. Ferracane JL. 26:165–171. J Dent Res 1984. for reviewing and proofing this manuscript. Therefore. Gwinnett AJ. Mitchem J. Dent Mater 1993. Pashley DH. 74:1168–1178. The results indicate that distribution of contraction stress generated within the transparent composite is similar to that generated within the clinical posterior material. 73:1470–1477. Photoelastic analysis of polymerization contraction stresses in resin composite restorations. Douglas WH. Kemp-Scholte CM.

J Dent 2000. J Dent Res 1990. Feilzer AJ. Davidson CL. Koran P. J Esthet Dent 2000. 11:17–22. 19:403–410. Ciucchi B. Feilzer AJ. 30. J Dent Res 1994. 2000 319 . and gold. Caputo AA. 66:1636–1639. Mahler DB. 27. Relaxation of polymerization contraction stresses by flow in dental composites. 35. PhD. et al. and degree of polymerization. Visco-elastic parameters of dental restorative materials during setting. Dent Mater J 1987. Dent Mater 1993. Davidson CL. Sano H. 1-8 Yamadaoka. 25:321–330. Braem M. Ebisu S. A new electrical method for detecting marginal leakage of in vitro resin restorations. Dent Mater J 1991. et al. Johnson DW. Iwami Y. J Prosthet Dent 1990. DDS. Feilzer AJ. 28:241–247. 42. Davidson CL. Rueggeberg FA.osaka-u. dental cements. Stress distribution surrounding endodontic posts. 28. Osaka 565-0871. Japan. J Dent Res 1984. Mehl A. Scand J Dent Res 1991. 73:1205–1211. 41. Relationship between the velocity of polymerization and adaptation to dentin cavity wall of light-cured composite. J Dent Res 1961. 37. Burns DR. Dent Mater 1992. 32. Am J Dent 1998. et al. Inokoshi S. 10:38–45. 99:440–444. Contrivance of bubble-less mixing technique for paste-paste type composite resins. Tensile properties of mineralized and demineralized human and bovine dentin.KINOMOTO ET AL 24. 28:1266–1278. Effect of stepped light intensity on polymerization force and conversion in a photoactivated composite. Suita. 25. 9:2–5. adhesion.” J Dent 1997.ac. 40. 6:32–37. Compressive properties of enamel. Osaka University Graduate School of Dentistry. Hosoda H. Yamada T. Effect of sequential versus continuous irradiation of a lightcured resin composite on shrinkage. 12:23–32.jp ©2000 BC Decker Inc VOLUME 12. 39. A classification of dental composites according to their morphological and mechanical characteristics. 64:412–418. De Gee AJ. Asmussen E. 31. Craig RG. 8:310–319. 40:936–945. Yamamoto Y. e-mail: kinomoto@dent. J Dent Res 1974. Kato H. Ui T. Kurschner R. J Dent Res 2000. Setting stress in composite resin in relation to configuration of the restoration. Hickel R. Letter to the editor. Marginal adaptation of a restorative resin polymerized at reduced rate. Krause WR. Craig RG. Davidson CL. Willems G. Burns DA. Peyton FA. Jpn J Conserv Dent 1985. Quintessence Int 1988. et al. J Dent Res 1987. 33. Department of Restorative Dentistry and Endodontology. Standlee JP. Stress analysis of three marginal configuration of full posterior crowns by three-dimensional photoelasticity. 63:146–148. Takeshige F. Kunzelmann KH. Douglas HB. 34. Load transfer by fixed partial dentures with three abutments. 79:818–823. De Gee AJ. 36. The relationship between polymerization shrinkage measured by a modified dilatometer and the inorganic filler content of light-cured composites. Uno S. Setting stresses in composites for two different curing modes. De Gee AJ. 69:913. Boyer DB. Bouschlicher MB. 38. Lambrechts P. 29. Farah JW. De Gee AJ. Dauvillier BS. 26. Iga M. Matthews WG. viscosity. 53:1219–1225. Physical properties and gap formation of light-cured composites with and without “soft-start polymerization. NUMBER 6. Reprint requests: Yoshifumi Kinomoto.

8 and 4. Connecticut). Results: At 0 mm the mean (± SD) power density from the two standard light guides was 743 ± 6. Halifax. Photographs showed that the light dispersed at a wider angle from the Turbo light guides than from the standard light guide. Therefore. Malmö. PRICE. Halifax. Nova Scotia. a polynomial regression line was fitted.0001). Dental School. K-S p-value < . The two estimated polynomials intersected at 3. LONEY. PHD† MARY SEDAROUS. Dalhousie University.1 mW/cm2. To determine the effect of distance on power density. Canada # Professor. FDS RCS (Edin)* TORE DÉRAND. At 6 mm the power density from the standard light guides fell to 372 mW/cm2 (50% of the original value) and the power density from the Turbo light guides fell to 263 mW/cm2 (23% of the original value). 2000) *Associate Professor. Dalhousie University.66 mm. Sweden ‡ Research Assistant. Community Health and Epidemiology. Canada † Professor and Head. DMD. Photographs of the light dispersion from each tip were also taken. beyond 5 mm away from the tip of the light guide.0246. Faculty of Dentistry. CLINICAL SIGNIFICANCE Because the design of the light guide affects light dispersion. the power density decreased. Department of Oral Technology and Dental Materials Science. Danbury. Department of Clinical Dental Sciences. As the distance from the tip of the light-guide tip increased. Halifax. manufacturers should report the power density at the tip of the light guide and 6 mm from the tip of the light guide (J Esthet Dent 12:320–327. MS. Dalhousie University. Nova Scotia. Nova Scotia. Halifax. Department of Dental Clinical Sciences. DDS. DDS. PHD§ ROBERT W. MS# ABSTRACT Purpose: This study determined the effect of distance on the power density from standard and Turbo light guides (Demetron/Kerr. Canada 320 JOURNAL OF ESTHETIC DENTISTRY . the standard light guides gave higher power density readings than the Turbo light guides. Both the K-S statistic and the WR sum test indicated that the distribution of light intensities was significantly different from the two light guides (WR p-value . Canada § Biostatistician. and the 95% prediction intervals intersected at about 2. but the rate of decrease was greater from the Turbo light guides than from the standard light guides. Nova Scotia. Faculty of Dentistry.8 mm.1 mW/cm2 and from the four Turbo light guides was 1128 ± 22. Materials and Methods: Power density was measured from 0 to 10 mm away from the tip of standard 8-mm curved light guides and 13/8-mm Turbo curved light guides. Malmö University. The Kolmogorov-Smirnov (K-S) statistic and the Wilcoxon rank sum (WR) tests were used to determine if there was a difference in the rate at which the power density decreased for the standard and Turbo light guides as the distance from the tip increased.Effect of Distance on the Power Density from Two Light Guides RICHARD B. Faculty of Dentistry. BSc‡ PANTELIS ANDREOU. Dalhousie University.

9. The individual fiber optic bundles in the Turbo light guide have a larger diameter at the proximal entrance and have a narrower diameter at the distal exit (Figure 1).22 This has been attributed to several factors.1–4 increase its cytotoxicity.7.26 Other developments include high-intensity plasma arc (PAC) lights.PRICE ET AL T he light energy density received by a resin composite from a curing light can be calculated by multiplying the power density at the surface of the resin composite by the duration of light irradiation.20 This distance adversely affects the power density received by the resin composite at the floor of the proximal box. deterioration of the reflector and filter. and malfunction of photoconductive fibers in the light guide. This compares to an 8-mm proximal entrance aperture for a standard light guide with an 8-mm distal exit aperture diameter. manufacturers have raised the power output from their light sources. the power density had fallen to 61% of the original power density. including fluctuations in line voltage.21. and this boosts the power density output from the Turbo light guide. The Turbo light guide has been reported to increase the degree of conversion at the bottom of 2 mm of resin composite and may cure resin composite 48% faster than when an 11-mm conventional tip on the same curing light is used. The Turbo light guide has an 8-mm diameter distal exit aper- ture but has a larger (13-mm diameter) proximal aperture where the light enters the light guide. This concentration provides more fiber optic bundles per square millimeter at the distal exit aperture of the Turbo light guide compared with the standard light guide of the same size.6–11 decrease its dynamic elastic modulus. closest to the light guide.5 reduce its ultimate hardness. Surveys have shown that many curing lights used by dentists do not provide adequate energy output.25.23.14 Light energy is absorbed as the light passes through air.13 It also may leave uncured bonding resin at the bottom of the restoration. NUMBER 6. Westlake Village. If the resin composite restoration does not receive sufficient energy density this may reduce degree of conversion in the monomer. For example it has been reported that the distance between the cusp tip and the floor of the interproximal box can exceed 7 mm.19 Although it is recommended to place the light tip as close as possible to the surface of the resin composite. Inc.27 However.7. clinically this is often difficult to achieve. it has been reported that the depth of polymerization for three composites was less when the Apollo 95E PAC light was used for 3 seconds compared to when a conven- VOLUME 12. 6 mm away from the tip the power density had fallen to 47% of the original power density. receiving a lower energy density than the top increment. Connecticut) to boost the power density.4.12 and increase wear and breakdown at the margins. effect of disinfection procedures on light transmission through the curing-light guide. One option uses the Turbo light guide (Demetron/Kerr. Prati et al reported that 2 mm away from the light guide. To increase depth of cure and decrease the irradiation time. California) are equivalent to 45 seconds exposure with a conventional quartz tungsten halogen (QTH) light with a power density of at least 500 mW/cm2. Danbury.15 The power density recorded by hand-held radiometers can be used to predict the curing efficiency of a dental curing light.1. If the restoration is built up incrementally this results in the first increment. 2000 321 .15–19 Pires et al reported that 2 mm away from the tip of the light guide the power density had fallen to 78% of the original power density. One manufacturer claims that 3 seconds of light exposure with their Apollo 95E PAC light (Dental/Medical Diagnostic Systems.. 6 mm away the power density had fallen to 23% of the original power density. light-guide wear or contamination. age of the bulb.17 In contrast. resulting in a weak bond to the tooth. furthest away from the light source.24 Regular checks for any deterioration of the light-curing unit are recommended using these radiometers to ensure that the curing light produces a power density greater than 300 mW/cm2.

30 The power density is usually greatest at the tip of the light guide. MATERIALS AND METHODS Figure 1. The power density outputs from the light guides were all measured using a Cure Rite digital radiometer (Dentsply/Caulk. Left.16 Additionally. the purpose of this study was to investigate whether the Turbo light guide had a focusing effect on the light output and to determine the effect of distance on One Optilux 500 curing light (serial #5808041 Demetron/Kerr) with an 80 W OptiBulb was used to examine the power density from two standard 8-mm curved light guides (model #20941 Demetron/Kerr) and two 13/8-mm Turbo+ curved light guides (model #952213 Demetron/Kerr). Delaware) with a new battery. The power density from this light guide reached a maximum value at 1 mm from the tip of the light guide and did not fall below the zero distance power density until 3 mm away from the tip of the light guide.31 This design difference may also affect the relation between distance and power density. However. The entrance and exit apertures showing 1. but the design of the light guide may alter the relation between power density and distance from the lightguide tip. it has been reported that a light-guide tip with a convex profile focused the light output. After a pilot project using two Turbo light guides showed a marked decrease in power density as the distance increased. exit aperture. Since the design of the Turbo light guide is different from a standard light guide. Milford.28 Increased microleakage along the dentin margins has also been reported when using a PAC light compared with using a QTH light and 20 seconds irradiation with one PAC light did not polymerize composite as well as when conventional QTH lights were used for 40 seconds.EFFECT OF DISTANCE ON THE POWER DENSITY FROM TWO LIGHT GUIDES the power density (mW/cm2) from standard and Turbo light guides. right. the design of some light guides made with random fiber optic filaments has been shown to produce more even light output across the surface of the light guide compared with light guides manufactured using graded fibers.17. The hypothesis was that as the distance increased.6 times and 6. The Cure Rite radiometer has been shown to be within 2% of a laboratory grade power meter when measuring the power density from a 7. tional QTH light source was used for 40 seconds.4 times views of the fiber optic filaments in the 13/8-mm Turbo light guide.5-mm diameter light guide. entrance aperture.33 and it provides a digital output in 1 mW/cm2 increments in place of the analog meter found on some radiometers.29. The power density (mW/cm2) was first measured at 322 JOURNAL OF ESTHETIC DENTISTRY .32 The Cure Rite has been used by other researchers. the Turbo light guides would always deliver a greater power density than the standard light guide. one more 13/8-mm Turbo+ curved light guide (model #952213) and a previous model of 13/8-mm Turbo curved light guide (model #21020 Demetron/Kerr) were also included in the study.

The curing light was turned on for a period of 20 seconds before taking the radiometer reading. The tip of an 8-mm light guide was positioned over the cusp tip and the distances from the tip of the light guide to the pulpal and gingival floors of the preparations were measured using calipers. The entire sequence of measurements over the 10-mm distance was repeated five times starting from 0 mm for each light guide. a polynomial regression line was fitted. North Carolina). 2000 323 . The mean (± SD) distance from the cusp tip to the pulpal floor was 4. For both light guides the Kolmogorov-Smirnov (K-S) statistic and the Wilcoxon rank sum tests were used to determine whether there was a difference in the rate at which the power density decreased as the distance increased (SAS/STAT Software V8. NUMBER 6.0. and then at 0. Mean distances from cusp tip to pulpal and gingival floors. The curing light was allowed to cool between measurements until the fan in the curing light had stopped. VOLUME 12. The preparations were similar in size and shape and were representative of a typical deep Class II preparation. The radiometer and the curing light were clamped in a jig that ensured that the tip of the light guide was always parallel to and directly over the radiometer aperture as the light guide was moved away from the radiometer. and there were no pulpal exposures on the pulpal floor. Cary. RESULTS At 0 mm from the tip of the light guide the mean (± SD) power densities from five measurements from Figure 2.5 mm and to the gingival floor was 6. To determine over what distance it would be clinically relevant to measure power density. Therefore.6 ± 0. To determine the functional form of the dependence of intensity on distance. photographs were taken of the light dispersing across a piece of black paper placed midway across the diameter of the tip of the light guides. A millimeter scale was included in the photographs.3 ± 0. 10 Class II preparations were cut by one experienced dentist in extracted human molar teeth of a similar size and cusp form. The gingival box extended just beyond the cementoenamel junction. To obtain a visual impression of how the light dispersed from the standard and Turbo light guides.PRICE ET AL 0 mm with the light guide gently touching the radiometer.5-mm increments in air up to 10 mm away from the radiometer. which were taken under standardized lighting conditions and magnification. The mean power-density readings from the standard and Turbo light guides were plotted to show where the power density outputs from the light guides intersected. SAS Institute Inc.7 mm (Figure 2). the light guides and the distance between the radiometer and the tip of the light guide were the only variables.

at distances greater than 5 mm away from the tip.995.8 mm) the sta- tistical power to determine whether an observation from the Turbo group would be greater than from the standard group declined from 95% to 5%.1 944 ± 35. there was no significant difference between power densities from the Turbo and the Turbo+ light guides (K-S p-value = .0 573 ± 3.6 68 ± 10.2 782 ± 24.2 351 ± 22. TABLE 1. the standard light guide delivered a greater power density than the Turbo light guide.3 mW/cm2.3 263 ± 25.1 mW/cm2.6. and from the three Turbo+ light guides. The images of the light exiting from the tips of the light guides showed that as the distance from the tip increased the light diffused at a wider angle of about 54 degrees from the Turbo light guides than about 25 degrees from the standard light guide (Figure 4). The 95% prediction intervals for the two polynomials intersected at approximately 2. the data from the Turbo and Turbo+ light guides were combined. Kruskal-Wallis.EFFECT OF DISTANCE ON THE POWER DENSITY FROM TWO LIGHT GUIDES two standard light guides were 747 ± 5. . the power densities were 1159 ± 2.0 194 ± 17. Therefore.0001). The two estimated polynomials intersected at 3.3 mW/cm2. Therefore. respectively. 1110 ± 1. although initially all the Turbo light guides gave greater power-density readings than the standard light guides. Mean Power Density Standard Tip Distance (mm) mW/cm2 ± SD Percentage of Original Power Turbo Tip mW/cm2 ± SD % Original Power 0 1 2 3 4 5 6 7 8 9 10 743 ± 6. and the mean power density from the two standard light guides was 743 ± 6.999.1 mW/cm2 and that of the four Turbo light guides was 1128 ± 22.7 470 ± 29.66 mm from the tip of the light guide.3243.2 185 ± 1. The power density decreased as the distance increased. The effect of the distance from the light-guide tip on the power density is shown in Table 1. EFFECT OF DISTANCE FROM THE STANDARD AND TURBO LIGHT GUIDES TO THE RADIOMETER ON POWER DENSITY. the relation between power density and distance was a second degree polynomial equation with an adjusted R2 = 0.9.5427).1 323 ± 2. For the standard light guide. which also shows the percentage decrease from the original power density. but for all four Turbo light guides its rate of decline was greater than that from the standard light guides.6 mW/cm2. The inverse relation between power density and distance is shown in Figure 3. From the one Turbo light guide.1 and 738 ± 3. For the Turbo light guide.1 681 ± 6. Both the K-S statistic and the Wilcoxon rank sum test showed that the distribution of the power densities over the distance interval (0 to 10 mm away from the tip of the light guide) was significantly different for the standard and Turbo light guides (Wilcoxon p-value = .0 372 ± 4. the relation between power density and distance was a third degree polynomial equation with an adjusted R2 = 0.8 and 4.7 100 92 85 77 66 59 50 44 37 30 25 1128 ± 22. the power density was 1107 ± 8.2 633 ± 6.4 272 ± 3.2 101 ± 15.0246.3 435 ± 3. respectively.6 613 ± 24.1 100 84 69 54 42 31 23 17 13 9 6 324 JOURNAL OF ESTHETIC DENTISTRY .8–4.8 mm from the tip of the light guide (see Figure 3).1 225 ± 5. Within this distance interval (2. Although the Turbo+ light guides gave slightly greater mean power densities. K-S p-value < . and 1136 ± 2.5 142 ± 16.0 489 ± 3.

Therefore. Light diffusion from a Turbo+.8 and 4. 2000 325 .8 mm away in air from the light tip. The power density outputs from three Turbo+ light guides and the one Turbo light guide all showed that as the distance increased the radiometer did not always receive more light energy when the Turbo light guide was used. the experiment was repeated using two standard 8-mm curved light guides. Effect of distance on power density for the standard and Turbo light guides. one Turbo curved light guide. At a distance of between 2. which then reacts with the carbon-to-carbon double bond of a monomer molecule and initiates polymerization. compared with the standard light guide. light energy than the standard light guide was rejected. at distances greater than 4. VOLUME 12. more photons hit the camphorquinone photoinitiator molecules within the resin and more photoinitiator molecules are activated and raised to the “triplet” or excited state. In this excited state. Therefore. camphorquinone collides with an amine.PRICE ET AL DISCUSSION The present experiment supports a previous study that reported that the design of the light guide may alter the relation between power density and distance from the light guide tip.16 To ensure that the results were not attributable to a faulty Turbo or standard light guide. the power density from the standard light guide was greater than that from the Turbo light guide. and a free radical is formed. the hypothesis that as the distance increased the Turbo light guides would always deliver more Figure 3. and standard light guides. this light energy diffused at a much greater rate than from the standard light guide (see Figures 3 and 4). NUMBER 6. and three Turbo+ curved light guides.34 If insufficient camphorquinone molecules Figure 4. When more intense light energy is used to cure resin composites.8 mm. the statistical power to determine if the Turbo light guide produced a greater power density than the standard light guide fell from 95% to 5%. Although initially the radiometer received more light energy when the Turbo light guide was used. Turbo.

to simulate a typical clinical distance from the cusp tip to the floor of a proximal box.25 Different results might have been obtained if the tip had been placed 6 mm away from the resin composite. Davis HC. Oper Dent 1994. Hirasawa T. an 8-mm standard light guide delivered a greater power density than the 13/8-mm Turbo light guide. A 6-mm space may often be encountered clinically between the surface of the resin composite or a light-activated bleaching material and the tip of the light guide. Goltea. DISCLOSURE AND ACKNOWLEDGMENTS The curing light and light guides were kindly donated by the Kerr Corporation. Beyond 5 mm from the tip of the light guide. Effect of light intensity on polymerization of light-cured composite resins. However.EFFECT OF DISTANCE ON THE POWER DENSITY FROM TWO LIGHT GUIDES are raised to the triplet or activated state.g. the 8-mm standard light guide delivered 37% more light energy than the 13/8-mm Turbo light guide. Curtis JW Jr. 400 mW/cm2 will fall to 200 mW/cm2 at 6 mm away from the tip of the standard light guide). The study was financially supported by the Dalhousie University Alumni Oral Health Research Fund. This result complemented a previous study that reported that using the Turbo light guide increased the degree of conversion of resin composite. especially if the initial power density from the curing light is low (e. Danbury. This may adversely affect the degree of conversion and physical properties of the resin composite or the effectiveness of the bleaching material. the 13/8-mm Turbo light guide increased the power density output by 52% compared with the 8-mm standard light guide.35 Using the same Optilux 500 light source.3 ± 0. 3.1 mW/cm2 power density from the 8-mm standard light guide. 19:26–32. Factors affecting cure at depths within light-activated resin composites.19 This was a greater reduction than that found in the present study. 326 JOURNAL OF ESTHETIC DENTISTRY . Rueggeberg FA. Effect of light intensity and exposure duration on cure of resin composite. Nomoto R. but the tip of the light guide was close to the resin composite. Vougiouklakis GJ. reported that 6 mm away from the tip the power density was 47% of the original power density. 2.20 This 6-mm space causes a 50% reduction in power density from the standard light guide and a 77% reduction from the Turbo light guide. 6:91–95. Using a SureCure radiometer (Ho Dental Co. 3. REFERENCES 1. At 10 mm from the tip of the light guide. Caputo AA. The mean distance of 6. which used a Cure Rite radiometer and an Optilux 401 curing light with an 11-mm light guide. Caughman WF.7 mm from the cusp tip to the gingival floor of a proximal box was similar to the 7-mm distance previously reported. Degree of double-bond conversion in light-cured composites. California).17 This was similar to the present study. CONCLUSIONS 1.3. it has been reported that 6 mm away from the tip the power density falls to 23% of the original power density. another study. This means that there may be many clinical situations in which use of the standard light guide rather than the Turbo light guide would be advisable. Dent Mater 1987. the 8-mm Turbo light guide boosted the power density output by 52% (1128 ± 22. Am J Dent 1993. 2. 4. Caughman WF. Rueggeberg FA. Uchida K. Connecticut.34 The power densities from the three light guides were well above those found from curing lights in many dental offices. Thus.9 and they were all more than the minimum 300 to 400 mW/cm2 power density values previously reported as necessary to polymerize resin composite. Curtis JW Jr.. 13:198–205. the power density from the curing light affects the extent and rate of the polymerization reaction. At 0 mm from the tip of the light guide. in which at 6 mm there was a 50% reduction in power density using the 8-mm standard light guide (see Table 1).1 mW/cm2) compared with the 743 ± 6. Eliades GC. USA. 3:19–25. the resin composite is not adequately polymerized. Dent Mater J 1994.

23. Light-curing unit effectiveness assessed by dental radiometers. O’Doherty DM. Abraham D. Swift EJ Jr. 76:1508–1516. Clinical Research Associates Newsletter 2000. Apollo 95E 1-3 Second Curing Instructions. MS. Effect of air. Gen Dent 1995. Correr Sobrinho L. Greener EH. 2000 327 . 22:175–181. 43:428–433. 24:31–37. The effect of curing-light variations on bulk curing and wall-to-wall quality of two types and various shades of resin composites. Int Dent J 1985. An evaluation of four light-curing units comparing soft and hard curing. 1990. Knowles JC. Factors affecting cure of visible light activated composites. Some factors influencing the depth of cure of visible light-activated composite resins. Peters MC. Atmadja G. 15:167–172. 12:231–234. 1998:1–17. Pilo R. Halifax. Aust Dent J 1990. de Gee AJ. J Oral Rehabil 1988. Charlton DG. Precision of hand-held dental radiometers. Cardash HS. Richard Price. Montanari G. Yearn JA. 33. Condon JR. Faculty of Dentistry. DeGoes M. 15. 25. Dalhousie University. Montebugnoli L. Walker R. Am J Dent 2000. filler loading. Nova Scotia. Ripps AH. 7. September 14–16. 2000. The effect of curing light intensity and test temperature on the dynamic mechanical properties of two polymer composites. 16. e-mail: rbprice@is. Jacobsen PH. Correlation between light intensity and exposure time on the hardness of composite resin. 35. Westlake Village. Covey DA. Biomaterials 1991. 10. Peutzfeldt A. Department of Dental Clinical Sciences. Consani MA. Peutzfeldt A. Wilson HJ. A survey of output intensity and potential for depth of cure among light-curing units in clinical use. Curtis JW Jr. J Dent 1995. Poulos JG. 18. Int J Prosthodont 1993. Clinical Research Associates. 21. Compendium 1999. 27:235–241. 32. 102:73–75. Quintessence Int 1993. 26:239–243. 11. Am J Dent 1999.ca © 2000 BC Decker Inc VOLUME 12. Cvitko E. Rueggeberg FA. 45:70–73. Tantbirojn D. Harrington L. Canada. Helft M. NUMBER 6. Prati C. B3H 3J5. J Oral Rehabil 1999.PRICE ET AL 5. Sinhoreti MAC. Lee SY. Rueggeberg FA. Rueggeberg F. 6. Effect of curing-tip diameter on the accuracy of dental radiometers. Wear and marginal breakdown of composites with various degrees of cure. Curing efficiency of the Turbo Tip. Jordan DM. Br Dent J 1997. 22: 377–385. Reprint requests: Dr. Dent Mater 1997. 13:121–122. J Dent 1999. Nova Scotia. Todd R. 11:125–132. A survey of the efficiency of visible light curing units. 29. Ferracane JL. 11:361–364. Sakaguchi RL. Quintessence Int 1993. 26:635–639. FDS RCS (Edin). Oelgiesser D. 35:218–225. 14. J Dent Res 1997. 31. Rueggeberg F. Burgess JO. J Oral Rehabil 1995. Baharav H. Do dental composites always shrink toward the light? J Dent Res 1998. 12. 20:183–188. 6:364–370. 24:517–521. 28. Bryant RW. Halifax. Schuster GS. Mitchem JC. Shiflett RA. Caughman GB. 20:S4–15.dal. Cardash HS. 27. 19. Effect of exposure time on the depth of polymerization of a visible lightcured composite resin. 23:227–232. Pract Periodont Aesthet Dent 1999. Hilton TJ. CT: Demetron Research Corp. Curing lights: changes in intensity output with use over time. Harris JS. Davidson CL. Haisch LD. 12:737–740. 16:330–336. Effects of curing tip distance on light intensity and composite resin microhardness. Rueggeberg FA. Martin FE. Asmussen E. Brackett WW. 22.. Chersoni S. Effect of plasma arc curing on the microleakage of Class V resin-based composite restorations. Denehy GE. 13:344–352. 24:391–396. Sahafi A. Erdilek N. 183:95–100. DDS. Scand J Dent Res 1994. Pires JA. 13. Contemporary issues in photocuring. Curing light performance and polymerization of composite restorative materials. 24:1–4. J Dent 1992. Wilson HJ. 20. 30. Oper Dent 1999. and curing time of dental composites. De Goes MF. Versluis A. J Dent 1994. Associate Professor. 77:1435–1445. Curing radiometer operating instructions. Harrington E. CA: Dental/ Medical Diagnostic Systems. Leonard DL. Determination of radiation energy emitted by light activation units. Effect of light-tip distance on polymerization of resin composite. Correlation between recordings obtained with a light-intensity tester and degree of conversion of a light-curing resin. 34. Caughman WF. J Mat Sci Mat Med 2000. Dent Mater 2000. Resin curing lights: rapid cure. Effectiveness of battery powered light activation units. 26. Effect of excitation energy on dentine bond strength and composite properties. 17. Davidson-Kaban SS. Danbury. 8. Gen Dent 1997. Douglas WH. Shortall AC. Douglas WH. Characterization of resin composites polymerized with plasma arc curing units. Presented at the Canadian Academy of Restorative Dentistry and Prosthodontics Annual Scientific Session. Harrington E. Styner DL. dentin and resin-based composite thickness on light intensity reduction. 9. Lee AJ. Correlation of cytotoxicity. Canada. Shortall AC. 24. Feilzer AJ. 35:213–218. J Dent 1998.

and 2 mm) using Fourier transform infrared spectroscopy (FTIR).7 N. MED: 25. Augusta. and group 1. configuration factor = 1. group 2. EXP: 20.25 mm apart. 2-STEP. BOUSCHLICHER. Medical College of Georgia.Effect of Ramped Light Intensity on Polymerization Force and Conversion in a Photoactivated Composite MURRAY R.03 N/s. Maximum curing force (N250s) and maximum force rate of the four groups were compared using one-way analysis of variance (ANOVA) (α = 0. The slower conversion rate resulting from ramped light intensity helped to reduce the rate and maximum polymerization stress.44 ± 0. single-intensity cure mode. EXP: (150 mW/cm2 logarithmic increase to 800 mW/cm2 over 15 s) + (25 s × 800 mW/cm2). Department of Oral Rehabilitation. group 2. Degrees of conversion obtained with STD. RUEGGEBERG. and STD curing modes. MED: 0.0 N. group 4. Georgia 328 JOURNAL OF ESTHETIC DENTISTRY . 1 mm.4 ± 5. EXP and group 4.4 ± 2. since similar degrees of conversion were obtained. The University of Iowa. DDS. and MED cure modes were evaluated at three depths (top surface. 2-STEP: 0. Section Director. 2-STEP.5 ± 2. STD: 0.35 ± 0. MS* FREDERICK A. MED: (80 s × 400 mW/cm2).0-mm depth. group 3. School of Dentistry. 2-STEP: (10 s × 150 mW/cm2) + (30 s × 800 mW/cm2). Iowa † Professor. Ramped light intensity decreased conversion rate at the top surface and at 1. MS† ABSTRACT Purpose: This study evaluated the effect of ramped light intensity on the polymerization shrinkage forces and degrees of conversion (DC) of a hybrid composite. and did not affect the total extent of conversion compared to a standard 40-second. EXP: 0. STD: 30. 2000) *Assistant Professor. MED were statistically equivalent and lower than group 1. EXP. 1. The EXP ramp was successful in reducing the conversion rate at the top surface and at 1.05) and the Tukey test.0) mounted in a universal testing machine using a constant displacement mode. Results: Maximum rates of polymerization shrinkage force development and standard deviations (SD) in ascending order were group 4. but would not be expected to compromise the physical properties for the restorative material.8 N. Maximum rates of polymerization shrinkage force development of group 2. group 4.46 ± 0. Polymerization contraction force was recorded for 250 seconds under four light exposure conditions: group 1.03 N/s. DDS. Maximum shrinkage forces (± SD) in ascending order were group 2.33 ± 0. Dental Materials. CLINICAL SIGNIFICANCE Maximum shrinkage force and force rate exhibited during the first 250 seconds of polymerization were significantly lower using a ramped light intensity exposure. but it did not affect the total conversion compared to the STD 40-second cure mode. group 3. There was no difference in DC at the top surface and 1-mm depth with mode of cure. Materials and Methods: Composite samples were bonded between two steel rods (2. and group 3.06 N/s. The MED cure mode resulted in a higher DC than the EXP mode at a depth of 2 mm. (J Esthet Dent 12:328–339.5 N. Department of Operative Dentistry.50 mm diameter. group 1. Iowa City. STD and group 3. College of Dentistry.07 N/s.8 ± 1. 2-STEP: 27. Maximum force of the EXP mode was statistically lower than MED.0-mm depth. STD: (40 s × 800 mW/cm2).

9 However. and allowed to air dry for 60 seconds. and recurrent caries.10 This finding presumably results from a more extended period of viscous flow in the pre-gelation phase within the setting resin similar to that observed in chemical-cure composites. contraction forces may transfer stress to surrounding tooth structure.11–14 Commercially available light-curing units with EAS that transition from a low to high PD include a stepped increase (Elipar® Highlight. However. marginal leakage.50 mm diameter and 15. xenon plasma arc (PAC). The flat bonding surfaces were microetched with 30 µ silanized silica (CoJet-Sand. the increased exposure duration required to obtain an ED resulting in an equivalent DC may be objectionable to clinicians from a time utilization standpoint. with increasingly higher light intensities or power densities (PD. Several studies report improved marginal adaptation with stepped or ramped intensity increases in PD that may improve marginal adaptation by allowing viscous flow of the material during polymerization. units = mW/cm2) for photoinitiation of resin composite polymerization.) was applied to the silanated rod ends.. Within limits. Pennsylvania). higher polymerization shrinkage force rates generated by more rapid conversion may result in loss of adhesion at the tooth–restoration interface. MTS Systems Corp. Minnesota) in a tensile test configuration with an extensometer maintaining constant displacement of 1. fractures in surrounding high-modulus enamel have been reported. If contraction forces exceed the bond strength at this interface. in high configurationfactor (C-factor) restorations. high-intensity application. tooth sensitivity. ESPE America. and light- VOLUME 12.0 mm height.7 Whereas an elevated PD is desirable for achieving high conversion and improved mechanical properties in the shortest possible exposure interval. brush thinned. When an initial. final PD by either a stepped or ramped transition. Use of a higher PD for fixed exposure durations generally results in a higher degree of monomer conversion to polymer with associated improvements in the mechanical properties of resin composite being polymerized. the resulting “soft start” energy application sequence may result in improved marginal adaptation and a DC equivalent to that of a single.8. the resulting strain or deformation may cancel a portion or all of the developing stress. MTS 318 Biaxial Test System. Bisco. lower light intensities over longer exposure intervals are more favorable for maintenance of the tooth–restoration interface. ESPE America). An unfilled bonding resin (All Bond 2 D/E Resin. Bisco.BOUSCHLICHER AND RUEGGEBERG M anufacturers have introduced conventional quartz tungsten halogen (QTH). Eden Prairie. NUMBER 6.8 Lower light intensity minimizes marginal gap formation.9 with less residual stress transfer. Illinois). it is possible to compensate for a lower PD by increasing exposure duration to obtain an energy density (ED. 2000 329 . Inc.6 If the surrounding tooth structure is compliant. The purpose of this study was to evaluate the stress development (maximal stress value and stress rate) as well as conversion rate of a commercially available.250 ± 0. the resulting interfacial gap can lead to staining. photoinitiated resin composite when exposed to a variety of curing-light exposure profiles.2–4 If this interface remains intact. silanized with ESPE-Sil (ESPE America). It was hypothesized that light exposure methods applying initial low power density values would provide significantly lower stress values than a continuous.5. ESPE America). and a logarithmic increase (Elipar Trilight. and argon ion laser curinglights. Schaumburg.. a dis- continuous or interrupted step increase (VIP or Variable Intensity Polymerizer. units = mJ/cm2 = mW/cm2 × s) that results in an equivalent degree of conversion (DC). Inc.1 However. Norristown. low PD is increased to a higher. continuous-intensity energy application sequence.001 mm (Figure 1). The rods were attached to the load cell and crosshead of a universal testing machine (UTM. MATERIALS AND METHODS Threaded steel rods were machined to a cylindrical cross-section 2.

and light cessation as monitored by a photocell voltage change were recorded on a separate data channel. Two single-intensity curing modes (Elipar Trilight) were tested: a conventional high-power density curing mode (STD. establishing the pre-set C-factor of 1.25 mm. Light unit onset. 400 mW/cm2) with an 80-second exposure duration. the instrument was zeroed. cured for 20 seconds with a curing light (Elipar® Trilight. and light polymerization was initiated.16 Following composite placement. intensity change. shade A2. The matrix was then rapidly slid up onto the upper rod.BOUSCHLICHER AND RUEGGEBERG EFFECT OF RAMPED LIGHT INTENSITY ON POLYMERIZATION FORCE AND CONVERSION IN A PHOTOACTIVATED COMPOSITE Figure 1. The means of the maximum force rate development (N/s) and maximum contraction force (N250s) were calculated from the force:time curves of all trials for each experimental group (n = 5/group). The ends of the vertically oriented rods opposed one another.0-mm tip-tosample distance (see Figure 1). All tests were conducted at room temperature (23. the two ends were positioned at a distance greater than h allowing access for loading a hybrid composite (Pertac II. Polymerization force was evaluated at a C-factor of 1. 800 mW/cm2) with a 40second exposure duration.1-second intervals over a period of 250 seconds from initiation of curing exposure. The two variable- 330 JOURNAL OF ESTHETIC DENTISTRY .0. the inter-rod distance was reset to h = 1. These two singleintensity curing modes had equivalent energy densities (800 mW/cm2 × 40 s) = (400 mW/cm2 × 80 s) = 32. the ratio of bonded to unbonded surface areas. Ophir Optronics Jerusalem Ltd.25 mm. their parallel end surfaces defining two 2.50 mm. or energy application sequences (EASs). ESPE America.0). Configuration factor. elapsed time. d = 2.5 ± 1°C).0. Polymerization contraction force (N). as the amount of premature composite curing attributable to ambient fluorescent lighting has been shown to be negligible. Light intensity output was measured with a visible light radiometer (Nova Laser Power/ Energy Monitor. and the light guide was positioned at a 1. The extensometer was attached to the upper and lower rods.15 When the upper and lower rods approximated each other. ESPE America) using a standardized output (800 mW/cm2). Pennsylvania) into a movable matrix positioned on the lower rod.50-mm diameter (d) disks. Samples were polymerized using four different cure modes. Norristown. Following surface treatment. This measurement reference allowed accurate positioning of the rod ends at the desired distance or height (h = 1. MTS Model 318 Biaxial Test System. Composite specimens were placed under illumination of overhead fluorescent light. was measured according to the method of Feilzer et al. and extensometer displacement were recorded at 0. C-factor [C] = d/2 h = 1. which removed any excess composite and formed a cylindrically shaped specimen of uncured composite.. Jerusalem. The UTM was switched to extensometer displacement control. Israel).0 Joules/cm2. and an intermediate-power density (MED.

Elipar® Highlight.0 mm. using newly developed methodology. and 2. N/s) and force maxima (N250s) for each of the four EAS groups (n = 5. and then exited (Figure 2).0 (top surface). Monomer Conversion Maximal rate (DC/s) and degree of conversion during the first 100 seconds from onset of light-curing exposure (DC100s) (three curing modes or EASs) were determined at a depth of 0. KRS-5 total attenuated reflectance crystal and resin. ESPE America) [100 mW/cm2 × 10 s] + [800 mW/cm2 × 30 s] and a ramped-PD EAS (EXP. 1.18 This methodology compared changes in the ratio between the aromatic carbon-to-carbon (C=C) double bond and that of the aliphatic C=C before and during Figure 2. Tukey’s HSD post hoc test was used for pair-wise comparison. Real-time cure kinetics was obtained from the composite at a depth of 0.17 This methodology provides conversion values every 1.0 mm. The polymerization force rates (maximum slope. the infrared beam penetrated the composite applied to the surface for only a few microns.7 seconds. VOLUME 12. Thus. Power density and total energy per EAS (units = Joules [J]) was measured with a visible-light radiometer (Nova Laser Power/Energy Monitor). The infrared spec- trum of the specimen was obtained in a real-time format during the light exposure. The maximal cure value (DC100s) following light-curing also was obtained.0. a set of 40 such totaled and averaged scans was obtained that represents conversion values at specific intervals during and immediately following light-activation. 1. and then again after the polymerization process was activated. The spectrometer collected four spectra at a resolution of 4 cm–1 and averaged them to provide a single spectrum during the time period of 1.7 seconds. As a result of differences in the refractive indices between the crystal and the resin. 2000 331 .BOUSCHLICHER AND RUEGGEBERG intensity EASs included a steppedPD EAS (STEP.0 mm using Fourier transform infrared spectroscopy (FTIR) with a KRS-5 total attenuated reflectance crystal. The resin spectrum was obtained for a depth of approximately 5 microns against the crystal face. total of 20 specimens) were compared with a one-way ANOVA. NUMBER 6. This process was continued throughout the entire exposure for a total of approximately 100 seconds. reflected off the surface at specific points.0 mm (top surface). and the mean values were grouped into homogeneous subsets.05. and 2. The infrared beam exited the crystal after being attenuated by contact with the resin material. The resulting spectrum was then analyzed for characteristics of the resin prior to curing. All statistical testing was performed at a pre-set alpha of 0. The extent of cure (monomer conversion into polymer) was determined using methods previously published. as well as the conversion rate (DC/s). Infrared energy entered the crystal on one beveled surface. Elipar® Trilight) [150 mW/cm2 with a logarithmic increase to 800 mW/cm2 in 15 s] + [800 mW/cm2 × 25 s].

46 ± 0. The maximum rates of STD and 2-STEP curing modes were statistically similar. and group 3. The MED.03 N/s. 40 MED Trilight. Curing with the EXP mode decreased the maximum force rate development to 80% of the STD rate. EXP: 20.33 (0.8 N. Specimens exposed to STEP and EXP modes exhibited longer delays before contractive force was recorded.5) 25. 40 STD Trilight. the maximum force of the exponential (EXP) mode was statistically lower than only the 2-STEP and STD mode. 80 STEP Highlight.44 (0. Statistical comparisons involved the total conversion (%) at the end of the light-curing cycle as well as the maximum cure rate (%/s) during the first few seconds of light activation. STD: 30. 2-STEP: 0.46 (0.4 ± 2.5 ± 2. 2-STEP: 27. group 2.0) 27. and group 1. If Tukey’s post hoc test was used. Except for the 10-second shift of the STEP force:time curve on the time axis.7) Vertical lines join statistically equivalent groups *Five specimens per experimental group 332 JOURNAL OF ESTHETIC DENTISTRY . respectively. group 3. The TukeyKramer post hoc test was applied for pair-wise group comparisons.07 N/s.001). the 2-STEP force development TABLE 1. 2-STEP (Table 1). MED: 25.03 N/s. Curing with an intermediatepower density (400 mW/cm2) and an 80-second exposure (providing equivalent energy density) reduced the force rate development to 75% of the STD group’s maximum rate.EFFECT OF RAMPED LIGHT INTENSITY ON POLYMERIZATION FORCE AND CONVERSION IN A PHOTOACTIVATED COMPOSITE curing.33 ± 0.07) 0. EXP and group 4.03) 0.03) 20. but statistically similar to MED mode (p = . 40 0. The maximum rate of the 2-STEP mode was statistically equivalent and 104% of the STD rate. Following cessation of light application.35 (0. MED: 0. the initial 40 seconds of STD and STEP curves had similar slopes with maximum force rates of 0.06 N/s. Maximum shrinkage forces (± SD) in ascending order were group 2.46 ± 0. Experimental Group* Mode/Curing Unit Exposure Maximum Force Rate N/s (SD) Maximum Force N (SD) 2 4 3 1 EXP Trilight. and STD curing modes when Duncan’s multiple range test was used as a post hoc test.5 (2. All statistical testing was performed at a pre-set alpha of 0.8 ± 1. group 1. RESULTS Force Rate and Maximum Force Force:time curves were S-shaped (Figure 3). MAXIMUM RATE AND MAXIMUM FORCE.03 N/s and 0. If interactions were present between cure mode and depth.8 (1. The maximum rates of polymerization shrinkage force development of group 2. STD: 0. Maximum force rate development (± SD) in ascending order were group 4. STD and group 3. which roughly corresponds to the low light-intensity portion of the EAS. 2-STEP. A two-way ANOVA was performed to determine the effect of cure mode and depth on conversion 100 seconds after light initiation. MED were statistically equivalent and lower than group 1.4 (2. Maximum polymerization shrinkage forces among the four curing modes were statistically different (p = .05. EXP: 0.07 N/s.5 N. and STD modes were statistically equivalent (contained in a second homogeneous subset). Three replications for each test condition were performed.7 N (see Table 1).44 ± 0.35 ± 0.4 ± 5.0 N.8) 30. 2-STEP. group 4.06) 0.4 (5.44 ± 0. The maximum force of the EXP mode was statistically lower than MED. oneway ANOVAs were performed to examine the differences.051). A two-way ANOVA also was performed to determine the effect of cure mode and depth on peak conversion rate.

B).5 N).003).2%/s).0001). However. a series of one-way ANOVAs were run to study these effects individually (Figure 4).4 N). even with this slowing. and the lowest was EXP 40-second exposure (5.7%/s). followed by the 80-second MED intensity (7. However. Both cure mode and depth had a significant influence on conversion rate (p = . at 1.5%/s). 30.4 N) and approximately equal to that of the STEP mode (27. which was statistically equivalent to the 40-second EXP exposure value (3.3%/s).35 N/s). Again. Thus.8 N vs.4 N/ 30. in descending order. the use of the three different cure methods (standard × 40 s = STD. However. Depth had a significant influence on DC (p = . were STD (5. at 1. 2000 333 .0-mm depth cure mode significantly affected peak conversion rate (see Figures 5 and 6. Representative force:time curves for Elipar® Trilight and Elipar® Highlight. 40-second STD exposure had a significantly faster conversion rate than did the EXP or 80-second MED exposure.0001).7%/s ÷ 9. the final force of the MED mode was higher (25. cure mode did significantly interact with the depth (p = . At 1. On the top surface. However. resulting in a lower maximum force (27. C). there was no significant difference in conversion 100 seconds after initiation with respect to the different methods of curing (see Figures 4 and 6. exponential × 40 s = EXP.33 N/s vs.8%/s). Maximal conversion rates.BOUSCHLICHER AND RUEGGEBERG curve reached an inflection point sooner than the STD specimens (see Figure 3). The EXP mode slowed the conversion rate to only 61% of the peak value seen using the 40-second STD exposure (5. the overall extent of cure was not affected (see Figures 4 and 6.0015). 0. 20. Figure 3.0885). A). The EXP mode reduced maximum polymerization shrinkage force to 67% of the maximum value seen using the 40-second STD exposure (20. D).0-mm depth.0-mm depth.3%/s). Real-Time Infrared Spectroscopy Cure mode (or EAS) had no significant influence on DC (p = . The EXP mode curve had both a low maximum force rate (N/s) and the lowest maximum polymerization shrinkage force (20. followed by MED (3. The fastest conversion rate was seen using the 40-second STD exposure (9. a series of one-way ANOVAs were performed to examine these differences (Figure 5). Therefore. however. medium × 80 s = MED) did not significantly affect the total extent of cure 100 seconds after light initiation (see Figure 4 and Figure 6. B). use of the EXP cure mode at this depth significantly reduced conversion rate compared to the two other modes (see Figures 5 and 6. NUMBER 6.003).7%/s).4 N).4 N vs. depth also interacted significantly with cure type (p = . they interacted significantly (p = . The 40-second EXP cure mode VOLUME 12. Whereas the MED force:time curve had a lower initial slope similar to the EXP mode (0.5 N). however.

Figure 5. a rate saturation effect is reached at which the maximum rate of conversion is hardly changed. There was no significant difference in conversion rates among the three methods at 2. the PD must not only exceed the minimal energy to initiate conversion but also fall below the saturation point of the available photoinitiator.8%/s). The STD and EXP cure modes produced statistically equivalent conversion values. Vertical bar = ± 1 standard deviation. Within a depth.3/5. F). doubling the intensity results in only a 1.5). there was a significant difference in conversion values 100 seconds after light initiation with respect to the different curing methods (see Figures 4 and 6. Maximal conversion rates with respect to light intensity delivery. At a depth of 2. exposure duration. Maximal conversion values measured 100 seconds following light initiation. As light intensity continues to increase beyond a certain point.0-mm depth from the top surface (see Figures 5 and 6. Within this intensity range.0 mm from the top surface. Vertical bar = ± 1 standard deviation.EFFECT OF RAMPED LIGHT INTENSITY ON POLYMERIZATION FORCE AND CONVERSION IN A PHOTOACTIVATED COMPOSITE produced a conversion rate that was only 57% of that of the 40-second STD (3. the maximum rate of cure is proportional to intensity raised to the half power (I0. at least 334 JOURNAL OF ESTHETIC DENTISTRY . and depth from the top surface. but the 80second MED intensity conversion was significantly greater only than that of the 40-second EXP method. similar lower case letters describe statistically equivalent groups For low. DISCUSSION Figure 4. Groups with similar letter are statistically equivalent. N = three speciments per group. This rate limitation is attributable.19 Accordingly. N = three specimens per group. for the first time.or variable-intensity lightcuring to serve as a rate-limiting factor on the slope of the force:time curve.414-fold increase in conversion rate. E).

0-mm simulated depth from surface (C and D). VOLUME 12. and 2.0-mm simulated depth from surface (E and F). 2000 335 . NUMBER 6. Effect of cure type on rate of conversion (%/s) and degree of conversion (%) at top surface (A and B) 1.BOUSCHLICHER AND RUEGGEBERG Figure 6.

The conversion rate using this exposure method was approximately 75% that of the 40-second STD exposure (7.0 mm 100 seconds after light initiation. at 2. to a decrease in the production of initiating radicals under intense illumination.5%/s). This increased DC is probably related to the more extended temperature increase from the curing light and to the exotherm reaction. polymerization rates and shrinkage force rates are lower. This equivalent DC must be achieved without incurring a clinically unacceptable time penalty for the total exposure duration. The lower force rate. These factors may result in higher thermal mobility of the reacting network. the conversion rate can be manipulated by acting on the initiation rate through the intensity (or PD) of the curing light. lower maximum force. an equivalent degree of monomer conversion (DC).2 %/s ÷ 9. maximum polymerization shrinkage forces recorded with these two EAS were dissimilar. there was no difference in degree of conversion at a simulated depth of 1. This reduction in force rate with reduced PD is consistent with previously reported results.9 Lower conversion rate with an accompanying reduction in the force rate at the surface of the composite may be responsible for the improved marginal adaptation reported by several studies that have examined reduced PD curing.0 mm from the top surface. however. The external surface of the restoration also is the most highly irradiated surface.EFFECT OF RAMPED LIGHT INTENSITY ON POLYMERIZATION FORCE AND CONVERSION IN A PHOTOACTIVATED COMPOSITE partly. the 80-second MED intensity conversion rate was equivalent to both the 40-second STD and EXP rates. the EXP force:time curves had lower inflection points and lower mean maximum force. top surface of the restoration that can relieve stress by flow. in turn. Slowing the conversion rate by lowering the PD is most critical at the unbound.7.0 mm beneath the top surface.20 Therefore. while obtaining a DC that was statistically equivalent to the STD 40-second cure mode. reduced intensity values allow an extended time for composite flow prior to mobility restrictions brought on by gelation and solidification of the irradiated material. within the previously mentioned intensity range. thereby decreasing the rate of conversion. which. but doubling the exposure time (MED: 400 mW/ cm2 × 80 s vs. One would also expect a reduced force rate (N/s). The mean maximum force-rates (N/s) of MED and EXP cure modes were similar. Similarly. at this depth. Whereas a similar DC was observed at the top surface and 1-mm depths. However. The EXP ramp was successful in reducing the conversion rate at the top surface and at 1. a variable-intensity EAS should demonstrate a reduced rate of conversion (%/s or DC/s) at the top surface. the 80-second MED exposure produced a significantly greater DC than was achieved with the EXP mode. further increases in light intensity may not affect the rate of conversion. Although the DC achieved with the 336 JOURNAL OF ESTHETIC DENTISTRY . Therefore. The 80-second MED EAS demonstrated both a reduced conversion rate (%/s) and a reduced maximum force rate (N/s).10–12 Halving the intensity. However. Thus. to be effective. since light attenuation by the overlying thickness of composite slows the reaction rate. Also. leads to enhanced conversion of C=C double bonds. The initial low PD of a variable light intensity EAS reduces the formation of free radicals. and equivalent DC of the EXP mode would presumably optimize maintenance of the bonded interface without compromising the mechanical properties and biocompatibility that are associated with a high DC. and exposure durations roughly equivalent to a standard. Deeper within the restoration. The lower conversion rates (%/s) recorded with EXP and MED cure modes had correspondingly low rates of polymerization shrinkage force development. STD: 800 mW/cm2 × 40 s) to provide similar ED (32 J/cm2) had no effect on total conversion at the top surface. Higher light intensity following the initial low PD phase of the EAS is necessary to obtain a DC equivalent to a standard single-intensity EAS. single-intensity curing mode.

In the present study. rate of conversion.5 mm. and maximum shrinkage force may be strongly influenced by chemical and physical properties unique to each composite. One would expect a lower maximum force with a numerically lower ratio of bound to unbound surface area (C-factor) through stress relief by flow from the unbound surface area.12. Although the force and force rate in the both of these studies were equivalent for the STD and STEP modes. curing light (Elipar Highlight). filler loading.22 The total energy flux simultaneously applied from both sides of the sample may have exceeded the ED normally applied in a clinical situation.21 the results of this study and a prior study found no difference in force rate or maximum force between the STD and STEP cure modes. was 5. the degree of conversion was similar in both studies (DC ≅ 60%). therefore. diluents added to improve handling. shrinkage force rate. with C = 1.5-mm diameter cylindrical composite specimen from one side only. The current study confirmed findings that evaluated the “soft-start. maximum forces. Therefore. Whereas some studies report improved marginal adaptation using the Elipar Highlight.22 Such findings suggest that no improvement in marginal adaptation would be expected because of decreased tensile forces with the specific composite and C-factors tested.2) MPa versus the 8. However. with C = 2. C = d/2h = 2.0 mm was numerically higher than that with the 40second STD mode.0-mm depth.15 who found that shrinkage stress is dependent on the ratio of bound to unbound surface area (d/2h) and independent of the volume of a restoration. A prior study tested a higher C-factor (d = 5. h = 1. the magnitude of the reported results would vary with the specific composite brand evaluated. NUMBER 6. It could also be speculated that the difference in energy flux resulting from the simultaneous use of two curing lights in the prior study might have resulted in higher degrees of conversion and. Polymerization shrinkage force generally depends on the composition of the monomers in the matrix. 2000 337 . the resultant modulus of elasticity. The mean maximum force in the present study. lower C-factor specimen (d = 2. the STD and STEP cure modes resulted in similar force rates and maximum forces. they were statistically equivalent. the values reported by the current study (C = 1.0). The current study used the STD cure mode of the newer Elipar Trilight as a control for STEP cure mode of the earlier Elipar Highlight.0) where the 5. the present study used a single light-curing unit to irradiate a smaller diameter. As in the prior study.0) are numerically lower than those reported from the prior study (C = 2. and the coefficient VOLUME 12. filler silanization. h = 1.23 who found that using a low-start curing-light intensity did not provide better marginal adaptation in Class V composite resin and polyacid-modified resin restorations. where only one unbound external surface of the restoration would be irradiated. Therefore.0.0 mm.0. Since degree of conversion. higher contraction forces. there was no significant difference in conversion rates among the different treatments. These findings are in agreement with those of Feilzer and co-workers. At 2. mode of the Elipar Highlight. and DC for equivalent exposure durations of the STD and STEP cure modes. and energy application sequence (40-s 2-STEP) was used in both studies. owing to concerns over depth-of-cure and the temporal effects of a stepped power density energy application sequence.0-mm diameter sample required simultaneous use of two curing lights. a single lightcuring unit was used to cure a 2. A prior study found statistically equivalent force rates.25 mm.BOUSCHLICHER AND RUEGGEBERG MED mode at 2. since the same composite (Pertac II).8 (0.0) from only one side. C = d/2h = 1.6) MPa mean maximum shrinkage force recorded in the prior study. any difference in the maximum shrinkage force between the two studies should be related to the difference in C-factor. filler type.6 (1.25. This is in agreement with Friedl and colleagues.” or stepped light intensity.

5:240–243. CONCLUSION not be expected to compromise the physical properties of the restorative material.’ J Dent 1997. owing to a similar degree of conversion. 17:103–111. Polymerization shrinkage of posterior composite resins and its possible influence on postoperative sensitivity. Goracci G. 7:159–166. 66:1636–1639. 129:1103–1109. Rueggeberg FA. Dent Mater 1991. Novel approach to measure composite conversion kinetics during exposure with stepped or continuous light-curing. 7. Uno S. Dent Mater 1990. J Am Dent Assoc 1998. Pract Periodont Aesthet Dent 1999. Assessing the effect of extraneous light on photoactivated resin composites. 3rd Ed. Rapson JE.24–29 Additionally. Bowen RL. Suh BI. 15. Rueggeberg FA. J Dent Res 1987. 16. Hickel R. Decker D.30 Therefore. Kunzelmann KH. Feilzer AJ. the power density. 17. Intermediate intensity (MED 80-s Trilight) also resulted in a significantly lower rate of force development than standard (STD) or stepped intensity (STEP) light-curing.0 mm beneath the surface. Quintessence Int 1996. Welch FH. The slower conversion rate resulting from ramped light intensity helped to reduce the rate and maximum polymerization stress. Photopoly- This study was supported by a grant from ESPE America. Caughman WF. J Esthet Dent 1999. Walker R. Bouschlicher MR. 20. 27:355–362. Mehl A. Morel F. Vargas MA. 6. Pulse activation: reducing resin-based composite contraction stresses at the enamel cavosurface margins. 12. Muessner R. 61:654–658. Caughman WF. 25:321–330. 1984:49–58. and energy application sequence of the curing light must be tailored to the overall composition of the composite to maximize the degree of conversion while minimizing the shrinkage stress rate and maximum stress. Eur J Oral Sci 1995. 10. Dentin adhesives and microleakage in cervical resin composites. Burgess JO. Sidhu SK. Bowman CN. exposure duration. An evaluation of four light-curing units comparing soft and hard curing. the photoinitiator and accelerator concentrations may affect the rate of conversion (%/s) and final DC (%) that can be expected with a specific light intensity. light intensity. Mori G. 99:440–444. Benkeser G. Effect of composite type. Dooren LH. Light intensity and temperature effect in photoinitiated polymerization. 4. 2. single-intensity cure mode. Am J Dent 1997. The Netherlands: Elsevier Science Publishers. J Dent 1995. 10:279–283. 14. 11:125–132. Kanca J. Influence of light intensity on two restorative systems. The authors thank John M. Am J Dent 1999. Chan DCN. 6:241–249. de Gee AJ. 1989:281–286. Scand J Dent Res 1991. Fairhurst CW. Int J Prosthodont 1994. 13. Hashinger DT. J Dent Res 1982. Davidson CL. Calibration of FTIR conversion analysis of contemporary dental resin composites. Barbakow F. Ripps AH. 10:107–113. Oral implantology and biomaterials. A predictive model for the polymerization of photo-activated resin composites. but would 338 JOURNAL OF ESTHETIC DENTISTRY . Rueggeberg FA. Asmussen E. In: Kawahara H. Billmeyer F Jr. 103:322–326. Thus. Ramped light intensity slowed the rate of cure at the top surface and at 1. and laser polymerization on polymerization contraction forces. Maximum polymerization shrinkage force and maximum rate of force development were significantly lower with ramped light intensity (EXP 40-s Trilight). REFERENCES 1. Textbook of polymer science. Eick JD. 3. Peiffer RW. Winterbottom for programming and operation of the MTS 318 Biaxial Test System. New York: John Wiley and Sons. 8. De Goes M. Dickson G. Davis HC. Hardening shrinkage and hygroscopic expansion of composite resins. Unterbrink G. Rueggeberg FA. 12:107–112. 5. but did not significantly affect the total conversion value compared to a standard 40-second. Krejci I. de’Martinis LC. Decker C. In: Scranton AB. Lutz F. Soltesz U. Am J Dent 1992. eds. 11. DISCLOSURE AND ACKNOWLEDGMENTS 9. Caughman WF. the clinician should not assume that a pre-set energy application sequence for photopolymerization is optimal for all composites. Feilzer AJ. 23:183–189. 19. ed. 11:197–205. Quintessence Int 1986. Dlugokinski MD. Curing light intensity and marginal leakage of resin composite restorations.EFFECT OF RAMPED LIGHT INTENSITY ON POLYMERIZATION FORCE AND CONVERSION IN A PHOTOACTIVATED COMPOSITE of linear thermal expansion. Influence of light intensity on polymerization shrinkage and integrity of restoration-cavity interface. de Gee AJ. Physical properties and gap formation of light-cured composites with and without ‘softstart-polymerization. Davidson CL. configuration factor. Fatigue behaviour of filling materials. Boyer DB. Quality and durability of marginal adaptation in bonded composite restorations. Marginal adaptation of a restorative resin polymerized at reduced rate. Setting stress in composite resin in relation to configuration of the restoration. Curtis JWJ. Henderson LJ. 18.

Aarnts MP. 26. Ferracane JL. 27. Ferracane JL. J Dent Res 1999. Feilzer AJ. 25:26–32. J Am Dent Assoc 2000. (Abstr) Reprint requests: Murray R. 33:337–343. Aarnts MP. Sakaguchi RL. J Dent Res 1999. 12:23–32. Hiller K. Kremers L. Dent Mater 1998. Marginal adaption of Class V restorations with and without “softstart-polymerization. Hickel R. Vol. 21. Akinmade A. Ferracane JL. Effects of photoinitiator concentration on conversion. 131:497–503. e-mail: murray_bouschlicher@uiowa.” Oper Dent 1999. Douglas WH. Schmalz G. Thermal expansion coefficient of dental composites measured with strain gauges. 673. 14:106–111. Versluis A. J Esthet Dent 2000. Composite restorative resins: composition versus wall-to-wall polymerization contraction. Bouschlicher MR. MS. 29. Sakaguchi RL. Reduction of composite contraction stress through nonbonded microfiller particles. 23. Friedl KH. 1997:63–80. 14:256–260. 30. Physical properties and marginal quality of Class II composite fillings after softstart polymerization. Rueggeberg FA. DC: American Chemical Society. 25. IA 52242. Condon JR.edu ©2000 BC Decker Inc VOLUME 12. 76:279. strength. 12:290–294. Feilzer AJ. The University of Iowa. DDS. NUMBER 6. Boyer DB. 78:482. (Abstr) 22.BOUSCHLICHER AND RUEGGEBERG merization: fundamentals and applications. Dent Mater 1998. Dent Mater 1996. 78:234. Effect of filler load on contraction stress and volumetric shrinkage. Washington. 2000 339 . Effect of stepped light intensity on polymerization force and conversion in a photoactivated composite. Department of Operative Dentistry. Akinmade A. Iowa City. Märkl A. (Abstr) 28. Manhart J. 24. Asmussen E. Mehl A. Condon JR. J Dent Res 1996. Assessing the effect of composite formulation on polymerization stress. College of Dentistry. and stress development. Bouschlicher. Stress transfer from polymerization shrinkage of a chemical-cured composite bonded to a pre-cast composite substrate. Kunzelmann KH. Acta Odontol Scand 1975.

Georgia 340 JOURNAL OF ESTHETIC DENTISTRY . DDS. Medical College of Georgia.5-mm depth for a specific curing light and scenario. soft-start (pulse-delay and step-cure) methods yielded similar hardness as the standard. High-intensity QTH units and the argon laser can reduce exposure time while providing composite with similar hardness as conventional QTH curing. Orange. Department of Oral Rehabilitation. Plasma-arc exposure for less than 10 seconds produced inferior hardness compared with the standard. † Research Assistant. Augusta. Dental Materials Section.5 mm from the irradiated. Depth of cure was defined as the deepest hardness value found equivalent to that at 0. high-intensity QTH and plasma arc curing (PAC) lights. 2000) *Professor and Section Director. RUEGGEBERG. composite increments should still be no greater than 2 mm to provide homogeneous hardness. Knoop hardness was measured 0. Results: Conventional QTH lights provided similar hardness profiles. CLINICAL SIGNIFICANCE Similar-type conventional QTH lights with different tip diameter (8 and 12 mm) provide similar composite cure characteristics. A 10-second PAC and a 5-second laser exposure gave equivalent hardness at 2-mm depth as the 40-second standard. shade A2. MS* JANET W. Hardness values were compared by analysis of variance at similar depths within a specific curing-light classification. Cured compules were sonicated to remove uncured composite and were sectioned and polished along the long axis to expose cured composite. (J Esthet Dent 12:340–349. Kerr. using the hardness of the standard 40-second conventional QTH exposure as comparison (Dunnett’s t-test).Polymerization Depth of Contemporary Light-Curing Units Using Microhardness FREDERICK A. At 2-mm depth. and one argon laser.0-mm increments until reliable readings could no longer be obtained. Materials and Methods: Composite (Herculite XRV. At this depth. California) was exposed in opaque compules to conventional quartz tungsten halogen (QTH) units. METTENBURG† ABSTRACT Purpose: This research investigated composite depths of cure using a variety of light-curing units and exposure protocols. Even with consideration of high-intensity curing units. Depth of cure for almost all curing scenarios was not greater than 2 mm. top surface and then at 1. ERGLE† DONALD J. School of Dentistry. High-intensity QTH lights provided similar hardness at 2-mm depth in 10 seconds as the standard 40-second exposure. Soft-start techniques provide similar cure profiles as conventional QTH technique when used according to manufacturer’s recommendations. use of a different unit or curing tip made no difference in hardness compared with the standard. Plasma-arc exposure should be at least of 10 seconds duration to provide hardness equivalent to that achieved with conventional 40-second QTH exposure.0 mm and in 1. soft-start units.

6 This level could be reached merely by replacing the conventional light-curing tip with one that concentrates light into a smaller distal tip end diameter. Manufacturers claim these sources can effectively reduce clinical exposure duration to only 1 to 10 seconds.6 When using these light sources. Such a modification of light output is termed ramping. The rate of composite cure. between 400 and 500 nm2–5. the output intensity is typically lower than 1000 mW/cm2. Immediately following this phase.12–17 To minimize shrinkage. A modification of the step-cure method is the pulse-delay procedure. the intensity of these sources is in excess of 1000 mW/cm2. Connecticut). is used in a popular unit to provide enhanced output level: Optilux 501 in burst mode (Demetron Research. NUMBER 6. The intense irradiation from this unit is directed to the restoration via means of a liquid-filled light guide (Kreativ Kuring Unit. the unit generates full output for the remainder of the exposure. however. operate by gathering light from a large proximal tip diameter near the focal plane of the QTH source and concentrating that light into a smaller distal tip diameter. An additional method of providing enhanced output levels from a QTH light is use of a high wattage-source generating light remote from the operating field. low-intensity exposure is provided only to the last incremental layer.18. manufacturers have introduced QTH-based lights specifically designed to provide low levels of intensity during the initial exposure. many features related to output control during exposure have been provided.6 Output levels from these sources are remarkably higher than those of conventional or high-intensity QTH units. The PAC lights also use liquid light guides to reduce levels of infrared and ultraviolet radiation. fixed level.. Kreativ Inc. These tips.20 These systems use a number of methods to provide control over light output. along with a turbo tip.11 This mechanism. The initial light intensity level can also be slowly increased during the exposure and then maintained at a high.10 This concentration results from use of a tapered fiber optic glass bundle. a second. when activated.RUEGGEBERG ET AL F or years.6 These newer units offer remarkably higher output intensity levels than conventional QTH units previously described.19 Lowering light intensity. Typically. High-intensity QTH lights are a separate classification of curing units. referred to as turbo tips. At completion of this time. Danbury.15. after filtering. conventional methods of exposing photoinitiated resin composite materials have been with relatively low-powered (35–75 W) quartz tungsten halogen (QTH) units. The source voltage driving a conventional QTH bulb can also be increased to provide increased radiant output. A completely different method of providing extremely high levels of irradiance uses the newly introduced plasma arc curing (PAC) units. are clinical concern.7–9 Currently. 2000 341 . more intense and longer exposure is provided to finalize conversion. is thought to reduce the rate at which free radicals are formed and the rate at which polymerization occurs. Also. recommended exposure duration for 2-mm incremental composite placement is between 40 and 60 seconds. A designated time is allowed to pass. Conventional QTH curing sources operate in a continuous output mode. the source is driven to provide full output intensity for the selected exposure duration.6. a wide variety of curing lights and methods is available.21 Step-cure units generate an initial low-level output for a predetermined time into the curing exposure. whereas a 40-second VOLUME 12. San Diego. during which the composite surface is contoured and polished. California). a shortduration. Providing a low initial rate of cure is intended to allow composite to flow from the unbonded surfaces to relieve stresses prior to attaining a gel point. and the development of stress from polymerization shrinkage at the tooth– resin interface as well as within the tooth structure itself.1 These units provide a wide spectral output.20 In this method.

claims of reduced exposure requirements while providing similar conversion values and depths of cure as conventional QTH units are made. New Jersey) and sonicated for 1 hour. MATERIALS AND METHODS The composite used throughout this study was a hybrid. 320. The argon ion laser was once popular for curing photoactivated composites. to remove the plastic casing and to expose cured composite along a top–bottom plane. and the open compule end.22 However.23 Thus. Fisher Scientific. specimens were prepared for microhardness testing. Fair Lawn. 400. Lay Industrial Diamond Corp. 40-7628. Michigan). St. Preparation for specimen curing included removal of the curved compule end with a sharp knife blade and removal of the plunger from the other end.POLYMERIZATION DEPTH OF CONTEMPORARY LIGHT-CURING UNITS USING MICROHARDNESS exposure from a conventional QTH light would be required. composite was cured in black. Fifteen minutes following exposure. manufacturers’ claims of reduced exposure time and maintenance of high conversion levels of these new light-curing units and methods need to be verified. photoactivated dental composite. allowing for vertical movement of the specimen. the compule was placed in solvent (methyl ethyl ketone. Mylar-covered end facing upward (Figure 1). A small piece of Mylar was placed on a tabletop.22. Kerr Dental Products.. wet-ground (silicon carbide. M209-4. Joseph. where the plunger had been. and 600 grit. Immersion and sonication removed uncured composite by dissolution. opaque. fewer manufacturers are supporting this technology for dental curing purposes. The specimen was then placed in another holding device that held the compule along its horizontal axis. 15. California). lot 712557. The compule was ground in this device. Attention was given to slow speed and to wet grinding to ensure a minimal impact of specimen preparation on hardness readings. Each compule was positioned in another holding jig that 342 JOURNAL OF ESTHETIC DENTISTRY . photoactivated material (Herculite XRV. Lake Bluff. The distal end of a light-curing tip was held in position so that the tip center was coincident with the compule long axis. To minimize light penetration from reflection and scattering. and 1 synthetic diamond paste. was placed on top of the plastic square. Illinois) was as follows: 240. The sequence of abrasives used on the rotary grinding apparatus (Ecomet III. Orange. indicating significant reduction in clinical exposure time compared to the conventional QTH methods while yielding similar conversion and physical properties. when a variety of commercial curing units and methods are used to polymerize a single lot of commercial. Many claims have been made related to this curing mode. This jig was attached to the platform of a laboratory jackstand. preserving mechanical retention in the holder and compule. Composite was exposed with the curing tip end held 1 mm from the Mylar surface. The composite was then condensed against the Mylar surface. using microhardness values. with the top. shade A2. The purpose of this research is to examine the depths of cure. Clinical success of a photocured dental restoration may depend upon obtaining high levels of conversion. plastic compules. The packed compule was positioned in a holding jig that aligned the specimen vertically.24 With the clinician’s reputation and livelihood being based on the success of restorations placed.). Following polishing.. The specimen was ground almost in half. Deerfield Beach. This method produced a stringent environment in which to examine specifically the effect of irradiated light without the confounding factors of side reflection or translucency of surrounding matrix structure. Buehler Corp. Florida) on a polishing cloth (No. Buehler Corp. The hypothesis tested is that the hardness value obtained using a conventional QTH exposure method (standard) is equivalent to those achieved when the other curing units and methods are applied as directed by the manufacturer. 6. transferring the uncured mass from one compule end to the other. Leco Corp. diamond paste (Nos..

0 mm and then at 1. and then applying Dunnett’s two-tailed post hoc t-test. using the standard value as control. At depths of 0. All statistical testing was performed at a pre-set alpha of 0. Readings were averaged to represent the hardness of that specimen at the specified depth from the top surface. For this analysis. Where possible. This unit type and exposure duration were believed to represent the majority of conventional light-curing units in use.RUEGGEBERG ET AL at a similar depth. RESULTS maintained the polished surface parallel with the mounting stage of a Knoop hardness testing machine (model MO.05.0-mm increments until values could no longer be validly determined.0. For comparative purpose. At 3-mm depth. 40-s exposure). This analysis was accomplished by performing a one-way analysis of variance (ANOVA) on hardness values Conventional Quartz Tungsten Halogen Units Figure 2. The hardness values of all QTH units within each depth were compared to the values obtained for the standard.0 mm. This value was defined as the greatest depth that yielded hardness value statistically equivalent to that seen at the 0. The depth of cure of each light-curing treatment was also determined. Hardness values were also obtained at a depth of 1.5-mm hardness value used as control. hardness using the standard treatment was equivalent to values from all other units with the exception of those from the Optilux 401 with turbo VOLUME 12. and 2. This curve is seen in all subsequent hardness profile graphs and represents hardness values obtained using the standard QTH unit and exposure duration. a one-way ANOVA was performed using Dunnett’s one-tailed t-test with the 0. irradiated surface.5. New York). 1. Hardness readings were obtained using a 0. 2000 343 . 8-mm diameter tip.5-kg load and 10 times magnification. presents hardness values at different depths for conventional QTH units. all units were used with new light sources. Three specimens were made for each test condition (72 specimens).5 mm from the top. Statistical analysis consisted of comparing the hardness at each specified depth from the top surface using the different light sources and curing modes to that obtained using the standard method previously described. Tukon Tester. Note the data line representing the standard curing mode (Optilux 401. New York. ACCO Wilson Instrument Division. the hardness obtained when using the conventional QTH unit (Optilux 401) with an 8-mm diameter tip and a 40-second exposure were considered to represent the standard. Triplicate readings were made at a distance of 0. Figure 1. NUMBER 6. The light-curing units and modes of photopolymerization used represented a wide variety of contemporary models and methods (Table 1). the standard treatment yielded hardness values equivalent to those for all other units. Schematic representation of specimen light-curing. A.5-mm depth for a specific treatment.

Hicksville. 3-min wait. 40-second exposure. Classification of Curing Unit Tip Diameter (mm) Exposure Duration (s) Manufacturer Serial Number Conventional QTH Optilux 401 Optilux 401 Optilux 500 Optilux 501 Optilux 501 Soft-start QTH Highlight Highlight VIP High-intensity QTH Optilux 501 Kreativ Kuring Unit Kreativ Kuring Unit Kreativ Kuring Unit Kreativ Kuring Unit Plasma arc Apollo 95E Apollo 95E Apollo 95E Apollo 95E ADT 1000 PowerPAC Virtuoso ARC Light Argon ion laser Accucure 3000 Accucure 3000 Accucure 3000 8 Turbo tip (14 × 10) 8 8 12 10 10 12 Turbo tip (14 × 8) 8 8 8 8 470 nm tip. 1 mm. CA Kreativ Inc. Kreativ Inc. Woodland Hills. Pennsylvania). ADT = American Dental Technologies.POLYMERIZATION DEPTH OF CONTEMPORARY LIGHT-CURING UNITS USING MICROHARDNESS TABLE 1. Danbury. Optilux 500. normal 10. TX ADT Den-Mat. CA Air Techniques. Santa Maria. 7 470 nm tip. CT Demetron/Kerr Demetron/Kerr Demetron/Kerr Demetron/Kerr ESPE America. 4 s at 300 W. Corpus Christi. and Optilux 501 12-mm tip. NY LaserMed. DMD. Thereafter. San Diego. 8-mm tip. UT LaserMed LaserMed 4733101 4733101 5800112 5810289 5810289 3801548 3801548 013-205 5810289 6801501520 6801501520 6801501520 6801501520 NE 808 349 NE 808 349 NE 808 349 NE 808 349 1126 5333 99F1634A760 5406 9803896 9803896 9803896 *10 s at low level. exposure to 600 mW/cm2 for 10 s. PA ESPE America Bisco. 40-s exposure. CA DMD DMD DMD ADT. B). Schaumburg. Optilux 401 with turbo tip. boost 20 1 2 3 Step-cure‡ 10 10 11 10 5 10 20 Demetron/Kerr. QTH = quartz tungsten halogen (the standard). †200 mW/cm2 for 3 s. the hardness value for the standard method was lower than that for either the continuous or step output from the Highlight (ESPE America. DMD = Dental Medical Diagnostics. 7 8 8 6 8 12 12 12 40 20 40 40 40 40 40 step* Pulse-delay† 10. ‡2 s at 150 W. 7 470 nm tip. At 4. 8-mm tip. tip for 20-second exposure. ramp 10. 40 s) and Optilux 501. At 5-mm depth. hardness values using the standard method were equivalent to those from all other units. 30 s at continuous output. 7 470 nm tip.. 8-mm tip. The depths of cure for the various treatments (as previously defined) were as follows: standard unit (Optilux 401. Kreativ Inc. burst 10.and 5-mm depths. Salt Lake City. 20-second exposure. Depth of cure for the standard method 344 JOURNAL OF ESTHETIC DENTISTRY . Norristown. LIGHT-CURING UNITS USED IN THE PRESENT STUDY. 2 mm. hardness of the pulse-delay technique was significantly less than than that of other methods. IL Demetron/Kerr Kreativ Inc. 40-second exposure. Soft-Start Quartz Tungsten Halogen Units Hardness values from the top surface for soft-start QTH units were equivalent (within a specific depth) among the standard method and all soft-start units up to a depth of 2 mm (Figure 2. which were lower. Norristown.

using various exposure durations from an argon ion laser (n = 3 specimens/group). except the 10-second normal and ramped exposures of the Kreativ unit. and E. only the Kreativ 10-second boost and 20-second normal exposures provided hardness values equivalent to those of the standard. High-Intensity Quartz Tungsten Halogen Units Hardness values at a depth of 0. whereas for all methods from the Highlight. At 1.0-mm depths.and 2. C). At 3-mm depth.0. it was only 1 mm. E VOLUME 12. quartz tungsten halogen units. C. Hardness profile (± 1 SD) of composite exposed: A. NUMBER 6. cure depth was 3 mm. all others were lower. D. The standard treatment provided a depth of cure of 2 mm. using various soft-start. using various plasma arc (PAC) units. whereas the Optilux 501 with turbo tip used in the 10-second A B C D Figure 2.RUEGGEBERG ET AL was 2 mm. using various high-intensity quartz tungsten halogen units. and for the pulse-delay technique. 2000 345 .5 mm from the top irradiated surface for high-intensity QTH units were equivalent to standard. B. all hardness values were equivalent to those of the standard. using various quartz tungsten halogen units and tip diameters (all Optilux models). whereas only the standard unit provided readable values at 5-mm depth. which were less (Figure 2. Hardness of Kreativ 20-second normal exposure and standard unit was equivalent at 4-mm depth.

At 4-mm depth. as did the 5. California). the ADT 1000 and Virtuoso units had hardness values equivalent to those of the standard method. At 3. and the PowerPAC units [American Dental Technologies]) demonstrated hardness values similar to those of the standard. used in all four scenarios. Corpus Christi. at depths of 1. the Virtuoso 2 mm. This trend was also seen at 1. Only the PAC units providing at least 10-second exposure (Virtuoso. D). Hicksville.0 mm deep. no hardness values for the 1-second Apollo 95E could be recorded. yielded hardness values lower than all other units as well as the standard method at 3-mm depth.and 10-second laser exposures.5-mm depth. which were equivalent.or 2-second exposure and the step-cure mode from the Apollo 95E unit gave a depth of cure of 1 mm. except that at this level. the ADT 100 unit yielded a depth of cure of 3 mm.5-mm depth for PAC units and exposure methods were equivalent to standard. which yielded lower values (Figure 2. A 1. The poor performance of the turbo tip could be related to a focusing effect. However. The only hardness readings obtainable at 5-mm depth were from the standard technique and from the Virtuoso unit.0-mm depth. Perhaps.0 mm from the Mylar 346 JOURNAL OF ESTHETIC DENTISTRY . The only hardness values attainable at 4-mm depth were from the standard technique and the 20-second laser. the hardness from a 3-second Apollo 95E exposure was equivalent to that of standard. All units had similar type sources (80W Optibulb). Woodland Hills. The reason that the Optilux 401 with 8-mm tip should provide hardness values superior to those achieved by either the 500 or the 501 with similar sized tip and equivalent exposure duration is not known. DISCUSSION For the conventional QTH units.0-mm depths of cure. Plasma Arc Curing Units Hardness values at 0. so hardness differences may be related to the specific optics of the source and curing tip combinations. The Kreativ unit. The standard technique provided a 2-mm depth of cure. the focal plane of the QTH source was aligned better with respect to the proximal curing tip aperture than in the other units. with the exception of all specimens exposed using the Apollo 95E (Dental Medical Diagnostics. as well as use of the ARC Light (Air Techniques. Of the PAC lights providing exposure duration of at least 10 seconds. At this depth. not all the units provided depths of cure up to 2 mm with respect to hardness values at 0. and the PowerPAC and ARC Lights gave 1-mm cure depths. At 2-mm depth. The standard unit and method and the Optilux 500 and 501 units with 8-mm tip for 40-second exposure yielded 2-mm cure depths.POLYMERIZATION DEPTH OF CONTEMPORARY LIGHT-CURING UNITS USING MICROHARDNESS burst mode had a depth of cure of less than 1 mm. all lights and methods provided equivalent hardness values within a given depth up to 2 mm. The only exposure scenario using the Apollo 95E that provided recordable hardness values at 3-mm depth was the step-cure mode.0 mm. the 10-second laser exposure gave lower hardness values than either the 20-second laser or the standard mode. provided similar 2.0 and 2. whereas use of the turbo tip in the Optilux 401 provided only a 1-mm depth. New York). ARC Light. Argon Ion Laser All hardness values at a depth of 5 mm for an argon ion laser at highest output (250 mW) using various exposure durations were equivalent. Statistically. which were equivalent. Texas]. but those from the PowerPAC were lower. This technique. but lower than values achieved by the standard method (Figure 2. in the specific Optilux 401 unit tested. all hardness values from the laser were equal to those of the standard method. E). validating the research hypothesis. ADT 1000 [American Dental Technologies. The standard mode provided a depth of cure of 2 mm. whereas the 3-second exposure cure depth was less than 1 mm. The depth of cure using a 20-second laser exposure was 3 mm. hardness from the 5-second laser exposure could no longer be recorded. The distal end of all curing tips was held at a distance of 1.

past this depth. it is believed that the argon laser can be used to reduce chairside curing time. not all exposure scenarios from the Kreativ or from the Optilux 501 in burst mode with turbo tip provided values equivalent to those achieved with the standard unit.5. such a reduction of time. This result demonstrates that a 10-second PAC light exposure provides equivalent composite hardness when a 2-mm increment is used. the depth to which hardness values could be obtained also increased. The purpose of using highoutput light sources is to reduce chairside exposure time while producing properties equivalent to those that would have been realized if the longer exposure. These results indicate that the step-cure method would provide a cure value equivalent to that of a continuous exposure. However. NUMBER 6. validating the research hypothesis. invalidating the research hypothesis. In general. At this depth. Depths of cure using the laser were equivalent to that of the standard method. The research hypothesis for PAC lights was not proven true for all exposure scenarios. At 2-mm depth. Thus. none of the exposure scenarios from the Apollo 95E provided hardness similar to the former. all PAC lights providing at least this duration had hardness equivalent to that of the standard method.RUEGGEBERG ET AL film during exposure. Thus. conventional QTH mode had been used. PAC lights do not tend to provide enhanced depths of cure when used for 10-second exposures. or a step-cure exposure of less than 6 seconds) from a PAC light is seen not to provide a polymer matrix of properties similar to that of a conventional QTH unit. eliminating the possibility of under-cure owing to the use of a lower initial intensity. it should be noted that this technique is recommended only for the last 1. Thus. The 20-second argon exposure mirrored the hardness profile of the 40-second standard technique. All methods of providing high-intensity QTH light provided similar hardness values at 2-mm depth compared to the standard 40-second treatment. Only one PAC unit (ADT 1000) indicated a depth of cure value exceeding the 2-mm level of the standard method. but perhaps by only one-half of the recommended exposure time recommended when using conventional QTH units. Use of a step-cure method of exposure duration equivalent to a continuous one (Highlight step and normal) produced hardness values equivalent to not only each other but also to that of the standard method. There was great variation in hardness profiles among the various units and methods compared to the standard QTH mode. However. as a rule. 2000 347 . If the turbo tip had a focal point. In many cases. It is interesting to note that no high-intensity QTH unit provided an enhanced depth of cure greater than that seen when using the standard mode. while providing equivalent hardness. the pulse-delay technique demonstrated inferior curing. As exposure duration from this unit increased. Thus. equivalent to that achieved with the standard technique. which was 2 mm. the depths of cure are low. Use of the turbo tip with this type of unit did reduce exposure duration by half while providing equivalent hardness values at 2-mm depth. with the 20-second exposure providing a cure depth of 3 mm. it did not enhance hardness values above the value achieved with the standard method. was realized. When used for less than this duration. All soft-start methods provided hardness up to a depth of 2 mm. short exposure duration (3 seconds or less. Those PAC units providing exposure duration of at least 10 seconds generated hardness values similar to those of the standard technique. use of the different conventional QTH units yielded similar hardness profiles. use of the Optilux 501 in Burst mode with a turbo tip for 10-second dura- VOLUME 12. The research hypothesis for hardness values obtained with the laser was validated. However. For the high-intensity QTH units. the tip could have been used outside of its most effective target-source distance.to 2-mm thick increment.

or 3 seconds. It is interesting to note that hardness values for curing scenarios providing light intensity tend to drop dramatically at thickness greater than 2 mm. the following conclusions may be made: 1. 4. both of these methods provided hardness values equivalent to those seen with the standard mode. provided inferior hardness at 2-mm depth compared to all other PAC treatments. hardness values cannot be compared between or among other commercial products. For the PAC lights. Exposures of 1. If a curing treatment produced a relatively poor hardness at 0. the recommendation of incremental thickness layering to a maximum of 2 mm still holds. Other types of composites that may be more or less photosensitive may provide different curing patterns with the lights tested.5-mm depth. the results indicate that a minimum 10-second exposure should be used to provide composite hardness at 2-mm depth similar to that achieved with the standard QTH mode. 2. Use of high-intensity QTH units (stated output level in excess of 1000 mW/cm2) provided hardness values at 2-mm depth equivalent to that of the standard QTH method. PAC. 3. CONCLUSIONS Within the restrictions imposed in the current study. provided hardness similar to that achieved with the standard method at 2-mm depth. only relative ones. First. It was anticipated that use of high-powered curing lights (QTH. Soft-start QTH curing modes (step-cure and the pulse-delay) provided hardness values at 2-mm depth similar to those of the standard QTH curing method. When considering hardness values at 2-mm depth.POLYMERIZATION DEPTH OF CONTEMPORARY LIGHT-CURING UNITS USING MICROHARDNESS tion as well as the Kreativ unit. However. Exposure durations of these high-intensity lights may be as low as 10 seconds to provide hardness similar to that with a 40-second exposure using a conventional QTH source. and the argon laser) would provide cure depths in excess of the currently advocated 2-mm level. the reader is cautioned in applying the results of this study universally to all types of composites and curing units. Thus.7–9 The results of this research need to be considered with respect to certain factors. Thus. However. Exposure from PAC lights should be at least 10 continuous seconds to provide hardness 348 JOURNAL OF ESTHETIC DENTISTRY . Such readings may be misleading. comparison of hardness may be used to indicate the relative cure of the resin matrix. Within a single composite system. for most systems. within the restrictions imposed by the experimental methods. However. 2. clinicians need not fear “under-curing” composite when using these curing scenarios when the units are used according to the manufacturer’s directions. or even a step-cure with a PAC light lasting approximately 6 seconds. the absolute hardness values could be below those of more efficient curing units. because the resin systems and filler content are not similar. It is for this reason that a single composite system was used throughout this study. Hardness values may not be used as absolute indicators of composite cure. only one brand of composite was tested in this research. Use of many different types of conventional QTH curing units and tips did not significantly affect hardness readings compared to the standard curing method at a depth of 2 mm from the irradiated surface. and also yielded low values throughout the hardness profile.5-mm depth. However. the 20-second laser exposure almost perfectly matched the hardness profiles of the standard QTH unit up to a depth of 4 mm. comparisons of the potential for resin cure among different types of curing lights and methods are presented. A 5-second exposure from the argon ion laser gave hardness values at 2-mm depth equivalent to those with the standard QTH mode. the reader may mistakenly consider that this particular unit yielded a “high” depth of cure. However. The soft-start methods evaluated were a step-cure and a pulse-delay technique. the depth of cure values presented are with respect to hardness values obtained at the 0. Also. even in its normal 10-second exposure mode.

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