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A review of orthodontic curing lights

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 Indian J Stomatol 2013;4(1):40-44

A Review of Orthodontic Curing Lights

1 1 2 3
Ankur Chaukse , Rachna Dubey , Neeraj Agrawal , Ankur Jain

Abstract
The desire to cure resins faster to increase efficiency and saving time is increasing nowadays by number of orthodontists and
general practiceners in their busy practice. The introduction of light cure adhesives not only removed a step in the bonding pro-
cedure, but also allowed practitioners the freedom to work with sufficient time to cure after bracket placement or composite rest-
oration depending on individual's efficiency. The orthodontic society or group then got introduction of high intensity plasma arc
and laser curing lights as these lights offer the orthodontist a significant reduction in bracket cure time over conventional curing
lights which helped in reducing their consultancy hours. Choosing the right light cure unit is very important for an orthodontist
and a general practitioner. Currently there are various types of light cure units available in the market, of which the information
obtained through various advertisements, websites or manufacturers, may be misleading. This paper describes various genera-
tions of light cure units with their advantages and disadvantages and factors affecting the strength of composite used in general
dental practice.

Keywords: Light cure unit; blue light emitting diode; plasma arc.

Introduction (B)The polymerization of the light-cured composites dep-

Bonding orthodontic attachments to enamel became avail- ends completely on an adequate delivery of light energy.
able to the orthodontic community in the early 1960s. Visi- Usually, the light required for curing is between 360 to 500
ble-light-cured adhesives, now used by the vast majority of nm with a maximum of 460 to 470nm. For camphorqui-
orthodontists, were first described by Bassiouny in 1978.1 none, light at wavelength of 470nm is essential
Light cure restorative materials are widely used because of (C) Polymerization is initiated and sustained when the cur-
advantages aesthetics, improved physical properties and ing light intensity is sufficient to maintain camphorquino-
control over the working time. Previous studies stated that ne, the light sensitive agent in the composite in its excited
inadequate polymerization cause discoloration, pulpal irri- state. Only when the camphorquinone is in this excited sta-
tation, post-operative sensitivity and eventual failure of re- te, then, will it react with an amine-reduction agent to form
storation.2 Factors affecting the polymerization of the resi- free radicals, thus initiating the resin's polymerization.
ns include shade, thickness during polymerization and co- The problem of polymerization shrinkage and the methods
mposition of the material and factors like light intensity, used to overcome this have concerned clinicians and resea-
wavelength, exposure duration, size, location and orienta- rchers. Previously chemically activated resins were having
tion of the tip of the source are dependent on light curing 2 pastes, benzoyl peroxide initiator and an aromatic tertiary
units.3,4 Also, recent research demonstrates that orientation amine activator (N, N-dimethyl-p-toluidine) with shrinka-
and diameter of the light probe tip can have a significant ge towards center, no control working time, increased fini-
impact on the degree of light-curing producing better phy- shing time, and less colour stability due to breakdown of
sical properties, as well as improved adhesion to tooth sub- tertiary amines. Then, light-activated systems introduced
strates. This low cost technology device have drawbacks having ultraviolet (UV) light but again due to harmful eff-
such as decline of irradiance over time due to bulb and filter ects of UV rays and poor penetration through the tooth str-
ageing which could lead to inadequate polymerization of cture, they were replaced by visible blue light which we use
resin. According to the ISO specification for light curing nowadays the most having polymerisation towards the lig-
unit, the energy output must be in range of 460 to 500nm.5,6 ht source. Different types of light curing units have been
LEDs are highly efficient light sources that produce light introduced to avoid stress developed while polymerisation.
within a narrow spectral range used commonly nowadays.
The purpose of this study was to get knowledge about the Different types of Curing Lights
light intensity of different curing lights and various factors The first came Halogen lights used electricity to heat a tun-
affecting their curing efficiency of resins in general prac- gsten filament in majority of the energy is converted to heat
tice. and only a small part is converted to light with just 1% of
According to composition: Most of the composite resins the energy is converted to output blue light.7 Therefore one
contain monomer, inorganic filler, inhibitors, stabilizers, of the disadvantages is heat production that can cause blist-
pigments and initiators. ering of expensive light filters and discolouration of the
(A) The most commonly used initiator is camphorquinone. reflectors. The time required to cure the composite undern-
The light cured composite required some form of light pro- eath metal brackets is 40 seconds per tooth.8
duced by the light-curing unit to activate the polymeriza-
tion process Ultra-Violet Light Curing unit
1
Department of Orthodontics, 2Department of Periodontics, 3Department of Pedodontics, Peoples College of Dental Science, Bhanpur,
Bhopal, India. Correspondence: Dr. Ankur Chaukse, email: [email protected]

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 Indian J Stomatol 2013;4(1):40-44

Ultra-Violet light curing unit was the first to be used in cur- in aeronautical .This light uses xenon gas, distilled from
ing light cured composite. The wavelength is in the range liquid air and then electric current is passed through the gas
of 364-367nm. Later, it was found that this light could cau- which ionizes it and produces negative and positive charg-
se damage to the eye. Since then the use of this unit in clin- ed particles. High-powered light produced is than filtered
ical practice has been discarded and are no more available to an effective curing wavelength of 450 to 500nm. These
in the market. It was time consuming, as a 90 seconds appl- lights have an energy level of 900mV from 2000mV, which
ication must be given to each bracket. is much higher than halogen lights and so shortens the cur-
ing time.14 The plasma bulb generates considerable heat
Quartz Tungsten Halogen (QTH) Lights and therefore requires a large fan to cool it off during and
These lights contain lamp with a tungsten filament in an in- after each burst of light. The most significant advantage is
ert gas with a small amount of halogen gas. An electric that it can cure the composite in 2 seconds.
current passed heats the tungsten to 2700°C, creating visi- Disadvantage
ble light and infrared radiation. The light is filtered to app- - They are expensive and produces more heat so filters and
roximately 380nm to 500nm, which is can easily cure com- ventilating fan are required
posites, but the challenge with these lights is that they only - More bulky and heavy to use.
use 9% of the total energy produced and majority is dissi-
pated as heat and so requires cooling fan and filter. Light-emitting diode (LED)
These were introduced by Mills in 1995.15 They used jun-
High Performance Halogen Curing Light ctions of doped semiconductors to generate visible light
These have got advantage of less curing time over conven- with no light filtration required. LEDs are highly efficient
tional halogen light cure. The special tungsten quartz halo- light sources that produce light within a narrow spectral ra-
gen optibulb degrade less with time.9,10 It has range of 400 nge. Blue Light Emitting Diodes (LED) curing unit has an
to 505nm. Curing time for metal is 8 and a ceramic bracket advantage over halogen light curing unit in that it is inexpe-
is 5 seconds. The light produced by this unit is intense and nsive. The LED unit has no bulb or filter that requires
the tip of the guide may occasionally cause some discomf- maintenance. They do not require filters because they emit
ort to the skin mucosa.11 light at a specific wavelength within the 400nm to 500nm.
Disadvantages: Overtime only little degradation of light output is observed
- Slower cure time (about 15 seconds to 20 seconds). and they do not produce heat. This may be another advant-
- Bigger in size. age for avoiding any possible gingival or pulpal irritation.
- The light performance degrades with time. LED is very popular among paediatric dentists particula-
- It generates more heat and requires filter and ventilating rly, since less chair time and an adequate polymerization is
fan. the main goal. It has been suggested that even though the
strength is inadequate, by far, it is the most reliable.
Adaptor Light Guide Disadvantages:
This guide is made by computer technology having max- - Cost is more than conventional halogen lights.
imum tapered optic fibres for better output compared to - The curing time is more than plasma.
others. It ranges from 880 to 1120 mW/cm2. Among the - Need to recharge batteries.
advantages are that it can be sterilized either chemically or The light-curing unit should be able to cure the composite
in an autoclave, it can cure the composite with reduced to the optimum bond strength. Curing lights all generate
time and it is economical since the adaptor is cheaper than heat and require a cooling fan especially halogen which ge-
other light curing units.12 nerates noise and so bulb life reduces to only 100 hours and
Argon lasers: These were introduced in 1991 having 488 minimum is generated by LED.16 Halogen lights do signifi-
nm wavelength. Dual-wavelength argon lasers are used cantly increase the pulpal temperature more than other lig-
minor procedures like gingival recontouring and coagulat- ht cures.
ion. They operate at 488nm for curing and 514nm respecti- Because LED uses minimal energy and produces less heat,
vely.13 The time required to cure the orthodontic composite they are marketed as cordless units with a rechargeable bat-
is five seconds. It has the potential to cause retinal damage tery and with no other parts or light filaments present so
and the possibility of selectively altering the oral micro flo- they better resist vibrations and shock. Therefore these are
ra through exposure of ionizing radiation but no damage to effective for more than 10,000 hours.17
the pulp tissue.
Disadvantages: Factors effecting bond strength:
- The curing depth is limited to 1.5mm to 2mm. 1. From orthodontic point of view increase in thickness of
- The curing tip is small, so more time is needed to cure the resin reduces the shear strength of bonding at enamel-bra-
RBCs. cket interface.18
- They have narrow spectral outputs. 2. Penetration of light depends on shade and opacity of co-
- They are expensive. mposite: translucent, very light shades will have easier pe-
netration that dark ones. Opacity of composite- light trans-
Plasma Arc lucent shades may cure about 3mm below surface while
In the mid-1990s, these curing lamps were introduced as a darker ones maybe only 1 or 2mm
more affordable, high-speed curing light. This unit has be- 3. Bulk of material: Bulk filling should only be done on sh-
en developed after the technology used by The United Sta- allow preperations to make certain that the deepest layer is
tes National Aeronautics and Space Association (NASA) polymerized.

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 Indian J Stomatol 2013;4(1):40-44

4. Depth of cure and time: A standard time of 20 seconds is Indian J Stomatol

ended.27 The International Organization 2013;4(1):36-39
for Standardizati-
usually required to cure to a depth of 2.0 to 2.5mm by most on (ISO) also recommended the intensity of 300 mw/cm2
curing-light units having a power density of 800 mW/cm2 in clinical practice.28 The battery powered LED would emit
and for a unit emitting 400 mW/cm2, an exposure time of 40 a continuous and stable light with less degradation of ener-
seconds is important. Increasing the power density of the gy. Light Cure Unit provides better degree of conversion,
lamp reduces the required exposure time and also increases physical and mechanical properties for the light cure resin
the rate of cure. If the preparation requires more than 2mm composites.29 Among these properties, testing microhard-
material than we should use incremental curing. In general, ness is an efficient method to assess the relative degree of
most commercially available light curing units will poly- 30
conversion of resins. Also the light scattering is affected
merize most light-cured composites to a depth of 3 mm, by shade, translucency, filler content, particle size, etc. Lig-
though some systems are more efficient than others. Time hter shade produces greater depth of cure as light passes ea-
of exposure is more responsible than intensity of light.19 ily through it whereas darker shades are more opaque and
With standard metal brackets, recommended curing times they tend to absorb more light and thus require longer cur-
for a complete cure are 15 to 20 seconds on the mesial and ing times. Lighter shade of resin composites demonstrates
distal of each bracket using a halogen light, 10 seconds me- better fracture toughness than its darker one of the same
sial and distal for LED lights, 4 seconds mesial and distal during curing.31 Myers et al., compared composite shade A4
using an argon laser, and 2 seconds mesial and distal with a and A1 and concluded that light intensity of A4 was half of
plasma arc lamp while Ceramic brackets require only half that of A1.32 Shortall et al., compared the depth of cure of
of the total time. Molar bonds require about 150% longer A2, A3.5, and C2 shade composite resins and stated that A2
curing times on each the mesial and distal. Latest, halogen demonstrated greater depth of cure than A3.5.33
lights introduced bonds brackets only in 6 seconds time.20 On light exposure for bracket bonding, it is considered that
5. Distance between the light curing tip and composite: Ho- the enamel with darker colour is related to decreased light
wever, the decrease in light intensity of the light curing unit transmission. Transillumination has also been used to cure
was found not to obey the inverse square law for the dista- the composite resin under the metal brackets. During light
nces 0 to 15mm.21-23 Ideally, the tip should be within 3mm of exposure with transillumination, the light passes through
composite to be effective. For the darkest shades, increm- the tooth structure including enamel and dentin. Tooth stru-
ents should be limited to 1mm of thickness. The distance of cture of 1mm reduces the light intensity to approximately
the light tip to the bracket can decrease bond strength. With 30% of its initial value.34 In orthodontic practice, problem
increased distance, bond strength degrades more signific- comes with reduction of light intensity reduction because
antly with LED lights than with other curing lights. Caldas of anterior teeth thickness which ranges from 5-7mm in
et al., evaluated the effect of light-tip distance on the hard- faciolingual width.35 Mills et al., studies shown that depth
ness of composite resins and reported that the halogen, LE of cure of LED with intensity 290 mW/cm2 was more as
D, and plasma arc units showed a decrease in the resin co- compared to Tungsten Quartz Halogen with intensity 300
mposite hardness as the light-tip distance increased.22 Ano- mW/cm2.36 In clinical practice, an irradiance of 400mW/
ther investigation evaluated the decrease in power output cm2 is used to get uniform and maximal cure benefit is reco-
of LED curing devices with increasing distance to the fill- mmended.37 Quartz Tungsten Halogen curing lights prod-
ing surface. The halogen light showed that no significant uce more yellowing of composites than LED on curing bec-
differences in bond strength were found among the 3 dista- ause of high intensity. The light guide should be positioned
nces. Using the LED light, a greater light-tip distance pro- such that the light is perpendicular and as close as possible
duced significantly lower shear bond strengths, whereas to the restoration. It is important to know that the light can-
using the plasma arc lamp, a greater light-tip distance caus- not reach directly to the surface of the bracket base there-
ed significantly higher shear bond strengths. Many studies fore practitioners place the light guide in a tipped position
have shown that bond strength is dependent on curing sys- as close to the brackets as possible. The maximum light int-
tems also suggested that plasma arc curing offers superior ensity occurs when the surface of light guide is perpendi-
bond strengths compared in all.24 Reynolds suggested that cular to the surface of light-cured adhesives. Light intensity
minimum 6 to 8 MPa is adequate for most clinical work.25 and exposure time both are important factors causing tem-
6. The longer wavelengths of light more penetrating better perature change when curing resins. The reduction of light
curing will be.26 intensity depends on various clinical exposure terms such
7. Size of Light-Curing Unit Tip: A light-curing unit as the direction of light guide, shade of enamel, and dista-
standard diameter tip (11mm) energy is more scattered, nce between the end of light guide and the surface of adhe-
whereas in a light-curing unit with a smaller tip (3mm ) it is sives. Distance is one of the most important factors in cur-
more focused and so less time to cure but at the same time ing as affecting the intensity. The drop in light intensity wi-
more temperature can be dangerous to tooth pulp. th distance is exponential, and 1mm of air reduces the light
intensity by approximately 10%.34 Clinically realistic dista-
Discussion nces of 5 to 10 mm would dramatically decrease the light
Light-cured dental materials are polymerized by the acti- intensity. On the other side higher light intensity leads to
ons of photo initiators. Camphorquinone is used as photo increased fracture hardness, and greater flexural strength of
initiator of composite resin and activated in range 410 and resin and greater bond strength of brackets bonded to tee-
490nm. In summary, a curing light with an intensity of 300 th.38 The speed offered by plasma arc curing can save much
mW/cm2 will effectively cure most composite is recomm- more time compared to LED. Time up to 8 minutes using

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 Indian J Indian
Stomatol 2013;4(1):40-44
J Stomatol 2010;1(1):1-5

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