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Light Curing in Dentistry and Clinical Implications: a Literature Review

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Light Curing in Dentistry and Clinical Implications: a Literature Review CRITICAL REVIEW Dental Materials/Dentistry Light curing in dentistry and clinical implications: a literature review Abstract: Contemporary dentistry literally cannot be performed without use of resin-based restorative materials. With the success Frederick Allen RUEGGEBERG(a) Marcelo GIANNINI(b) of bonding resin materials to tooth structures, an even wider Cesar Augusto Galvão ARRAIS(c) scope of clinical applications has arisen for these lines of products. (d) Richard Bengt Thomas PRICE Understanding of the basic events occurring in any dental polymerization mechanism, regardless of the mode of activating the process, will allow clinicians to both better appreciate the tremendous improvements that have been made over the years, and (a) Augusta University, Dental College of will also provide valuable information on differences among strategies Georgia, Department of Restorative Sciences, Augusta, GA, United States of America. manufacturers use to optimize product performance, as well as factors under the control of the clinician, whereby they can influence the long- (b) Universidade Estadual de Campinas – Unicamp, Piracicaba Dental School, term outcome of their restorative procedures. Department of Restorative Dentistry, Piracicaba, SP, Brazil Keywords: Polymerization; Light; Curing Lights, Dental; (c) Universidade Estadual de Ponta Grossa – Photoinitiators, Dental; Dental Restoration, Permanent. UEPG, Department of Restorative Dentistry, Ponta Grossa, PR, Brazil (d) Dalhousie University, Faculty of Dentistry, Department of Dental Clinical Sciences, Polymerization Halifax, NS, Canada In dentistry almost the entire gamut of resin-based restorative products use the same basic monomer family and polymerization mechanism: methacrylates and vinyl, free radical addition polymerization.1 Declaration of Interests: The authors certify that they have no commercial or associative interest that represents a conflict Vinyl-free radical methacrylate polymerization of interest in connection with the manuscript. The term “vinyl” refers to the presence of an electron-rich, carbon-to- carbon double bond appearing at the terminal end of a monomer molecule. Specifically, methacrylates are distinguished by the presence of a methyl Corresponding Author: group covalently bond to the “α” carbon atom. The basic structure of a Marcelo Giannini methacrylate-based monomer is presented in the Figure 1, where the “R” E-mail: [email protected] symbol indicates a wide variety of substitution groups that can be added to provide monomers with unique properties. http://doi.org/10.1590/1807-3107BOR-2017.vol31.0061 α carbon H CH3 C C H C-O-R Submitted: May 14, 2017 Accepted for publication: May 22, 2017 Last revision: May 29, 2017 O Figure 1. Chemical structure of a methacrylate-based monomer. 64 Braz. Oral Res. 2017;31(suppl):e61 Rueggeberg FA Giannini M, Arrais CAG, Price RBT In this figure, substitution of the “R” with a methyl as component proportioning, temperature, and amount group provides the monomer methyl methacrylate, of radiant energy exposure are under the control of use of an ethyl group yields “ethyl methacrylate”, a the clinician, and will all significantly influence the component in some temporary restorative resins, and rate at which the polymerization process will proceed. placement of a “hydroxyethyl” generates hydroxyethyl methacrylate (HEMA). Substitution with other Initiation of the polymerization process species that also contain an additional methacrylate Once created, the freshly formed free radical group on the other monomer end, provides what are diffuses through the resin medium in search of a known as “dimethacrylate” monomers: Bis-GMA, highly electron-rich area, which happens to be the TEGDMA, UDMA, etc. carbon-to-carbon double bond of a methacrylate- based monomer. When these two species collide, the Creation of radicals resulting effect is the initiation of polymerization, The methacrylate vinyl group can be conceived and is displayed in the following diagram (Figure 3). of as a “compressed spring” awaiting release of its In this process, the free radical takes one electron constrained, internal energy, which will subsequently from the 4 contributing to the carbon double bond, be used to link together (polymerize) other such and forms a covalent bond between itself, and one methacrylate groups present in the restorative carbon atom. In addition, the now extra electron material. The key to starting the unlocking of between the carbons atoms moves to a different shell, this internal energy is creation of a very reactive leaving behind a single covalent bond between the chemical species that aggressively seeks a high- two carbon atoms, where a double bond occupied this density electron location (the carbon double bond). space before. Now, the extra electron in the outermost The free radical generator is such a species. Different carbon atom becomes the free radical species, and types of chemicals are used for this role, but the end actively diffuses through the low viscosity resin result is similar: the compound is acted upon by some medium in search of another electron-rich, carbon external form of energy (heat, chemicals, or radiant double bond with which to react, in a similar manner. energy), and becomes “activated.” This process is shown diagrammatically in the Figure 2. Chain propagation Once in this form, the species becomes a “free The first monomer turned free radical then seeks radical,” having an outer shell electron actively seeking other electron-rich monomeric species, with which it another electron to share its orbital, thus forming a reacts to form covalent bonds (building the developing stable, covalent bond. The clinician should note that polymer network), and also subsequently creates a new it is this step that he/she uses to control when and radical end for every monomer unit that is joined. This how fast, and to what extent the polymerization process is presented diagrammatically in the Figure 4. reaction will proceed. It is the number of free radicals In this manner, the polymer chain grows in formed, the rate at which they are formed, and the length, by covalently adding monomer units one at a rate at which they are annihilated that controls the time. As the process continues, the rate of monomer subsequent polymerization reaction. Thus, factors such consumption drastically increases, resulting in a very Heat, chemical, radiation R H CH3 H CH3 RR R R CC R CC H H C-O-R C-O-R Figure 2. Schematic illustration of external energy factors O O acting on a radical-generating species to result in formation of “free radicals”. Figure 3. Diagram of the polymerization initiation step. Braz. Oral Res. 2017;31(suppl):e61 65 Light curing in dentistry and clinical implications: a literature review sharp spike in the rate of the overall polymerization there was no true production-step polymerization process (termed “auto-acceleration”). With increasing process in their final chemical structure. Polymethyl incorporation of monomer into the growing polymer methacrylate (PMMA) was the first organic polymer network, the viscosity of the resin system increases, used for construction of heat-processed denture base and the rate of diffusion of growing radical ends is materials. Previous to his material, dentures base greatly decreased, causing an overall lowering in materials were made using heat-processed rubber the rate of polymerization, as well as depletion of (Vulcanite), ceramics, or swage-formed metals. The available, unreacted monomer. ability for clinicians to use PMMA was based upon licenses, and the products were heavily under control Termination of major manufacturers.2 After World War II, the The polymerization reaction can stop for a number ability to polymerize methyl methacrylate at room of different reasons. The concentration of available temperature (the co-called, cold-cured, or chemical- monomer decreases as the reaction progresses, and cured materials) became available.3 With this ability, the the growing radical chains have an ever-increasing processing of dentures became much less expensive, difficulty in diffusing through the initially gel like and less cumbersome. Early forms of a direct, esthetic and then glass-like resin matrix. However, the most restorative material (Sevitron, LD Caulk Company, easily understood mechanism is the scenario when Milford, DE, USA) used a powder/liquid system.4 two growing radical ends collide. This results in Initial results were good, however, the restoration formation of a covalent bond between them, thus discolored, wore at a very high rate, and displayed quenching each radical element, bringing further unacceptable leakage at the margins. It was not until growth of either polymer chain to a halt. This process advancements in monomer chemistry (Bis-GMA, is presented in the Figure 5, where two radical chains “Bowen’s monomer”) and the incorporation of finely meet to form a covalent bond between them, stopping ground inorganic filler became available, through any further chain growth. efforts of the Paffenbarger Research Center at the National Institutes for Science and Technology, that Chemically cured products serious consideration for use of resin-based, direct, esthetic restorative materials became a reality.5 Use of resin-based products as restorative materials To reduce resin viscosity, and thus allow higher is not new. The first products utilized for these purposes filler loading, a functional methacrylate co-monomer were based on plant or animal components,
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