general practice
message board
How Is My Curing Different From
Pulse Curing?
Townies discuss pulse curing.
Dentaltown.com > Message Boards > Restorative Dentistry > Bonding Products & Techniques > How Is My Curing Different From ...
Kanna Member Since: 08/01/13
Post: 1 of 43
My curing method from dental school: Cure in 10-second increments, last increments for 20
seconds instead of 10 seconds. How is pulse-curing different in terms of both method and result? n
SEPT 17 2015
Flyfishindoc Member Since: 04/06/04
Post: 2 of 43
Related Message Boards
Tell Me Everything I Need to
Know About Pulse Curing
Everything Pulse
Pulse Curing Changed My Life!
Pulse Curing
Ok, here is the 101 on pulse-curing. It seems that curing lights are always advertised as
the fastest cure. That is not what you want. The faster the cure, the more (and faster) the
polymerization shrinkage. This leads to composite pulling away from the tooth. This results in
temperature sensitivity and biting sensitivity.
The idea behind pulse-curing is to slow the process and reduce polymerization shrinkage. I
use a Valo light (Ultradent). I use the normal cure setting at five seconds for the first intervals.
Then the last layer is only cured for one second. Then, after polishing, it is cured again for
10–20 seconds.
The only change to this protocol is for Class V restorations, where every layer is one second.
Don’t worry about incomplete curing. Composite is not so much light-cured as light-initiated.
So the polymerization will continue (slowly) after the light is off the tooth. Try an experiment. Take a blob of composite (pea size). Hit it with the curing light for one second or less.
Check if it’s hard everywhere. It won’t be. Check it in five minutes. It will be more cured
at that point.
The main idea behind pulse-curing is to cure slowly, so it shrinks slowly, and you
maintain a strong bond over the entire tooth/composite interface. When you achieve this,
post-op temperature and biting sensitivity will disappear from your practice. n
SEPT 17 2015
almunk Member Since: 12/17/05
Post: 3 of 43
Or you can do it another way: Cure for two seconds, move light away for two seconds,
repeat. This supposedly relieves some of the shrinkage stress on the tooth. n
SEPT 17 2015
JimmyJames Member Since: 04/10/12
Post: 4 of 43
I wait until all finishing and polishing is completed until doing the final cure. This is a few
minutes after the last “pulse” cure. I’m probably putting incorrect words in John’s mouth, but I
thought he said you wanted those few minutes in between. n
SEPT 17 2015
Flyfishindoc Yes. That is correct. That is why I finish, adjust occlusion, and then polish before the final cure. n
Member Since: 04/06/04
Post: 5 of 43
DentistPk Member Since: 05/07/15
Post: 6 of 43
SEPT 17 2015
Sorry, but this really confuses me a lot. Can you please tell me how to pulse-cure in a
Class II cavity? Here, I will make this easier for you to reply with. The question mark refers to
pulse-curing time (normal/pulse mode?)
Continued on p. 42
40
APRIL 2016 // dentaltown.com
practice management
message board
Continued from p. 40
1.
2.
3.
4.
Initial 1mm flowable layer in proximal box =?
Second 2mm incremental layer of packing composite =?
Third 2mm incremental layer of packing composite =?
Final 1–2mm layer of packing composite =? n
SEPT 18 2015
Flyfishindoc Member Since: 04/06/04
Post: 7 of 43
Very simple. Class II sequence for pulse-curing. I use a Valo light on the standard cure setting.
Bond: Five seconds
Flowable layer: Five seconds
Composite layers: Five seconds
Final layer: One second
When I have to use my older Ultradent light (the one before the Valo came out) I double those
times. It just doesn’t have the power the Valo does. The point of pulse-curing is to only start the
cure, not complete it right away. Polymerization shrinkage is much less, so the composite doesn’t
pull away and cause sensitivity.
Before you think this won’t cure sufficiently, I use the same materials and curing sequence
for my crown build-ups, and I have never cut one of these teeth down and found uncured
composite. As Dr. Ed stated in another thread, we would eliminate most post-op problems with
composites if they were placed with proper isolation (RD or Isolite), placed in small increments,
and pulse-cured. n
•
•
•
•
SEPT 18 2015
jazzfandentist Member Since: 02/25/08
Post: 8 of 43
So when you guys are finishing/polishing, are you using water spray on the high speed? Is the
composite that is still slowly polymerizing only beneath the surface so the water doesn’t affect it? n
SEPT 18 2015
Flyfishindoc Member Since: 04/06/04
Post: 9 of 43
Finishing and polishing with water spray. Composite surface is hard as a rock after a
one-second cure. n
SEPT 18 2015
DentistPk Member Since: 05/07/15
Post: 10 of 43
Thank you very much for the explanation. Hmmm, what if one does not have the Valo, then?
I mean I am currently using a Chinese light, which does have a separate pulse-curing option. But
I am sure it can’t touch the quality of a Valo light. So how much of a difference does this make? n
SEPT 18 2015
Flyfishindoc Member Since: 04/06/04
Post: 11 of 43
I highly doubt your light has a “pulse cure” setting. It’s probably a plasma setting (meaning
its highest power). You want to use the lowest power setting, and if you are using a cheap light,
double my times (10 seconds each layer, two seconds last). n
SEPT 18 2015
tooth43 Member Since: 09/06/13
Post: 12 of 43
Hi, Matt, I have a Valo as well. I have set the lamp for three seconds (blinking lights = extra
power). I do cure twice every increment. Is this OK or should I change it to five seconds and
cure once? Thanks. n
SEPT 18 2015
toothdoc34 Member Since: 09/06/11
Post: 13 of 43
Why cure the flowable separately? I place a small amount of flowable and then a good layer of
Filtek Supreme. You can literally see the flowable rise up. That way the margins are 100 percent
Continued on p. 44
42
APRIL 2016 // dentaltown.com
dentaltown.com \\ APRIL 2016
42
practice management
message board
Continued from p. 42
sealed. Cure this layer for 10 seconds. Place the next (usually final) layer and cure 10 seconds.
Polish, adjust bite, and cure 10 seconds. No sensitivity and 100 percent sealed margins. n
SEPT 18 2015
Flyfishindoc Member Since: 04/06/04
Post: 14 of 43
To pulse-cure, you have to use the low power setting. Any setting designed to cure faster will
produce faster (and more) shrinkage. n
SEPT 18 2015
rgillam Member Since: 05/31/05
Post: 15 of 43
So are you guys pulse-curing the initial layers? How about flowable first layer? At one time I
thought everyone was talking about pulse-curing the last layer that contacted enamel (in order
to prevent white lines). Maybe I misunderstood. n
SEPT 18 2015
Flyfishindoc Member Since: 04/06/04
Posts: 16 & 17 of 43
The protocol I outlined is the pulse-curing protocol. Short curing times for all layers (5–10
seconds depending on your light), with only one second cure of the final layer. Then, after
polishing, curing is completed. Your statement says it all: I thought it was done to get rid of the
white lines. Why do the white lines form? Because the composite cures and shrinks so fast that
it pulls away from the margin.
The white lines are polishing debris that gets trapped in the gap. Now, extrapolate that
pulling from the margin to the inside of your prep. You now have a gap between dentinal
tubules and bond/composite. Result? Temperature sensitivity. Or, your bond stays intact and the cusps are
pulled towards each other by the shrinkage. Result?
Biting sensitivity. Or sometimes you get a combination
of both.
I will give you a real world example of a patient that
left my practice because she got an HMO plan. She is
in her early 20s. Her mom, brother and stepdad are still
patients. Mom calls me upset because she had a filling
done on #18, and now it hurts to cold and biting. The
other office saw her and said the tooth was going non
vital and referred her to the endodontist.
I asked mom to bring me the X-ray. No way this
composite was deep enough to need endo. I explained
to mom and daughter about proper isolation and curing
when doing composites. Mom said she would pay me to
redo it (because she trusts me). I told her I thought the
tooth would be fine afterwards.
So, I remove the composite with my Waterlase. When
I get to the point where I am almost done, half of the
pulpal floor just comes flying out on its own. Not bonded
at all. The rest was. So, this particular part of the restoration pulled away from the dentin during the curing
process. Long story short, rubber dam, several layers with
pulse-curing and no cold sensitivity, no biting sensitivity,
and no endo. The effects were immediate, by the way. n
SEPT 18 2015
FREE FACTS, circle 22 on card
44
APRIL 2016 // dentaltown.com
general practice
message board
I use Apex’s Titan flow- brcinsf able and it recommends a 20 Member Since: 10/09/04
second cure. I’m doing five Post: 18 of 43
seconds for layered resin but you’re saying five seconds
for flowable is fine? n
SEPT 18 2015
You really need John over THE Token Redneck here to answer your pulse-cure Member Since: 09/22/03
Post: 19 of 43
questions. For what it’s worth I
have two Valos and love them. I also use normal setting. n
SEPT 18 2015
Surpass protocol says cure
10 seconds after Surpass3.
Curing five seconds must be
against Dr. Kanca’s protocol. n
Kanna Member Since: 08/01/13
Post: 20 of 43
SEPT 19 2015
Ha-ha, good one! I use
Peak Universal from Ultradent,
so I don’t have to follow the
directions for Surpass. n
Flyfishindoc Member Since: 04/06/04
Post: 21 of 43
SEPT 19 2015
If I only have one layer of
composite after flowable, do I
just cure one second since it’s
the last layer? n
Kanna Member Since: 08/01/13
Post: 22 of 43
SEPT 19 2015
Correct! You are starting Flyfishindoc to get it! Class I and II are Member Since: 04/06/04
Post: 23 of 43
cured at normal times (low
power) up until the final layer which is only cured for
one second. Class III, IV and V each layer (except for the
bond) is only cured for one second. n
SEPT 19 2015
Join the discussion online
at: dentaltown.com
Curing Different
FREE FACTS, circle 26 on card
dentaltown.com \\ APRIL 2016
45