PRACTICE

Guidelines for the selection, use, and maintenance

of LED light-curing units – Part II
A. C. Shortall,*1 R. B. Price,2 L. MacKenzie1 and F. J. T. Burke1

InInbrief
brief
Informs practitioners about the most important Warns practitioners about the risks behind using Discusses the blue-light hazard and advises how to
things to consider when choosing a light-curing unit untested and unregulated LCU devices. protect dental personnel and patients.
for their practice.

This paper is the second in a two-part series on the topic of LED light-curing units (LCUs). This part discusses LCU selection,
cross infection and decontamination, maintenance, the blue-light hazard, and some possible future developments for LCUs.
The article focusses on the practical aspects of the subject from the clinician’s perspective. Scientific aspects are dealt with in
the cited literature.

Light curing unit selection often highly inhomogeneous.3 The batteries in requirements of the RBCs being cured. Fans
these unregulated LCUs may explode or catch are incorporated into some light emitting diode
The light curing unit (LCU) and the process of fire with disastrous consequences and any (LED) LCUs to prevent the LED chip and the
light curing is a critical step in the restorative perceived price advantage may turn out to be body of the unit from overheating. However,
process when using light-activated resin-based a false economy resulting in serious long-term fans can only cool to the ambient temperature
composites (RBCs). It is recommended that negative clinical and financial consequences. and thus such units are less appropriate for use
new LCUs be purchased from a reputable A UK press release by the Medicines and in tropical regions. Well-designed LED units
manufacturer who will usually also market Healthcare Regulatory Agency (MHRA) in will have a protective thermal cut-off to protect
light-cured RBCs as well as LCUs. Some October 2013 highlighted the issue of fake the LED and electronics from overheating.
dentists buy their light units from budget and unapproved dental LCUs being sold Consequently, the unit may shut down during
online sources because they are cheaper than online and imported into the UK for sale.4 The long exposure times. Some LED LCUs have
major dental manufacturers who produce MHRA cautioned that such devices had not batteries that can only be changed by the man-
high-quality well-tested units. There is no been tested for safety or efficacy and warned ufacturer at considerable expense. Some LED
accountability regarding the manufacture or dentists not to use such devices. The use of an units have a corded backup option that negates
distribution of these budget lights and there unregulated and untested medical device on a the need for extra batteries or additional
is often a lack of electrical safety certification. patient should be regarded as in vivo testing on backup units. There is also a wide diversity of
These budget LCUs are usually flimsy and a patient who has not given informed consent. light unit styles ranging from mains-powered
poorly made.1 Inadequate heat dissipation LCUs that offer only a single fixed exposure gun-style or pistol-grip handpieces to smaller
leads to premature LED failure. The electronics time do not account for differing energy lightweight pen style units (Fig. 1).
in many budget lights do not compensate for
changes in battery output over the discharge
cycle, and this may result in a sharp decline
in output without warning.2,3 Instructions for
use are often poorly translated into English and
are sometimes missing or illogical. In order to
deliver an acceptable irradiance, the light tips
of budget lights are typically smaller than those
of major manufacturers, and the light output is

1
University of Birmingham, School of Dentistry, 5 Mill Pool
Way, Birmingham, B5 7EG; 2Dental Clinical Sciences, Dal-
housie University, Halifax, Nova Scotia, Canada, B3H 4R2
*Correspondence to: Adrian Shortall
Email: a.c.c.shortall@bham.ac.uk

Refereed Paper. Accepted 15 August 2016

DOI: 10.1038/sj.bdj.2016.814
©
British Dental Journal 2016; 221: 551-554 Fig. 1 A range of contemporary LED LCUs

BRITISH DENTAL JOURNAL | VOLUME 221 NO. 9 | NOVEMBER 4 2016 551

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 PRACTICE

The vast majority of LED units only offer a

single standard-diameter (7–8 mm) light guide
tip, but due to the protective cladding, the
active or light-emitting exit tip diameter of a
standard multi-filament light guide is typically
1 mm less than the external diameter. For ‘one-
shot’ light-curing, the active diameter of the tip
must be greater than the greatest width of the
restoration (Fig. 2). Small tips require overlap-
ping cure cycles, reduce efficiency and increase
the risk of missing a portion of the restoration.
Wide tip diameters (10–13 mm) are required
when the dentist seeks to cure large direct
or indirect restorations efficiently.5 However,
exposure times may need to be extended with
larger tips, because the irradiance declines
Fig. 2 Beam profiles of two LED LCUs superimposed over a MOD cavity (cavity margins
greatly as the tip area increases, for example outlined) in a maxillary premolar tooth. The outer white circles show the areas covered
increasing the tip size from 7 to 10 mm doubles by the tip of the light guides. The inner black circles define the effective light-emitting
the area and halves the irradiance. Small- or areas of the light guide tips. The average radiant exitance (within the black circle) for the
narrow-diameter guides (2‑3 mm) are useful BA Ultimate 1400 was 1,497 mW/cm2 and 1,234 mW/cm2 for the Deep Cure-S unit when
for spot or tack curing of indirect restorations measured accurately with laboratory grade equipment. Note the homogeneous light output
and large-diameter tips can be used for ‘single- for the Deep Cure-S unit. However, the power (W) output for the Deep Cure-S unit (785 mW)
was 40% more than for the BA Ultimate 1400 unit (560 mW). The inhomogeneous output and
shot’ light curing of larger restorations.
smaller light-emitting area of the BA Ultimate 1400 LCU mean that the critical peripheral
Some of the LED units do not have audible regions of the MOD restoration would not be adequately cured in a single light exposure
or visual countdown timer displays indicating
the progress of curing. While some view the
lack of a timed display as a minor inconven- polywave LED or quartz-tungsten-halogen by many variables. Irradiance declines with
ience, it may lead to insufficient curing if the (QTH) LCU may be a better option than a single increasing distance, but the rate of decline
operator loses track of time or makes errors in blue peak LED LCU in this situation. varies greatly with unit design and beam col-
counting the number of curing cycles in units Recommended exposure times made by limation (Fig. 3).
with automatic shut-off intervals. Dentists who various authors have declined over the last A survey of over 400 dental practices recently
undertake extended orthodontic and restora- 20 years; this is understandable given improve- conducted across 18 cities in North America
tive treatments, such as multiple-bracket and ments in light curing technology. Light exposure found that dentists’ cure times ranged from
multiple veneer placements, require long times of between 1 and 60 seconds are currently 3 to 90 seconds.6 Recent studies have concluded
uninterrupted run times and some LED units proposed by manufacturers of different light that at least 10 seconds exposure time with a
fail to meet this requirement. Radiometers sources and resin-based materials, and dental second-generation LED LCU (average irradi-
that are built into the LCU allow the dentist to authors. Short exposure times are driven both by ance >1,000 mW/cm2) is indicated for lighter
monitor the light output from their unit over the practitioner’s desire for speed and increased shades of fast-curing materials under optimal
time. Other important considerations include clinical efficacy, and also by competition between clinical circumstances.7 How fast the RBC is
ergonomic features and unit costs. manufacturers of LCUs. Before purchasing a new able to polymerise is a significant factor. As
The light curing times recommended by LCU LCU, the dentist is advised to assess the manufac- exposure time increases, the extent of cure
and RBC manufacturers can be very different. turer’s data and the related evidence base behind lateral to the directly-irradiated area may
Curing times cited by LCU and RBC manu- any marketing and performance claims. increase somewhat, and spectral matching
facturers may differ greatly. As they will have Ideally the radiant power (W) should be between light source and initiator absorption
carried out extensive testing, a manufacturer given by manufacturers as well as irradiance may not be quite so critical, but most authori-
who markets light-cured RBCs as well as their figures. The dentist would then know if they ties recommend that a new LED unit should
own LCUs is best placed to advise the end user were purchasing a powerful light, or just an deliver a minimum irradiance of 1,000 mW/
regarding appropriate exposure times for their average power light that has a small tip. If cm2 and be used for at least 10 seconds.
products (these can vary eightfold between 5 LCU manufacturers stated radiant exposures
and 40 seconds for one manufacturer’s products/ (J/cm2) for their units at available settings, Cross infection and decontamination
shades alone). At least one manufacturer who dentists would be in a better position to
incorporates non-proprietary or alternative identify appropriate exposure times for their Fan exits, protective tips and pistol grips are
photoinitiators in their materials markets only materials. Manufacturers should also state common areas for clinical contamination of
broad-spectrum polywave® LED LCUs for this irradiance values at clinically relevant distances QTH LCUs. In a pilot study, better results from
reason. If very light or ‘bleach’ shades of RBCs in addition to their usual zero source distance a cross infection viewpoint have been reported
are used, the dentist should find out whether figures. Appropriate exposure times are a for pen-style LED units with autoclavable light
alternative photoinitiators are used because a subject of much debate and are influenced guides.8 Autoclavable light guides are the gold

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 PRACTICE

comparing the value with the value recorded

when the unit was new using the unit’s built-in
radiometer (if present), or a radiometer rec-
ommended by the manufacturer. Although
radiometers may give reproducible irradiance
values, do not rely on radiometers to give
accurate irradiance values. Simply use the
radiometer to determine whether the light
output has changed from new. If the output
has reduced it will be necessary to increase
the exposure time
• Only use the LCU if the light source tip or
exit window is clean and undamaged. Check
Fig. 3 Irradiance decline at 0 mm to 10 mm distances for two light units multi-filament light guides for broken fibres
(which may show as black or dark areas). Do
not touch the unpolymerised resin-based
standard from an infection control viewpoint, limits for UV light was greater than 8 hours at bonding agent or RBC with the light guide
but they can be easily damaged or contami- all working distances and light source orienta- tip. Check the light source for contaminants
nated with scale and should ideally be replaced tions. However, the maximum permissible immediately after patient use. Remove con-
on a regular basis. Fixed-lens-type light sources cumulative daily exposure time to blue light was taminants and if the light guide or lens is
require barrier protection that can reduce light only 6 seconds when irradiating from the upper scratched or damaged, replace the component
output by 10% or more.9 Ingress of disinfectant anterior palatal aspect with a PAC light and was if possible. Alternatively, return the unit to the
fluids into the LED unit can lead to contami- up to 1.5 hours when the light from a low-power manufacturer for repair
nation and loss of reflector efficiency, or even blue LED LCU was reflected back from the • Do not immerse the system components in
total unit failure of the electronics. facial aspect of a central incisor. McCusker water or disinfectant solutions. Do not spray
et  al.13 have assessed the weighted irradiance liquid disinfectants directly onto the LCU
The blue-light hazard and safe exposure times of 11 dental LCUs at six handpiece or charger base. Prevent liquids
different working distances from the light guide from entering unit ports or openings. If the
The optical hazards for patients and staff of exit. Corresponding parameters were assessed light guide is removed for autoclaving, use a
retinal exposure to light in the blue region of for reflected light from the most powerful unit protective cap to seal the light guide portal
the spectrum (the blue-light hazard) have been during simulated bonding of different orthodon- when cleaning the handpiece
documented and deserve greater attention given tic brackets. Bracket material and shape affected • Follow the manufacturer’s protocol and
the popularity of light curing and the trend the amount of reflected light. The maximum local regulations for appropriate disinfection
towards ever more powerful light curing units. cumulative exposure from reflected light when regimes for handpiece and battery charger
Our eyes are at risk from acute and cumulative viewed at typical tooth to operator distance of base units. Avoid flammable or corrosive or
effects, mainly due to the significant reflection 30 cm was between 22 and 123 minutes each abrasive cleaning agents
of blue light from the tooth surface. Phototoxic day for different LCUs. Although the risk was • Autoclavable light guides are the ‘gold
and photoallergic reactions may also occur from judged to be low if adequate safety precautions standard’ from a cross infection viewpoint.
absorbed radiation in endogenous or exogenous were employed, the authors concluded that the Polyethylene barrier sleeves will reduce light
substances which may accumulate in the opera- potential long-term ocular risks of prolonged output by approximately 10%. Thus the light
tor’s eyes and hands as well as in the patient’s oral exposure to blue light in a busy dental surgery output should be tested with the barrier in
mucosa.10,11 The greatest retinal hazard from blue were still uncertain. However, any long-term place, if they are used. Ensure that the seam
light occurs at 440 nm and, unfortunately, this is risks can be presented by using suitable blue of the barrier sleeve does not cross the light
close to the peak spectral emission from many light-blocking glasses or hand-held shields. source exit, because this will further reduce
blue LED LCUs. Eye protection is required to output. Barrier sleeves are single use, and
protect against this blue light photochemical Maintenance of LED light curing units elastomer or rubber light shields should be
hazard. Filters may take the form of protective inspected and cleaned immediately after use.
spectacles, stationary lamp shields or hand-held It is well reported that many dental LCUs are not Clean contaminants off immediately and
shields. Insufficient protection may occur if the properly maintained. Regular testing and mainte- discard the shield if damaged.
filter is of poor quality, has aged, or is used to nance of any piece of dental equipment is recom-
protect against emission from a light source with mended to maintain effectiveness. Quality LED Current and future developments
output characteristics different from the filter’s LCU manufacturers give detailed maintenance
intended use. Labrie et al.12 assessed the ocular protocols which should be referred to. General Work into designing modified LED LCUs that
hazard potential of four types of LCU by estimat- recommendations that all can follow are: have a more uniform irradiance distribution
ing the maximum permissible ocular exposure • Keep a record to show that the light output has been reported. The Deep Cure-S LED
times for each unit during an 8-hour work from the LCU was checked. Verify adequate LCU recently introduced by 3MESPE is an
day. The maximum permissible daily exposure unit output before each clinical session by example of such a unit (Fig. 2).14 This unit and

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the Bluephase Style from Ivoclar Vivadent should give a better insight into the complexi- 1. Gordon J. Christensen: Clinicians report. Available online
at http://www.cliniciansreport.org/uploads/files/403/
feature ‘low-profile’ light guides that allow the ties of the subject. The key points are:
MktgRT0314.pdf (accessed October 2016).
operator improved access posteriorly which 1. LED units offer significant advantages 2. Price R B. Light-curing units. Dent Advisor 2015; 32: 2–7.
may be critical for patients with restricted 2. The use of an unregulated and untested 3. AlShaafi M M, Harlow J E, Price H L et al. Emission char-
acteristics and effect of battery drain in ‘budget’ curing
mouth opening. Other units like the Smartlite medical device on a patient should be lights. Oper Dent 2016; 41: 397-408.
Focus (DENTSPLY) and Valo (Ultradent) have regarded as in vivo testing on a patient who 4. Shortall A C. Fake and unapproved dental curing lights
sold online – MHRA warns dentists. The Probe 2013; 10.
the LEDs incorporated directly into their low has not given informed consent 5. Palin W M, Senyilmaz D P, Marquis P M, Shortall A C.
profile heads. One manufacturer (Satelec, 3. Manufacturers should state the power Cure width potential for resin composite MOD molar
restorations. Dent Mater 2008; 24: 1083–1094.
ACTEON) has already introduced a unit with output, the emission spectrum, beam 6. Felix C, Ferracane J L. Curing light outputs, protocols
a low-power laser aiming function (ScanWave) profile and effect of distance on the irradi- and composite requirements at 422 dental offices. J Dent
Res 2015; 94 (Spec Iss A); abstract #340.
that puts a red light circle on the tooth before ance from their LCU 7. Busemann I, Lipke C, Schattenberg A, Willershausen
light curing and an ‘autofocus’ LED LCU 4. When choosing an LCU the extent and B, Ernst C P. Shortest exposure time possible with LED
curing lights. Am J Dent 2011; 24: 37–44.
(AutoFocus Mark II) designed to compensate quality of resin polymerisation and unit
8. Janoowalla Z, Porter K, Shortall A C C, Burke F J T,
for the decline in the irradiance with increased efficacy and reliability should be paramount Sammons R L. Microbial contamination of light curing
distance by automatically increasing exposure over any price or convenience features units: a pilot study. J Inf Prev 2010; 11: 217–221.
9. Price R B, Shortall A C, Palin W M. Contemporary Issues
time to counter this issue.15 Work has also been 5. Use a light that is optimised to cure the in light curing. Oper Dent 2014; 39: 4–14.
reported into developing a method that allows resins you are using 10. Bruzell Roll E M, Jacobsen N, Hensten-Pettersen A.
Health hazards associated with curing light in the dental
the operator to determine the appropriate 6. At any given required radiant exposure, the clinic. Clin Oral Investig 2004; 8: 113–117.
exposure time for any light-activated material, exposure time is a critical factor. 11. Bruzell E M, Johnsen B, Aalerud T N, Christensen T.
Evaluation of eye protection filters for use with dental
irrespective of the characteristics of the LCU, 7. Regular testing and maintenance are curing and bleaching lamps. J Occup Envir Hyg 2007; 4:
or the material to be cured.16 These and other important. Keep a record to show that the 432–439.
12. Labrie D, Moe J, Price R B, Young M E, Felix C M. Evalua-
future developments will hopefully assist in light output from the LCU has been regularly tion of ocular hazards from 4 types of curing lights. J Can
improving the success and longevity of light- checked against the output when new Dent Assoc 2011; 77: b116.
13. McCusker N, Lee S M, Robinson S, Patel N, Sandy J R,
cured RBC restorations in dental practice. 8. Keep the light tip as close as possible to the
Ireland A J. Light curing in orthodontics; should we be
restoration when light curing concerned? Dent Mater 2013; 29: e85–e90.
9. Beware of the blue-light hazard and use 14. Shimokawa C A K, Turbino M L, Harlow J E, Price H L,
Conclusions Price R B. Light output from six battery operated dental
suitable eye protection. If you just look curing lights. Mater Sci Eng‑C 2016; 69: 1036-1042.
Many developments have taken place in the away, you cannot see what you are doing 15. Shortall A C, Palin W M, Jacquot B, Pelissier B. Advances
in light-curing units: Four generations of LED lights and
field of light curing since the first UV light- with the LCU. clinical implications for optimizing their use: Part 2. From
cured materials and LCUs were introduced. present to the future. Dent Update 2012; 39: 13–22.
16. Harrington E, Wilson H J, Shortall A C. Light-activated
This two-part series has reviewed the devel- This article is dedicated to the memory of our former restorative materials: a method of determining effective
opment and current status of LED LCUs and colleague and friend Edward Harrington. radiation times. J Oral Rehabil 1996; 23: 210–218.

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