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Q U I N T E S S E N C E I N T E R N AT I O N A L
Key words: composite, cure, curing light, hardness, light energy, light intensity, shrinkage,
soft start
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Ta b l e 1
Type of
light-curing unit
Quartz-tungsten-halogen
Light-emitting diode
Soft-start quartztungsten-halogen
Model
(3M ESPE)
Light intensity*
(mW/cm2)
Elipar 2500
Elipar Free Light
Elipar TriLight
634
529
579
Light energy
(mJ/cm2)
25,440
21,810
17,216
*Mean value at output plateau (see Fig 3) (determined with a Cure Rite Model 8000, EFOS radiometer).
Mean value calculated from area under the light intensitytime curves (see Fig 3).
polymerization.37 Curing at low light intensities reduces the rate of polymerization and
residual shrinkage stresses by allowing more
flow, and thus stress relaxation, before the
composite solidifies. Low-intensity curing,
however, may not achieve the desired level of
polymerization and therefore requires additional light curing at high intensities or light
exposure over a longer period of time.8,9
Various light sources are used in dental
practices.10 Quartz-tungsten-halogen (QTH)
units have been a common source of blue
light for curing restorative composites. The
halogen bulb emits full-spectrum light that is
filtered to a 380- to 520-nm blue wavelength
range, which covers the absorption peak
(468 nm) of camphorquinone, the photoinitiator used in most dental composites.1,11
Because only a small part of the spectral
bulb output is relevant for activating the photoinitiator, the efficiency of a QTH unit is low.
Part of the light energy is released as heat.12,13
More recently, light-emitting diode (LED) curing units have become commercially available that feature narrow spectral ranges that
are highly efficient.14,15 The spectral range
emitted by dental LED units is between 440
and 490 nm, specifically targeting camphorquinones maximum absorption.
Given the availability of various curing light
design options with a manifold of restorative
composite compositions,16 the challenge for
clinical practitioners is to maintain optimal
physical properties through thorough polymerization while minimizing residual shrinkage
stress if possible. To gain a better understanding of the interaction between curing
light design and various composites, we
studied the effect on depth of cure and postgel shrinkage of 3 representative types of
light units (conventional QTH, soft-start QTH,
and LED) with comparable light output on 4
light-activated restorative composites. The
Shrinkage measurements
The strain-gauge method17 (Fig 1) was used to
measure the development of postgel shrinkage for the different curing unit and composite
combinations. Shrinkage strains at the bottom
of the composite samples were measured in
2 perpendicular directions using a biaxial
stacked strain gauge (CEA-06-032WT-120,
Measurements Group). Uncured composite
was placed on the strain gauge. The sample
area attached to the strain-gauge backing
was approximately 9 mm2, while the actual
gauge area was 0.656 mm2. This ensured that
sample boundary artifacts would not affect
the measurement area. The light intensity that
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Ta b l e 2
Microfilled
Filtek A110
Anterior Restorative
Nanofilled
Filtek Supreme
Universal Restorative
Hybrid
(continuum-filled)
Hybrid
(continuum-filled)
Z100 Restorative
Filtek Z250
Universal Restorative
Description of fillers
Shade
Lot no.
A2D
3BA
A2 Body
3BF
A2
HE
A2
3XC
Curing light
Curing light
Composite
sample
Composite
sample
Cover
Light cell
d
Data
output
Strain gauge
Mold
s
Glass slide
Hardness measurements
Microhardness as a function of depth was
measured (Fig 2) to evaluate the distribution of
degree of cure within the cured composite.19
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700
600
500
400
300
200
QTH
100
LED
Soft-start QTH
0
0
10
20
Time (s)
30
40
Fig 3 Light intensity output during 40-second light cure for the 3 light
sources used in this study: Elipar 2500 (QTH), Elipar Free Light (LED), and
Elipar TriLight (soft-start QTH). The surface area under the curves represents the light energy (reported in Table 1).
Indentations were placed at 0.5-mm increments, starting 0.5 mm from the light-cured
edge until the composite was too soft to
measure. In addition, the hardness at 0-mm
depth was measured from the composite
surface cured against the glass slide. The
sample size for each light source and composite was 5. Only the hardness values at the
composite surface (0 mm) and 2-mm depth
were used for statistical analysis.
Two-way ANOVA at a significance level of
.05 was performed to determine if there was
any difference in hardness as a result of light
sources, composites, or composite*light
source interaction.
RESULTS
Each light source had its characteristic irradiation pattern, as shown in Fig 3, where the
light intensity was recorded as a function of
time. The mean intensities of the QTH and
LED units were 634 and 529 mW/cm2,
respectively (n = 3). The light intensity output
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A110
Supreme
500
0
100
200
300
400
500
600
500
QTH
1,000
LED
1,500
Soft-start QTH
2,000
2,500
3,000
500
3,500
0
100
200
300
400
500
600
500
QTH
1,000
LED
1,500
Soft-start QTH
2,000
2,500
3,000
3,500
Time (s)
Time (s)
Z100
Z250
500
500
0
100
200
300
400
500
600
500
QTH
1,000
LED
1,500
Soft-start QTH
2,000
2,500
3,000
3,500
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100
200
300
400
500
500
600
QTH
1,000
LED
Soft-start QTH
1,500
2,000
2,500
3,000
3,500
Time (s)
Time (s)
Fig 4 Development of shrinkage strain (postgel shrinkage) during polymerization for 10 minutes after the start of light cure.
Curves are the mean of each light sourcecomposite combination (n = 15), where positive values indicate expansion and negative values contraction.
Shrinkage results
Shrinkage strain (or postgel shrinkage)
development in each composite, cured with
different light sources, was recorded for 10
minutes. Mean curves were created by calculating the mean strain-time curves for each
light unitcomposite combination (Fig 4).
During the initial few seconds after the start
of the light cure, the strain values became
positive, indicating thermal expansion, which
is caused by the temperature rise due to the
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Ta b l e 3
A110
Z250
1,496 117b
1,328 56f
1,005 74i
2,242 163c
2,042 77g
1,384 327j
1,208 121d
1,290 86f
900 69i
2,489 151l
2,263 78p
2,130 176s,t
3,045 168m
2,744 85q
2,196 347t
1,938 137n
2,010 108r
1,662 106u
Vertical lines connect results within each composite that are not significantly different. Same letter denotes mean values within
each light unit that are not significantly different. (Two-way ANOVA, pairwise comparisons; P > .0167).
A110
Supreme
Z100
Z250
3,500
40 s
Shrinkage strain (106)
3,000
10 min
2,500
2,000
1,500
1,000
500
0
QTH LED
Softstart
QTH
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A110
Supreme
80
80
QTH
QTH
70
70
LED
60
Knoop hardness
Knoop hardness
LED
Soft-start QTH
50
40
30
20
60
Soft-start QTH
50
40
30
20
10
10
0
0
0.5
1.5
2.5
3.5
0.5
Depth (mm)
1.5
2.5
3.5
Depth (mm)
Z100
Z250
80
80
QTH
QTH
70
70
LED
60
Soft-start QTH
Knoop hardness
Knoop hardness
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50
40
30
20
10
LED
60
Soft-start QTH
50
40
30
20
10
0
0
0.5
1.5
2.5
Depth (mm)
3.5
0.5
1.5
2.5
3.5
Depth (mm)
Fig 6 Knoop microhardness (mean and SD) of 4 composites cured by various light sources, measured 15 minutes after light curing (n = 5).
Hardness results
Knoop hardness profiles were determined at
various depths, as an indication of the
achieved degree of polymerization in the
cured composite (Fig 6). For all light sources
and composites, hardness values decreased
with increasing depth. In general, the hybrid
composite Z100 had the highest hardness
values, while the lowest values were found
for the anterior microfilled composite A110.
The differences between curing lights were
the largest for the nanofilled composite
Supreme and hybrid composite Z250.
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Ta b l e 4
A110
Microhardness of
composite surface (0 mm)
QTH
LED
Soft-start QTH
Microhardness at 2-mm depth
QTH
LED
Soft-start QTH
Z250
29.9 3.3
28.7 6.3
33.8 4.6
55.0 2.7
36.5 2.3
44.1 7.1
61.9 4.7
58.9 3.4
64.3 8.9
52.7 1.4
50.2 2.5
36.3 5.8
14.8 6.8
10.0 6.1
9.4 3.6
28.4 3.0
18.2 3.4
17.8 2.3
23.0 6.6
28.1 7.3
18.2 3.6
38.4 4.0
27.2 3.8
12.5 4.7
Vertical lines and bracket connect results within each composite that are not significantly different (2-way ANOVA, pairwise comparisons; P > .0167).
A110
Supreme
Z100
Z250
75
0 mm
2 mm
Knoop hardness
60
45
30
15
QTH LED
Soft- QTH
start
QTH
Softstart
QTH
DISCUSSION
Clinicians, researchers, and dental industries
likewise perceive polymerization shrinkage,
which threatens the adhesive bond and
restoration longevity, as one of the most challenging properties of restorative composites.1 Apart from improvements in the
resin matrix chemistry, curing light philosophy and clinical techniques have brought
about some reduction in polymerization
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stress are both crucial for clinical performance of composites, and since degree of
cure and shrinkage stress do not have a
direct correlation, both variables were
assessed through the combination of hardness and postgel shrinkage measurements.
It was found that both the curing unit and the
type of composite significantly affected the
postgel shrinkage and hardness. The softstart QTH curing unit reduced postgel
shrinkage (and thus potential shrinkage
stress) in most of the composites tested but
produced optimal hardness only at the surface of 2 composites. The conventional QTH
unit (highest light intensity output) usually
provided favorable hardness, but this was
associated with high postgel shrinkage. The
tested LED unit, with its intermediate light
intensity output, achieved intermediate values for both shrinkage strain and hardness.
The ideal conditions for a high degree of
cure and a low postgel shrinkage were not
easy to obtain together. This likely requires a
soft-start light cure followed by a higher intensity or extended exposure time.
ACKNOWLEDGMENTS
This research was supported by the Minnesota Dental
Research Center for Biomaterials and Biomechanics and
by NIH grant 5T35DE07098. The authors thank Dr James
S. Hodges for his statistical advice.
REFERENCES
1. Ferracane JL. Current trends in dental composites.
Crit Rev Oral Biol Med 1995;6:302318.
2. Tantbirojn D, Versluis A, Pintado MR, DeLong R,
Douglas WH. Tooth deformation patterns in molars
after composite restoration. Dent Mater 2004;20:
535542.
3. Bouschlicher MR, Vargas MA, Boyer DB. Effect of
composite type, light intensity, configuration factor
CONCLUSION
4. Watts DC, al Hindi A. Intrinsic soft-start polymerisation shrinkage-kinetics in an acrylate-based resincomposite. Dent Mater 1999;15:3945.
5. Emami N, Sderholm KJM, Berglund LA. Effect of
light power density variations on bulk curing properties of dental composites. J Dent 2003;31:189196.
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1:1114.
2004;20:543553.
133:429434.
180:411416.
25):S4S15.
2004;20:554564.
27. Bowen RL. Properties of a silica-reinforced polymer
for dental restorations. J Am Dent Assoc 1963;66:
5764.
112:8488.
1997;25:321330.
30. Leinfelder KF. Ask the expert. What intensity is best
18. Felix CA, Price RBT. The effect of distance from light
Dent 2003;5:283291.
20(suppl 25):S34S41.
1984;156:209215.
J Dent 2001;14:145147.
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