Article_5_3_1

                   DENTAL MATERIALS
                   LIGHT TRANSMISSION THROUGH RESIN COMPOSITES
Original Article
                   Nicoleta Ilie1a* , Eva-Maria Plenk2b
                   1
                     Department of Operative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-Universität München, Goethestr. 70, D-80336 Munich,
                   Germany
                   2
                    Privat clinic, Bahnhofsweg 6, D-82008 Unterhaching, Germany

                   a
                       Prof. Dr. Dipl. Eng.
                   b
                       DDS, Dr.




                   ABSTRACT                                          DOI: 10.25241/stomaeduj.2018.5(3).art.1
                   Introduction: The study aimed to quantify the amount of light that passes through different
                                                                                                                                                 OPEN ACCESS This is an Open
                   resin-based composite (RBC) types and to assess if a clinically used polymerization procedure in                              Access article under the CC BY-NC
                   curing incrementally filled deep cavities is justified.                                                                       4.0 license.

                   Methodology: Light transmission through 2-mm thick specimens made of three regular RBCs - a                                   Peer-Reviewed Article

                   nano, a flowable nano and a microhybrid – of the same shade A3, was analyzed under 24 different                           Citation: Ilie N, Plenk E-M. Light transmis-
                   curing conditions, that resulted by varying the curing mode, exposure distance and exposure time                          sion through resin composites. Stoma Edu J.
                                                                                                                                             2018;5(3):148-154
                   when using a violet-blue LED light curing unit. Incident and transmitted irradiances were assessed
                                                                                                                                             Academic Editor: Jean-François Roulet,
                   in real-time on a spectrophotometer and radiant exposure, transmittance (T) and absorbance (A)                            DDS, PhD, Prof hc, Professor, University of
                   were calculated. A multivariate analysis assessed the effects of various parameters on T and A.                           Florida, Gainesville, FL, USA

                   Results: Incident irradiance varied among 656.4 (8.1) mW/cm² (Standard mode, exposure                                     Received: June 29, 2018
                   distance = 7 mm) and 3361.5 (33.6) mW/cm² (Plasma Emulation mode, 0 mm). The filler amount                                Revised: July 02, 2018
                                                                                                                                             Acccepted: July 7, 2018
                   (weight and volume %) exerted a significant effect on transmitted irradiance (p < 0.001; partial                          Published: August 01, 2018
                   eta squared ηP² = 0.400 and 0.362, respectively) while the effect of exposure distance was low (p                         *Corresponding author: Prof. Dr. Dipl.
                   < 0.001, ηP² = 0.141). Light transmittance was material-dependent and very low. The significant                           Eng. Nicoleta Ilie, Department of Operative
                   lowest absorbance was identified in Filtek Supreme XTE flow (1.11 ± 0.09), followed by Filtek                             Dentistry and Periodontology, University
                                                                                                                                             Hospital, Ludwig-Maximilians-Universität
                   Silorane (1.21 ± 0.03) and Filtek Supreme XTE (1.62 ± 0.13). Incident and transmitted radiant                             München, Goethestr. 70, D-80336 Munich,
                                                                                                                                             Germany,
                   exposure correlated exceptionally well in each RBC (Pearson correlations coefficient > 0.99).                             Phone: +49-89-44005-9412, Fax: +49-
                   Conclusion: When restoring a deep cavity with regular RBCs, each increment needs to be cured                              89-44005-9302
                                                                                                                                             e-mail: nilie@dent.med.uni-muenchen.de
                   adequately, since final curing to compensate for deficits in polymerisation is insufficient.
                   Keywords: resin-based composites, light curing unit, irradiance, radiant exposure, transmittance,                         Copyright: © 2018 the Editorial Council
                                                                                                                                             for the Stomatology Edu Journal.
                   absorbance.

                   1. Introduction                                                              reinforcing particles and polymer matrix is minimized
                   The optical properties of light cured resin-based                            when the mismatch in refractive index between
                   composites (RBC) are essential material characteristics                      each material is reduced [14]. It is thus a function of
                   that are relevant for both the esthetical appearance                         the chemical composition of both constituents and
                   of a restoration [1,2] and the quality of curing in                          differs accordingly within individual RBCs. In addition
                   depth [3]. The latter is fundamentally related to the                        to the refractive index, also the filler dimension exerts
                   translucency of the material and thus to the amount                          a significant effect on light scattering, that was shown
                   of light (photons) that is allowed to pass through                           to be highest when the filler diameter approaches
                   the RBC during polymerization. While the surface                             approximately one-half the wavelength of incident
                   of an RBC filling is prevalently sufficiently cured, the                     light, i.e. ~0.2–0.3 µm [3]. It must also be noted that
                   polymerization of deeper increments is decisively                            large variation in light transmission was observed also
                   influenced by the light transmitted through the                              within resin composite of similar shade [15]. Moreover,
                   material [4]. Yet, an insufficient polymerization may                        light transmittance varied during polymerization,
                   not be immediately noticeable. It is evidenced later                         while increasing or decreasing during curing as a
                   in the reduced mechanical properties [5], low degree                         function of the RBC type and composition [16].
                   of conversion [6], elution of unreacted monomers [6],                        In clinical dentistry, many of the aspects described
                   increased toxicity [7] and potential hypersensitivities.                     above are not sufficiently considered when making
                   The transmitted light through a material sums the                            recommendations on restoration techniques. It is, for
                   remaining light, after the incident light, striking                          instance, occasionally acclaimed to only “pre-cure”
                   the surface of the RBC, was reflected, absorbed and                          the first, lowest increment for 2-3 seconds, when
                   scattered. Light absorption occurs when atoms                                restoring incrementally a deep cavity with an RBC.
                   or molecules of the RBC’s constituents, such as                              This proceeding is justified by the additional amount
                   monomers [8], filler particles [9,10], photo-initiator                       of light that would pass through the filling when the
                   molecules [11], dyes and pigments [8,12,13] take up                          upper RBC increments are exposed to light or, as usual
                   the energy of a photon of light. In contrast, scattering                     clinically, when the entire filling is exposed again to
                   take place on reinforcing particles or porosity voids                        light at the end of the restoration.
                   [9]. The extent of scattering at the interfaces between                      Therefore it was the aim of the present study to




 148                                                                           Stoma Edu J. 2018;5(3): 148-154. http://www.stomaeduj.com
                                                                                   LIGHT TRANSMISSION THROUGH RESIN COMPOSITES




                                                                                                                                                                 Original Article
  Table 1. Resin composite brand, type, chemical composition of matrix and filler as well as filler content by weight (wt.) and volume (vol.) %. All materials
are manufactured by 3M ESPE.
                                                                                                                                               Filler wt%/
       RBCs              RBC-Type             Batch            Shade                        Resin Matrix                         Filler
                                                                                                                                                   vol%

    FiltekTM                                                    A3             Bis-GMA, Bis-EMA, UDMA, TEGDMA,                 ZrO2, SiO2
                           Nano             N229448                                                                                             78.5/63.3
  Supreme XTE                                                  Dentin                       PEGDMA                             ZrO2/SiO2

    FiltekTM
                                                                                                                               ZrO2, SiO2
  Supreme XTE         flowable Nano         N236527              A3          Bis-GMA, Bis-EMA, TEGDMA, PEGDMA                                     65/55
                                                                                                                               ZrO2/SiO2
      flow
                                                                             3,4-Epoxycyclo-hexylethylcyclopolym
     FiltekTM                                                                            ethylsiloxane
                       Microhybrid          N225426              A3                                                            SiO2, YF3          76/55
     Silorane                                                                Bis-3,4-epoxycyclo-hexylethylphenyl-
                                                                                         methylsilane

simulate and quantify the amount of light that would                             (6 mm diameter, increment thickness 2 mm, n = 5),
pass through 2 mm thick increments of different RBC                              and cured by applying the aforementioned curing
types - a nano, a flowable nano and a microhybrid –                              unit directly, perpendicularly and centered on the
as it would be received from a lower layer in a resin                            surface of the sample using a mechanic arm. While
composite filling. To simulate clinically relevant curing                        the specimens were cured, the spectrophotometer
conditions, 24 different radiant exposures were                                  measured in real-time the irradiance at the bottom
considered for each material, that were obtained                                 of the specimens. The cylindrical Teflon molds
by varying the curing mode of a modern, high-                                    containing the material were aligned centered on
performance LED light-curing unit (LCU), the exposure                            the round detector of the spectrometer, which had a
distance and the exposure time.                                                  diameter of 3.9 mm. Consequently, the irradiance and
The null hypotheses assume: a) similar light                                     radiant exposure reaching this area were considered.
transmittance (= ratio of transmitted to incident                                The miniature fiber optic USB4000 Spectrometer
radiant power) through all material types; b) within                             employs a 3648-element Toshiba linear Charge-
one material, similar transmittance for all curing                               coupled Device (CCD) array detector and high-
modes of the LCU; c) similar absorbance in all                                   speed electronics (Ocean optic, Largo, FL, USA). The
materials.                                                                       spectrometer was calibrated using an Ocean Optics’
                                                                                 NIST-traceable light source (300–1050 nm). The
                                                                                 system uses a CC3-UV Cosine Corrector (Ocean optic,
2. Materials and Methods                                                         Largo, FL, USA) to collect radiation over a 180° field of
Light transmission through three regular RBCs (Table                             view, thus mitigating the effects of optical interference
1) was analyzed under different curing conditions at                             associated with light collection sampling geometry.
a specimen thickness of 2 mm. Therefore the violet-                              Irradiance and radiant exposure at a wavelength
blue LED LCU VALO (Ultradent, South Jordan, USA,                                 range of 360–540 nm were individually collected
serial number VO 7710) was applied in three different                            at a rate of 16 records/s. The sensor was triggered
exposure modes (Standard, High Power and Plasma                                  at 20 mW. The radiant exposure was calculated by
Emulation), at various exposure times (5 s, 10 s, 15 s,                          integrating the irradiance versus the wavelength at
20 s and 40 s in the Standard mode; 1 s, 2 s, 3 s, 4 s                           the used exposure time.
and 12 s in the High Power mode and 3s and 6s in the
Plasma Emulation mode) and exposure distances (0                                 2.2. Transmittance and absorbance
mm and 7 mm). This resulted in 24 different curing                               Transmittance (T) is defined as the ratio of transmitted
conditions.                                                                      irradiance (radiant power) to incident irradiance: T =
                                                                                 It/I0, where It is the irradiance after the beam of light
2.1. Spectrophotometry: measurement of the                                       passes through the specimen and I0 is the irradiance
Incident irradiance and Light Transmittance                                      of the incident light.
Incident irradiance and light transmittance through                              Transmittance is related to absorbance by the
the analyzed RBCs were assessed on a laboratory-                                 expression: Absorbance (A) = − log(T) = −log(It/Io),
grade National Institute of Standards and Technology                             where absorbance stands for the amount of photons
(NIST)-referenced USB4000 Spectrometer (MARC                                     that are absorbed.
(Managing Accurate Resin Curing) System, Blue light                              Being defined as ratios of irradiance values,
Analytics Inc., Halifax, NS, Canada). The incident                               transmittance and absorbance are dimensionless.
irradiance (the irradiance reaching the specimen’s
surface) was determined on five occasions, by                                    2.3. Statistical Analysis
applying the curing unit directly to the sensor.                                 A Shapiro–Wilk test verified the normal distribution
With each program (standard, high power, plasma                                  of the data. A multivariate analysis (general linear
emulation) and material (Table 1) the maximum                                    model) assessed the effects of various parameters
irradiance reaching the sensor was measured in a                                 as well as their interaction terms on the transmitted
random order. The exposure distance was set at 0 mm                              irradiance and absorbance. The partial eta-squared
and 7 mm.                                                                        statistic reports the practical significance of each
Specimens were prepared in cylindrical Teflon molds                              term, based on the ratio of the variation accounted




Stomatology Edu Journal                                                                                                                                           149
                   LIGHT TRANSMISSION THROUGH RESIN COMPOSITES



                   for by the effect. Larger values of partial eta-squared
Original Article   indicate a greater amount of variation accounted for
                   by the model effect, to a maximum of 1. Correlation
                   among incident and the transmitted radiant exposure
                   was assessed by a Pearson correlation analysis. In all
                   statistical tests, p-values < 0.05 were considered
                   statistically significant when using SPSS Inc. (Version
                   24.0, Chicago, IL, USA).


                   3. Results
                   The irradiance of the analyzed LED LCU at an exposure
                   distance of 0 mm amounted to 1174.1 (12.4) mW/
                   cm² in the Standard mode, 1760.3 (9.8) mW/cm² in
                   the High Power mode and 3361.5 (33.6) mW/cm² in
                                                                                 Figure 1. Incident irradiance as a function of the curing mode and
                   the Plasma Emulation mode. The incident irradiance
                                                                                exposure distance.
                   decreased at an exposure distance of 7 mm to 656.4
                   (8.1) mW/cm², 986.3 (10.6) mW/cm² and 1917.8 (31.6)           Table 2. Absorbance as a function of RBC, curing mode and exposure
                   mW/cm², respectively (Fig. 1).                               distance as well as loss in transmitted irradiance (Δ I, %) at an exposure
                   The effect of the parameter filler amount (weight            distance of 7 mm related to 0 mm within each RBC and curing mode.
                   and volume %) was proved to be significant on the              Curing                         Exposure
                   transmitted irradiance (p < 0.001; partial eta squared                          RBC                          Absorbance          ΔI
                                                                                  mode                           distance
                   ηP² = 0.400 for weight % and 0.362 for volume %),
                                                                                                 FiltekTM           0mm          1.58 (0.2)
                   while the effect of exposure distance was low (p <                                                                             43.3 %
                                                                                              Supreme XTE           7mm          1.57 (0.21)
                   0.001, ηP² = 0.141).
                   The Plasma Emulation mode induced the highest                                 FiltekTM           0mm          1.08 (0.14)
                   transmitted irradiances in each analyzed RBC, while                        Supreme XTE                                         47.1 %
                                                                                                  flow              7mm          1.10 (0.14)
                   the lowest values were identified when the LCU was            Standard
                   run in the Standard mode. Increasing the exposure                                                0mm          1.1 (0.15)
                                                                                             FiltekTM Silorane                                    43.1 %
                   distance from 0 mm to 7 mm lowered the transmitted                                               7mm         1.10 (0.143)
                   irradiance by 43 % to 49 % (Table 2), while the incident                                         0mm               -
                   irradiance was lowered by 42.9% to 44.1%.                                        air                                           44.1 %
                                                                                                                    7mm               -
                   Within each curing mode and exposure distance,
                   the significant highest transmitted irradiances were                          FiltekTM           0mm          1.63 (0.03)
                                                                                                                                                  46.6 %
                   identified in the Filtek Supreme XTE flow, followed by                     Supreme XTE           7mm         1.65 (0.006)
                   the Filtek Silorane, while the significant lowest values                      FiltekTM           0mm         1.1 (0.0001)
                   were identified in the Filtek Supreme XTE (p < 0.001).                     Supreme XTE                                         49.3 %
                   Within the analyzed incident irradiances, which varied          High           flow              7mm         1.14 (0.003)
                   in the range 656.4 (8.1) mW/cm² (Standard mode, 7 mm           Power                             0mm        1.13 (0.0001)
                   exposure distance) to 3361.5 (33.6) mW/cm² (Plasma                        FiltekTM Silorane                                    42.9 %
                                                                                                                    7mm         1.13 (0.013)
                   mode, 0 mm exposure distance), the transmitted
                   irradiance was reduced within the range 16.5 (1.3)                                               0mm               -
                                                                                                    air                                           44.0 %
                   mW/cm² to 71.7 (4.9) mW/cm² in Filtek Supreme XTE,                                               7mm               -
                   49.5 (2.3) mW/cm² to 217.9 (13.0) mW/cm² in Filtek                                               0mm          1.66 (0.01)
                                                                                                 FiltekTM
                   Silorane and 49.7 (2.4) mW/cm² to 249.1 (16.3) mW/                                                                             45.1 %
                                                                                              Supreme XTE           7mm         1.69 (0.008)
                   cm² Filtek Supreme XTE flow (Fig 2). This means that
                   within the above-mentioned intervals the percentage of                        FiltekTM           0mm         1.13 (0.006)
                                                                                              Supreme XTE                                         48.5 %
                   transmitted irradiance relative to the incident irradiance                                       7mm         1.17 (0.006)
                                                                                                  flow
                   amounted 1.4% to 2.1% in the Filtek Supreme XTE, 4.2%         Plasma E.
                                                                                                                    0mm          1.14 (0.2)
                   to 6.5% in the Filtek Silorane and 4.2% to 7.4% in the                    FiltekTM Silorane                                    47.0 %
                   Filtek Supreme XTE flow. Within these limits, by trend,                                          7mm          1.22 (0.02)
                   the lower the incident irradiance, the higher the %                                              0mm               -
                   transmitted light related to the initial irradiance.                             air                                           42.9 %
                                                                                                                    7mm               -
                   The significant lowest absorbance was identified in
                   the Filtek Supreme XTE flow (1.11±0.09), followed            exposure distance of 0 mm, the highest incident
                   by the Filtek Silorane (1.21±0.03) while the highest         radiant exposure was identified when the LCU was
                   absorbance was measured in the Filtek Supreme XTE            run in the Standard mode and an exposure time of
                   (1.62±0.13). A strong influence on absorbance was            40s (46.96 J/cm²), followed by the 20s exposure in the
                   identified in the parameter RBC (p < 0.001; partial          same curing mode (23.48 J/cm²), the 12 s exposure
                   eta squared ηP² = 0.744), followed by the parameter          in the High Power mode (21.12 J/cm²), and the 6s
                   curing mode (p < 0.001; ηP² = 0.364) while the               exposure time in the Plasma Emulation mode (20.17
                   exposure distance exerted only a low influence (p <          J/cm²). The lowest radiant exposure resulted at an
                   0.001; ηP² = 0.117) (Table 2).                               exposure time of 1s in the High Power mode (1.76 J/
                   Within the 12 analyzed curing conditions at an               cm²) (Fig. 3). For an exposure distance of 7 mm, the



 150                                                               Stoma Edu J. 2018;5(3): 148-154. http://www.stomaeduj.com
                                                                            LIGHT TRANSMISSION THROUGH RESIN COMPOSITES




                                                                                                                                                Original Article
 Figure 2. Transmitted irradiance through 2 mm thick specimens of the                                      (a)
analysed RBCs as a function of curing mode and exposure distance.




                                                                                                             (b)
                                                                           Figure 4. Radiant exposure as recorded at the bottom of 2-mm thick
 Figure 3. Radiant exposure received by the top-surface of the analysed   specimens of the analysed RBCs, as a function of exposure time and
specimens as a function of exposure time, distance and curing mode.       curing mode at an exposure distance of a) 0 mm and b) 7 mm.
radiant exposure varies in the same sequence at lower                     more reasons against exposure to high irradiance, as
values, which varied from 26.26 J/cm² (40s, standard                      curing fast at high irradiances leave no room to relieve
mode) to 0.99 J/cm² (1s, High Power mode).                                internal stresses accumulated during shrinkage [17].
An excellent correlation was found in each RBC                            To address light transmittance also from the perspective
between the incident and the transmitted radiant                          of a different chemical composition of the organic matrix,
exposure (Fig. 4 a, b) (Pearson correlations coefficient                  the silorane based material Filtek Silorane was additionally
= 0.997 for Filtek Supreme XTE, 0.999 for Filtek                          selected. It must be noted that this material is no longer on
Supreme XTE flow and 0.925 for Filtek Silorane).                          the market. The reasons therefore were not motivated in
                                                                          the physical properties or curing behavior of Filtek Silorane,
                                                                          since there were comparable to regular methacrylate-
4. Discussion                                                             based RBCs [18,19]. The siloran monomer was obtained
The present study quantifies the attenuation of                           from the reaction of oxirane and siloxane molecules, thus
light when traveling through different types of resin                     combining the two key advantages of the individual
composite specimens of a predetermined thickness                          components: low polymerization shrinkage due to the ring-
of 2 mm. This thickness was chosen owing to the fact                      opening oxirane monomer and increased hydrophobicity
that all three analyzed materials are regular RBCs that                   due to the presence of the siloxane species [20]. It is a four-
need to be placed incrementally, while the thickness                      branched monomer (methacylate monomers are only
of an increment should not exceed 2 mm. The selected                      two-branched) which suggest a high crosslinking density
materials belong to different RBC types - nano, flowable                  of the final polymer and, as a result, good chemical stability.
nano and microhybrid. Two of the analyzed RBCs - Filtek                   A further particularity of this system is the cationic initiated
Supreme XTE flow and Filtek Supreme XTE – have a quite                    polymerization which is less sensitive to oxygen compared
similar chemical composition of all their constituents and                to the radical polymerization of the methacylate-based
primarily differ with respect to the filler amount (Table 1).             RBCs. The cationic polymerization initiation system
Both are methacrylate-based RBCs. The difference in filler                consists of camphorquinone, an iodonium salt, and an
amount resulted in significantly lower light transmittance                electron donor. In the redox process, the electron donor
and a ca. 50% higher absorbance in the higher filled                      decomposes the iodonium salt to an acidic cation which
material. Although light transmittance was higher in the                  then starts the ring-opening polymerization process [20].
Filtek Supreme XTE flow, it amounted to less than 250                     The transmittance and absorbance characteristics
mW/cm² also at the highest analyzed incident irradiance                   measured in the present study for Filtek Silorane were
(3361.5 ± 33.6 mW/cm², Plasma Emulation). Considering                     rather comparable to the flowable then to the nano RBC
that the polymerization at such high irradiances should                   Filtek Supreme XTE. Apart from differences in the refractive
not exceed a few seconds, due to the increased risk                       index and filler size that influence light scattering and thus
to over-heat the pulp, the amount of light available to                   light transmittance [3,14] as mentioned above, the results
potentially complete the curing of an underneath pre-                     may be explained by the similar volumetric filler amount of
cured increment might be by far insufficient. There are                   both materials (Table 1).



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                   LIGHT TRANSMISSION THROUGH RESIN COMPOSITES



                   The 24 different curing conditions analyzed in the              thick increments, this amounted to less than 4 J/cm² in
Original Article   present study were simulated by using a violet-blue             the most translucent RBCs at highest incident radiant
                   LED LCU that offers three different curing programs of          exposure (40s, standard mode, exposure distance 0
                   medium and high irradiances: 1174.1 (12.4) mW/cm² in            mm) and less than 2 J/cm² at an exposure distance of 7
                   the Standard mode, 1760.3 (9.8) mW/cm² in the High              mm at similar curing conditions. A general value for the
                   Power mode and 3361.5 (33.6) mW/cm² in the Plasma               radiant exposure that is needed to adequately cure a 2
                   Emulation mode. The LCU is equipped with four high-             mm increment of an RBC is indicated as 16 J/cm², thus
                   power LED chips emitting three different wavelength             the transmitted values measured in the present study
                   ranges (two chips with a peak at 465 nm, one chip with          are far away from fulfilling this requirement (Fig 4).
                   a peak at 445 nm and 405 nm, respectively) and placed           To transfer these data to a clinical relevant situation,
                   directly into the head of the LCU.                              we may consider the Standard mode of the LCU used
                   In addition to the exposure distance, the angle at which        in the present study (ca. 1200 mW/cm²), which would
                   an LCU is placed on the restoration plays a major role for      correspond to a modern and well-working LCU, as
                   the quality of polymerization. Particularly in posterior        used by many clinicians. For this curing settings and
                   cavities that are difficult to access, the LCU may not be       under ideal laboratory conditions (exposure distance 0
                   placed perpendicularly on the restoration. In this case, the    mm, LCU placed perpendicularly on the RBC’s surface)
                   RBC may cure inhomogeneously in depth, according to             significantly less than 100 mW/cm² pass through a 2 mm
                   the placement of the LCU, even if the surface appears to        increment of a flowable RBCs (FiltekTM Supreme XTE
                   be well cured. This situation is a good indication for using    flow), which was the most translucent material analyzed
                   a "pin-shaped" LCU, like the one analyzed in the present        in the present study. These values are even reduced to
                   study. Furthermore, in a clinical situation, if the composite   87.2 (1.9) in the FiltekTM Silorane and to 29.1 (1.3) in the
                   surface is larger than the light exit window of the LCU, it     FiltekTM Supreme XTE. Thicker composite layers, as they
                   must be polymerized in an overlapping manner to cover           may result in a clinical situation during restoring a cavity,
                   the entire composite surface. It must also be taken into        are even completely impermeable to light [22]. Under
                   account that the amount of light emitted by an LCU is not       clinical relevant conditions, light transmittance may be
                   equal to the amount of light a restoration receives. Apart      even lower, accounting for numerous factors related to
                   from angulation, the access to lower increments in deep         the LCU or clinician. This comprises the use of LCUs with
                   restorations in a clinical situation may be impeded by the      low irradiance, defect or contaminated waveguides,
                   presence of cusps. Therefore, the exposure distance was         improper polymerization due to angulation and high
                   set in the present study either at 0-mm, to simulate the        exposure distances. Thus, the present study provides
                   closest contact between restoration and LCU, or at 7 mm.        clear arguments against the above-claimed curing
                   As shown in the present study the enlarged exposure             techniques and reinforces the recommendation to
                   distance lead to a loss of almost 50% of the incident           sufficiently polymerize each RBC layer. The data also
                   irradiance related to the closest contact, also when using      suggest that a subsequent polymerization of an RBC
                   a modern, high-performance LCU.                                 filling to potentially alleviate tooth sensitivity due
                   For economic reasons, clinicians often demand short             to insufficient polymerization in depth is useless.
                   curing times when polymerizing RBCs. This led to the            Besides, it should also be mentioned that an important
                   development of the concept of "exposure reciprocity".           requirement for a successful polymerization is an intact
                   This concept considers the product of the incident              and clean waveguide. This needs to be checked clinically
                   irradiance (mW/cm²) and exposure time (s), which is             before each exposure, as residues of composite or
                   denominated as radiant exposure (J/cm²). It assumes             adhesive, which often sticks to the waveguide, leading
                   that, at a given radiant exposure, the effect induced in the    to a strong reduction in the irradiance of the LCU, as
                   RBC would be similar, irrespective if the radiant exposure      the results of the present study suggest. It should also
                   is reached by lowering the exposure time and increasing         be borne in mind, that the variation of irradiance with
                   the irradiance or vice versa. Even if this simple construct     exposure distance is LCU-specific. What is especially fast
                   sounds plausible and useful in a clinical situation, it is      is the reduction of the irradiance with the distance for
                   not universally valid. It does not apply especially if very     LCUs when using a so-called "turbo" waveguide.
                   high or very low irradiances are used. [21]. Numerous
                   studies in recent years have clearly shown that efficient
                   polymerization, especially in depth, is achieved with LCU       5. Conclusions
                   of moderate irradiance (maximum 1200 mW/cm²) and                All null hypotheses must be rejected. Light transmittance
                   exposure times of at least 20 s [5].                            was shown to be material dependent and very low
                   The recommendation to pre-cure the lowest increment             in regular RBCs, irrespective of RBC composition and
                   for only few seconds as justified by the additional             type. It is therefore indicated to adequately cure each
                   amount of light supplied during the cavity restorations         increment when restoring a deep cavity, and not to
                   must be declined. As summarized in Fig. 2, the light that       relay on a final curing of a restoration to compensate for
                   passes through 2 mm thick layers of various RBCs after          deficits in polymerisation in deeper increments.
                   light exposure by means of a high-performance LCU is
                   too low. It must be pointed out that, within the analyzed
                   curing conditions, the transmitted light related to             Author contributions
                   the incident light amounted only 1.4% to 2.1% in the            NI: designed the study, designed and established the
                   Filtek Supreme XTE, 4.2 to 6.5 in the Filtek Silorane and       methods and infrastructure, analysis and interpreted
                   4.2% to 7.4% in the Filtek Supreme XTE flow. In terms           the data, made statistics and wrote the manuscript. EP:
                   of radiant exposure measured at the bottom of 2-mm              collected and analyzed the data.



 152                                                                 Stoma Edu J. 2018;5(3): 148-154 http://www.stomaeduj.com
                                                                              LIGHT TRANSMISSION THROUGH RESIN COMPOSITES



                                                                            12.   Haas K, Azhar G, Wood DJ, et al. The effects of different




                                                                                                                                                            Original Article
                                                                                  opacifiers on the translucency of experimental dental
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                                                                                                        Nicoleta ILIE
                                                                               Dipl. Eng, PhD, Professor
                        Department of Operative/Restorative Dentistry, Periodontology and Pedodontics
                                         Faculty of Medicine, Ludwig-Maximilians University of Münich
                                                                                      Münich, Germany



CV
Dipl. Eng. Nicoleta Ilie attended the “Technology of silicates and high-temperature oxides” at the Traian Vuia University,
Timişoara, Romania (1989-1993). She studied material sciences with a focus on glass and ceramics at the Friedrich Alexander
University, Erlangen-Nuremberg, Germany (1994-1999). She got her doctoral degree in material sciences from the Ludwig-
Maximilians-University, Dental School, Münich, Germany (1999-2004), followed by her postdoctoral lecture qualification
(habilitation) at the same university (2004-2009). Since 1999, she has been assistant professor, associated professor (2009) and
tenured professor (2014) of biomaterials at the Dental School of the Ludwig-Maximilians-University in Münich.




 Stomatology Edu Journal                                                                                                                                       153
                   LIGHT TRANSMISSION THROUGH RESIN COMPOSITES


Original Article
                   Questions
                   1. Which parameters do not affect light transmittance through resin composites?
                   qa. Reflection, absorption and scattering of the incident light;
                   qb. Refractive index of filler and matrix;
                   qc. Filler size;
                   qd. Type of resin composites.

                   2. Which type of resin composites has been analyzed in the present study?
                   qa. A bulk-fill resin composite;
                   qb. A macro-fill resin composite;
                   qc. A resin-modified glass-ionomer;
                   qd. Nano and microhybrid resin composites.
                   3. Light transmittance through the analyzed 2-mm thick resin composite
                   increments amounted:
                   qa. > 50% of the incident light;
                   qb. > 25% of the incident light;
                   qc. < 10% of the incident light;
                   qd. 0% of the incident light.

                   4. When restoring a deep cavity with resin composites incrementally:
                   qa. The lower increment needs to be cured adequately;
                   qb. The lower increment must only be pre-cured for few seconds since it will receive sufficient light at the
                   end of the restoration;
                   qc. At very high irradiance, curing each increment for 1-2 s is sufficient, since exposure reciprocity is a valid
                   concept;
                   qd. Curing at very high irradiance will reduce shrinkage stress.




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 154                                                              Stoma Edu J. 2018;5(3):148-154.     http://www.stomaeduj.com