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Advances in light-curing units: four generations of LED lights and clinical

implications for optimizing their use: Part 2. From present to future

Article  in  Dental update · June 2012

DOI: 10.12968/denu.2012.39.1.13 · Source: PubMed

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 RestorativeDentistry

Adrian C Shortall

Will M Palin, Bruno Jacquot and Bruno Pelissier

Advances in Light-Curing Units:

Four Generations of LED Lights
and Clinical Implications for
Optimizing their Use: Part 2. From
Present to Future
Abstract: The first part of this series of two described the history of light curing in dentistry and developments in LED lights since their
introduction over 20 years ago. Current second- and third-generation LED light units have progressively replaced their halogen lamp
predecessors because of their inherent advantages. The background to this, together with the clinical issues relating to light curing and
the possible solutions, are outlined in the second part of this article. Finally, the innovative features of what may be seen as the first of a
new fourth-generation of LED lights are described and guidance is given for the practitioner on what factors to consider when seeking to
purchase a new LED light activation unit.
Clinical Relevance: Adequate curing in depth is fundamental to clinical success with any light-activated restoration. To achieve this goal
predictably, an appropriate light source needs to be combined with materials knowledge, requisite clinical skills and attention to detail
throughout the entire restoration process. As dentists increasingly use light-cured direct composites to restore large posterior restorations
they need to appreciate the issues central to effective and efficient light curing and to know what to look for when seeking to purchase a
new light-curing unit.
Dent Update 2012; 39: 13–22

Light-activation units are standard items
of equipment in contemporary dental
practice. An inherent problem for light-
cured direct restorations is that materials
harden first nearest the light source.
AC Shortall, BDS, DDS, WM Palin, BSc,
PhD, The Dental School, University of
Birmingham, St Chad’s Queensway,
Birmingham B4 6NN, UK, B Jacquot,
BDS, PhD and B Pelissier, BDS, PhD,
UFR d’Odontologie de Montpellier I 545,
Avenue du Professeur Jean-Louis Viala
34193, Montpellier Cedex 5, France.
Unfortunately, surface hardness, as
detected by a dental explorer, does not
indicate adequate polymerization. Perhaps
even more critically the operator does
not know ‘what lies beneath’. The ultimate
expression of inadequate polymerization
is something that has colloquially
been termed as the ‘soggy bottom’
phenomenon!
Original features of third-
generation LED LAUs
Ratio of consumption to power supplied
The ideal light would convert
all the electrical power into light of
the desired wavelength. As the power
conversion improves less heat is generated.
Because LED LAUs need less electrical
energy for the same optical power output
than QTH and PAC lamps, it has meant
that small, lightweight battery-operated
units have become practical and popular.
Broad spectrum QTH and PAC LAUs require
wavelength restricting photon and heat
filters to suppress dangerous and inactive
radiation, such as UV, red and IR. Only
about 1–2% of the energy used to power
a QTH LAU is converted into useful curing
energy. Filters used by traditional lamps
return the filtered radiation as heat. Noisy
and bulky fans are required to remove this
heat and they have the added drawback
of consuming energy themselves. LED

January/February 2012 DentalUpdate 13

 RestorativeDentistry
Figure 1. Four wand style LED LCUs. From left
to right two corded Ultralume 5® and Valo®
(Ultradent) and two cordless battery powered
units SmartLite Max® (Dentsply) and Elipar S10®
(3M ESPE).
units are inherently more efficient in
this respect. Putting together all these
energy losses (heat/fan) or these levels of
unused energy (halogen/plasma), a third-
generation LED unit with equal power may
be assumed to consume between 5 to 10
times less energy than a halogen lamp and
20 times less than a xenon plasma lamp. In
these circumstances, a simple battery can
replace the mains electricity supply.
Cordless battery or mains powered corded
LED units
Third-generation LED lights are
either battery powered or corded (Figure
1) and may be integrated into a complete
dental unit. Battery powered units offer
extreme portability and convenience,
freeing the handpiece from a mains power
supply. Battery life may range from 30
minutes to over three hours. As batteries
have developed in parallel with LEDs, from
Nickel cadmium to Nickel-metal-hydride
and now Lithium-ion (thanks partly to
mobile phones and MP3 players), several
cordless units now offer over two hours
of battery activation life, allowing greater
convenience and improved ergonomics
for the dental team. The consequences
of this overflow of energy, in terms of
14 DentalUpdate January/February 2012
consumption and hence battery life,
remains to be seen. A second-generation
LED unit could operate for 3 to 4 days
without needing to be recharged. Third-
generation lights are generally only
required to operate half as long overall as
second-generation lights, giving us ~10–
15% longer running times in everyday
practice. Ni-Cad batteries and their
memory effect are a thing of the past for
well-made lights. These lights now only
use Ni-Mh or Li-ion, whose durability
of performance is acknowledged over
more than 5 years (loss of capacity is
noticeable as a very fast decline in their
ability to retain charge over time). The
new cordless version of Valo, VALOCL®
(Ultradent) may be used either with non-
rechargeable camera batteries or Lithium
iron phosphate batteries, which are stated
to last for approximately 400 cure cycles
or a week and can be recharged >1,000
times before replacement. Although
the energy of most of these LED units
is supplied by batteries, increasingly
versions are appearing which are
integrated into dental units (Adec, Kavo,
Sirona, Planmeca, etc) or are adaptable to
accessory equipment such as ultrasonic
generators (Satelec, EMS). This is not
surprising because contemporary LED
lights have designs and electronics that
facilitate this integration. A pen- or wand-
type light is hardly any more bulky than
a turbine or a surgical aspirator. However,
batteries may add signficantly to unit
bulk and weight. In addition, because
rechargeable batteries have a finite
lifespan and they are relatively expensive
items to replace; many practitioners still
prefer mains powered corded units.
Design
The second-generation
lights had changed considerably in
comparison with the first-generation, but
the same cannot be said of the arrival of
the third-generation lights. They have
retained the familiar outlines endorsed
by practitioners: pen shape with optic
fibre (such as MiniLed™), pen shape
without optic fibre-LED at the end, micro
light type such as Coltolux® (Coltene),
SmartLite PS® (Dentsply) or gun design
with fan – Bluephase® (Ivoclar Vivadent)
and SmartLite IQ® (Dentsply).
Problems for the clinician
A number of questions have
arisen since the advent of light curing
in dentistry. Thus there have been, and
continue to be, debates about the power
employed and the radiation spectrum,
shrinkage or stress of composites or
the source and precise role of the
heat generated. Even though several
excellent studies have been published
on these subjects,1-9 no precise answer
to these issues has ever been provided.
This is entirely understandable because
these analyses were, and still are, highly
dependent on factors that are constantly
changing: the energy source (light-curing
lamp) and the material to be activated
(essentially restorative composites,
sealants and bonding agents).
It therefore makes sense to look
to this third generation to help solve these
problems. Even if these suggestions do not
solve all the current problems, they do at
least raise the issues and demonstrate that
today there are certain routes which are as
yet unexplored.
Nowadays what we choose
as the maximum energy reference value
and the way the energy is delivered by a
LAU should be dictated by the needs of
different clinical situations. The light-curing
unit and irradiation protocol (radiation
time, spectrum and energy delivery
sequence) should be tailored to meet
diverse clinical demands. For example:
 Curing orthodontic brackets in 5
seconds or less;
 Allowing adequate bonding of fibre
posts and curing through ceramic veneers
or through CAD/CAM or pressed onlays
and crowns;
 Allowing all composites, irrespective
of initiator chemistry, opacity and setting
rate, to be cured to a pre-determined (by
the operator) depth whilst minimizing
polymerization contraction stress and
heating effects.
Optimal radiant exposure,
wavelength and irradiance delivered over
time will vary greatly according to clinical
circumstances. Here are a few examples:
 The end of the light guide is always
against, or very close to, the sealing
cement of a bracket and some specific
adhesives react best to light around
410 nm wavelength. Furthermore, this
adhesion has to be extremely rapid to

Figure 2. Irradiance recorded over time with MARC™-RC (Bluelight Analytics Inc, Halifax, Nova Scotia)
onto a 4 mm diameter target by two LED lights. At 2 mm distance the radiant exposure for light A
(Turbo guide) is >16 J/cm2, more than double light B (standard guide), but unit B delivers twice the
energy of unit A at 8mm distance because of its superior collimation.
avoid any movement of the bracket during
bonding.
 Light-sensitive resin-based luting
cements for indirect composite and
ceramic restorations can only receive
enough photon energy if the light from
the lamp is capable of passing through
the prosthesis, and if the useful spectrum
does not shift significantly during this
transmission (or spectral shift has to be
anticipated).
 Irradiation time needs to be increased to
account for reduced irradiance caused by
intervening restorative material.
One manufacturer has
recommended an eight-fold difference
in radiant exposure for curing their
composites (6-48 J/cm2) based on product
choice and shade selection. It is generally
recommended that a 2 mm increment
of composite should receive 12–36 J/
cm2 radiant exposure to be adequately
polymerized, but energy quality and
material properties are also crucial.
A light does not have the same
irradiance if it is placed 1 mm from the
luting cement in orthodontics and up to
8 mm from the bottom of a deep cavity
that needs to be reconstructed in multiple
layers.10 Collimation varies with unit
design and output irradiance declines by
50% or more at 4 mm distance for some,
January/February 2012 DentalUpdate 15
but not until 8 mm or more for others.
Deep restorations may not be adequately
cured if the irradiation time is based on
data when the curing light is positioned
adjacent to the material. Undercut
cavities may further complicate adequate
light energy delivery. Manufacturers
recommend radiation times which are
often based on the latter ideal situation
and the light guide is fixed normal and
stationary to the composite surface.
Clinically this is almost impossible to
achieve. Turbo light guide tips have a
greater disparity between the entrance
and exit diameters of the light guide
(higher R-value) than standard light guides
and increase irradiance when the tip is
close to the material surface, but suffer at
distances over 5 mm as they have poorer
collimation (Figure 2).11 In general, units
with standard light guides are better
collimated than units without optic-
fibre guides or micro light types. Some
manufacturers now address this problem
by using convex or Fresnel (as used in
Lighthouse lamps) light collimating lenses
to improve collimation with distance. Price
and co-workers have recently reported
the effect of distance on irradiance for
four popular LED LAUs.12 The useful beam
diameter of two of the four units tested
(defined as the beam diameter having
RestorativeDentistry
a minimum irradiance of 400 mW/cm2)
varied between 7.1 mm and 6.8 mm
at a 2 mm distance, whereas at 8 mm
distance this had declined to 5.3 mm
and 2.6 mm, respectively. Over a 3.9 mm
target diameter representative of a Class
I restoration, this corresponded to a 60%
and 80% irradiance decline for the units
in question. The superior collimation of
the former unit (Fusion) was attributed
to the wider collection angle of its lens
enabling ‘soliton-like’ propagation of the
optical beam.
Original features and
solutions provided by third-
generation LED units
Controlling the power
The first solution provided
by third-generation LED lights regards
power: these lights are capable of offering
irradiance ranges that can be described
as unlimited in both low and high energy.
Some units may allow less than 300
mW/cm² for 40 seconds without any
noticeable heating effect. These lights,
via a simple menu choice, may also allow
1,000–3,000 mW/cm² or more which can
provide ‘flash’ curing for orthodontics.
Controlling time/power curves
This unlimited provision of the
energy required for all clinical situations
leads to a second form of control, namely
that of the profiles and modulations
linking time and power. Until the present
day, low powers as well as high powers
were totally incompatible. Some lamps
(xenon plasma in particular) could never
emit below 80% of their power rating.
The same problem occurred with the first
LEDs to some extent and many halogen
units. The light was, so to speak, an
all-or-nothing lamp. The arrival of new,
custom-made LEDs offers all the desired
options with the same emission area, and
the responses to ‘menu instructions’ are
almost instant.
It is thus possible nowadays to
have a program linking time and power
with the desired profile and giving free
rein to the clinician’s imagination. Soft
and step menus are likely to become
more complex but without increasing the
practitioner’s task in the process.
 RestorativeDentistry
Controlling the irradiance (power density) as
target distance changes
When people talk about power
they do not necessarily mean power
density or irradiance. It is well known
that the further away one is and the
more the light diverges, the lower the
effective irradiance is on the illuminated
surface. Until now this correction for
distance has been done in a purely
‘empirical’ way by the practitioner during
the clinical irradiation phase, at the risk
of underestimating the energy loss. A
long-term retrospective study of the
survival rate of endodontically-treated
posterior teeth restored with MOD
composite resin restorations reported
that teeth restored with a light-activated
resin had a much lower survival rate
than teeth restored with a chemically-
activated material. The cause was
attributed to inadequate polymerization
of the light-activated restorations.13
Accordingly, several publications have
recommended that researchers position
their lamp between 4 and 8 mm from
the composite surface during their
experiments to avoid ‘underestimating’
their lamp’s power. This power reduction
has never been integrated into the power
or exposure time, despite a number
of recommendations in the past. It is
the third-generation LEDs and, more
particularly, their small dimensions and
speed of response to electrical impulses
received via menus that have made it
possible to offer and launch onto the
market new functions such as ‘auto-
focus’. The principle of the auto-focus
developed for a third-generation LED unit
the MiniLed™ AF® from Acteon14 aims to
provide a solution to the loss of energy
caused by this natural or deliberate
distancing of the light source exit window
from the surface of the material being
cured. The auto-focus on the unit being
used correlates the light irradiation time
as a function of the distance measured
between the end of the light guide and
the composite surface, like the auto-
focus on a camera which correlates the
sharpness of the picture as a function of
the distance between the lens and the
object being photographed. Nowadays,
the correlation is no longer done by
measuring the distance but by measuring
the light reflected from the composite
16 DentalUpdate January/February 2012
surface. The light sends a narrow beam
of light or emits its curing light at low
intensity. After being reflected from the
target the beam returns to the guide and
then strikes the surface of a selective
photodiode cell (specific for detecting
the indicator beam). This photodiode
will allow more or less current to pass,
depending on the irradiance received,
and it is this information that enables
a linked, calibrated micro-calculator to
deduce the distance as a function of the
measured light reflected by the composite.
If the light level is weak, the time will be
lengthened, and vice versa.
Ideal light orientation and stabilization
The shorter the irradiation time,
the more important it is that the beam is
positioned in the right direction on the
composite surface. Moving away from the
optical projection axis is seen to reduce
the irradiance received at the surface of
the material. Achieving stable and accurate
light source alignment throughout
polymerization during intra-oral curing
is not always as easy and, unfortunately,
may be neglected. In 2002, Shortall and
co-workers15 demonstrated that operator
variability is a critical issue for successful
intra-oral curing. In 2010, this finding was
confirmed by Price and colleagues,16 who
showed that cavity location and light
source type are also important variables.
When access is restricted, relatively
small changes in light guide alignment
may result in considerable reduction in
irradiance on the target material surface.
Many light units have designs which make
it difficult to see and position the light
beam optimally. Accurate and stable light
source alignment and position are required
during the entire irradiation period to
optimize intra-oral cure – something that
should be obvious! This is central to the
use of light curing but may be taken for
granted or relegated to an assistant who
might not be completely aware of the
scientific nuances.
There are hence two types of
reduction in power:
 Related to the distance between the
optical and central axis of the source and
the light housing exit window.
 Related to the distance between the
light source exit window or light guide tip
Figure 3. Demonstrates the laser ring alignment
aid for Scanwave introduced by Acteon first with
it’s MiniLed™ AF LED LAU.
and the target.
The latter factor is the one that
the dentist varies in clinical use. A second
factor may have a significant influence on
the power of the light beam and hence
on curing of the composite. This is the
divergence of the rays exiting the light
guide. Moreover, the further away, the
greater is the divergence. It should also
be noted that the stated real power of a
light being used is always measured in
a central, well circumscribed area. The
dental surgeon cannot really see where
this area is when starting to operate his/
her unit because of the dazzling power
of the light on a particularly shiny tooth.
It therefore seemed crucial to combine
this auto-focus feature with an indication
of the optimum power area (and hence
measuring area) before starting actual
polymerization. To do this, a red aiming
circle (the laser aiming function) was
created, which precedes emission of
the visible blue light. The low power
laser aiming system emits at 650 nm.
All the practitioner has to do is position
this circle (of non-curing light) at the
centre of the restoration before starting
polymerization to ensure that he/she
is going to illuminate in the right place
(Figure 3). The two factors ‘auto-focus
and laser function’ improve the time
and spatial positioning of the light as
a function of the distance between the
optical guide exit and the composite.
Provide broad spectrum output
Halogen lights offer broad
spectrum output for universal curing of
photo-activated dental resins irrespective
of initiator formulation, unlike second-

Figure 4. Cordless Scanwave by MiniLedTM unit in
base station.
Figure 5. Display window showing operating
mode (full scan), radiation time, battery status
and Laser Target ring alignment aid activated for
Scanwave by MiniLedTM.
generation monowave blue LED LAUs.
Manufacturers have added violet as well
as blue LEDs to some third-generation
units to address this limitation. To date
these polywave LED units do not possess
the spectral spatial homogeneity of their
QTH predecessors.
January/February 2012 DentalUpdate 17
Figure 6. Profile view of Scanwave by MiniLedTM
unit. Modified pen style with activation buttons
on both sides of handpiece allows either ‘pen’ or
‘gun’ style grip.
Towards fourth-generation
LED units
Scanwave by MiniLedTM
(Acteon) could be considered as the first
fourth-generation LED light to come to
the market (Figures 4 to 6). As well as
incorporating many of the ideal features
of the best third-generation lights, other
significant improvements have been
incorporated into its design.
This unit will be described in
some detail as it is the first of its type. It
features patented wavelength scanning
technology incorporated into its mode
selection, allowing the dentist to choose
the most appropriate spectral output
mode and radiation time for any possible
material and clinical situation. It has four
different diode wavelengths, the most of
any dental LED LAU to date, offering broad
spectrum curing in ‘Full Scan’ mode for all
resin-based materials, irrespective of their
photo-initiator chemistry. Figure 7 presents
preliminary data on the effectiveness of
Scanwave in curing experimental resins
with three common dental photo-initiators
RestorativeDentistry
found in modern resin-based restoratives.
Preliminary investigations
on a prototype Scanwave unit have
revealed that, by sequentially activating
different diode wavelength combinations
throughout the irradiation cycle in ‘Full
Scan’ mode, it allows good conversion in
depth whilst minimizing heating effects,
which are common with high irradiance
second- and third-generation LED LAUs
(Figure 8). Spacing the diodes off centre
distributes the energy across the light
guide face and prevents ‘central hot spots’,
which can occur with high irradiance
third-generation single blue diode LED
units (Figures 9a and b). Beam profile
imaging has revealed the sequential on/off
nature of the different diode wavelengths
in full and ‘soft’ scan menus (Figures
9c and 10). Scanwave has dedicated
bonding and orthodontic menus,
allowing customization of irradiation
time and wavelength selection for curing
adhesives and restoratives in a timely
manner, thus minimizing heating and
associated polymerization stress events. By
sequencing the activation of the different
wavelength diodes in scan modes, the
manufacturer has integrated broad
spectrum curing capability for universal
curing of all materials whilst eliminating
overheating issues, which challenge
unit stability. The soft scan menu allows
advocates of ‘soft’ polymerization to use
ramp, pulse and ‘soft stop’ concepts in a
single sequence, optimizing cure whilst
negating high stresses possible with
bulk polymerization of fast-setting high
modulus materials and thermal stressing
caused by sudden light cessation.
Scanwave’s dual button
activation system, coupled with its
modified pen style handpiece, allows
improved ergonomics by allowing either
pen or gun style grasps. It has also been
designed to meet best practice from
a cross-infection risk viewpoint. The
intra-oral optical guide is removable
for autoclaving, thus meeting the gold
standard and eliminating the need for
barrier protection, which may reduce
light delivery significantly. The grasping
part of the handpiece has a metal casing
for efficient disinfection and its exclusive
cooling system obviates the need for a
fan, thus avoiding stagnation of micro-
organisms within the unit body, which
 RestorativeDentistry

may be a cross-infection risk for patients

and the dental team.17 The charging base
of this cordless unit features a drain to
avoid trapping cleaning fluids. Scanwave is
also available in an OEM corded version for
integration into a dental unit. The award-
winning inbuilt Laser target ring feature
allows the operator to view and control
the zone to be irradiated, maximizing light
delivery (Figure 4). This innovative unit sets
the standard for the next generation of
LED LAUs.

Selection criteria for the

clinician considering
purchasing a new LED LAU,
including cost considerations
When deciding on a new
LAU to purchase the practitioner has to
consider many factors. Amongst those the
practitioner and manufacturer may wish to
consider are:
 Does the unit offer broad spectral
coverage to allow curing of all restorative
resins?
 Does the unit offer a good selection
of power settings and energy delivery
modes?
 Does the unit have autoclaveable light
guides in a suitable range of diameters?
 Does the gun or wand holder base unit
allow easy unit placement and retrieval?
 Has the manufacturer a reputation for
offering reliable high quality products?
 Is the power output stable for the time
required to cure multiple restorations?
 Has the unit an inbuilt ‘radiometer’ for
checking emitted power regularly?
 Does the unit facilitate compliance with
current cross-infection control standards?
 Is the irradiance and special output
temporally and spatially consistent?
 If cordless type, are the unit batteries
removable or integral to the unit?
 Does the manufacturer offer a reliable
and efficient repair programme?
 Does the unit have inbuilt thermal
cutout protection for the diodes?
 Does the unit offer a good range of
programmable time settings?
 Is there a corded power back-up option
Figure 7. Preliminary degree of conversion of experimental resins containing three common dental if the battery fails?
photo-initiators (see also Figure 9 of part 1 of article) cured using Scanwave by MiniLedTM in ‘Full Scan’  Is there audible indication of elapsed
mode compared with a monowave blue LED light source. The monowave high power blue LED is less irradiation time?
effective at curing a PPD-based resin and it fails to polymerize a TPO-based resin at all whereas the full
 Is the unit robust, portable, easy to use
spectrum (405 to 480 nm) Scanwave cures all three resins effectively.
and reliable?
20 DentalUpdate January/February 2012

Figure 8. Graph illustrating temperature profile recorded at the base of 2 mm increments of Tetric
EvoCeram (A3) during polymerization with (a) Scanwave in ‘Full Scan’ mode and (b) a high irradiance
control blue LED LAU. Note the significantly lower curing temperature change with Scanwave.
 Is the unit comfortable to hold and not
too heavy?
 Does the light source exit allow 360°
rotation?
 Is the light beam well collimated?
A fundamental need is that
the unit needs to cure the dentist’s
restorations reliably in a predictable and
timely manner. Other considerations are
secondary to this basic requirement. When
all factors are taken into account, cheaper
does not necessarily mean better!
Summary
It is interesting to note that,
as recently as 2008, a review paper into
developments in polymerization lamps
concluded that the most reliable unit
for curing any type of composite resin
is a ‘high-density’ halogen lamp which
features both pulse delay and soft-start
curing modes.18 This, and a recent review
published in Dental Update by Ario Santini
(2010),19 recommend that information
be available to allow the practitioner to
ensure that the emission spectrum of the
LAU is compatible with the light-activated
bonding resins and restorative materials to
be used. Unfortunately, such information is
not generally available and, also, many LAU
manufacturers do not produce or supply
restorative materials, so they may not test
January/February 2012 DentalUpdate 21
RestorativeDentistry
c
for light unit/material compatibility. The
profession is still a long way from meeting
Suh’s proposal that our resin-based
materials carry labels with indications
for required spectral bandwidth of LAU,
radiant exposure and recommended cure
protocol.20
The current articles have
reviewed the history, development and
progress of dental LED light-curing units
since their inception through to the latest Figure 9. (a, b) Digital images of the light guide
fourth-generation LED LAU and also faces of Scanwave and the high irradiance single
blue LED source mentioned in Figure 8. (c) Beam
discussed some clinical aspects of the
profile image of Scanwave’s light guide tip or exit
photo-polymerization process common
to all light-activated restoratives and
window seen ‘end on’ showing the four different
wavelengths of diode operating sequentially
orthodontic materials. Working with light- in ‘Full Scan’ mode. This patented ‘scanning’
activated restoratives requires a profound technology prevents excessive unit and tooth
understanding of the curing process of heating whilst maintaining broad spectrum
the materials used and the factors which output.
influence the outcome. The goals of
dental photo-curing, as originally outlined
by Davidson and de Gee in 2000, are to
achieve high, uniform conversion to the her radiation protocol (irradiation time
full extent of the increment thickness and mode of energy delivery - combining
chosen, whilst minimizing polymerization time/power/wavelength depending on
stress resulting in a durable restoration.21 the type, shade and increment thickness
A short radiation time is preferred for of material and the precise restorative
practical reasons. Depending on the situation) to best meet the aims of
choice of restorative material (fast or slow optimal polymerization. By offering
setting, initiator chemistry, etc) and the varied wavelength selection, radiation
clinical circumstances (cavity size and times and energy delivery rates, some
location, preferred restorative technique, polywave third-generation LED LAUs and
etc), the dentist will need to vary his or a new fourth-generation LED LAU allow
 RestorativeDentistry
Figure 10. Beam profile camera image as for
Figure 9c but with a Lambertian diffuser screen
interposed between the light source and the
camera lens to induce light scattering as might
occur within a restoration.
the practitioner the greatest freedom
to cope with the diverse demands of
modern clinical practice. Advances in
materials science will underpin further
developments and assist dentists in
choosing appropriate radiation protocols
for specific materials and clinical situations,
thus allowing them to provide optimal care
for their patients. With recent advances
in LED technology, the future for dentists
using LAUs is indeed bright.
Acknowledgements
The authors acknowledge
the advances made to the development
of light-curing technology in dentistry
by dental manufacturers and research
workers. Their contributions will
significantly benefit patient care.
Disclaimer
The authors confirm that they
have no financial interest in any of the
products mentioned in these articles and
have only been reimbursed expenses
for test evaluation purposes concerning
a prototype of the ScanwaveTM (Acteon)
light-activation unit. In this two part series
the authors have classified LED LAUs by
generation in order to highlight major
developmental steps. No commercial
product ranking for quality or efficacy is
necessarily implied by this classification.
References
1. Price RB, Fahey J, Felix CM. Knoop
hardness of five composites cured
22 DentalUpdate January/February 2012
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with single-peak and polywave LED
curing units. Quintessence Int 2010; 41:
e181–e191.
2. Brandt WC, Schneider FJ, Frollini E,
Correr-Sobrinho L, Sinhoreti MA. Effect
of different photo-initiators and light
curing units on degree of conversion
of composites. Braz Oral Res 2010:
24(3): 263–270.
3. Goracci G, Mori G, Casa De Martinis L.
Curing light intensity and marginal
leakage of resin composite
restorations. Quintessence Int 1996;
27(5): 355–361.
4. Davidson CL, Feilzer AJ. Polymerization
shrinkage and polymerization shrinkage
stress in polymer-based restoratives.
J Dentistry 1997; 25: 435–440.
5. Ernst CP, Brand N, Frommator U,
Rippin G, Willerhausen B. Reduction of
polymerization shrinkage stress and
marginal microleakage using soft-
start polymerization. J Esthet Rest Dent
2003; 15(2): 93–103.
6. Ilie N, Kunzelmann K-H, Visvanathan A,
Hickel R. Curing behavior of a
nanocomposite as a function of
polymerization procedure. Dent
Mater J 2005; 24(4): 469–477.
7. Feng L, Carvalho R, Suh BI. Insufficient
cure under the condition of high
irradiance and short irradiation time.
Dent Mater 2009; 25(3): 283–289.
8. Leprince J, Devaux J, Mullier T,
Vreven J, Leloup G. Pulpal-temperature
rise and polymerization efficiency of
LED curing lights. Oper Dent 2010;
35(2): 220–230.
9. Ilie N, Jelen E, Hickel R. Is the soft-start
polymerization concept still relevant
for modern curing units? Clin Oral
Invest 2011; 15: 21–29.
10. Aravamudhan K, Rakowski D, Fan PL.
Variation of depth of cure and
intensity with distance using LED
lights. Dent Mater 2006; 22: 988–994.
11. Corcioliani G, Vichi A, Davidson CL,
Ferrari M. The influence of tip
geometry and distance on light-curing
efficacy. Oper Dent 2008: 33(3): 325–
331.
12. Price RB, Labrie D, Whalen JM,
Felix CM. Effect of distance on
irradiance and beam homogeneity
from 4 Light-Emitting Diode curing
units. J Can Dent Assoc 2011; 77: b9.
13. Hansen EK, Asmussen E. In vivo
fractures of endodontically treated
posterior teeth restored with
enamel-bonded resin. Endodont Dent
Traumatol 1990; 6(5): 218–225.
14. Pelissier B, Castany E, Crouan M,
Maurat V, Duret F. Évolution des
lampes à photopolymériser: troisiéme
generation des lampes à LED et
applications cliniques. EMC (Elsevier
Masson SAS, Paris): Stomatologie
22-020-A-09, 2009: p1–17.
15. Shortall AC, Harrington E, Patel HB,
Lumley PJ. A pilot investigation of
operator variability during intra-oral
light curing. Br Dent J 2002; 193(5):
276–280.
16. Price RB, Felix CM, Whalen JM. Factors
affecting the energy delivered
to simulated class I and class V
preparations. J Can Dent Assoc 2010;
76: a94.
17. Janowalla Z, Porter K, Shortall ACC,
Burke FJT, Sammons RL. Microbial
contamination of light curing units: a
pilot study. J Infect Prevent 2010; 11(6):
216–221.
18. Jiménez-Planas A, Martin J, Abalos C,
Lamas R. Developments in
polymerization lamps. Quintessence Int
2008; 39(2): e74–e84.
19. Santini A. Current status of visible
light activation units and the curing of
light-activated resin-based composite
materials. Dent Update 2010; 37(4):
214–227.
20. Suh BI. Controlling and understanding
the polymerization shrinkage-induced
stresses in light-cured composites.
Compend Cont Educ Dent Suppl 1999;
25: S34–S41.
21. Davidson CL, de Gee AJ. Light-curing
units, polymerization, and clinical
implications. J Adhes Dent 2000; 2(3):
167–173.
CPD Answers
DECEMBER 2011
1. B, C 6. B, D
2. B, C 7. A, C
3. A, B, C 8. C
4. A, D 9. C, D
5. A, B 10. A, B, D