lcu 1

Download as pdf or txt
Download as pdf or txt
You are on page 1of 12

Effect of duration and infection control

barriers of light curing unit on hardness of


Bulk Fill composite resin
Xinmin He*, Denghui Zhang* and Shuli Deng
Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang
Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical
Research of Zhejiang Province, zhejiang university, Hangzhou, Zhejiang, China
* These authors contributed equally to this work.

ABSTRACT
Background: This study aimed to investigate the impact of the duration of light
curing unit (LCU) usage and the use of infection control barriers on the hardness of
Bulk Fill composite resin after curing. The hypotheses were that extended usage of
the LCU would not reduces its output power and resin hardness, and that the
presence of polyethylene film barriers exacerbates the reduction in resin hardness.
Methods: Based on the absence or presence of polyethylene film (PE) and the
number of layers used, a 3M LED curing light (EliparTM DeepCure-S; 3M ESPE, St
Paul, MN, USA) was divided into three groups: PE0, PE1, and PE3. The curing light
was used 30 times daily for 20 s per exposure, at frequencies of 0, 6, and 12 months.
Maximum output power tests were conducted for each group of curing lights.
Custom-made plastic modules were used to stack Bulk Fill composite resin (Filtek
Bulk Fill Posterior Restorative; 3M ESPE) to a thickness of 4 mm. Each group of
curing lights was used to cure the modules in a direct contact manner for 20 s.
Vickers hardness measurements were taken at the top and bottom surfaces of the
resin specimens using a digital microhardness tester. A one-way or two-way ANOVA
analyzed the power of LCUs, Vickers hardness of Bulk Fill composite resin, and
hardness decrease percentage across groups. Pairwise comparisons used the Tukey
test (a = 0.05).
Submitted 7 May 2024 Results: As the duration of usage increased, both the power of the curing light and
Accepted 9 August 2024
Published 26 September 2024
the hardness of the resin significantly decreased. Significant differences were
observed in power and resin hardness among the PE0, PE1, and PE3 groups. When
Corresponding author
Shuli Deng, dengshuli@zju.edu.cn the duration of usage was 6 months or less, only multi-layered PE films led to a
significant increase in the percentage decrease of hardness of cured resin from top to
Academic editor
Amjad Abu Hasna bottom. However, at 12 months, both single-layer and multi-layered PE films
Additional Information and
resulted in a significant increase in the percentage decrease of hardness of cured resin
Declarations can be found on from top to bottom.
page 10 Conclusion: The output power of the light curing unit decreases with prolonged
DOI 10.7717/peerj.18021 usage, thereby failing to meet the curing requirements of Bulk Fill composite resin.
Copyright The use of single-layer PE as an infection control barrier is recommended.
2024 He et al.
Distributed under
Subjects Dentistry, Drugs and Devices
Creative Commons CC-BY 4.0
Keywords Light curing unit, Hardness, Power, Bulk Fill composite resin

How to cite this article He X, Zhang D, Deng S. 2024. Effect of duration and infection control barriers of light curing unit on hardness of
Bulk Fill composite resin. PeerJ 12:e18021 DOI 10.7717/peerj.18021
INTRODUCTION
Since the publication of the first successful case using resin-based composite materials
filled by Bowen (1963), light-curing composite resins have become widely utilized in
clinical dentistry due to their aesthetic appearance, high plasticity, and ease of
manipulation (Fidalgo-Pereira et al., 2022; Guan, Zhu & Zhang, 2023). Concurrently, light
curing unit (LCU), serving as essential equipment for curing light-cured resin materials,
have become indispensable in dental practice (Lee, Young Kim & Seo, 2024). Regular
inspection and maintenance of LCUs are imperative tasks for dental care personnel
(Altaie et al., 2021).
Traditional light-curing composite resins, when cured with LCUs, achieve a curing
depth of only 2 mm per cycle. Consequently, the filling of deep cavities requires layering,
resulting not only in increased chairside time but also the potential for the formation of
bubbles or saliva contamination between layers (Asyraf et al., 2023; El-Safty, Silikas &
Watts, 2012). To meet the demands of clinicians and the market for increased curing depth
and simplified operational steps, Bulk Fill composite resin emerged. This material allows
for a one-time filling of 4 mm, streamlining the procedure and saving chairside time. In
addition to these benefits, Bulk Fill composite resin exhibits favorable physical and
mechanical properties, including superior flexural and compressive strength, as well as
excellent glossiness and wear resistance, compared to traditional composite resins (Parra
Gatica, Duran Ojeda & Wendler, 2023). As a result, it has gained increasing favor among
dentists, consequently raising the performance expectations of LCUs.
In dental treatment, to ensure the thorough curing of Bulk Fill composite resin, it is
recommended to minimize the distance between the light guide tip of the LCU and the
composite resin, typically within the range of 1–3 mm (Price, Felix & Andreou, 2004).
Consequently, the light guide tip inevitably comes into contact with the patient’s saliva
during procedures, posing a risk of cross-contamination. LCU are not resistant to high
temperatures and pressures (Soares et al., 2020). Given the impeative to prevent the spread
of diseases such as hepatitis B, acquired immunodeficiency syndrome (AIDS), and more
recently, COVID-19, the use of protective infection control barriers on such equipment
has become paramount (Dos Santos, 2021; Janoowalla et al., 2010; Verbeek et al., 2020).
However, while employing physical barriers is crucial, the impact of barrier materials on
light intensity cannot be overlooked (Khode et al., 2017; Soares et al., 2020). If the output
light intensity falls below the acceptable standards, it can compromise the effective curing
of Bulk Fill composite resin, subsequently affecting the treatment outcomes (Al Nahedh,
Al-Senan & Alayad, 2022). Research has shown that food wrap material can be as effective
a barrier as some commercial products (McAndrew et al., 2011). Due to its accessibility and
low cost, this study opted to utilize polyethylene film (PE), a common food wrap material,
with varying layers as an infection control barrier.
This study aimed to investigate the impact of the duration of LCU usage and the use of
infection control barriers on the hardness of Bulk Fill composite resin after curing. The
purpose of the study was to evaluate the effects of prolonged LCU usage and the presence
of PE barriers on the curing efficiency and hardness of Bulk Fill composite resin. The null

He et al. (2024), PeerJ, DOI 10.7717/peerj.18021 2/12


hypotheses were that: (1) The duration of LCU usage would have no effect on its power
output and the hardness of the cured resin; (2) The presence of the PE as infection control
barriers would have no influence on the power output or the hardness of the cured resin.

MATERIALS AND METHODS


Experimental grouping and LCU usage
Sixty-three new LCUs (EliparTM DeepCure-S; 3M ESPE, St Paul, MN, USA) were
randomly divided into three groups based on the presence or absence of PE (Miaojie,
China) and the number of film layers. Each group consisted of three LCUs. The first group,
designated as the PE0 group, had no PE. The second group, named the PE1 group, had one
layer of PE. The third group, denoted as the PE3 group, had three layers of PE. All LCUs
underwent 30 cycles of 20-s light exposure daily to simulate the frequency of clinical usage.
Subsequently, LCUs were assessed at three time points: 0, 6, and 12 months after initial
usage, for further experimentation.

LCU power testing


Maximal output power testing of all LCUs within each group was conducted using
the CheckMARC portable radiometer (BlueLight Analytics, Halifax, Canada). The
strongest power mode of the LCUs was employed, with zero-distance vertical
irradiation onto the CheckMARC testing device. Each LCUs underwent three
repetitions. Measurements were repeated at three time points: 0, 6, and 12 months
after initial usage of the light curing units.

Resin stacking and curing


Using saliva ejectors (Medicom AMD Medicom Inc., Milan, Italy) with internal diameters
of 4 mm for both top and bottom, plastic hollow cylindrical modules with a height of 4 mm
were created. These modules were wrapped with PVC black electrical insulation tape (3M
ESPE, Saint Paul, MN, USA) to avoid light exposure. The completed specimen modules
were placed on glass slides. Bulk Fill composite resin (3M ESPE, Saint Paul, MN, USA) was
filled into the modules using a resin dispenser, stacked to a thickness of 4 mm, compacted
with a resin dispenser, and then lightly pressed at the top with another glass slide. The
content information of Bulk Fill composite resin was provided in Table S1. Excess resin
was removed using a resin dispenser. Following the instructions provided with the 3M
LCU, the modules were cured using a zero-distance vertical irradiation method for 20 s
(with the end face of the light guide tip in close contact with the top surface of the module).
After curing, the plastic modules were cut open with a blade to remove the specimens,
excess edge portions were trimmed, and the top surface was marked. Five resin specimens
were stacked for each group. The cured composite resin specimens were stored in artificial
saliva (D54264; Acmec biochemical, Shanghai, China) at 37  C for 24 h, which typically
contains KCl (0.4 g/L), NaCl (0.4 g/L), CaCl₂·2H₂O (0.906 g/L), MgCl₂·6H₂O (0.2 g/L),
NaH₂PO₄·2H₂O (0.78 g/L), Na₂S·9H₂O (0.005 g/L), Urea (1 g/L), distilled water (Balance
to 1 liter) to mimic the composition of natural saliva.

He et al. (2024), PeerJ, DOI 10.7717/peerj.18021 3/12


Microhardness testing of resin blocks
The resin specimens were polished through sequential grinding with silicon carbide papers
(Buehler, Lake Bluff, IL, USA) of increasing fineness, followed by fine and final polishing
with alumina suspension (Struers, Cleveland, OH, USA), to achieve a smooth and
scratch-free surface for the Vickers micro-hardness test. Vickers hardness measurements
were taken at the top and bottom of the resin specimens stacked in modules with thickness
of 4 mm using the XHV-1000T-CCD Image Automatic Touch Screen Digital
Microhardness Tester (Suzhou Nanguang Electronic Technology Co., Ltd, Jiangsu, China).
The specimens were air-dried, and placed flat on the measurement table. A diamond
cone-shaped microindenter was selected, with a test force of 500.0 g and a holding time of
15 s. Three points were selected for measurement on both the top and bottom surfaces of
each specimen. Rhomboid indentations were visible on the specimen surface.
Microhardness analysis was conducted using Microhardness Tester Software V3.03
(Suzhou Nanguang Electronic Technology Co., Ltd, China), employing the Vickers
hardness four-point measurement method to obtain hardness values. The mean value of
indentations for each sample was measured as followed equation to calculate Hv values:
Hv = 1,854.4 × F/d2
Hv is Vickers Hardness in Kg/mm2, F is load in Kg and d is diameter in mm (Hetzner,
2003). The average and standard deviation of Vickers hardness for the top and bottom
surfaces of each resin group were calculated, along with the percentage decrease in
hardness as followed equation
the percentage decrease ¼ ðtop bottomÞ=top  100%
Top is Vickers Hardness of top surface of resin specimen, while bottom is Vickers
Hardness of bottom surface of resin specimen. A schematic diagram of the whole research
methodology is depicted in Fig. 1.

Power analysis and statistical analysis


A power analysis using G*Power software version 3.1 (Universität Düsseldorf, Düsseldorf,
Germany) determined the required total sample size to be 57 with an effect size of 0.40,
a = 0.05, and power = 0.80. Therefore, the number of resin specimens in each group was
set to 21, resulting in a total sample size of 63.
A one-way ANOVA was conducted to analyze the power of the light-curing units
(LCUs), the Vickers hardness of the Bulk Fill composite resin, and the percentage decrease
in hardness across different groups. Pairwise comparisons were performed using the
Tukey test with a significance level of a = 0.05. Statistical analysis was performed using
SPSS 20.0 (IBM, Armonk, NY, USA).

RESULTS
The impact of usage time on LCU output power
ANOVA showed regular power checks of the LCU revealed a significant decrease in LCU
power with increasing usage duration (p < 0.05) (Fig. 2). The power of the new LCU was

He et al. (2024), PeerJ, DOI 10.7717/peerj.18021 4/12


Figure 1 Experimental grouping and procedure. The images of the light curing unit and composite resin were photographs taken by the authors.
Diagrams were sourced from the product manuals of the respective manufacturers. Full-size  DOI: 10.7717/peerj.18021/fig-1

Figure 2 The impact of usage time on LCU output power.


Full-size  DOI: 10.7717/peerj.18021/fig-2

1,486 ± 22 mW/cm². After 6 months of usage, the power significantly decreased to


1,158 ± 56 mW/cm² compared to new LCU (p < 0.05). After 12 months, it further
decreased to 1,034 ± 55 mW/cm². However, the power difference between 6 and 12
months was not statistically significant (p = 0.1159).

He et al. (2024), PeerJ, DOI 10.7717/peerj.18021 5/12


Figure 3 The impact of infection control barrier on LCU power at different usage durations. PE,
polyethylene film. Different uppercase letters indicate a significant difference within groups of same usage
time (P < 0.05). Different lowercase letters indicate a significant difference between groups of same PE
layer (P < 0.05). Full-size  DOI: 10.7717/peerj.18021/fig-3

The impact of infection control barrier on LCU power at different usage


durations
At different usage durations, the LCU power output was tested with and without the
infection control barrier PE. Two-way ANOVA showed usage time and infection control
barrier both had significantly different adverse effects on the light output (p < 0.05). The
results (Fig. 3) indicated that at 0 months of usage, the power output for PE0 was 1,486 ±
22 mW/cm2, for PE1 it was 1,346 ± 43 mW/cm2, and for PE3 it decreased to 1,183 ±
21 mW/cm2. There were significant statistical differences among the three groups
(p < 0.05). At 6 months of usage, the power output for PE0 was 1,158 ± 56 mW/cm2, for
PE1 it was 1,055 ± 44 mW/cm2, and for PE3 it decreased to 861 ± 53 mW/cm2. Again,
significant statistical differences were observed among the three groups (p < 0.05). At
12 months of usage, the power output for PE0 was 1,034 ± 55 mW/cm2, for PE1 it was 950
± 57 mW/cm2, and for PE3 it decreased to 754 ± 61 mW/cm2. Once more, significant
statistical differences were observed among the three groups (p < 0.05).

The impact of infection control barrier on the hardness of Bulk Fill


Resin after curing at different LCU usage durations
Two-way ANOVA showed usage time and infection control barrier had significantly
different adverse effects on both top and bottom hardness of Bulk Fill Resin after curing
(Figs. 4A, 4B). Figure 4A showed that at 0 months of LCU usage, the Vickers hardness at
the top of the resin for the PE0 group was 114.3 ± 5.7 HV, for the PE1 group it was 104.6 ±
7.5 HV, and for the PE3 group it was 96.9 ± 4.1 HV. Only the PE3 group exhibited a
significant difference in Vickers hardness at the top compared to the PE0 group (p < 0.05).
At 6 months of LCU usage, the Vickers hardness at the top of the resin for the PE0 group
was 104.2 ± 9.4 HV, for the PE1 group it was 97.3 ± 4.3 HV, and for the PE3 group it
decreased to 61.4 ± 3.5 HV. The PE3 group showed significant differences in Vickers
hardness at the top compared to both the PE0 and PE1 groups (p < 0.05). At 12 months of

He et al. (2024), PeerJ, DOI 10.7717/peerj.18021 6/12


Figure 4 The impact of infection control barrier on the hardness of Bulk Fill Resin after curing at different LCU usage durations. (A) Vickers
microhardness of top surface of cured resin. (B) Vickers microhardness of bottom surface of cured resin. (C) The percentage decrease in hardness of
cured resin from top to bottom. PE, polyethylene film; Different uppercase letters indicate a significant difference within groups of same usage time
(P < 0.05). Different lowercase letters indicate a significant difference between groups of same PE layer (P < 0.05).
Full-size  DOI: 10.7717/peerj.18021/fig-4

LCU usage, the Vickers hardness at the top of the resin for the PE0 group was 86.8 ± 9.2
HV, for the PE1 group it was 77.2 ± 5.4 HV, and for the PE3 group it decreased to 49.4 ±
2.6 HV. Differences in Vickers hardness at the top of the resin were observed among all
groups (p < 0.05). Comparing different usage durations (Fig. 4A), within the PE0 group,
the Vickers hardness at the top of the resin cured with 12-month-old LCU showed
significant differences compared to those cured with 0-month and 6-month-old LCUs
(p < 0.05). In the PE1 group, only the Vickers hardness at the top of the resin cured with
12-month-old LCU showed significant differences compared to that cured with 0-month-
old LCU (p < 0.05). For the PE3 group, the Vickers hardness at the top of the resin cured
with LCUs of different usage durations differed significantly (p < 0.05).
Figure 4B showed that at 0 months of LCU usage, the Vickers hardness at the bottom of
the resin for the PE0 group was 72.6 ± 3.1 HV, for the PE1 group it was 65.2 ± 3.8 HV, and
for the PE3 group it was 56.4 ± 3.5 HV. The PE3 group exhibited significant differences in
Vickers hardness at the bottom of the resin compared to both the PE0 and PE1 groups
(p < 0.05). At 6 months of LCU usage, the Vickers hardness at the bottom of the resin for
the PE0 group was 64.2 ± 6.1 HV, for the PE1 group it was 56.4 ± 2.4 HV, and for the PE3
group it decreased to 29.5 ± 2.3 HV. Significant differences in Vickers hardness at the
bottom of the resin were observed among all groups (p < 0.05). At 12 months of LCU
usage, the Vickers hardness at the bottom of the resin for the PE0 group was 49.7 ± 5.4 HV,
for the PE1 group it was 40.7 ± 2.7 HV, and for the PE3 group it decreased to 22.1 ± 1.8
HV. Differences in Vickers hardness at the bottom of the resin were observed among all
groups for LCUs of different usage durations (p < 0.05). Comparing different usage
durations (Fig. 4B), within the PE0 group, the Vickers hardness at the bottom of the resin
cured with 12-month-old LCU showed significant differences compared to those cured
with 0-month and 6-month-old LCUs (p < 0.05). For the PE1 group, differences in Vickers
hardness at the bottom of the resin cured with LCUs of different usage durations were
observed (p < 0.05). For the PE3 group, the Vickers hardness at the bottom of the resin

He et al. (2024), PeerJ, DOI 10.7717/peerj.18021 7/12


cured with 0-month-old LCU differed significantly from those cured with 6-month and
12-month-old LCUs (p < 0.05).

The impact of infection control barrier on the reduction of hardness of


cured resin from top to bottom at different LCU usage durations
The percentage decrease in hardness of cured resin from top to bottom at different LCU
usage durations was calculated ((top-bottom)/top × 100%). Two-way ANOVA showed
usage time and infection control barrier had significantly effects on percentage decrease in
hardness of cured resin from top to bottom (Fig. 4C). The results (Fig. 4C) showed that at 0
months of usage, the hardness decrease for the PE0 group was 36.4 ± 0.4%, for the PE1
group it was 37.6 ± 3.0%, and for the PE3 group it was 41.7 ± 4.7%. There was no
significant difference in the hardness decrease percentage between the PE0 and PE1 groups
(p = 0.1324), while the hardness decrease percentage in the PE3 group differed significantly
from the other two groups (p < 0.05). At 6 months of usage, the hardness decrease for the
PE0 group was 38.4 ± 1.4%, for the PE1 group it was 42.0 ± 0.7%, and for the PE3 group it
was 52.0 ± 1.1%. There was no significant difference in the hardness decrease percentage
between the PE0 and PE1 groups (p = 0.1026), while the hardness decrease percentage in
the PE3 group differed significantly from the other two groups (p < 0.05). At 12 months of
usage, the hardness decrease for the PE0 group was 42.7 ± 1.4%, for the PE1 group it was
47.3 ± 0.9%, and for the PE3 group it was 55.2 ± 3.5%. There were significant differences in
the hardness decrease percentage among all groups (p < 0.05). Comparing different usage
durations (Fig. 4C), within the PE0 group, only the hardness decrease percentage of resin
cured with the 12-month-old LCU showed a significant difference compared to that cured
with the 0-month-old LCUs (p < 0.05). In the PE1 group, the hardness decrease percentage
of resin cured with the 12-month-old LCU differed significantly from that cured with both
the 0 and 6-month-old LCUs (p < 0.05). For the PE3 group, the hardness decrease
percentage of resin cured with the 0-month-old LCU differed significantly from that cured
with both the 6-month and 12-month-old LCUs (p < 0.05) (Fig. 4C).

DISCUSSION
Since usage time had significantly different adverse effects on the light output (Fig. 2) and
hardness of the cured resin (Fig. 4), the first hypothesis was rejected. As the infection
control barrier had significantly different adverse effects on both the light output (Fig. 3)
and the power output or the hardness of the cured resin, the second hypothesis was
rejected (Fig. 4). In present study, we found that the output power of the light curing unit
decreases with prolonged usage, thereby failing to meet the curing requirements of Bulk
Fill composite resin. The use of single-layer PE as an infection control barrier is
recommended.
Unlike traditional nanocomposites that require layering with each layer not exceeding
2 mm (Besegato et al., 2019), the Bulk Fill resin currently used in clinical practice allows for
a one-time filling of 4 mm (Silva et al., 2023). The bulk-fill composite is selected for its high
filler content and clinical performance, ensuring durability and effective curing in deep
cavities (Osiewicz et al., 2022). Therefore, the Bulk Fill resin higher demands on the LCU.

He et al. (2024), PeerJ, DOI 10.7717/peerj.18021 8/12


Its widespread use and relevance in restorative dentistry make it ideal for assessing the
impact of curing protocols and infection control barriers.
This study demonstrated that the LCU experience a decrease in power output over time,
consequently affecting the surface hardness of Bulk Fill resin, which was line with existing
studies (Dundić et al., 2021). Therefore, regular testing of LCU power output is warranted
(Sadeghyar, Watts & Schedle, 2020). Should the power output fall below the clinically
acceptable range, replacement of the light guide tip is necessary, or alternatively, these
LCUs should be restricted to curing conventional resin rather than Bulk Fill resin. This
underscores the importance for healthcare professionals to pay closer attention to the
maintenance and management of light curing units (Rohini et al., 2023).
Contamination at the tip of the light guide of LCUs also weakens light output and
diminishes resin polymerization reactions, which was also confirmed in previous study on
a normal composite resin (Hwang et al., 2012). Therefore, in clinical practice, it is common
to wrap the tip of the light guide with infection control barrier to prevent contamination
(Soares et al., 2020). This study found that the use of infection control barriers further
decreases the power output of LCUs, resulting in a noticeable decrease in the Vickers
hardness of Bulk Fill composite resin after curing, with a more pronounced decrease in
bottom surface hardness. Fortunately, compared to no infection control barrier, a single
layer of PE had no significant effect on the surface hardness and the percentage decrease in
hardness from top to bottom of resin cured by LCUs within 6 months. However, three
layers of PE significantly reduced both the surface hardness of resin and the percentage
decrease in hardness from top to bottom. Research also suggests that when employing an
infection control barrier with low-power LCUs, caution should be exercised to avoid
compromising polymerization efficiency (Hwang et al., 2012). Therefore, a single layer of
PE can be used as an infection control barrier when the power output of the LCU is
sufficient. As the power decreases, there is an increasing trend in the percentage decrease in
resin hardness from bottom to top, especially when curing Bulk Fill resin using LCUs that
have been in use for more than 6 months.
This reduction in curing efficacy from the top surface to the bottom surface can be
attributed to the attenuation of light intensity as it penetrates deeper into the composite
resin. The bulk-fill composite materials are designed to be cured in thicker layers (Osiewicz
et al., 2022), but the light curing units may still experience a decrease in light energy as it
travels through the material. This reduced light intensity at greater depths results in lower
polymerization efficiency, which subsequently leads to a reduction in the hardness of the
composite resin at the bottom surface compared to the top surface (Mazão et al., 2023). To
achieve a curing depth of 4 mm for Bulk Fill resin, sufficient output power and appropriate
infection control barriers are both indispensable.
This reduction in curing efficacy from the top surface to the bottom surface can be
attributed to the attenuation of light intensity as it penetrates deeper into the composite
resin. The bulk-fill composite materials are designed to be cured in thicker layers, but the
light curing units may still experience a decrease in light energy as it travels through the
material. This reduced light intensity at greater depths results in lower polymerization

He et al. (2024), PeerJ, DOI 10.7717/peerj.18021 9/12


efficiency, which subsequently leads to a reduction in the hardness of the composite resin
at the bottom surface compared to the top surface (Mazão et al., 2023).
It is important to acknowledge certain limitations of this study. Firstly, the experimental
setup may not fully replicate the complexities of clinical practice, as controlled laboratory
conditions were utilized. Additionally, while efforts were made to mimic clinical scenarios,
factors such as patient variability and intraoral conditions were not accounted for.
Furthermore, the study focused solely on a specific brand and model of light curing unit,
and results may vary with different equipment. Future research could explore the impact of
various infection control barriers and curing conditions on different types of light curing
units to provide a more comprehensive understanding of their effects on resin curing
outcomes in clinical settings.

CONCLUSIONS
The output power of the light curing unit decreases with prolonged usage, thereby failing
to meet the curing requirements of Bulk Fill composite resin. The use of single-layer PE as
an infection control barrier is recommended.

ADDITIONAL INFORMATION AND DECLARATIONS

Funding
This study was supported by the Key R&D program of Zhejiang (2022C03060) and
General Research Project of Zhejiang Provincial Department of Education (Y201942154).
The funders had no role in study design, data collection and analysis, decision to publish,
or preparation of the manuscript.

Grant Disclosures
The following grant information was disclosed by the authors:
Key R&D program of Zhejiang: 2022C03060.
General Research Project of Zhejiang Provincial Department of Education: Y201942154.

Competing Interests
The authors declare that they have no competing interests.

Author Contributions
. Xinmin He conceived and designed the experiments, performed the experiments,
analyzed the data, prepared figures and/or tables, authored or reviewed drafts of the
article, and approved the final draft.
. Denghui Zhang performed the experiments, prepared figures and/or tables, authored or
reviewed drafts of the article, and approved the final draft.
. Shuli Deng conceived and designed the experiments, authored or reviewed drafts of the
article, provided resources, and approved the final draft.

Data Availability
The following information was supplied regarding data availability:

He et al. (2024), PeerJ, DOI 10.7717/peerj.18021 10/12


The raw measurements are available in the Supplemental File.

Supplemental Information
Supplemental information for this article can be found online at http://dx.doi.org/10.7717/
peerj.18021#supplemental-information.

REFERENCES
Al Nahedh H, Al-Senan DF, Alayad AS. 2022. The effect of different light-curing units and tip
distances on the polymerization efficiency of bulk-fill materials. Operative Dentistry
47(4):E197–e210 DOI 10.2341/20-282-L.
Altaie A, Hadis MA, Wilson V, German MJ, Nattress BR, Wood D, Palin WM. 2021. An
evaluation of the efficacy of LED light curing units in primary and secondary dental settings in
the united kingdom. Operative Dentistry 46(3):271–282 DOI 10.2341/20-092-LIT.
Asyraf M, Rafidah M, Madenci E, Özkılıç Y, Aksoylu C, Razman M, Ramli Z, Zakaria S, Khan T.
2023. Creep properties and analysis of cross arms’ materials and structures in latticed
transmission towers: current progress and future perspectives. Materials 16(4):1747
DOI 10.3390/ma16041747.
Besegato JF, Jussiani EI, Andrello AC, Fernandes RV, Salomão FM, Vicentin BLS, Dezan-
Garbelini CC, Hoeppner MG. 2019. Effect of light-curing protocols on the mechanical
behavior of bulk-fill resin composites. Journal of the Mechanical Behavior of Biomedical
Materials 90:381–387 DOI 10.1016/j.jmbbm.2018.10.026.
Bowen RL. 1963. Properties of a silica-reinforced polymer for dental restorations. The Journal of
the American Dental Association 66(1):57–64 DOI 10.14219/jada.archive.1963.0010.
Dos Santos WM. 2021. Use of personal protective equipment reduces the risk of contamination by
highly infectious diseases such as COVID-19. Evidence Based Nursing 24(2):41
DOI 10.1136/ebnurs-2020-103304.
Dundić A, Rajić Brzović V, Vlajnić G, Kalibović Govorko D, Medvedec Mikić I. 2021. A
measurement of irradiance of light-curing units in dental offices in three Croatian cities.
Medicinski Glasnik 18(2):505–509 DOI 10.17392/1323-21.
El-Safty S, Silikas N, Watts DC. 2012. Creep deformation of restorative resin-composites intended
for bulk-fill placement. Dental Materials 28(8):928–935 DOI 10.1016/j.dental.2012.04.038.
Fidalgo-Pereira R, Carpio D, Torres O, Carvalho O, Silva F, Henriques B, Özcan M, Souza JCM.
2022. The influence of inorganic fillers on the light transmission through resin-matrix
composites during the light-curing procedure: an integrative review. Clinical Oral Investigations
26(9):5575–5594 DOI 10.1007/s00784-022-04589-5.
Guan X, Zhu T, Zhang D. 2023. Development in polymerization shrinkage control of dental
light-cured resin composites: a literature review. Journal of Adhesion Science and Technology
37(4):602–623 DOI 10.1080/01694243.2022.2042122.
Hetzner DW. 2003. Microindentation hardness testing of materials using ASTM E384. Microscopy
and Microanalysis 9(S02):708–709 DOI 10.1017/S1431927603443547.
Hwang IN, Hong SO, Lee BN, Hwang YC, Oh WM, Chang HS. 2012. Effect of a multi-layer
infection control barrier on the micro-hardness of a composite resin. Journal of Applied Oral
Science 20(5):576–580 DOI 10.1590/S1678-77572012000500014.
Janoowalla Z, Porter K, Shortall A, Burke F, Sammons R. 2010. Microbial contamination of light
curing units: a pilot study. Journal of Infection Prevention 11(6):217–221
DOI 10.1177/1757177410385488.

He et al. (2024), PeerJ, DOI 10.7717/peerj.18021 11/12


Khode RT, Shenoi PR, Kubde RR, Makade CS, Wadekar KD, Khode PT. 2017. Evaluation of
effect of different disposable infection control barriers on light intensity of light-curing unit and
microhardness of composite-an in vitro study. Journal of Conservative Dentistry 20(3):180–184
DOI 10.4103/JCD.JCD_171_16.
Lee H, Young Kim RJ, Seo DG. 2024. Shear bond strength of dual-cured resin cements on
zirconia: the light-blocking effect of a zirconia crown. Journal of Dental Sciences 19(1):162–168
DOI 10.1016/j.jds.2023.05.011.
Mazão JD, Ribeiro MTH, Braga SSL, Zancopé K, Price RB, Soares CJ. 2023. Effect of thickness
and shade of CAD/CAM composite on the light transmission from different light-curing units.
Brazilian Oral Research 37(4):e114 DOI 10.1590/1807-3107bor-2023.vol37.0114.
McAndrew R, Lynch CD, Pavli M, Bannon A, Milward P. 2011. The effect of disposable infection
control barriers and physical damage on the power output of light curing units and light curing
tips. British Dental Journal 210(8):E12 DOI 10.1038/sj.bdj.2011.312.
Osiewicz MA, Werner A, Roeters FJM, Kleverlaan CJ. 2022. Wear of bulk-fill resin composites.
Dental Materials 38(3):549–553 DOI 10.1016/j.dental.2021.12.138.
Parra Gatica E, Duran Ojeda G, Wendler M. 2023. Contemporary flowable bulk-fill resin-based
composites: a systematic review. Biomaterial Investigations in Dentistry 10(1):8–19
DOI 10.1080/26415275.2023.2175685.
Price RB, Felix CA, Andreou P. 2004. Effects of resin composite composition and irradiation
distance on the performance of curing lights. Biomaterials 25(18):4465–4477
DOI 10.1016/j.biomaterials.2003.11.032.
Rohini N, Sunil G, Ram RR, Ranganayakulu I, Vijaya Krishna B. 2023. Impact of a high-power
light-emitting diode unit with reduced curing times on the shear bond strength of orthodontic
brackets and their adhesive remnant index scores. Cureus 15:e39855 DOI 10.7759/cureus.39855.
Sadeghyar A, Watts DC, Schedle A. 2020. Limited reciprocity in curing efficiency of bulk-fill
resin-composites. Dental Materials 36(8):997–1008 DOI 10.1016/j.dental.2020.04.019.
Silva G, Marto CM, Amaro I, Coelho A, Sousa J, Ferreira MM, Francisco I, Vale F, Oliveiros B,
Carrilho E, Paula AB. 2023. Bulk-fill resins versus conventional resins: an umbrella review.
Polymers 15(12):2613 DOI 10.3390/polym15122613.
Soares CJ, Braga SSL, Ribeiro MTH, Price RB. 2020. Effect of infection control barriers on the
light output from a multi-peak light curing unit. Journal of Dentistry 103:103503
DOI 10.1016/j.jdent.2020.103503.
Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, Tikka C, Ruotsalainen JH,
Kilinc Balci FS. 2020. Personal protective equipment for preventing highly infectious diseases
due to exposure to contaminated body fluids in healthcare staff. Cochrane Database of
Systematic Reviews 4(12):Cd011621 DOI 10.1002/14651858.CD011621.pub4.

He et al. (2024), PeerJ, DOI 10.7717/peerj.18021 12/12

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy