CURING LIGHTS IN

ORTHODONTICS
BY
PERTHISH SHARMA
 INTRODUCTION
• The use of lights curing as a means of initiating
the polymerization of orthodontic adhesive has
gained in popularity in recent years, having first
been described by Tavas and Watts.
• Bonding orthodontic attachments to enamel
became available in orthodontics in the early
1960s.
• With the use of visible light cure adhesive , now
used by vast majority of the orthodontist ,was
first described by Bassiouny in 1978.
• Light curing adhesive have become more
popular than self curing resin in recent years
for orthodontic bonding because of the
following advantages:-
I. Good Aesthetics
II. Improved physical property
III. Control over working time
IV. Acceptable bond strength
 COMPOSITION OF COMPOSITE RESIN
• The basic constituents of the composite resin
include :-
1. Inorganic filler
2. Inhibitor
3. Stabilizers
4. Initiators
5. Monomer and colouring pigments
• The most commonly used initiator is
camphorquinone which helps to initiate the
polymerization reaction in the composite.
• Usually the light required for curing is
between 360 to 500 nm
• For camphorquinone , light at wavelength of
470 nm is essential. Only when this is
achieved will the polymerization reaction
begin by formation of the free radicals.
 DIFFERENT TYPES OF CURING LIGHTS
• Over the years many forms of curing lights have been
introduced which range from very old (Ultraviolet
spectrum) to more recent ones (LASERS) having
significant advantages over the other. The various
system include the following:-
1. Ultra-violet light cure unit
2. Quartz Tungsten Halogen (QTH) unit
3. High performance QTH unit
4. Plasma Arc
5. LED Unit
6. LASERS
 Ultra-Violet Light Curing Unit
• This was the Initial very first
curing unit that was introduced
for curing composite resins.
• The wavelength was in the
range of 364-367nm
• But due to its hazardous effects
on the eye, it was discontinued
• The time needed for curing was
as much as around 90 sec.
 Quartz-Tungsten Halogen(QTH) Light
• These lights contain lamp with a
tungsten filament in an inert gas with
small amount of halogen gas.
• The filament was heated to about
2700 0c creating visible light and UV
radiations which was filtered to
approximately 380-500 nm.
• But the main disadvantages with
these include the production of heat
and only 9% of the total energy is
converted to light and hence to
decrease the temperature cooling
fans are needed which further add to
the noise of the unit.
 High performance QTH Light
• They have got advantage of less curing
time over conventional halogen light
cure
• The special tungsten quartz halogen
optibulb degrades less with time
• The wavelength produced is in the
range of 400-505 nm
• The main disadvantages include :-
1. Slower curing as compared to recent
advancements
2. Bigger unit size
3. Heat production still an issue along
with fan noise
 Plasma Arc
• Introduced in the mid 1990’s as a
affordable , high speed curing light
• Developed after the technology
used by NASA in aeronautical
research.
• Light uses a xenon gas, distilled
from liquid air and then electric
current is passed through the gas
which ionises it and produces
negative and positive charged
particles
• This light is the filtered into the
wavelength of 450-500nm with an
energy level of 900V from 2000mV which
is much higher than QTH and hence
shorter curing time can be achieved
• The curing of composite can be done in
about 2 sec time
• The main disadvantages include:-
1. Need a much lager cooling fan due to
considerable heat generation
2. Expensive
3. Bulky and heavy to use
 LIGHT EMITTING DIODE(LED)
• Introduced in 1995 by Mills
• They used junctions of
doped semiconductors to
generate visible light with no
light filtration needed
• LED are highly efficient light
source that produce light in
a narrow spectrum range of
400-500nm
• Advantages include the following:-
1. less degradation of the light output hence good
self life
2. No filters needed and no fans needed so
compact unit can be made
3. Avoid the production of heat so less pulpal
irritation effect is seen
4. Most commonly used and inexpensive
5. Available in cordless forms
• Disadvantages of LED include :-
1. More cost as compared to
QTH
2. Curing time longer than
plasma arc
3. Need to recharge batteries
 LASERS
• Argon laser are most commonly
employed for the curing of the
composite resin
• Wavelength of 488nm and 514
nm
• Curing time is 5 sec for
orthodontic composite
• Can also be employed for other
minor procedure like gingival
recontouring and coagulation at
different wavelength
• Major disadvantages of lasers include :-
1. Curing depth is limited to 1.5- 2 mm
2. Curing tip is small so more time is needed to
cure
3. Narrow spectrum output
4. Very expensive
 EFFECT OF CURING TIME ON SHEAR
BOND STRENGTH
• According to Lalani et al and Elvebak et al at
300 W power the argon laser has the capability to
maximally polymerize the adhesive in as little as 5
sec.
• Oesterle et al and Signorelli et al found out that
xenon plasma arc curing lamp exposure time of 6
to 9 sec produce shear bond strength equal to
those produced with 40 sec exposure to a
conventional Tungsten Quarts halogen lamp
• Turkkahraman and Kucukesmen studied that
orthodontic brackets be photo polymerized
for at least 20 sec with the LED light cur eunits
before arch wire are engaged and that this is
equivalent to 40 sec of halogen based
illumination.
 FACTORS AFFECTING THE BOND
STRENGTH
• From orthodontic point of view increase in the
thickness of resin reduce the shear strength of
the bonding at enamel bracket interface
• Penetration of light depends on the shade and
opacity of the enamel lighter shades will have
easy penetration and vice versa
• Bulk of material if added decrease the
polymerization rate hence decrease the
overall bond strength
• Depth of cure:- A standard time of 20 sec is usually
required to cure to a depth of 2-2.5 mm by
most lights units having a power density of
800mW/Cm2 and for a unit emitting 400mW/Cm2 an
exposure of 40 sec is needed.
• Distance between the light source and composite
ideally speaking the tip must be placed about 3mm
away from the bracket –composite interface to allow
effecting curing. If this distance gets increased this can
lead to decrease in the overall bond strength
• Longer wavelengths light sources help to
penetrate more hence allow better
polymerization of the composite
• Size of the curing tip:- A standard diameter of
11 mm helps to dissipate energy much more
evenly than a small size of about 3 mm tip size
which can reduce the curing time but increase
the pulpal temperature.
 Light and Bracket Failure Rate
• To test the failure rate of brackets with
different light sources various studies have
been performed through out a set time period
which range from 6 months to 18 months
duration
• Data on the failure rates for the halogen lamps
may be in the range of 3-5% with overall equal
to that of LED lamps
• High bond failure rates were seen in the
mandibular dental arch compared to the
maxillary and in the posterior segment
(premolar region) compared to the anteriors.
• Some other factors that can contribute to the
failure rate of the bracket include the type of
malocclusion, type of food habits and the
material being used.
 BIOLOGICAL ACTION OF CURING
LIGHTS
• Initially blue light was characterized as
harmless, more recent studies have shown
that it affects several aspects of cell physiology
• Mainly associated with disturbed
mitochondrial function thus causing oxidative
stress leading to activation of stress response
pathway, oxidative damage to DNA, or even
inhibition of mitosis
• Investigation s have shown that blue light induces
effects on the DNA integrity , cellular mitosis, and
mitochondrial status in various cell types through
the generation of reactive oxygen species.
• However the result of sole investigation adopting
to the time exposure in orthodontic bonding has
shown that blue light did not affect the viability
of these cells as no signs of cytotoxicity were
observed
 TEMPERATURE CONSIDERATIONS
• Halogen, argon laser and plasma arc lights all
generate significant heat and need a cooling fan.
• Hence this heat generated is transferred to the
tooth which can increase the pulpal temperature
and cause discomfort to the patient.
• According to Powell et al in vitro pulp chamber
increase from the laser unit were significantly
lower than that from conventional curing lights
• Cobb et al and Powell et all also concluded
that the argon laser should pose no threat to
the pulp chamber if used at recommended
energy level.
 CONCLUSION
• Polymerization shrinkage is the main concern
about composite resin and needs to be kept in
mind while using along with the initiator used
• The new generation of the system have high
power density, high light intensity and shorter
exposure time so there is reduced chair time and
enhanced depth of cure
• The proper selection and maintenance of the
light is important for quality control
• LED are the most popular with least maintenance
while the halogen unit need heavy maintenance
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