International Dental Journal 2020; 70: 407–417

CONCISE CLINICAL REVIEW

doi: 10.1111/idj.12582

The light-curing unit: An essential piece of dental

equipment
Richard B. Price1 , Jack L. Ferracane2 , Reinhard Hickel3 and Braden Sullivan1
1
Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada; 2Department of Restorative Dentistry, Oregon Health & Science University,
Portland, OR, USA; 3Department of Conservative Dentistry and Periodontology, University Hospital, LMU, Munich, Germany.

Introduction: This article describes the features that should be considered when describing, purchasing and using a light-
curing unit (LCU). Methods: The International System of Units (S.I.) terms of radiant power or radiant flux (mW), spec-
tral radiant power (mW/nm), radiant exitance or tip irradiance (mW/cm2), and the irradiance received at the surface
(also in mW/cm2) are used to describe the output from LCU. The concept of using an irradiance beam profile to map
the radiant exposure (J/cm2) from the LCU is introduced. Results: Even small changes in the active tip diameter of the
LCU will have a large effect on the radiant exitance. The emission spectra and the effects of distance on the irradiance
delivered are not the same from all LCUs. The beam profile images show that using a single averaged irradiance value to
describe the LCU can be very misleading. Some LCUs have ‘hot spots’ of high radiant exitance that far exceed the cur-
rent ISO 10650 standard. Such inhomogeneity may cure the resin unevenly and may also be dangerous to soft tissues.
Recommendations are made that will help the dentist when purchasing and then safely using the LCU. Conclusions:
Dental manufacturers should report the radiant power from their LCU, the spectral radiant power, information about
the compatibility of the emission spectrum from the LCU with the photoinitiators used, the active optical tip diameter,
the radiant exitance, the effect of distance from the tip on the irradiance delivered, and the irradiance beam profile from
the LCU.

Key words: Dental curing lights, light measurement techniques, beam profiling, fibre optic spectrometer, resin-based composites, light
and optics terminology, radiant exposure

of inadequate light curing, the dentist may not use the

INTRODUCTION
LCU correctly, and they may purchase an inexpensive
The FDI World Dental Federation represents over one device from the Internet, thinking that all LCUs emit
million dentists, most of whom will own and use a similar blue light and will have equivalent efficacy.
dental light-curing unit (LCU). This LCU and how it is This can result in the dentist unknowingly delivering
used will affect the physical properties, biocompatibil- less overall energy or the wrong wavelengths of light
ity and the clinical success of light-cured dental poly- to photocure the resin in the mouth in comparison to
mer systems (resin-based composites, adhesives, the energy delivered in the vast majority of laboratory
orthodontic resins, luting agents, sealants, etc.) that are studies and in well-controlled clinical trials. After read-
used in the dental office1 3. Of note, globally, there ing this article, the reader will know what to look for
exists a large discrepancy between how long resin com- when purchasing and using a curing light. They will
posite restorations are reported to last in well-con- understand reasons why there can be considerable dif-
trolled clinical trials4,5, and how long they last when ferences between LCUs, and why reliance upon a single
placed in most dental offices6 9. Although the reasons reported irradiance value can be misleading.
for these discrepancies in the long-term success of
restorations are multifactorial, the general lack of
understanding about the differences between LCUs, Light-curing units
how to describe the output from the LCU, and how to Small, battery-operated and energy-efficient light-emit-
use the LCU in everyday dentistry10 19 may very well ting diode (LED) curing lights dominate the mar-
be contributing factors. Due to this lack of knowledge ket10,14,18,20. The LCUs in Figure 1 offer different
and information about the LCU and the consequences features but, unfortunately, the cost of the unit and a
© 2020 FDI World Dental Federation 407
Price et al.

‘high’ irradiance value greater than 1,000 mW/cm2 Describing the light-curing unit
are the two main factors upon which many clinicians
Most manufacturers and researchers alike do not
base their decision when purchasing a new LCU.
describe the light output from the LCUs in a consis-
However, there are considerable differences in the
tent manner21,28. This has led to the unintentional dis-
light output from almost all currently available LCUs
semination of misinformation about the light
that cannot be adequately described by an irradiance
sources21, or about the photo-curing requirements of
value alone21. Because most dentists were never
light-cured dental polymer systems28 30. Because the
taught what to look for when purchasing their next
output from the LCU, the radiant exposure, and the
LCU, or how to use the LCU correctly, a meeting
wavelengths (nm) of light received by the light-cured
attended by over 50 key opinion leaders and manufac-
dental polymer systems used in the vast majority of
turers was held in 2014. At the conclusion, a consen-
studies have often not been adequately reported28,
sus was achieved on what the clinician should look
clinical decisions based on the results and conclusions
for when purchasing and using a new curing
from these studies may not be valid.
light22 24. These recommendations are freely available
To ensure that all parties are describing the light
to download22,23.
from the LCU using the same terms, the International
System of Units (S.I.) should be used by manufactur-
Curing lights are medical devices ers, researchers and clinicians alike (Table 1). While
the current ISO 10650 standard31 provides much use-
In most countries, dental LCUs are classified as medi-
ful and important information, it is based on the
cal devices, and it behooves the dentist to ensure that
assumption that the light output is homogeneously
any medical device they use has been ’cleared’ or ‘ap-
distributed across the light tip. This is not the case in
proved’ for use on patients25 27. Indicators that a cur-
many dental LCUs21,32 37. In the standard31, the total
ing light should not be used on patients, or that the
radiant power (mW) is measured from the LCU and
safety of the electrical components in the LCU and its
then divided by the optical cross-sectional area of the
charger, has not been verified, would be the lack of
light guide/light-emitting tip to produce a single aver-
appropriate certification labels, poorly worded
aged radiant exitance value in mW/cm2. This radiant
instructions for use, the lack of contact information
exitance at the light tip is the same as the irradiance
should any harm or malfunction occur, or that the
(also in mW/cm2) at the light tip. The standard31 also
device is not listed as being cleared or approved on
requires that the radiant exitance in the
the regulatory authority database.
380 515 nm wavelength region should not be greater
than 4,000 mW/cm2.

Relationship between radiant power (radiant flux),

active light-emitting area and radiant exitance (tip
irradiance)
The use of budget priced LCUs that have often been
purchased over the Internet is becoming popular16.
Many of these budget LCUs appear to be equivalent
to higher cost LCUs from quality manufacturers
because these budget lights often claim similar radiant
exitance (irradiance) values. However, the light output
from these budget lights is often unstable and some-
times declines rapidly as the battery discharges38 41.
In addition, most budget LCUs have only a small 6-
or 7-mm diameter ‘active’ light tip from where useful
light is emitted, whereas most lights from quality
manufacturers have a 9 11+ mm active tip diame-
ter42,43. Because the active area is calculated from the
cross-sectional area, pr2, any reduction in the active
tip diameter from where light is emitted will have a
substantial effect on the tip area and the radiant exi-
tance. For example, if the active tip diameter is
Figure 1. An assortment of light-emitting diode (LED) curing lights. reduced from 10 to 7 mm, the area from where light
Note the range of shapes and sizes.
is emitted is halved from 78.6 mm2 to 38.5 mm2.

408 © 2020 FDI World Dental Federation

 Describing the dental curing light

Table 1 Glossary of S.I. radiometric terms used to describe the output from dental light curing units (LCUs)21,29
Term Unit commonly used in dentistry Symbol Explanation

Radiant energy Joule J This is the energy emitted from the LCU
Radiant power (or radiant flux) Watt W or J/second This is the energy per unit of time emitted from the LCU
Radiant exposure Joule per square centimetre J/cm2 This is the energy received from the LCU per unit area
Radiant exitance, tip irradiance, milliWatts per square centimetre mW/cm2 This is the radiant power from a defined unit area.
or radiant emittance The radiant exitance is the same as the tip irradiance
from the LCU at zero distance
Irradiance (incident irradiance) milliWatts per square centimetre mW/cm2 This is the radiant power received by a unit area.
It reflects an average value received over a defined area.
Emission spectrum nanometres Nm These are the wavelengths of the light emitted
from the LCU
Spectral radiant power milliWatts per nanometre mW/nm This is the radiant power at a specific nm wavelength
delivered from the LCU
Spectral irradiance milliWatts per square mW/ cm2/nm This is the irradiance received by a defined area at each
centimetre per nanometre nm of light emitted from the LCU

This will double the radiant exitance. Consequently, In contrast to quartz-tungsten-halogen (QTH) curing
without increasing the radiant power output from the lights that emitted a broad spectrum of both violet and
LCU, a manufacturer can increase the radiant exi- blue light (Figure 2a), the LED emitter used in many
tance (irradiance) by reducing the tip area. For this contemporary LCUs can only produce light over a lim-
reason, comparing LCUs using the radiant exitance ited spectral range (Figure 2b). Thus, single-peak LED
(tip irradiance) value alone without also knowing the curing lights that deliver very little light below 420 nm
radiant power from the LCU and the active optical are not ideal LCUs to activate the initiators that require
tip diameter or the active tip area should be violet light1,2,21. However, the differences between the
avoided21. resin-based products or between LCUs are not readily
apparent to the purchaser because all LCUs will acti-
vate the CQ initiator that is used in almost all resin-
Effect of distance from the light tip
based products and the top surface of the resin will feel
As the distance from the light tip increases, the irradi- hard. Consequently, the dentist may not realise that
ance received declines2,44 46. The effect of distance is their LCU does not deliver light below 420 nm and
not the same for all LCUs. This reduction in the irra- thus cannot activate the additional photoinitiators.
diance received does not follow the ’inverse-square To better activate these alternative photoinitiators,
law’ because the light from most LCUs is a somewhat some LED curing lights (Figure 2c,d) now include
focused beam of light. Some LCUs emit a well-colli- additional LED emitters that produce additional light
mated beam of light and, for others, the beam spreads in the violet range of wavelengths2,20,21,32,36. Figure 2
out rapidly. Thus, manufacturers should report the (c,d) illustrates that the number and location of these
radiant exitance not only at the light tip, (tip irradi- violet and blue light emission peaks can vary between
ance), but also the irradiance delivered at clinically manufacturers, as does the relative contribution of
relevant distances up to 10 mm away. each wavelength peak to the total radiant power out-
put from the LCU. However, unless the LCU is care-
fully designed, the addition of several different
Emission spectrum
wavelength LED emitters in the LCU can negatively
Dentists can now purchase light-cured resin systems affect the total amount of blue light present and the
that use a variety of alternative photoinitiators in overall uniformity of the emitted light beam. This will
addition to or as replacements for camphorquinone then change the spectral irradiance received across the
(CQ), and they can also buy LCUs that emit different resin surface, which may then produce an uneven
emission spectra of light1,2,21. The CQ initiator that is polymerisation within the RBC2,21,32,36,49,50.
used in almost all dental resins is most efficiently acti-
vated by blue light at 468 nm. However, CQ is yel-
Light beam irradiance uniformity
low, and some manufacturers use several other
photoinitiators that are less yellow and are more effi- Beam profiling using a digital camera is used to exam-
cient than CQ. These initiators are usually most sensi- ine the uniformity of light beams51,52. The beam-pro-
tive to ultraviolet or violet light between 380 and filing software can produce both two-dimensional and
410 nm1,2,47,48. three-dimensional images of the radiant exitance

© 2020 FDI World Dental Federation 409

Price et al.

Figure 2. Emission spectra (nm) from (a) a quartz-tungsten-halogen (QTH), (b) a single-peak light-emitting diode (LED), (c) a dual-peak, and (d) a mul-
ti-peak LED curing light. To the human observer, the light-curing units (LCUs) will appear to emit similar ‘blue’ light.

across the tip of the light source as well as numerical irradiance of 4,000 mW/cm2 allowed in the ISO
data about the light source51,52. The two images in 10650 standard31and six times more than the 2,000
Figure 3 illustrate the difference between the single mW/cm2 maximum value recommended in the 2014
averaged irradiance value provided by the ISO 10650 consensus document22
standard31 and the information provided by a beam
profile from the same LCU. In Figure 3(a), the radiant
Light beam spectral uniformity
power was divided by the optical tip area to produce
an averaged radiant exitance of 1,822 mW/cm2. The Figure 4 illustrates the beam profile of one dual-wave-
image captured by the beam profile camera in Fig- length peak LED curing light that has one violet light
ure 3(b) shows why this information can be mislead- and two blue LED emitters in the LCU. When the
ing. Although the average radiant exitance is still light output at the tip is viewed through blue-light-
1,822 mW/cm2, there are four ‘hot spots’of high radi- blocking orange glasses, the output from the one vio-
ant exitance that are above 12,600 mW/cm2, and let and two blue LEDs is visible, and ‘hot spots’ of
other regions where the light output is lower. These high irradiance are also evident. The image clearly
four ‘hot spots’ deliver three times the maximum shows that the light is not well mixed. When the tip
410 © 2020 FDI World Dental Federation
 Describing the dental curing light

Figure 3. This light-curing unit (LCU) had an averaged radiant exitance of 1,822 mW/cm2. The figure depicts the anticipated beam profile (a) that was
obtained from the quotient of the power and area (as per the ISO 10650 standard). (b) The actual scaled irradiance beam profile of the same LCU showing
that although the average radiant exitance is still 1,822 mW/cm2, there are four ‘hot spots’ where the radiant exitance is above 12,600 mW/cm2 sur-
rounded by regions of lower radiant exitance.

irradiance from the same LCU is viewed using a beam whole surface. To be practical, an overlap of 1 mm
profiler camera through narrow bandpass filters that beyond the restoration would be ideal, as this will
only allow either violet (400  5 nm) or blue allow for some small movements at the light tip.
(460  5 nm) wavelengths of light through, the spec- Because the active optical diameter of many LCU tips
tral uniformity of the light emitted from the LCU in is smaller than a MOD preparation in a molar
the violet and blue regions becomes quantifi- tooth14,21,32,42,43,45,55, the likely result will be that the
able33,36,49. Thus, dentists should look for a good adhesive and the resin at the bottom of the proximal
optical design in the LCU that can homogenise the boxes will be inadequately polymerised in just one
light so that both the irradiance and the emission exposure. Instead, multiple exposures from different
spectrum are uniformly distributed across the light locations are required. To illustrate this effect, the
tip, that is there are no ‘hot spots’. beam profiles of two different curing lights, one with
an 11.6-mm active optical tip diameter and the other
with a 6.6-mm active optical tip diameter, were super-
Active diameter of light beam
imposed over a maxillary central incisor and a
The beam profile also shows the active diameter of mandibular first molar tooth (Figure 5). The differ-
the tip from where light is emitted. This active tip ences in both the width and uniformity of light cover-
diameter is important because any RBC that is not age over the teeth are striking. However, although a
covered by the active region of the light tip will be wide tip may appear to be preferred, if the light tip
less well polymerised53,54, and most laboratory studies also covers the gingiva, the soft tissues may be burnt
only evaluate the ability of the LCU to polymerise the if the tip irradiance is too high, or the LCU is used
resin that is directly under the centre 4-mm diameter incorrectly56,57. Consequently, a narrower tip
region, not at the edges54. Based on a favourable (6 8 mm in diameter) is indicated for curing small
report, clinicians may then attempt to light cure the increments of RBC, or Class V restorations that are
entire adhesive layer in mesial-occlusal-distal (MOD) close to the gingiva.
cavities using just one exposure and, if using a bulk-
fill resin-composite, they may then also light cure the
Radiant exposure uniformity
restoration as a whole using only one light exposure.
The clinician may not realise that in order to ade- It has been suggested that each 2-mm-thick increment
quately light cure the entire surface of the cavity of RBC should receive approximately 16 J/cm2 in
preparation or restoration with a single exposure, the order to be adequately photo-cured58. Consequently,
active light tip area should completely cover the a novel approach using the data acquired from beam
© 2020 FDI World Dental Federation 411
Price et al.

Figure 4. This figure illustrates how the reader can view the light output from a dual-peak light-curing unit (LCU) through orange blue-light-blocking
glasses. The distribution of the wavelengths and the tip irradiance are clearly not uniform (b). Instead, they correspond to the location (a) of the two blue
and one violet light-emitting diode (LED) emitters in the LCU housing. When the same light is imaged through either (c) a 460  5 nm or (d) a
400  5 nm narrow bandpass filter into a beam profiler camera, the irradiance received in each region can be measured.

profiling is to multiply the irradiance (mW/cm2) by Clinically, if the beam profile consists of a small
the exposure time (seconds) to produce a map of the region of high irradiance compared with a more even
radiant exposure (J/cm2). When this is done, it can be 8 10-mm diameter of uniform irradiance, this means
seen that LCU (a) in Figure 6 does not deliver a uni- that the light tip must be very accurately positioned
form amount of energy across the light tip. Outside of over the target, and the resin at the edges may receive
the energy ‘hot spot’ at the centre, LCU (a) will emit an insufficient amount of light54.
less than 16 J/cm2 in 20 seconds, and here the resin
will not be as well photo-cured as in the centre. Light
Light-curing unit ergonomics
(b) has a lower, but more uniform, irradiance at
about 1,200 mW/cm2 that covers most of an 8-mm- In most laboratory experiments, direct access to the
diameter circle with over 24 J/cm2 in 20 seconds. material to be cured is rarely a factor1, and the light
412 © 2020 FDI World Dental Federation
 Describing the dental curing light

Figure 5. Two-dimensional irradiance beam profile of the tip of (a) and (b) curing lights scaled to 2,750 mW/cm2 and superimposed over a maxillary
central incisor or a mandibular first molar. Both lights deliver a similar average irradiance (1,155 mW/cm2 and 941 mW/cm2), but very different radiant
power outputs and tip diameters. Light (a) has a small tip size and an undesirable irradiance hot spot of 2,750 mW/cm2 at the centre, whereas (b) has a
lower, but more uniform, irradiance at about 1,200 mW/cm2 that covers most of the occlusal surface of the molar or the maxillary central incisor tooth.

Figure 6. Radiant exposure (J/cm2) delivered by two lights in 20 seconds. An 8-mm-diameter circle is drawn on both images. Note the smaller tip diam-
eter and the uneven radiant exposure from light (a) compared with light (b) that emits more than 24 J/cm2 uniformly across the 8-mm-diameter circle.
Light (b), in comparison, has a ’hot spot’ of high irradiance at the centre. This information would not be revealed in ISO 10650.

tip is precisely and rigidly positioned over the centre may prevent the light tip from achieving optimal
of the specimens. However, when used clinically, access to all locations in the mouth42,43. This may
Figure 7(a) illustrates how the design of the LCU cause the operator to increase the curing distance or
© 2020 FDI World Dental Federation 413
Price et al.

(a) (b)

Figure 7. Although the light-curing unit (LCU) may work well on the laboratory bench, the design of the LCU will affect access to some teeth (a). A
low-profile head (b) is preferred as it will allow better access to the posterior teeth.

angle the light tip. Doing so will reduce the amount Infection control
of energy delivered and reduce the ultimate polymeri-
It is important to recognise that the LCU can be a signif-
sation of the RBC3,59,60. Consequently, a low-profile
icant source of cross-contamination76,77, and the manu-
head (Figure 7b) that will allow better access to the
facturer’s instructions for disinfecting the LCU between
posterior teeth is recommended42,43,45. The light tip
each patient should be followed. Ideally, the LCU
should also be positioned both as close to the surface
should have removable, autoclavable light guides and
of the resin as is possible and perpendicular to the
easily disinfected surfaces. However, an autoclavable
surface of the resin throughout the exposure
light guide is impractical for many LCUs that do not
cycle19,61 65 (Figure 7b). Some manufacturers are
use a light guide and instead have the LED emitter at
now producing LCUs with sensing technologies that
the light tip (Figure 1). Of note, repeated autoclaving of
help the operator keep the LCU tip over the
fibre optic light guides can reduce the light output78,
tooth66,67. If the light tip moves away from the
and some surface disinfectants may both reduce the
tooth, the LCU first vibrates and then, if moved fur-
light transmission through the light guides and degrade
ther away, the LCU turns off. This feature is similar
the plastic LCU body79,80. In addition to wiping the
to the ‘lane assist’ technology in cars, and should
LCU with the recommended surface disinfectants for
help the dentist keep the LCU tip on target and over
the recommended time, plastic barriers or sleeves can
the resin.
be used to cover the LCU. However, the user must
recognise that covering the light tip with an infection
control barrier can reduce the irradiance delivered from
Blue light hazard
the LCU by as much as 40%81,82. Thus, the output
The dentist must protect the patient from harm, and from the LCU should be regularly checked using a digi-
employers should furnish a place of employment that tal radiometer such as the Bluephase Meter II (Ivoclar
is free from hazards that are causing or are likely to Vivadent, Schaan, Liechtenstein) both without and with
cause harm to their employees25,68. Most contempo- the same type of barrier that will be used on the LCU
rary dental LED curing lights emit light between 430 when treating patients. Then, depending on the percent
and 480 nm, and the most damaging wavelengths of decrease in the radiant exitance caused by the barrier,
blue light to the retina are thought to be around the clinician should increase the exposure times that
440 nm69. Exposure to blue light has also been they would use in the mouth81 84. The Bluephase
reported to affect sleep patterns25,70,71. Although a Meter II has been shown to be an accurate ( 10%)
‘blue light hazard’ to the retina has not yet been dental radiometer that can measure the radiant power
shown to occur in humans, dental personnel may be and, when the tip diameter is entered, this meter device
both chronically and acutely exposed to much greater can also report the radiant exitance85,86. As an added
high levels of blue light than the general population. benefit, when the dentist measures the output from their
Because this potential ‘blue light hazard’ can be pre- LCU, they quickly realise the effects of battery dis-
vented by using the appropriate blue-light-blocking charge38 41,43, the barrier they use81 84, and both tip
eye protection, it is recommended that appropriate angulation and distance23,44 46,60 have on the light
eye protection in the form of orange ‘blue-blocking’ received.
paddles, shields or eyewear should be used whenever
the dental LCU is used18,25,72 75. Watching the posi-
CONCLUSIONS
tion of the light tip while photo-curing will help
ensure that the tip is kept over and close to the resin Globally there exists a large discrepancy between how
so that the bottom of the restoration will be ade- long resin composite restorations are reported to last
quately polymerised19,54,61 65. in well-controlled clinical trials4,5, and how long they
414 © 2020 FDI World Dental Federation
 Describing the dental curing light

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Email: [email protected]

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