The Open Dentistry Journal, 2008, 2, 137-141 137

Open Access

Temperature Rise Within the Pulp Chamber During Composite Resin

Polymerisation Using Three Different Light Sources

A. Santini*, C. Watterson and V. Miletic

Edinburgh Postgraduate Dental Institute, The University of Edinburgh, Lauriston Place, Edinburgh, EH3 9HA. UK

Abstract: The purpose of the study was to compare temperature rise during polymerisation of resin based composites
(RBCs) with two LED light curing units (LCUs) compared to a halogen control light.
Methods: Forty-five extracted molars, patients aging 11-18 years were used. Thermocouples (TCs) were placed in contact
with the roof of the pulp chamber using a ‘split-tooth’ method. Teeth were placed in a water bath with the temperature of
the pulp chamber regulated at 37°±1°C.
Group 1 (control): Prismatics® Lite  (Dentsply Detrey, Konstanz, Germany), a halogen LCU, light intensity 500
mW/cm2.
Group 2: Bluephase® ( Ivoclar Vivadent, Schaan, Liechtenstein), light intensity 1100 mW/cm2. Group 3:Elipar Freelight2
(3M ESPE, Seefeld, Germany), light intensity 1000 mW/cm2. Temperature changes were continuously recorded with a
data logger connected to a PC.
Results: Significantly higher temperature rise was recorded during bond curing than RBC curing in all 3 groups. (Halo-
gen; p =0.0003: Bluephase; p=0.0043: Elipar; p=0.0002.). Higher temperatures were recorded during polymerisation of
both Bond and RBC with both LED sources than with the halogen control. There was no significant difference between
the two LED,LCUs (Bond:p=0.0279: RBC p=0.0562: Mann-Whitney).
Conclusion: The potential risk of pulpal injury during RBC polymerisation is increased when using light-curing units
with high energy output compared to low energy output light sources. The rise is greatest when curing bonding agent
alone and clinicians are advised to be aware of the potential hazard of thermal trauma to the pulp when using high inten-
sity light sources. However the mean temperature rise with all three units was below the limits normally associated with
permanent pulp damage.
Key Words: Light curing units, resin based composites, pulp temperature rise.

INTRODUCTION the tooth and may cause a rise in excess of this critical value
and are therefore a potential source of necrosis of pulp tissue
Tooth coloured resin based composites (RBCs) have
been traditionally cured with a halogen light source with a [7-9].
light intensity of approximately 400 mW/cm. More recently, Several factors may affect temperature change, including
in attempts to reduce clinical times for operator and patients the intensity of the light source, the exposure time [10-12]
and to achieve a deeper, more effective cure, higher intensity and the state of the remaining dentine beneath the cavity [13-
light sources have been introduced. These newer lights have 15]. The state of pulp tissue will also be a factor as will its
tended to move away from the traditional halogen type to the reparative ability [16] In addition, those related to RBC are,
higher intensity LED source which can have a light intensity amongst others, shade [17] and filler content [18, 19].
of up to 1200 mW/cm. Research has shown that the process
The aim of this study was to evaluate temperature rise
of light curing composite materials causes the temperature
within the pulp chamber during RBC polymerisation with
within the pulp chamber to increase [1, 2] and that pulp vital-
two high intensity light emitting diode light curing units
ity is compromised if there is a temperature rise of between
(LED), Bluephase® (Ivoclar Vivadent, Schaan, Liechten-
5-6 °C in the pulp [3], however, this has been questioned in stein.) and Elipar Freelight2 (3M ESPE, Seefeld, Germany).
more recent studies [4].
A conventional halogen light was used as a control, (Pris-
Previous studies have shown that light polymerisation of matics® Lite  , Dentsply De Trey, Konstanz, Germany).
RBCs with conventional light curing sources cause an intra-
The null hypothesis was that there was no difference be-
pulpal temperature rise of only a few degrees [5, 6]. More
tween pulp chamber temperature rises with two different
recent high intensity lights represent a potential hazard for high intensity LED lights and a conventional halogen LCU.

*Address correspondence to this author at the Edinburgh Postgraduate Den- METHODS AND MATERIALS
tal Institute, The University of Edinburgh, Lauriston Place, Edinburgh, EH3
9HA. UK; Tel: 0131 536 4970; Fax: 0131 536 4971; Forty five non-carious permanent molars that had been
E-mail: [email protected] extracted for orthodontic purposes and stored in 0.2% thy-

1874-2106/08 2008 Bentham Open

138 The Open Dentistry Journal, 2008, Volume 2 Santini et al.

mol for not more than 4 months, were selected. Informed the RBC during curing, the following procedures were un-
consent was obtained from patients for the use of these teeth dertaken (Fig. 1).
for research purposes. Patient age range was 11-18 years.
A. The apices of the roots were cut off and the tooth embed-
Ethical approval was granted by the Ethics Committee, Lo-
ded in clear acrylic up to the amelo-cemental junction.
thian NHS Board, Edinburgh, Scotland, to use such teeth in
this study. B. A diamond bur, no BD456 (UnoDent,Israel) in a high
speed hand-piece with water spray was used to reduce
Prior to the study the teeth were cleaned using an ultra-
cusps to create a flat occlusal plane just into dentine.
sonic scaler of all superficial debris. For the duration of the
experiment the teeth were kept in distilled water at 37º ± 2ºC C. Using the same diamond bur, a preliminary cavity was
to ensure adequate hydration of the dental tissues. cut into dentin, but not extending more than 1.5 mm from
the occlusal plane. A class I large Cerana diamond bur,
To standardise cavity preparation with respect to cavity
height 3mm; top diameter 4mm; bottom diameter 3mm
depth, cavity volume and remaining dentine thickness (RDT),
(Nordiska Dental, Angelholm, Sweden), normally (sug-
as well as standardising the distance of the light source from

A B C

D E F

Fig. (1). A. The root apices were cut off and the tooth embedded in clear acrylic up to the amelo-cemental junction. B. A diamond bur was
used to reduce cusps to create a flat occlusal plane just into dentine. C. Using the same diamond bur, a preliminary cavity was cut into den-
tine, but not extending more than 1.5 mm from the occlusal plane. A large Cerana diamond bur (Class1 type), height 3mm;top diameter
4mm;bottom diameter 3mm was used to enlarge the initial cavity. At this stage the depth of the cavity was under prepared. D. The teeth were
then sectioned through the prepared cavity, 1 mm off-centre, along the mesio-distal plane. All remaining remnants of pulp tissue were re-
moved by washing the cavity for five minutes with 5% sodium hypochlorite and flushing out with distilled water. E. A standard cavity with a
RDT of approximately 0.5mm was created using the Cerana bur. The depth of the cavity was then standardised to be 2mm deep by further
reduction of the flat occlusal pale. F. Both sections of each tooth were photographed using an image analysis system and the average RDT
was calculated from 5 randomly selected sites per section. Using a tungsten carbide bur, a groove in one root was prepared to receive the
leads of the TC which were glued to the dentin of the roof exactly in the midline of the cavity, in the larger of the two sections. The pulp
chamber was injected with ECG gel.
Temperature Rise Within the Pulp Chamber The Open Dentistry Journal, 2008, Volume 2 139

gest take out normally, without any other comment) used prepared teeth. Bonding agent was cured for 10
to prepare standardized cavities for ceramic inserts was seconds and a RBC (Image: Shade A2) was im-
used to enlarge the initial cavity. At this stage the depth mediately placed and cured for 20 seconds.
of the cavity was under prepared.
Group 3: Elipar Freelight2 LED (3M ESPE, Seefeld, Ger-
D. The teeth were then sectioned through the prepared cav- many): Light intensity 1000mW/cm. Adper
ity, 1 mm off-centre, along the mesio-distal plane using a Prompt L-Pop adhesive was applied to the pre-
slow speed saw (Isomet®, Buehler, Lake Bluff, Illinois, pared teeth. Bonding agent was cured for 10 sec-
USA). All remaining remnants of pulp tissue were re- onds before a RBC restoration (Image:shade A2),
moved by washing the cavity with 5% sodium hypochlo- was immediately and cured for 20 seconds.
rite and flushing out with distilled water. During curing of the bonding agent and RBC, the cavity
E. Cerana bur was then used to create a standard cavity with was covered with a glass microscope slide to ensure the light
a RDT of approximately 0.5mm. The depth of the cavity source was kept at a standard distance from the base of the
was equal to the size of the bur head and reduction of the cavity and the LCU tip help in contact with the slide.
flat occlusal plane was sometimes necessary to achieve
Temperature change was recorded by TCs connected via
this. a data logger to a computer and temperature was recorded
F. Using an image analysis system (Olympus Camedia and using software package TracerDAQ™ (Measurement Com-
SZ-CTV Olympus, Tokyo, Japan) both sections of each puting, Norton, MA, USA) continuously from the time of
tooth were photographed and the average RDT was cal- application of the bonding agent, through curing of the bond-
culated from 5 randomly selected sites per section. Using ing agent, placement and curing of the RBC. The results
a tungsten carbide bur one root was prepared to receive were statistically analysed using GraphPad InStat software
the leads of the thermocouples (TC) (USB-Temp, Meas- (GraphPad, San Diego, USA.).
urement Computing, Norton, MA, USA) and the TC head
fixed in position with Loctite® Super glue, (Henkels Con- RESULTS
sumer Adhesives, Winsford, Cheshire, UK) to the den-
There was no significant difference in RDT in any of the
tine of the pulp chamber roof exactly in the midline of
three groups. P= 0.9549 (Kruskal-Wallis; nonparametric
the cavity, in the larger of the two sections. The pulp ANOVA).
chamber was injected with ECG gel. The two sections
were then carefully glued together using Araldite® adhe- There was a significant difference in pulp chamber tem-
sive (Bostik Findlay, Staffordshire, UK). perature rise during bond curing with both LED LCUs com-
pared to the halogen control (p<0.05, Kruskal-Wallis; non-
Specimens were then randomly assigned to one of 3
parametric ANOVA) (Table 1).
groups according to the type of light source to be used for
polymerisation of the RBC. The intensity of the halogen However, there was no significant difference between the
LCU was monitored by a Demetron Radiometer (Demetron two LED LCUs (Bond:p=0.0279: RBC p=0.0562: Mann-
Kerr, Danbury, CT, USA) while the intensity of the two Led, Whitney).
LCUs was monitored via their integrated radiometer. There was a significant difference in pulp chamber tem-
Group 1: Halogen Control Light- Prismatics® Lite : Light perature rise during RBC curing with Bluephase® compared
intensity 500 mW/cm. Adper Prompt L-Pop (3M to the halogen control (p<0.001, Kruskal-Wallis; non-
ESPE, St. Paul, MN, USA. Lot 284081) dentine parametric ANOVA ) whereas temperature rise during RBC
bonding agent was applied to the prepared teeth. curing with Elipar Freelight 2 was higher compared to the
Bonding agent was cured for 10 seconds and a halogen LCU, but not statistically significant (p>0.05,
RBC (A2 (Image:shade A2:Septodont, Cedex, Kruskal-Wallis; nonparametric ANOVA ) (Table 2).
France. Lot D4600-3) was immediately placed With both LED LCUs and the halogen control, the results
and cured for 20 seconds. showed a greater temperature rise during the curing of the
Group 2: Bluephase®: Light intensity 1100mW/cm. Adper bonding agent alone compared to that recorded when the
Prompt L-Pop bonding agent was applied to the RBC was cured (Table 3).

Table 1. Temperature Rise in the Pulp Chamber During Bond Curing

Halogen Bluephase® Elipar Freelight 2

Median (°C) 3.8 5.2 4.4

Minimum (°C) 2.8 3.0 3.9

Maximum (°C) 4.9 7.1 6.4

Lower 95% conf. limit 3.482 4.824 4.303

Upper 95% conf. limit 4.144 6.056 5.123

140 The Open Dentistry Journal, 2008, Volume 2 Santini et al.

Table 2. Temperature Rise in the Pulp Chamber During RBC Curing

Halogen Bluephase® Elipar Freelight 2

Median (°C) 2.8 4.2 3.5

Minimum (°C) 1.3 1.7 2.0

Maximum (°C) 3.9 5.6 5.2

Lower 95% conf. limit 2.102 3.582 3.051

Upper 95% conf. limit 3.058 4.805 3.976

Table 3. Statistical Analysis of Temperature Rise During Bond Curing vs. RBC Curing

p Value Significance

Halogen:Bond vs. Halogen:RBC 0.0003 S

Bluephase:Bond vs. Bluephase:RBC 0.0043 S

Elipar:Bond vs. Elipar:RBC 0.0002 S

(Mann-Whitney test, nonparametric ANOVA).

DISCUSSION Clinicians should be cautioned by the results of the pre-

sent study to refrain from excessively long bonding times
Most manufacturers have in the recent past, introduced to
when using some LED units at 1100 mW/cm2. If the LED
the market, light curing units with irradiance approaching unit has a low irradiance mode this should be used for curing
1000mW/cm2 in an attempt to reduce clinical working time
the bonding adhesive and the higher mode restricted to cur-
and increase the depth of cure. Early reports suggest that
ing RBCs. Consideration should be given to the placement of
LED curing units are less harmful to the pulp, but this con-
a lining in very deep cavities.
clusion should be interpreted with a degree of caution as these
early units usually operated in the range of 400mW/cm2. The The particularly vulnerable pulp cells are the post-mitotic
LED units tested in the current study were 1000mW/cm2. odontoblast layer of cells just beneath the predentin, forming
Though the mean temperature rise was lower than 5.5oC, the the roof of the pulp chamber. There is considerable debate as
temperature frequently cited as sufficient to cause pulp cell to whether these cells can be replaced by differentiation of
damage, the maximum recorded temperature for the Blue- undifferentiated mesenchymal cells originating in the deeper
phase light was 5.6ºC. pulp tissue [3, 21-23]. It is important therefore to record the
temperature in this specific region.
The present results showed that high intensity LED lights
operating at approximately 1100 mW/cm2 caused a signifi- Previous studies have recorded temperature by inserting a
cantly higher temperature rise within the pulp chamber com- thermocouple into the pulp chamber through a preformed
pared with the conventional halogen lights which operate at channel in the root and therefore the precise position of the
about 500 mW/cm2. The amount of heat generated was in- electrode is unknown at the time of placement [1, 20]. A
fluenced by characteristics of the light curing unit and this is further problem in previous experiments are that the RDT
in agreement with previous studies [1,2]. There was a sig- above the thermocouple is unknown at the time of recording
nificantly higher temperature rise with both LEDs compared temperature change, [20] and was not standardised. As den-
to the conventional halogen control LCU which is in agree- tine constitutes a significant insulator to heat transfer, the
ment with former studies of Shorthall and Harrington [1] result of such studies can be questioned.
who concluded that it was the type of LCU, though Hanning Other studies have constructed pulp chamber models to
found that light intensity rather than the type of light source simulate the in vivo situation [24]. The present study used a
was important [20] In the present study the Bluephase® LCU “split tooth” technique [25], whereby each tooth was sec-
with a light intensity of 1100 mW/cm2 produced higher tem- tioned to allow cavity and TC placement standardisation.
perature rises than the Elipar LCU, with light intensity of Many variables which would otherwise exist were elimi-
1000 mW/cm2, though this was not at a significant level. A nated. As each cavity was of a standard depth and shape then
critical factor in reducing thermal transfer to the pulp tissue the bulk of composite placed each time was similar. The
is the low thermal conductivity of dentine. In spite of the low shade of composite may also influence the temperature rise
thermal conductivity of dentine the potential for pulp dam- [17-19] so to eliminate this variable for the duration of the
age is greater as the number of dentinal tubules increases per experiment only shade A2 was used.
unit area in deep cavity preparation; there is an increase in
pulpal trauma from heat as the RDT decreases. The ‘split tooth’ technique allowed each thermocouple’s
accurate placement, just touching the roof of the pulp cham-
Temperature Rise Within the Pulp Chamber The Open Dentistry Journal, 2008, Volume 2 141

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Received: September 19, 2008 Revised: October 28, 2008 Accepted: October 30, 2008

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