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Correlation between depth of cure and distance between curing light tip and
resin surface

Article · July 2011

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 L SOCIETY
BALKAN JOURNAL OF STOMATOLOGY ISSN 1107 - 1141

CA
GI
LO
TO
STOMA

Correlation between Depth of Cure and

Distance between Curing Light Tip and Resin Surface

Summary D. Dionysopoulos, E. Kolinioti-Koumpia,

Aim: to examine the relation between depth of cure and irradiation N. Kotsanos, P. Dionysopoulos
distance with different restorative composites and light curing units (LCUs). Aristotle University of Thessaloniki
Materials and Methods: 3 different composite resins (Simile, Filtek Faculty of Dentistry
Ζ250, Filtek Supreme XT) and 3 light curing units (Elipar High Light, Elipar Department of Operative Dentistry
Visio and LEDemetron) were used. Depth of cure was tested according Thessaloniki, Greece
to ISO 4049. A stainless steel mould was used for the preparation of
specimens (8mm long, 4mm in diameter). The mould was filled with 1 of the
composites and irradiated for 40sec. The distance between the exit window
of the lamps and the surface of the composite resin was 0, 2, 4, 8, 16 and 32
mm. After polymerization, the height of the cylinder of the cured material
was measured with a digital micrometer (accuracy ± 0.l mm). The relation
between the irradiation distance and the depth of cure was analyzed by
linear regression (p<0.05).
Results: Analyses of regression coefficient ranked the LCUs in order
of decreasing effectiveness as follows: LEDemetron > Elipar High Light >
Elipar Visio. All composite resins had, with all LCUs, the same reduction in
the depth of cure with increased irradiation distance.
Conclusions: The depth of cure of light-activated composites
decreased in a moderate and linear manner with the distance between the
exit window and the surface of the material. ORIGINAL PAPER
Keywords: Composite Resins; Depth of Cure; Polymerization; Light Curing Unit Balk J Stom, 2011:70-75

Introduction matrix or light tip sheath) and the distance between the
light source and surface of the restorative material3.
Depth of cure of a light-activated composite resin is An array of methods, such as hardness tests4-6,
an important property because poorly polymerized resin interaction with colour dyes7, translucency changes8,
can lead to undesirable effects, such as gap formation, double-bond conversion9,10, nuclear magnetic resonance
microimaging11, penetration tests11-13 and scraping tests14-
marginal leakage, recurrent caries, adverse pulpal effect 18 have been used to measure the depth of cure of resin-
and ultimate failure of restoration1. Depth of cure can be
based composites.
defined as the extent of quality resin polymerization deep
Layering of light-activated composites is a must in
from the surface of composite restoratives.
deep cavities to obtain a sufficient degree of conversion
The depth of cure of visible-light activated reduction of the polymerization shrinkage and thereby the
composites is affected by factors such as the materials’ risk of cuspal flexure and marginal gaps19-21. While light
filler composition, resin chemistry, shade and activating composite resins the light tip may not always
translucency, catalyst concentration, intensity and spectral be close to the surface of the restoration, when using a
distribution of the light source and duration of irradiation2. layering technique in the proximal part of class-II cavities.
Depth of cure of visible-light activated composites also This problem has been identified by several authors, and a
depends on the separating medium (intervening plastic not infrequent citation in the dental literature has been that
Balk J Stom, Vol 15, 2011 Correlation between Depth of Cure and Irradiation Distance 71

the loss of light intensity of curing units follows the law of Organization for Standardization for polymer based filling
Inverse Square. materials25.
Moseley et al22 studied the intensity loss of curing A stainless steel mould was used for the preparation
units versus distance between the exit window and of the specimens, 8 mm long x 4 mm in diameter (Fig. 1).
composite and found that the loss of intensity was linear. The mould was placed onto a strip of transparent film
Hansen and Asmussen23 found in a later study that a (Directa AB, SE-194 27, Upplands Vasby, Sweden) on
microfilled composite was cured to a depth of 4.1 mm glass microscope slide. The mould was overfilled slightly
with close contact between resin and exit window of the and a second strip of the transparent film was placed on
lamp tested; but the total curing depth was only reduced the top, followed by the second microscope slide. The
from 4.1 to 2.7 mm when the irradiation distance was mould and strips of film were pressed between the glass
increased to 18 mm. They also found that the depth of slides to excess the composite resin. The microscope slide
cure decreased moderately and in a linear manner with covering the upper strip of film was removed and the
increasing irradiation distance16. composite resin light cured for 40 sec using a LCU. The
The aim of this study was to examine the relation distance between the exit window of the lamp and the
between depth of cure and irradiation distance with surface of the composite resin was 0, 2, 4, 8, 16 and 32
different restorative resins and with a range of low to high mm (Fig. 2). 5 specimens were made for each composite
light intensity curing lamps. resin and for each light-curing mode. This method has
been used extensively by several researchers3,15-18.
The rationale for using distances of 16 and 32mm,
which are not clinically relevant, was to get a more
Materials and Method comprehensive understanding of the relation between
irradiation distance and depth of cure.
3 different composite resins were used in this study.
Filtek Z250 (shade A2, 3M ESPE, St Paul, MN, USA) and
Simile (shade A2, Pentron, Wallingford, USA) as micro-
hybrid composites, and Filtek Supreme XT (shade A2, 3M
ESPE, St Paul, MN, USA) as a nano-hybrid composite.
2 halogen light-curing units (Elipar High Light, Elipar
Visio) and a LED unit (LEDemetron) were selected to
provide lights of low to high output (Tab. 1). The intensity
of the light sources was checked with a radiometer (Hilux,
Curing Light Meter, Benlioglu Dental Inc, Turkey) before
the start of each experimental session.

Table 1. Type, manufacturer and light intensity of the 3 light

curing units used

LIGHT Curing Unit Manufacturer Intensity

Kerr Corp,
LEDemetron (LED) 1220mW/cm2 Figure 1. Illustration of the split stainless steel mould for curing depth
Danbury, USA
study
3M ESPE,
Elipar High Light (EHL) 780 mW/cm2
Seefeld, Germany
3M ESPE,
Elipar Visio (EV) 400 mW/cm2
Seefeld, Germany

These devices were selected to represent the range of

light-curing units (LCUs) still in use in clinical practice.
The composite resins were stored and used at room
temperature prior to placement, as insertion temperature
has been shown to influence polymerization of composite
resin using different LCUs24.
Scraping test methodology was performed
according to methods of ISO 4049 (1988) - International Figure 2. Illustration of the procedure for curing depth study
72 D. Dionysopoulos et al. Balk J Stom, Vol 15, 2011

After polymerization, the specimens were removed b = reduction of the depth of cure with the increased
from the mould and the inadequately cured soft restorative irradiation distance). The significance level was set to
material was removed from the bottom of the mould p<0.05.
with a plastic spatula. The length of the cylinder of the
cured material was measured with a digital micrometer
to an accuracy of ± 0.1 mm (Powerfix, Electronic Digital
Caliper, Mod.Z22855, London, UK). Results
The relation between the irradiation distance and
the depth of cure was analyzed by 3-Way ANOVA and The depths of cure calculated by measuring the
linear regression26. The various combinations of LCU thickness of cured composites remaining, according to the
and composite resin were also analyzed as to differences, ISO 4049 test, at each separation and for each light curing
between regression coefficients a and b (regression unit, are presented in table 2. The LCU with the lowest
coefficient a = depth of cure with close contact between light output had the least depth of cure and the LCU with
light tip and restorative composite; regression coefficient the greatest light output had the greatest depth of cure.

Table 2. Mean depth of cure of composites (mm), following 40 seconds light-cure with halogen units and with LED light unit at
increasing distances of the light tip from the composite

Distance (mm) 0 2 4 8 16 32
A. Filtek Z250
LEDemetron 6.9 (0.32) 6.7 (0.28) 6.5 (0.30) 5.8 (0.24) 4 (0.12) 2.2 (0.14)
Elipar High Light 5.9 (0.28) 5.7 (0.22) 5.4 (0.20) 4.7 (0.20) 3.5 (0.18) 2.2 (0.10)
Elipar Visio 5.4 (0.26) 5.3 (0.18) 5.1 (0.16) 4.5 (0.16) 3.1 (0.12) 1.9 (0.12)
B. Filtek Supreme XT
LEDemetron 6.1 (0.27) 5.9 (0.30) 5.6 (0.18) 4.5 (0.14) 3.5 (0.16) 1.9 (0.10)
Elipar High Light 5.3 (0.24) 5.1 (0.26) 4.9 (0.18) 4.3 (0.16) 3.2 (0.18) 2.1 (0.16)
Elipar Visio 4.7 (0.26) 4.6 (0.20) 4.5 (0.18) 3.8 (0.12) 2.6 (0.12) 1.6 (0.11)
C. Simile
LEDemetron 4.9 (0.30) 4.7 (0.26) 4.3 (0.20) 3.9 (0.14) 2.8 (0.22) 1.6 (0.10)
Elipar High Light 4.5 (0.20) 4.3 (0.16) 4.1 (0.16) 3.7 (0.18) 2.7 (0.12) 1.7 (0.10)
Elipar Visio 3.9 (0.16) 3.8 (0.18) 3.6 (0.19) 3.3 (0.17) 2.3 (0.16) 1.3 (0.12)

Analyses of 3-Way ANOVA indicated that there were The 3 composite resins with the 3 LCUs had not
statistically significant differences between composite the same reduction in the depth of cure with increased
resins and LCUs (Fig. 3). irradiation distance.
The correlation between depth of cure and irradiation
distance is presented in Figs. 4-6, which also gave the
linear regression lines.
Analyses of regression coefficient a (depth of Discussion
cure with close contact between light-tip and surface of
composite resin) ranked the LCUs in order of decreasing This study evaluated the relationship between depth
effectiveness as follows: LEDemetron > Elipar High Light of cure and irradiation distance with 3 different restorative
> Elipar Visio. Analyses of regression coefficient a ranked composite resins and 3 different light curing units. The
the composite resins in order of decreasing depth of cure 3 light curing units were selected to reflect a range of
as follows: Filtek Z250 > Filtek Supreme XT > Simile. intensities from very low to high, as used in clinical
As to regression coefficient b, there were statistically practice, as identified in previous studies16.
significant differences between the slopes of the 9 Posterior resin based materials required a high depth
regression lines. of cure rate for adequate cured restorations, because of
Balk J Stom, Vol 15, 2011 Correlation between Depth of Cure and Irradiation Distance 73

thickness of restorative materials due to the cavity depth. In light-curing composite resins, the light penetrates
Directing the LCU to the gingival margin in Class II the upper part of the resin, but absorption in the material
cavities is difficult. Inadequate depth of cure can cause prevents the light from reaching the deeper parts.
a weakening of adhesive properties and reduction of The free radicals generated in the upper parts initiate
flexural strength, colour stability, micro-hardness and polymerization, but the polymerization will not propagate
wear resistance of the composite restorations27. in depth beyond a certain limit.

Figure 3. Comparisons between composite resins and LCUs (3-Way ANOVA)

Figure 4. Elipar High Light: relation between depth of cure and Figure 6. LEDemetron: relation between depth of cure and irradiation
irradiation distance (mean and standard deviation) distance (mean and standard deviation).

Within the limits of experimental error, the mean

depths of cure obtained using LED LCU were about
15-23% higher than those obtained with the halogen
LCUs, for the 3 composite resins used. The larger depth of
cure obtained with the LED lamp can be explained by the
greater light intensity of the irradiance produced by this
LCU.
In this study depth of cure was greatly affected by
light source-specimen distance. At a distance 8 mm,
Figure 5. Elipar Visio: relation between depth of cure and irradiation LEDemetron cured ~5.8 mm of composite resin Filtek
distance (mean and standard deviation). Z250, ~4.7 mm of the Elipar High Light, and ~4.5 mm
74 D. Dionysopoulos et al. Balk J Stom, Vol 15, 2011

of the Elipar Visio. The maximum depth of cure was implies that composite resins even in deep proximal
achieved when the LCU tip was in very close distance to cavities may be sufficiently cured if one uses an effective
the composite; at 0 mm LED cured ~6.9 mm composite LCU and thin layers of restorative material.
Filtek Z250, ~5.9 mm Elipar High Light, and ~5.4 mm LED LCU did not perform differently from
Elipar Visio. other types of LCU as distance increased. Type of the
Development of narrower LCU tips, which could be restorative composite and LCU used influence the depth
used within the cavity, may help overcome the limitations of cure of the restoration.
of curing from distance and ensure that the deepest parts
of the restoration receive adequate irradiation.
Shortall et al11 have described a relation between
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